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.

Childhood obesity: should primary school children be routinely screened? A systematic review and discussion of the evidence

Background: Population monitoring has been introduced in UK primary schools in an effort to track the growing obesity epidemic. It has been argued that parents should be informed of their child's results, but is there evidence that moving from monitoring to screening would be effective? We describe what is known about the effectiveness of monitoring and screening for overweight and obesity in primary school children and highlight areas where evidence is lacking and research should be prioritised. Design: Systematic review with discussion of evidence gaps and future research. Data sources: Published and unpublished studies ( any language) from electronic databases ( inception to July 2005), clinical experts, Primary Care Trusts and Strategic Health Authorities, and reference lists of retrieved studies. Review methods: We included any study that evaluated measures of overweight and obesity as part of a population-level assessment and excluded studies whose primary outcome measure was prevalence. Results: There were no trials assessing the effectiveness of monitoring or screening for overweight and obesity. Studies focussed on the diagnostic accuracy of measurements. Information on the attitudes of children, parents and health professionals to monitoring was extremely sparse. Conclusions: Our review found a lack of data on the potential impact of population monitoring or screening for obesity and more research is indicated. Identification of effective weight reduction strategies for children and clarification of the role of preventative measures are priorities. It is difficult to see how screening to identify individual children can be justified without effective interventions.

Performance of asynchronous channel assignment scheme in non-uniform and dynamic topology WLANs

Dense deployments of wireless local area networks (WLANs) are fast becoming a permanent feature of all developed cities around the world. While this increases capacity and coverage, the problem of increased interference, which is exacerbated by the limited number of channels available, can severely degrade the performance of WLANs if an effective channel assignment scheme is not employed. In an earlier work, an asynchronous, distributed and dynamic channel assignment scheme has been proposed that (1) is simple to implement, (2) does not require any knowledge of the throughput function, and (3) allows asynchronous channel switching by each access point (AP). In this paper, we present extensive performance evaluation of this scheme when it is deployed in the more practical non-uniform and dynamic topology scenarios. Specifically, we investigate its effectiveness (1) when APs are deployed in a nonuniform fashion resulting in some APs suffering from higher levels of interference than others and (2) when APs are effectively switched `on/off' due to the availability/lack of traffic at different times, which creates a dynamically changing network topology. Simulation results based on actual WLAN topologies show that robust performance gains over other channel assignment schemes can still be achieved even in these realistic scenarios.

An asynchronous channel assignment scheme: performance evaluation

Due to its popularity, dense deployments of wireless local area networks (WLANs) are becoming a common feature of many cities around the world. However, with only a limited number of channels available, the problem of increased interference can severely degrade the performance of WLANs if an effective channel assignment scheme is not employed. In an earlier work, we proposed an improved asynchronous distributed and dynamic channel assignment scheme that (1) is simple to implement, (2) does not require any knowledge of the throughput function, and (3) allows asynchronous channel switching by each access point (AP). In this paper, we present extensive performance evaluation of the proposed scheme in practical scenarios found in densely populated WLAN deployments. Specifically, we investigate the convergence behaviour of the scheme and how its performance gains vary with different number of available channels and in different deployment densities. We also prove that our scheme is guaranteed to converge in a single iteration when the number of channels is greater than the number of neighbouring APs.

Effectiveness of asynchronous channel assignment scheme in heterogeneous WLANs

Due to their popularity, dense deployments of wireless local area networks (WLANs) are becoming a common feature of many cities around the world. However, with only a limited number of channels available, the problem of increased interference can severely degrade the performance of WLANs if an effective channel assignment scheme is not employed. Previous studies on channel assignment in WLANs almost always assume that all access points (AP) employ the same channel assignment scheme which is clearly unrealistic. On the other hand, to the best of our knowledge, the interaction between different channel assignment schemes has also not been studied before. Therefore, in this paper, we investigate the effectiveness of our earlier proposed asynchronous channel assignment scheme in these heterogeneous WLANs scenarios. Simulation results show that our proposed scheme is still able to provide robust performance gains even in these scenarios.

An asynchronous distributed dynamic channel assignment scheme for dense WLANs

Wireless local area networks (WLANs) have changed the way many of us communicate, work, play and live. Due to its popularity, dense deployments are becoming a norm in many cities around the world. However, increased interference and traffic demands can severely limit the aggregate throughput achievable if an effective channel assignment scheme is not used. In this paper, we propose an enhanced asynchronous distributed and dynamic channel assignment scheme that is simple to implement, does not require any knowledge of the throughput function, allows asynchronous channel switching by each access point (AP) and is superior in performance. Simulation results show that our proposed scheme converges much faster than previously reported synchronous schemes, with a reduction in convergence time and channel switches by tip to 73.8% and 30.0% respectively.

Discussion on the importance of making things right

Critical notice of 'From metaphysics to ethics' by Frank Jackson.