Dr John Snow and an early investigation of groundwater contamination

John Snow was a physician but his studies of the way in which cholera is spread have long attracted the interest of hydrogeologists. From his investigation into the epidemiology of the cholera outbreak around the well in Broad Street, London, in 1854, Snow gained valuable evidence that cholera is spread by contamination of drinking water. Subsequent research by others showed that the well was contaminated by sewage. The study therefore represents one of the first, if not the first, study of an incident of groundwater contamination in Britain. Although he had no formal geological training, it is clear that Snow had a much better understanding of groundwater than many modern medical practitioners. At the time of the outbreak Snow was continuing his practice as a physician and anaesthetist. His casebooks for 1854 do not even mention cholera. Yet, nearly 150 years later, he is as well known for his work on cholera as for his pioneering work on anaesthesia, and his discoveries are still the subject of controversy.

The Dark Monarch: magic and modernity in British art

This major curated exhibition, publication and events builds on Rowlands’ curatorial research. Working in collaboration with co-curators Martin Clark, Artistic Director, Tate St Ives and Michael Bracewell, cultural historian, the exhibition sought to explore new narratives within British art. The innovative curatorial methodology developed from a fiction found in the infamous novel, The Dark Monarch by Sven Berlin, Gallery Press 1962. The research sought specific archival and collection work that allowed thematic strands to emerge that represented influences across generations. The exhibition features two-hundred artworks, from the Tate Collection, archives and other significant British public and private collections. It examines the development of early Modernism, in the UK, as well as the reappearance of esoteric and arcane references in a significant strand of contemporary art practice. Historical works from Samuel Palmer, Graham Sutherland, Henry Moore and Paul Nash are shown alongside contemporary artists including Derek Jarman, Cerith Wyn Evans, Eva Rothschild, Linder and John Russell. The exhibition includes a key work by Damien Hirst ¬ the first time he has been shown at Tate St Ives and a number of contemporary commissions. The Dark Monarch publication extended the discourse of the research critically examining the tension between progressive modernity and romantic knowledge, the book focuses on the way that artworks are encoded with various histories - geological, mythical and magical. Essays examine magic as a counterpoint to modernity’s transparency and rational progress, but also draw out the links modernity has with notions such as fetishism, mana, totem, and the taboo. Often viewed as counter to Modernism, this collection of essays suggest that these products of illusion and delusion in fact belong to modernity. Drawing together 15 different writers commissioned to explore magic as a counterpoint of liberal understanding of modernity, drawing out links that modernity has with notions of fetish, taboo and occult philosophy. Including essays by Marina Warner, Ilsa Colsell, Philip Hoare, Chris Stephens, Jennifer Higgie and Morrissey.

Bayesian sample size for exploratory clinical trials incorporating historical data

This paper presents a simple Bayesian approach to sample size determination in clinical trials. It is required that the trial should be large enough to ensure that the data collected will provide convincing evidence either that an experimental treatment is better than a control or that it fails to improve upon control by some clinically relevant difference. The method resembles standard frequentist formulations of the problem, and indeed in certain circumstances involving 'non-informative' prior information it leads to identical answers. In particular, unlike many Bayesian approaches to sample size determination, use is made of an alternative hypothesis that an experimental treatment is better than a control treatment by some specified magnitude. The approach is introduced in the context of testing whether a single stream of binary observations are consistent with a given success rate p(0). Next the case of comparing two independent streams of normally distributed responses is considered, first under the assumption that their common variance is known and then for unknown variance. Finally, the more general situation in which a large sample is to be collected and analysed according to the asymptotic properties of the score statistic is explored. Copyright (C) 2007 John Wiley & Sons, Ltd.

The significance of "nonsignificance" in randomized controlled studies: a discussion inspired by a double-blinded study on St. John's Wort (Hypericum perforatum L.) for premenstrual symptoms

Objectives: This study aimed to investigate the efficacy of St. John's wort extract (SJW) as a treatment for premenstrual symptoms. Design: The study was a randomized, double-blinded, placebo-controlled trial, with two parallel treatment groups. After a no-treatment baseline cycle, volunteers were randomized to either SJW or placebo for a further two menstrual cycles. Settings/location: A postal trial conducted from The University of Reading, Berkshire, England. Subjects: One hundred and sixty-nine (169) normally menstruating women who experienced recurrent premenstrual symptoms were recruited onto the study. One hundred and twenty-five (125) completed the protocol and were included in the analysis. Interventions: Six hundred milligrams (600) mg of SJW (standardized to contain 1800 mug of hypericin) or placebo (containing lactose and cellulose). Outcome measure: A menstrual diary was used to assess changes in premenstrual symptoms. The anxiety-related subgroup of symptoms of this instrument was used as the primary outcome measure. Results: After averaging the effects of treatment over both treatment cycles it was found that there was a trend for SJW to be superior to placebo. However, this finding was not statistically significant. Conclusion: The possibility that this nonsignificant finding resulted from insufficient statistical power in the study, rather than a lack of efficacy of SJW, is discussed. Following this discussion the recommendation is made that, in future, similar studies should be powered to detect a minimum clinically relevant difference between treatments.