Assurance in clinical trial design

Conventional clinical trial design involves considerations of power, and sample size is typically chosen to achieve a desired power conditional on a specified treatment effect. In practice, there is considerable uncertainty about what the true underlying treatment effect may be, and so power does not give a good indication of the probability that the trial will demonstrate a positive outcome. Assurance is the unconditional probability that the trial will yield a ‘positive outcome’. A positive outcome usually means a statistically significant result, according to some standard frequentist significance test. The assurance is then the prior expectation of the power, averaged over the prior distribution for the unknown true treatment effect. We argue that assurance is an important measure of the practical utility of a proposed trial, and indeed that it will often be appropriate to choose the size of the sample (and perhaps other aspects of the design) to achieve a desired assurance, rather than to achieve a desired power conditional on an assumed treatment effect. We extend the theory of assurance to two‐sided testing and equivalence trials. We also show that assurance is straightforward to compute in some simple problems of normal, binary and gamma distributed data, and that the method is not restricted to simple conjugate prior distributions for parameters. Several illustrations are given. Copyright © 2005 John Wiley & Sons, Ltd.     

Organic and sustainable

The terrorist attacks of September 11, 2001, spawned 252 new nonprofit organizations. We know little about these organizations, including how they emerged, formalized, met constituents' expectations for immediate performance, and ultimately survived. This article explores these issues through a case study of one successful organization, the Windows of Hope Family Relief Fund. Using concepts from disaster, organizational ecology, and entrepreneurship research, the analysis identifies six propositions that link these literatures, notably the role of resource acquisition in formalization and the role of legitimacy in both fund development and organizational endurance. The study contributes new knowledge about the role of collaboration in acquiring capacity to enhance responsiveness. The findings suggest potential parallels to the evolution of new nonprofit organizations in other contexts.     

When elevators were for pianos: an oral history account of the civilian experience of using wheelchairs in Canadian society. The first twenty-five years: 1945-1970

In 1945 Canadian World War II veterans with spinal cord injury were among the first Canadians to have access to medical rehabilitation programs, the Everest and Jennings folding, self-propelled wheelchair and automobiles with hand-controls. A previous paper, Going back to Civvy Street (Tremblay, 1996) described how the veteran pioneers used these new opportunities to return to full participation in civilian life. Drawing on oral history and archival research, this paper examines the experiences of Canadian civilians with spinal cord injury as they tried to follow the veterans' example. It discusses the strategies these pioneers used to overcome obstacles, such as stairs and curbs, as well as providing examples of their experiences in finding housing, education and employment. The paper reviews the responses individuals received from their fellow citizens and highlights the limited recognition of architectural barriers in an era when elevators were for pianos!     

Social capital and women's reduced vulnerability to HIV infection in rural Zimbabwe

Social capital—especially through its “network” dimension (high levels of participation in local community groups)—is thought to be an important determinant of health in many contexts. We investigate its effect on HIV prevention, using prospective data from a general population cohort in eastern Zimbabwe spanning a period of extensive behavior change (1998–2003). Almost half of the initially uninfected women interviewed were members of at least one community group. In an analysis of 88 communities, individuals with higher levels of community group participation had lower incidence of new HIV infections and more of them had adopted safer behaviors, although these effects were largely accounted for by differences in socio-demographic composition. Individual women in community groups had lower HIV incidence and more extensive behavior change, even after controlling for confounding factors. Community group membership was not associated with lower HIV incidence in men, possibly refecting a propensity among men to participate in groups that allow them to develop and demonstrate their masculine identities—often at the expense of their health. Support for women's community groups could be an effective HIV prevention strategy in countries with large-scale HIV epidemics.     

‘All have to live in me …’: a study of the use of English alongside other African languages in a Kenyan school

The purpose of this paper, which builds on an earlier paper published in this Journal (Vol. 20, No. 6), is to develop the discussion around how English has been taught, used and perceived in Kenya, using data gathered from a small second‐level English‐medium school in Kenya. The complex relationships between language and identity are at work in the everyday routines of both staff and pupils within such a context. The paper seeks to set out a clear methodology for gathering data which could help describe these relationships with more clarity while also subjecting the data to analysis informed by the growing body of research and theory that focuses on language policy in post‐colonial and neo‐colonial settings. Finally, these pieces of data are used as the basis of a further exploration of the implications for classroom practice in teaching English in this environment.     

Isomorphism,Institutional Parochialism,and the Sociology of Religion

This article investigates whether the field of sociology of religion is occupied by parochial concerns. We characterize institutional parochialism as the degree to which people in an academic field tend to study their own societies. This study employs a content analysis of articles published in The Journal for the Scientific Study of Religion and Sociology of Religion from 2001 to 2008, with particular attention paid to the incidences in which Muslim and non-Western groups were studied before and after the 9/11 terrorist attacks. There was no change in the rate that “Muslim” communities were studied following the 9/11 attacks, but it appears journal content did change to reflect ongoing debates in the West and in response to mimetic pressures being placed on the field. Overall, if the sociology of religion can be characterized as parochial, we contend that the broader field of American sociology is likely far more so.