Skip to content
Advertisements

“Larkin with Women” in Eskdale

September 7, 2017

Who was “the one”?

   

Scene one. The poet, wrestling with the final verse of An Arundel Tomb, calls out to Monica: “Heraldic, two syllables, with oomph!” Fans in the audience bite their fists, and partners kick shins; it’s a play not a pantomime. But Monica comes up with “blazon” and smiles contentedly when she reads the soon to be famous final line “What will survive of us is love”. 

Scene two. The librarian hides his dirty magazine stash from his secretary. No-nonsense Betty turns a blind eye until a letter from the vice squad arrives – he’s been rumbled.  Larkin panics but Betty forces him to take a call from his fellow porn connoisseur, Bob Conquest. It’s a set-up!

And so it goes. Readers of the letters and biographies will know most of the stories; the hedgehog and the mower, Mrs Thatcher and Deceptions, jazz, drinking, and – three women.

Monica Jones, his intellectual equal, has stuck with him ever since Larkin’s best friend Kingsley Amis drew on her as the model for uptight Margaret Beale in Lucky Jim; she must love him to stay around after that. Betty Mackereth knows all his secrets, including that Monica takes precedence, but loves him all the same. Repressed Maeve Brennan, bowled over by a published poet, waits 15 years to go all the way; of course she loves him.

Ben Brown’s Larkin with Women tells the story of his 30-year entanglement with the trio. It’s been revived many times and this summer came to the village hall in the North Yorkshire hamlet of Glaisdale. One wonders how such a place can support even a summer season of professional theatre, but every year it does; Larkin easily sold out thirty shows. We, drawn by Larkin, had come up from Nottingham. Two ladies sitting next to us had come from Whitby. Conversation: “Not much of a looker.” “Miserable too.” “What did they see in him?” “I guess there are no ugly poets.”

We had popped in before the show to look around the empty theatre, and one of the scene shifters had told us its story. Esk Valley Theatre has been running ten years – Willy Russell’s Educating Rita last year – with minimal subsidy but much local volunteering.  The company bring their own seating and put on one production annually. They have some connection with Scarborough where Alan Ayckbourn tries out most of his plays; Larkin with Women was first performed there in 1999, and Ayckbourn himself had turned up in the audience the previous night.

And the play? The women were all brilliant, but I was disappointed in the Larkin character. Jonathan Pembroke occasionally showed a clunking lack of empathy, almost playing him as somewhere “on the spectrum”. The Freudian slip of admiring Monica’s “maeve” sheets was OK, but the laugh he got when denying that he’d had sex with Maeve, by gratuitously adding “not by choice”, grated. Larkin was selfish but, judging by the poems, few people were more empathic. Perhaps it’s difficult to differentiate selfishness and lack of empathy in a few lines.  

There were plenty of jokes. Waving a newspaper article about a woman who shrieked and vomited at a Ted Hughes poetry reading, he mutters: “I never felt like shrieking!” Tussling with Maeve he comes out with: “Marriage is a wonderful thing for other people, like going to the stake.”

But there was also much Larkin melancholy. Although death came late to his fourth woman, his mother, cancer comes to Larkin a good bit earlier. He asks Betty to give Monica a lift to the hospital. Maeve gives him her bible. The women meet by the death bed, each wanting to be told she is “the one”. Larkin withholds that comfort, although he does admit to loving Monica. Nor will he pretend to the faith he does not hold.

But we the audience have had time to read An Arundel Tomb more carefully than Monica did that day. To get to know the layers of ambiguity he got into that final line.

Time has transfigured them into
Untruth. The stone finality
They hardly meant has come to be
Their final blazon, and to prove
Our almost-instinct almost true:
What will survive of us is love.

The pun in the play’s title was misplaced. All Larkin’s women were “the one”.

Jim Thornton

Advertisements

“Success for All” literacy programmes

July 15, 2017

The Education Endowment Foundation trial results were negative

Is the Foundation spinning it as positive?

Success for All is a commercial education programme (click here) which claims to improve literacy in primary schools. Teachers are shown how to provide effective phonics teaching and provided with structured lesson plans. Heads and managers get help with ability grouping and with encouraging parental involvement.

Sounds good, but does it really make a worthwhile difference? The Education Endowment Foundation (EEF) has just published a randomised trial testing the programme’s effectiveness.

Ripe-tomato.org loves randomised trials of educational innovations, but criticised an earlier Foundation trial (click here), for playing down its predefined primary and secondary endpoints, which had shown no benefit, and claiming that the treatment had worked on the basis of new, possibly data driven, endpoints. Let’s look at the Success for All trial (click here for the full report or Success_for_All_Evaluation_Report).

It was a cluster randomised trial comparing 27 intervention schools (874 pupils) with 27 controls (893 pupils). That’s 54 schools and 1767 pupils in total. Randomisation details are not given in the main report but, according to the revised protocol, schools were “allocated in pairs based on a ranking of Key Stage 2 results”. The planned sample size (50 schools, 1250 pupils) was exceeded, and the trial had 80% power at conventional levels of statistical significance (5%) to detect a difference of 0.2 of a standard deviation in mean test scores. This would convert to about three months attainment difference. Educationalists generally label such an effect size as at the border between “small” and “medium”. The researchers presumably judged it as the minimum worthwhile difference for a relatively expensive intervention like this. That seems reasonable, although I confess I’m not qualified to judge. The intervention took place in two waves, June 2013-14 and 14-15, with results collected during the intervention (end of reception class) and at project completion (end of year one class), so the final results were in by August 2016.

The trial was retrospectively registered (click here) in June 2016, and the two versions of the protocol on the EEF website (click here) are dated Feb and August 2016. Nevertheless the analysis didn’t happen till November 2016, so this late registration may not matter.

The primary outcome on the registry and both protocols was the same, the six components of the Woodcock Reading Mastery Test score (high is good), three measured at end of reception and three at year one. Six primary endpoints are too many, but the authors eventually compared just the total Woodcock scores, so only two primary endpoints. Seven intervention schools gave up on the programme, but fortunately all but one of them collected outcome data so they were included in the primary “analysis by intention to treat”.  Schools and pupils were well balanced at trial entry (table 5), but 214 children (12% of the original sample) missed the reception class assessment, and by the year one point 430 children (24%) were lost to follow-up.

Results

The raw mean end of year one scores in the intervention schools were 82 v 78 controls (Table 6) but the standard deviation was huge (about 57 points) so the four point difference amounted to a tiny effect size of only 0.07 SD (95% CI -0.03 to 0.18, P=0.14). The effect size on the mean Woodcock score at the end of reception (trial midpoint) was even smaller 0.04 SD (95% CI -0.06 to 0.14 P=0.42).

In summary the main trial result was negative. These effects are too small to be educationally meaningful, they could easily have occurred by chance, and even if real, they would be too small to justify either the cost or the teachers’ time and effort.

The authors also looked at a phonics score at the trial end (not pre-specified) and adjusted for different combinations of baseline variables, but the effect sizes were smaller and the nominal P values larger. Curiously, although they had planned to test the Woodcock subscales, they decided not to do so “to avoid multiple testing”.  The raw sub-scale scores differed little (Table 7).

Subgroup analyses

No subgroup analyses are mentioned on the trial registry, but the original protocol planned “exploratory analysis [… e.g.] boys/girls, ethnicity, children of different abilities at baseline, high/low implementation schools”.  In the revised protocol they added “the main analysis will be repeated on a subsample […] eligible for free school meals”.

The free school meal subgroup analysis was negative at the end of the trial; effect size 0.12 SD (95% CI -0.10, 0.34, P = 0.23) but nominally significant at the midpoint reception class; effect size 0.22 SD (95% CI 0.01, 0.44, P = 0.03). This intermediate benefit would be worthwhile if real, although presumably not worth much if it disappeared a year later.

The secondary analysis by baseline attainment showed no differences, and the other secondary analyses by gender or ethnicity appear to have been quietly (and wisely) forgotten.

This left a secondary analysis excluding the seven intervention schools who gave up on the programme. Removing those schools, which were so disorganised that they couldn’t follow through on a two year literacy project, from the intervention group but not from controls, introduces bias in favour of the intervention. Even so the effect size was tiny, and of borderline statistical significance, 0.10 SD (95% CI -0.01, 0.22, P=0.05).

The programme cost £46,000 per school in the first year (about £169 per pupil) which fell steeply in subsequent years, so that over three years the cost per pupil per year was estimated at £62. The cost of the recipient school’s own staff training time was excluded from this figure.

Here are the Foundation evaluators’ conclusions together with my comments. Note an effect size of 0.07 is equivalent to one months progress.

“Children who took part in Success for All (SfA) made 1 additional month’s progress, on average, after two years compared to children in other schools. [We] are moderately confident that this difference was due to SfA.”

My interpretation. Depends what you mean by “moderately confident”. I’m moderately confident that the intervention is ineffective. The trial hasn’t ruled out a tiny beneficial effect size, but the observed difference could well have occurred by chance. The trial has not ruled out a small harmful effect either. No-one would licence a new drug on the basis of such a result.

“Children eligible for free school meals (FSM) made 2 additional months’ progress after two years, compared to FSM children in control schools. The smaller number of FSM pupils in the trial limits the security of this result, though combined with other findings in the report it provides some evidence that SfA does improve literacy ability for children eligible for free school meals.”

My interpretation. No they didn’t. The 2 months additional progress (total 3 months) comes from the effect size 0.22 SD P=0.03 for the interim score at the end of reception. Not only was this a secondary endpoint, albeit pre-specified, but the apparent effect faded by year one (effect size 0.12 SD. 95% CI -0.10 to 0.34. P = 0.23).

The remainder of the Foundation’s summary points are bland but positive, e.g “Schools that successfully delivered SfA were enthusiastic and valued the programme.”

The trial authors know the results were negative. The full report contains this sentence:

“The only other trials were based in the US and reported a positive effect of the programme, achieving effect sizes in the region of 0.15-0.30. The current trial has been unable to replicate these effects in an English context.”

But a visitor to the Foundation’s website would struggle to find it among the positive spin.

Perhaps it’s churlish to criticise. Randomised trials of educational innovations are few and far between, and I certainly don’t want to discourage them. But if negative trials are spun as positive, disinterested parties will soon disbelieve their results, as they currently do most non-randomised education research. That would be a pity.

This trial cost £1.4M. It was well designed and conducted. The result was negative. It should be reported as such.

Jim Thornton

Birth underwater

July 7, 2017

Charkovsky, Odent and Leboyer

        

For millennia, women lucky enough to live near suitable springs or tropical seas, have sat in warm water to ease their labour pains. But they mostly got out for the birth. This makes sense. Humans are land mammals; as the uterus empties, placental oxygen transfer falls and the baby needs to breathe quickly. Drowning, or short of that, inhaling hypotonic or infected water are both possible. The first doctor to advise a woman to actually give birth underwater was taking a risk.

He was also a charlatan. In the 1960’s a self-publicising Russian healer, Igor Charkovsky – he had a doctorate in yoga but no medical training – began to popularise birth underwater. Some say his original idea was to protect the baby from the shock of emerging from the fluid filled womb into gravity, but it seems he also wanted to toughen babies and mothers up. He advocated birth in icy water, and a technique he called baby yoga, tossing the baby in the air, swinging it by its legs and immersing it under water (click here or here). Sensitive Westerners may find parts hard to watch. At 29 minutes in the second clip, while onlookers stand around in the snow wearing fur hats, a few weeks old naked screaming baby is swung about by his legs a few times and then dunked repeatedly in a freezing pond.

His disciples, of which a few remain, film themselves giving birth in warm tropical seas with soft music accompaniment, and blather on about birthing with dolphins (click here). The sea is big, and dolphins swim in it, so I guess they’re right about that.

But sensible supporters of natural birth, like the late Sheila Kitzinger, condemned Charkovsky’s methods, the authorities caught up with him, and soon he was forced to flee Russia. He ended up in the US, where he was accused of sexually assaulting his adult female disciples (click here).

The next pioneer was more reputable.  Michel Odent, a French surgeon, who also ran the maternity unit in Pithiviers, a small town south of Paris, was a disciple of Frederick Leboyer, who in a famous 1975 book, Birth Without Violence, had advocated labouring (not birthing) in warm water with soft lights and music in the birth room. Odent put Leboyer’s principles into practice in Pithivers, and installed deep and roomy birth pools. Most women got out for the birth but a few didn’t, and by 1983 he had collected 100 cases where the mother had birthed underwater (Odent Lancet 1983). One baby had breathing difficulties and another died suddenly some weeks later. Neither, according to Odent, related to the birth underwater.

Odent left Pithiviers two years later, moved to London, and founded the Primal Health Research Centre to promote his ideas (click here for the Primal Health Research Database and here for a related website Wombecology).  So far as I can see he published no more original research on waterbirth, although he continued to advocate it. Instead he produced reviews and opinion pieces, and about 15 books on various aspects of childbirth, and became one of the fathers of the natural childbirth movement. Some of his ideas are a bit nutty, but few would argue with his general efforts to promote a calm environment for childbirth.  Even I have to admit to a scintilla of sympathy for his “Two sets of commandments for obstetricians” (J Med Ethics 1985 click here).

Leboyer meanwhile, who died last month, also continued to advocate tranquillity in the birth room, and lived to see many of his ideas enter mainstream practice. He continued to encourage warm baths during the long hours of labour, but to the end of his life argued that birth underwater was dangerous: “Waterbirth is completely wrong. To give birth, you need to be on dry land.” (click here).

I think we can all agree that Charkovsky was a dangerous child abuser and con artist.  But what about Odent and Leboyer?  Who was right about birth underwater?

I’m with Leboyer. For humans, birth underwater is a treatment like amniotomy, or oxytocin. It may have benefits, but it also has risks, and should only be offered outside well conducted trials if there is good evidence that the benefits outweigh the harms. There is no such evidence yet (click here for the Cochrane review).

Enthusiasts often rightly point to other interventions in obstetrics, such as the two above, for which the evidence base even now is relatively weak, but which are in widespread use.  Why discourage water birth but not those two?

Answer; we should discourage them too. They are both overused. Amniotomy and oxytocin should be limited to situations where the mother wants labour speeded up, there is evidence to support that (click here and here), and is prepared to take the risk of unintended side effects.

Labouring in a warm bath should be encouraged; it’s a useful method of pain relief. But women should be advised either to get out for the actual birth or for the bath to be drained. A few Odent disciples may want to give birth underwater, and take the risks. I guess they should be free to do so, but there’s no need to encourage them. Gently point them to Frederick Leboyer and Birth Without Violence instead.

Jim Thornton

Canoeing past Dampierre

June 3, 2017

On the river Loire

      

Having negotiated Belleville (click here) , I relaxed about Dampierre – until I neared it.  The power station and water inflow are on the right bank, and the portage on the left, so we hugged the left bank.  The trouble is that if you do that, the portage is invisible, until you’re right on top of the weir. So when the sign on the bank indicated “portage here” I panicked. Thinking they meant “right here”, I landed and scrambled through a nettle bed and brambles to reach the path. I’d pulled up too soon.

Keep your nerve and paddle on. At normal water levels the landing is easy and safe, albeit adjacent to the weir.

        

Easy portage. Relaunch from a sandy beach. To be honest the weir is shootable, but not by me in an overloaded open canoe without buoyancy.

No need for canoeists to fear Dampierre.

The power station’s four 1000 MW nuclear reactors were completed in 1980, seven years before Belleville came on stream. As a result the surrounding trees are much taller and only the cooling towers and some power lines are visible from the river. I think it’s coincidental that Dampierre’s four reactors have four cooling towers while Belleville’s two, also have one each.

Jim Thornton

Canoeing past Belleville

May 30, 2017

On the river Loire

Belleville, the most upstream of the Loire’s four nuclear power stations, supplies about four percent of France’s electricity, about equal to the country’s total wind farm capacity of over 10,000 turbines in 2015. Its two 1,300 MW concrete-domed reactors are dominated by the cooling towers which condense the steam for return to the river, which without them would be sucked dry. I doubt I’m the only canoeist, fearful how to get past. Easy – a simple short portage right.

Downstream from Cosne-Cours, the cooling towers come into view; often with their own private cloud!

      

As the power station nears, a sign directs canoeists to follow the right bank..

A few hundred metres on, a second sign directs canoeists down a narrow channel between the islands – a lovely route.

After warning signs for the dam at 1,500 and 500 metres, you emerge into open river near the right bank.

    

A jetty directs you towards an open lock and the portage.  Small boats can telephone for the gates to be operated, but the lock keepers expect canoeists to portage. Don’t shoot the lock!

The portage is easy.

The central part of the weir would be tricky in an open canoe.

Over on the left, nearer the power station, the drop is more gradual.  You’d need to inspect, and there is a no entry sign over the left arch of the bridge, but it looks shootable to me. I didn’t try!

The bridge is both road and rail.

Downstream of the bridge on the left is the cooling water outflow lagoon.

Here are some more views of the wonderful power station. Enjoy!

Jim Thornton

 

 

“Never Event” at the Oscars

February 28, 2017

Or, why didn’t Beatty “stop the line”?

oscar-muddle

How could La La Land get called, when Moonlight had won? I mean, it’s not hard! Count the votes, put the result in an envelope, and hand it to Warren Beatty. Surely a “never event”.

But how do operations get done on the wrong patient, or on the wrong side? How do swabs get left behind? That’s not hard either.

It’s not that the Oscar organisers are slapdash; more interested in getting the red carpet just so. They fret mightily over envelope checking. Instead of putting them on the rostrum for Beatty to pick up, they pay someone to hand them to him. In fact they pay two people, one each side of the stage, each with duplicate sets, to ensure the show runs smoothly. I bet they had rehearsals and procedures. But still Beatty got the wrong envelope.

It’s easy to guess why. At the critical moment someone distracted the envelope carrier; perhaps he had to restrain a previous winner from rushing back to thank his mum. Whatever the cause, he failed to do one simple task, remove the spare envelope.

The situation could still have been saved. Beatty realised he’d got the wrong envelope, “Best actress” instead of “Best picture”. But instead of stepping back to check, he handed it to Faye Dunaway anyway. She, caught up in the moment, ploughed on and announced the wrong winner.

Why didn’t Beatty “stop the line” for Oscar safety? Why don’t nurses “stop the line” for patient safety? Perhaps he thought it was a stunt, or he didn’t want to slow the show; it was running late, just like operating lists sometimes do. Whatever the reason, the wrong film got the Oscar, and “never events” happen. Three lessons I guess.

  1. Don’t over complicate. One set of envelopes, or one patient ID wristband, is plenty.
  2. Don’t distract people doing the checks.
  3. Teach everyone, from theatre orderlies to Warren Beatty, it’s OK to “stop the line”.

But “never events” won’t disappear. They don’t matter in Hollywood, but they do in hospital. So do you really need that operation? Will it do enough good to balance the risk of the surgeon maiming you by some simple, stupid, “never event”? Think about it.

Jim Thornton

Unrequited Desire

February 25, 2017

At the Real Marigold Hotel

sheila-ferguson-bill-oddie  rusty-lee

Touching scenes in episode two yesterday (BBC One); a group of elderly luvvies plonked in Kerala, on the unlikely premise that they might one day retire there, were fretting about their health and wondering if they might still get laid.

Divorcee Sheila Ferguson, ex Three Degree and still a great voice, was the most randy, telling the first fellow she met at an expatriate cocktail party that she was looking for a new man. Instead of flirting back, the terrified chap muttered “plenty around”, and ran away.

Bill Oddie was grumbling about his bipolar disorder, so a local healer recommended some cream to rub on his pecker; a non sequitor I agree, but I guess a wank can’t do much harm. Ever the comedian, Oddie asked if the woman on the packet came too!

Back at the hotel he told the TV chef Rustie Lee about it. She was obviously interested and commented; “We women better keep our doors locked tonight!” Cue another flirt back. But “Sheila better watch out!” was all poor Rustie got for her troubles.

It’s lovely watching old people flirt, and their dis-inhibitions, albeit mugged for the camera or created in the editing room, should move things on. But love remains tricky. Although Rustie wants to help Bill rub his cream on, Bill wants Sheila to do it, and when Sheila hits on her own target, the poor man’s too intimidated to respond. It doesn’t get easier.

Jim Thornton

%d bloggers like this: