Tobacco Control Is a Wicked Problem: Situating Design Responses in Yogyakarta and Banjarmasin

© 2019 Tongji University and Tongji University Press Tobacco use is a persistent social issue worldwide. The World Health Organization has found that policy change and regulation are the clearest paths to resolution. In Indonesia, where smoking is increasingly common, tobacco control has become a wicked problem, plagued by conflicting stakeholder interests, public mistrust of science and government, and the lack of a clear path to a nationally applicable approach. At the local level, however, social change can take many forms, and involve diverse communities, individual citizens, businesses, NGOs, and multiple levels of government in dynamic stakeholder configurations. By treating tobacco in Indonesia as a wicked problem, and taking an iterative, collaborative approach to resolution, we demonstrate how locally-organized, youth-focused anti-tobacco campaigns are less about finding a single solution to tobacco use and more about identifying, connecting, and supporting local stakeholders working together towards preferred futures. We argue for the inclusion of locally-focused design research programs when rethinking complex issues such as tobacco control in places where national regulation is failing

Leading edge stabilisation of vertical boundary layer diffusion flames

The leading edge stability of vertical boundary layer diffusion flames established over a 3D-printed porous gas burner is revealed through Planar Laser-Induced Fluorescence imaging of the OH radical (OH-PLIF). Flame stability is studied by premixing methane and ethylene with increasing volume fractions of bromotrifluoromethane (CF3Br/Halon-1301) to increase the characteristic chemical timescale. Blow-off occurs at 15.7% and 37.3% CF3Br addition for methane and ethylene respectively, which are remarkably large limits compared to other flame configurations. As CF3Br is added, the flame stand-off distance increases and the reaction zone broadens, thereby increasing the flame length. This accelerates the buoyancy-induced flow ahead of the leading edge, promoting O2 entrainment into the flame anchor. Consequently, the radical scavenging effects on the flame anchor reactivity are dampened, resulting in the flame re-anchoring slightly downstream along the plate. Towards extinction, the flame shortens dramatically due to efficient catalytic cycling and radiative quenching at the flame tip resulting from the brominated species and excessive soot formation. This reduces the O2 mass flux into the kinetically dampened flame anchor resulting in blow-off extinction. Therefore, blow-off is controlled by both the leading edge reactivity and trailing edge length. Methane is shown to be considerably more sensitive compared to ethylene to CF3Br owing to its larger flame speed. These results demonstrate that fire-induced buoyancy greatly increases blow-off limits when using chemically active or inert agents in vertical wall fire configurations

Testing Ecological Theory with Lianas

Lianas constitute a diverse polyphyletic plant group that is advancing our understanding of ecological theory. Specifically, lianas are providing new insights into the mechanisms that control plant distribution and diversity maintenance. For example, there is now evidence that a single, scalable mechanism may explain local, regional, and pan‐tropical distribution of lianas, as well as the maintenance of liana species diversity. The ability to outcompete trees under dry, stressful conditions in seasonal forests provides lianas a growth advantage that, over time, results in relatively high abundance in seasonal forests and low abundance in aseasonal forests. Lianas may also gain a similar growth advantage following disturbance, thus explaining why liana density and diversity peak following disturbance at the local, forest scale. The study of ecology, however, is more than the effect of the environment on organisms; it also includes the effects of organisms on the environment. Considerable empirical evidence now indicates that lianas substantially alter their environment by consuming resources, suppressing tree performance, and influencing emergent properties of forests, such as ecosystem functioning, plant and animal diversity, and community composition. These recent studies using lianas are transcending classical tropical ecology research and are now providing novel insights into fundamental ecological theory

On the structure of buoyant fires with varying levels of fuel-turbulence

This paper employs a novel burner to study the effects of fuel-generated turbulence on the spatial and temporal structure of buoyant turbulent diffusion flames which are representative of large fires. Fuel-turbulence levels are increased using a perforated plate that issues high-velocity jets, enabling shearing of the fuel stream. The perforated plate may be recessed to control the turbulence level at the jet exit plane. It is shown that the exit plane axial velocity fluctuations can be increased from 0.135 m/s to 1.813 m/s. Varying the levels of fuel-turbulence in the burner allows for the control of key processes defining buoyant fires such as the spatial and temporal flame structure and flame instability modes. These processes are characterised by high-speed simultaneous imaging of planar laser-induced fluorescence of the OH radical (OH-PLIF) and Mie scattering from soot particles. Increasing the fuel-turbulence level deforms the flame, which promotes non-radial lateral entrainment into the flame sheet. This results in a sharp increase in the tilting of the near-field flame sheet along the vertical flame axis. Strong angular entrainment forces are shown to overcome the diffusive and thermal expansive forces at the flame neck, which leads to a strained asymmetric sinuous flame pinch-off instability, followed by separation of the flame base. Sinuous pinch-off instabilities occur at a greater frequency than the symmetric varicose pinch-off instabilities observed for flames with low fuel-turbulence. The asymmetric stretching of the flame neck inhibits the formation of the classical puffing instability formed with an axisymmetric plume that defines classically buoyant flames. Probability density functions calculated for the flame front curvature and flame surface area are shown to monotonically broaden in the near-field region of the flame due to lateral entrainment effects. The transition to buoyancy-driven turbulence also shifts to an increasingly more upstream location. This burner, with its well-defined boundary conditions and novel data, forms a platform for advancing capabilities to model complex fire phenomena including turbulence-buoyancy interactions

Advocacy, support and survivorship in prostate cancer

© 2017 The Authors. European Journal of Cancer Care Published by John Wiley & Sons Ltd Across Australia, prostate cancer support groups (PCSG) have emerged to fill a gap in psychosocial care for men and their families. However, an understanding of the triggers and influencers of the PCSG movement is absent. We interviewed 21 SG leaders (19 PC survivors, two partners), of whom six also attended a focus group, about motivations, experiences, past and future challenges in founding and leading PCSGs. Thematic analysis identified four global themes: illness experience; enacting a supportive response; forming a national collective and challenges. Leaders described men's feelings of isolation and neglect by the health system as the impetus for PCSGs to form and give/receive mutual help. Negotiating health care systems was an early challenge. National affiliation enabled leaders to build a united voice in the health system and establish a group identity and collective voice. Affiliation was supported by a symbiotic relationship with tensions between independence, affiliation and governance. Future challenges were group sustainability and inclusiveness. Study findings describe how a grassroots PCSG movement arose consistent with an embodied health movement perspective. Health care organisations who seek to leverage these community resources need to be cognisant of SG values and purpose if they are to negotiate effective partnerships that maximise mutual benefit

The value of source data verification in a cancer clinical trial

Background Source data verification (SDV) is a resource intensive method of quality assurance frequently used in clinical trials. There is no empirical evidence to suggest that SDV would impact on comparative treatment effect results from a clinical trial. Methods Data discrepancies and comparative treatment effects obtained following 100% SDV were compared to those based on data without SDV. Overall survival (OS) and Progression-free survival (PFS) were compared using Kaplan-Meier curves, log-rank tests and Cox models. Tumour response classifications and comparative treatment Odds Ratios (ORs) for the outcome objective response rate, and number of Serious Adverse Events (SAEs) were compared. OS estimates based on SDV data were compared against estimates obtained from centrally monitored data. Findings Data discrepancies were identified between different monitoring procedures for the majority of variables examined, with some variation in discrepancy rates. There were no systematic patterns to discrepancies and their impact was negligible on OS, the primary outcome of the trial (HR (95% CI): 1.18(0.99 to 1.41), p = 0.064 with 100% SDV; 1.18(0.99 to 1.42), p = 0.068 without SDV; 1.18(0.99 to 1.40), p = 0.073 with central monitoring). Results were similar for PFS. More extreme discrepancies were found for the subjective outcome overall objective response (OR (95% CI): 1.67(1.04 to 2.68), p = 0.03 with 100% SDV; 2.45(1.49 to 4.04), p = 0.0003 without any SDV) which was mostly due to differing CT scans. Interpretation Quality assurance methods used in clinical trials should be informed by empirical evidence. In this empirical comparison, SDV was expensive and identified random errors that made little impact on results and clinical conclusions of the trial. Central monitoring using an external data source was a more efficient approach for the primary outcome of OS. For the subjective outcome objective response, an independent blinded review committee and tracking system to monitor missing scan data could be more efficient than SDV

Next generation sequencing of HIV-1 protease in the PIVOT trial of protease inhibitor monotherapy

BACKGROUND: The PIVOT trial examined whether patients with suppressed viral load on combination antiretroviral therapy could be safely switched long-term to ritonavir-boosted protease inhibitor (PI) monotherapy. The main trial publication reported that only one of 296 patients allocated to PI monotherapy experienced a loss of drug options due to protease mutations (identified by local Sanger sequencing resistance tests) likely selected by study drug. OBJECTIVES: To assess if we had missed low frequency mutations, using a more sensitive methodology. STUDY DESIGN: We performed next generation sequencing (NGS) on all available frozen plasma samples with VL >1000 copies/ml from patients who were randomised to PI monotherapy. Assays were performed at Public Health England laboratories using a previously described method. Median coverage depth was 76,000 and the threshold for detection of minority variants was 2%. Drug susceptibility was predicted using the Stanford HIVdb algorithm. RESULTS: 17 of 26 potential samples, all from different patients, were identified and successfully tested. The median viral load was 6780 copies/ml and the median time since randomisation was 43 weeks. NGS revealed previously unidentified minority variant protease mutations (G73D, I54T, L89V) in three samples, at frequencies ranging between 2% and 10%. None of these mutations predicted intermediate or high level resistance, the trial primary outcome. DISCUSSION: This report adds to the body of evidence that ritonavir-boosted PI monotherapy, when used as a switch strategy with prompt detection of viral load rebound and early re-introduction of combination therapy, rarely leads to the development of clinically important protease resistance mutations

“I am not a number!” Opinions and preferences of people with intellectual disability about genetic healthcare

There is limited research exploring the knowledge and experiences of genetic healthcare from the perspective of people with intellectual disability. This study, conducted in New South Wales (Australia), addresses this gap. Eighteen adults with intellectual disability and eight support people were interviewed in this inclusive research study. The transcribed interviews were analysed using inductive content analysis. The findings were discussed in a focus group with ten adults with intellectual disability and in three multi-stakeholder advisory workshops, contributing to the validity and trustworthiness of the findings. Five main themes emerged: (i) access to genetic healthcare services is inequitable, with several barriers to the informed consent process; (ii) the experiences and opinions of people with intellectual disability are variable, including frustration, exclusion and fear; (iii) genetic counselling and diagnoses can be profoundly impactful, but translating a genetic diagnosis into tailored healthcare, appropriate support, peer connections and reproductive planning faces barriers; (iv) people with intellectual disability have a high incidence of exposure to trauma and some reported that their genetic healthcare experiences were associated with further trauma; (v) recommendations for a more respectful and inclusive model of genetic healthcare. Co-designed point-of-care educational and consent resources, accompanied by tailored professional education for healthcare providers, are required to improve the equity and appropriateness of genetic healthcare for people with intellectual disability

On the accuracy of language trees

Historical linguistics aims at inferring the most likely language phylogenetic tree starting from information concerning the evolutionary relatedness of languages. The available information are typically lists of homologous (lexical, phonological, syntactic) features or characters for many different languages. From this perspective the reconstruction of language trees is an example of inverse problems: starting from present, incomplete and often noisy, information, one aims at inferring the most likely past evolutionary history. A fundamental issue in inverse problems is the evaluation of the inference made. A standard way of dealing with this question is to generate data with artificial models in order to have full access to the evolutionary process one is going to infer. This procedure presents an intrinsic limitation: when dealing with real data sets, one typically does not know which model of evolution is the most suitable for them. A possible way out is to compare algorithmic inference with expert classifications. This is the point of view we take here by conducting a thorough survey of the accuracy of reconstruction methods as compared with the Ethnologue expert classifications. We focus in particular on state-of-the-art distance-based methods for phylogeny reconstruction using worldwide linguistic databases. In order to assess the accuracy of the inferred trees we introduce and characterize two generalizations of standard definitions of distances between trees. Based on these scores we quantify the relative performances of the distance-based algorithms considered. Further we quantify how the completeness and the coverage of the available databases affect the accuracy of the reconstruction. Finally we draw some conclusions about where the accuracy of the reconstructions in historical linguistics stands and about the leading directions to improve it.Comment: 36 pages, 14 figure

Measuring measurement

Measurement connects the world of quantum phenomena to the world of classical events. It plays both a passive role, observing quantum systems, and an active one, preparing quantum states and controlling them. Surprisingly - in the light of the central status of measurement in quantum mechanics - there is no general recipe for designing a detector that measures a given observable. Compounding this, the characterization of existing detectors is typically based on partial calibrations or elaborate models. Thus, experimental specification (i.e. tomography) of a detector is of fundamental and practical importance. Here, we present the realization of quantum detector tomography: we identify the optimal positive-operator-valued measure describing the detector, with no ancillary assumptions. This result completes the triad, state, process, and detector tomography, required to fully specify an experiment. We characterize an avalanche photodiode and a photon number resolving detector capable of detecting up to eight photons. This creates a new set of tools for accurately detecting and preparing non-classical light.Comment: 6 pages, 4 figures,see video abstract at http://www.quantiki.org/video_abstracts/0807244