Wargaming for International Relations research

Political scientists are increasingly integrating wargames into their research. Either by fielding original games or by leveraging archival wargame materials, researchers can study rare events or topics where evidence is difficult to observe. However, scholars have little guidance on how to apply this novel methodological approach to political science research. This article evaluates how political scientists can use wargames as a method of scholarly inquiry and sets out to establish a research agenda for wargaming in International Relations. We first differentiate wargames from other methodological approaches and highlight their ecological validity. We then chart out how researchers can build and run their own games or draw from archival wargames for theory development and testing. In doing so, we explain how researchers can navigate issues of recruitment, bias, validity, and generalizability when using wargames for research, and identify ways to evaluate the potential benefits and pitfalls of wargames as a tool of inquiry. We argue that wargames offer unique opportunities for political scientists to study decision-making processes both in and beyond the International Relations subfield.

Screening of unruptured intracranial aneurysms in 50 to 60-year-old female smokers: a pilot study

The prevalence of unruptured intracranial aneurysms (UIAs) is around 2–3% in the general population. We hypothesized that the prevalence of small UIAs is higher among 50 to 60-year-old female smokers, since the incidence of aneurysmal subarachnoid hemorrhage (aSAH) is exceptionally high in 60 to 70-year-old female smokers. Ethics approval for this pilot study of 50 women was obtained from the hospital ethics committee. In order to minimize recruitment bias, preliminary invitation letters were sent to 50 to 60-year-old women who were known to be active smokers. Those interested in participating were further informed about the study rationale and protocol. Following written consent, participants filled a detailed questionnaire and underwent computed tomography angiography (CTA) analysis. All abnormalities were recorded. Of the 158 preliminary invitation letters, 70 potential participants initially replied. Of these, 50 returned questionnaires and written consents, 43 of which underwent CTA analysis. Most (39; 91%) were postmenopausal, and 9 (21%) were hypertensive. Two reported a family history (≥ 1 first-degree members) of intracranial aneurysms. UIAs (maximum sizes of 2, 2, 3, 3 and 7 mm) were found in five (12%) female smokers. One woman was operated on, and the remaining four were treated with non-invasive preventive actions (smoking cessation and follow-ups). Small UIAs, which may be best suited for non-invasive preventive actions, may be relatively common in 50 to 60-year-old female smokers. Whether this kind of targeted screening leads to improved health in female smokers requires further investigation.

Commentary: Pivoting during a pandemic: developing a new recruitment model for a randomised controlled trial in response to COVID-19

Background Many non-COVID-19 trials were disrupted in 2020 and either struggled to recruit participants or stopped recruiting altogether. In December 2019, just before the pandemic, we were awarded a grant to conduct a randomised controlled trial, the Should I Take Aspirin? (SITA) trial, in Victoria, the Australian state most heavily affected by COVID-19 during 2020. Main body We originally modelled the SITA trial recruitment method on previous trials where participants were approached and recruited in general practice waiting rooms. COVID-19 changed the way general practices worked, with a significant increase in telehealth consultations and restrictions on in person waiting room attendance. This prompted us to adapt our recruitment methods to this new environment to reduce potential risk to participants and staff, whilst minimising any recruitment bias. We designed a novel teletrial model, which involved calling participants prior to their general practitioner appointments to check their eligibility. We delivered the trial both virtually and face-to-face with similar overall recruitment rates to our previous studies. Conclusion We developed an effective teletrial model which allowed us to complete recruitment at a high rate. The teletrial model is now being used in our other primary care trials as we continue to face the impacts of the COVID-19 pandemic.

Screening of Unruptured Intracranial Aneurysms in 50 to 60-year-old Female Smokers – a Pilot Study

Background: The prevalence of unruptured intracranial aneurysms (UIAs) is around 2 to 3% in the general population. We hypothesized that the prevalence of small UIAs is higher among 50 to 60-year-old female smokers, since the incidence of aneurysmal subarachnoid hemorrhage (aSAH) is exceptionally high in 60 to 70-year-old female smokers. Methods: Ethics approval for this pilot study of 50 women was obtained from the hospital ethics committee. In order to minimize recruitment bias, preliminary invitation letters were sent to 50 to 60-year-old women who were known to be active smokers. Those interested in participating were further informed about the study rationale and protocol. Following written consent, participants filled a detailed questionnaire and underwent computed tomography angiography (CTA) analysis. All abnormalities were recorded. Results: Of the 158 preliminary invitation letters, 70 potential participants initially replied. Of these, 50 returned questionnaires and written consents, 43 of which underwent CTA analysis. Most (39; 91%) were postmenopausal, and 9 (21%) were hypertensive. Two reported a family history (≥ 1 first-degree members) of intracranial aneurysms. UIAs (maximum sizes of 2, 2, 3, 3 and 7 mm) were found in five (12%) female smokers. One woman was operated on, and the remaining four were treated with non-invasive preventive actions (smoking cessation and follow-ups). Conclusion: Small UIAs, which may be best suited for non-invasive preventive actions, may be relatively common in 50 to 60-year-old female smokers. Whether this kind of targeted screening leads to improved health in female smokers requires further investigation.

P100 Recruitment barriers in multicentre collaborative studies as demonstrated by a single unit experience of the Management of Acutely Symptomatic Hernias (MASH) study

Introduction MASH is a multi-centre prospective cohort study assessing the management of patients presenting with symptomatic abdominal wall hernia. Consenting patients are recruited during acute admission, with telephone follow up at day 30 and 90. We performed a retrospective review of all patients referred to a single general surgical unit with a symptomatic hernia to quantify recruitment rate and identify barriers to recruitment. Methods Patients meeting the inclusion criteria 1st August to 18th September were identified from prospective handover lists and electronic records and compared to the prospectively compiled screening log. Reason for not enrolment was coded according to protocol with an additional code added for patients not identified at time of admission. Results 8/23 (35%) eligible patients were enrolled. 15/23 (65%) were not enrolled due to; Patient not identified at time of admission n = 9 (60%), declined n = 2 (13.3%), too unwell to consent n = 2 (13.3%), translational barrier n = 1 (6.6%) and lacking capacity n = 1 (6.6%). Patients not identified at time of admission included those seen by clinicians not involved in study (new starters and locums) and those discharged directly from A&E with insufficient time and resources to gain consent. Conclusion In our unit 65% of eligible patients were not recruited, the majority of whom were missed at time of presentation. This study will generate important information on management and outcomes of acute hernias however strategies are required to recognise and mitigate recruitment bias. Staff turnover may be a significant factor in prospective studies, particularly those prolonged during the COVID-19 pandemic.

Panel Survey Recruitment with or Without Interviewers? Implications for Nonresponse, Panel Consent, and Total Recruitment Bias

Panel surveys are increasingly experimenting with the use of self-administered modes of data collection as alternatives to more expensive interviewer-administered modes. As data collection costs continue to rise, it is plausible that future panel surveys will forego interviewer administration entirely. We examine the implications of this scenario for recruitment bias in the first wave of a panel survey of employees in Germany. Using an experimental multi-mode design and detailed administrative record data available for the full sample, we investigate the magnitude of two sources of panel recruitment bias: nonresponse and panel consent (i.e., consent to follow-up interview). Across 29 administrative estimates, we find relative measures of aggregate nonresponse bias to be comparable between face-to-face and self-administered (mail/Web) recruitment modes, on average. Furthermore, we find the magnitude of panel consent bias to be more severe in self-administered surveys, but that implementing follow-up conversion procedures with the non-consenters diminishes panel consent bias to near-negligible levels. Lastly, we find the total recruitment bias (nonresponse and panel consent) to be similar in both mode groups—a reassuring result that is facilitated by the panel consent follow-up procedures. Implications of these findings for survey practice and suggestions for future research are provided in conclusion.

Combining cross-sectoral, prospective data linkage with other data sources to examine health outcomes for socially excluded populations: A case study from Australia

IntroductionStudies of the health of prisoners have proliferated in the past decade. However, relatively few studies have examined health outcomes after release from custody. As such, although >30 million people are released from prison globally each year, the health and health service experiences of this population remain poorly understood. Objectives and ApproachWell-powered longitudinal studies are essential for answering these questions but are expensive and difficult to conduct. Internationally, few such studies have been undertaken, and most suffer from either substantial and biased attrition, or recruitment bias. Cross-sectoral linkage of health and justice data circumvents some of these problems but presents its own ethical and methodological challenges. Large longitudinal studies, combining rich survey and clinical data with prospective data linkage, provide unique opportunities to examine and understand health outcomes for these highly marginalised individuals. ResultsThis presentation will describe the process and challenges of establishing the world’s largest (N=2,702) prospective study of adults released from prison: the Health After Release from Prison (HARP) cohort study. The cohort spans two Australian states and includes 538 women and 1,002 Indigenous Australians. An overview of the data collected through face-to-face surveys, medical record review, and prospective linkage with State-based health and correctional records, national Medicare and pharmaceutical records, and the National Death Index, will be provided. Some examples of how these data have been used to answer novel public health questions will be presented. The strengths and limitations of the cohort, and the applicability of this research design for other inclusion health populations, will be discussed. Conclusion/ImplicationsGiven their extreme vulnerability, understanding the health of people who cycle through prisons is important to addressing health inequalities at the population level. Novel research designs that combine prospective data linkage with other data sources provide new opportunities to examine the health of socially excluded populations.

A population-based data-linkage study of prescribed pain medications dispensed to persons with cerebral palsy

BackgroundPopulation-based surveys to investigate pain in cerebral palsy (CP) can be costly and results limited by recruitment bias, recall issues, and differences between self-reports and parental accounts. Secondary data analysis may provide a cost-effective alternative to study this issue and its impact in this population. ObjectiveInvestigate factors associated with dispensing of prescribed pain medications for those with CP. MethodsData from the Northern Ireland CP Register were linked with the Enhanced Prescribing Database, a database of prescriptions dispensed by community pharmacies, to investigate dispensing of prescribed pain medications (non-steroidal antiinflammatories, opioids, non-opioids) between 2010 and 2014. The sample comprised 1,430 individuals with CP and 699,645 with no diagnosis of CP, born 1981-2008. FindingsPain medications were dispensed to 61% of the CP population and 51% of the general population (p < 0.05). Individuals with CP displayed increased odds of receiving opioid analgesics compared to the general population (OR 2.81, 95%CI 2.32 to 3.40). Among those with CP, likelihood of being dispensed prescribed pain medications was greater amongst females (OR 1.34, 95%CI 1.06 to 1.70), younger age individuals (OR 1.60, 95%CI 1.02 to 2.51), those with reduced motor function (GMFCS V: OR 2.60, 95%CI 1.52 to 4.47), having seizures (OR 2.55, 95%CI 1.68 to 3.87), and living in deprived areas (OR 2.06, 95%CI 1.41 to 3.24). ConclusionDispensing of pain medications in CP is associated with clinical factors, though even after adjustment for these, living in deprived areas influences uptake of pain medication.