MAG: Clearing Improvised Landmines in Iraq

MAG’s recent experience in the Middle East has shown that clearing improvised landmines can be achieved even in the most complex humanitarian contexts. It is imperative that detail and specificity is given to discussions on improvised devices if we are to avoid negative repercussions for the safety of beneficiaries and humanitarian workers

Determining the sample size for a cluster-randomised trial: Bayesian hierarchical modelling of the ICC estimate

In common with many cluster-randomised trials, it was difficult to determine the appropriate sample size for the planned trial of the effectiveness of a systematic voiding programme for post-stroke incontinence due to the lack of a robust estimate of the intra-cluster correlation coefficient (ICC). One approach to overcome this problem is a method of combining ICC values in the Bayesian framework (Turner et al. 2005). We adopted this approach and used Bayesian hierarchical modelling to estimate the ICC

Changing stroke mortality trends in middle-aged people: an age-period-cohort analysis of routine mortality data in persons aged 40 to 69 in England

Background: In the UK, overall stroke mortality has declined. A similar trend has been seen in coronary heart disease, although recent reports suggest this decline might be levelling off in middle-aged adults. Aim: To investigate recent trends in stroke mortality among those aged 40–69 years in England. Methods: The authors used routine annual aggregated stroke death and population data for England for the years 1979–2005 to investigate time trends in gender-specific mortalities for adults aged 40 to 69 years. The authors applied log-linear modelling to isolate effects attributable to age, linear ‘drift’ over time, time period and birth cohort. Results; Between 1979 and 2005, age-standardised stroke mortality aged 40 to 69 years dropped from 93 to 30 per 100 000 in men and from 62 to 18 per 100 000 in women. Mortality was higher in older age groups, but the difference between the older and younger age groups appears to have decreased over time for both sexes. Modelling of the data suggests an average annual reduction in stroke deaths of 4.0% in men and 4.3% in women, although this decrease has been particularly marked in the last few years. However, we also observed a relative rate increase in mortality among those born since the mid-1940s compared with earlier cohorts; this appears to have been sustained in men, which explains the levelling off in the rate of mortality decline observed in recent years in the younger middle-aged. Conclusions: If observed trends in middle-aged adults continue, overall stroke mortalities may start to increase again

Disease and psychological status in ankylosing spondylitis.

Objectives. Psychological factors may be important in the assessment and management of ankylosing spondylitis (AS). Our primary objective was to describe associations between disease and psychological status in AS, using AS-specific assessment tools and questionnaires. Our secondary objectives were to identify patient subgroups based on such associations and to determine the stability of the measures over time. Methods. A total of 110 patients were assessed at 6-monthly intervals up to four times using tools to measure disease [Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI) and the Bath Ankylosing Spondylitis Metrology Index (BASMI)], psychological [Hospital Anxiety and Depression Questionnaire (HADS), Health Locus of Control—Form C Questionnaire (HLC-C)] and generic health [Short form (SF)-36] status. Results. Eighty-nine participants completed all four assessments. Throughout the study, BASDAI, BASFI and BASMI scores correlated significantly with anxiety, depression, internality and health status, but not with levels of belief in chance or powerful others. Clinically anxious or depressed subgroups had significantly worse BASDAI and BASFI, but not BASMI, scores. BASMI scores were the least closely linked to psychological status. Mean scores for disease, psychological and health status were clinically stable over the 18 months period. Conclusions. Disease status scores in AS correlated significantly with anxiety, depression, internality and health status. Interpretation of AS disease scores should take an account of psychological status and the choice of measures used. These findings have important potential applications in AS management and monitoring, including the identification of patients for biological therapies

It's all about risk, isn't it? Science, politics, public opinion and regulatory reform

Like most Western democracies, Australia has seen constant business complaints about the regulatory burden and the need for reform. Governments have been sympathetic to these concerns and initiated numerous enquiries into ways to reduce red tape. One, published by the Regulation Taskforce in 2006, argues that a key problem is that Australians are becoming 'risk averse'. Drawing on research into the regulatory aftermath of major disasters, this paper argues that the Taskforce's approach is over-simplistic. Risk has at least three dimensions: actuarial, social and political. Proliferation of rules and regulations in the aftermath of a major disaster can be as much, if not more, the product of political risk aversion as it is of social and actuarial assessments. 'Smart' regulation, which aims to reduce risk while avoiding an excess of rules, must address all three dimensions. The paper explores when and how there can be a 'smart' response to major disaster

Irradiated, colour-temperature-corrected accretion discs in ultraluminous X-ray sources

Although attempts have been made to constrain the stellar types of optical counterparts to ultraluminous X-ray sources (ULXs), the detection of optical variability instead suggests that they may be dominated by reprocessed emission from X-rays which irradiate the outer accretion disc. Here, we report results from a combined X-ray and optical spectral study of a sample of ULXs, which were selected for having broadened disc-like X-ray spectra and known optical counterparts. We simultaneously fit optical and X-ray data from ULXs with a new spectral model of emission from an irradiated, colour-temperature-corrected accretion disc around a black hole, with a central Comptonizing corona. We find that the ULXs require reprocessing fractions of ∼10−3, which is similar to sub-Eddington thermal dominant state black hole binaries (BHBs), but less than has been reported for ULXs with soft ultraluminous X-ray spectra. We suggest that the reprocessing fraction may be due to the opposing effects of self-shielding in a geometrically thick supercritical accretion disc and reflection from far above the central black hole by optically thin material ejected in a natal super-Eddington wind. Then, the higher reprocessing fractions reported for ULXs with wind-dominated X-ray spectra may be due to enhanced scattering on to the outer disc via the stronger wind in these objects. Alternatively, the accretion discs in these ULXs may not be particularly geometrically thick, rather they may be similar in this regard to the thermal dominant state BHBs

Does repetitive task training improve functional activity after stroke? A Cochrane systematic review and meta-analysis.

Repetitive task training resulted in modest improvement across a range of lower limb outcome measures, but not upper limb outcome measures. Training may be sufficient to have a small impact on activities of daily living. Interventions involving elements of repetition and task training are diverse and difficult to classify: the results presented are specific to trials where both elements are clearly present in the intervention, without major confounding by other potential mechanisms of action

Testing the Expert Based Weights Used in the UK’s Index of Multiple Deprivation (IMD) Against Three Preference-Based Methods

The paper has benefitted from helpful comments and suggestions from Koen Decancq, Rainer Schulz, and participants at the Weighting in Multidimensional Measures workshop at OPHI, Oxford, the Overseas Development Workshop at ODI, London, seminar participants at Universiteit Antwerpen, and conference participants at New Directions in Welfare III, Paris. Any errors or omissions, of course, remain the responsibility of the authors. The project was funded by the Department of the Communities and Local Government. The Chief Scientist Office of the Scottish Government Health and Social Care Directorates funds HERU. The views expressed in this paper are those of the authors only and not those of the funding bodies.Peer reviewedPostprin

A child’s-eye view of social difference

Children are increasingly the focus of Government policy, and improvement of outcomes for children in disadvantaged areas is a priority. However, little is known about how children see and experience poverty, wealth, and ‘social difference’ in their everyday lives. This report explores their own views, using their terms. A participatory approach was used, which enabled the children to lead the research focus. The report compares the similarities and differences between the findings from the two groups. The study was conducted with 42 children aged between 8 and 13. Of these, 19 were from a disadvantaged housing estate and 23 attended a fee-paying independent school. The children participated in a series of workshops and helped to choose the research methods, which included role play, photography, mapping and ‘draw and write’ techniques. The report will be of interest to researchers and policymakers in the fields of education and child poverty