Life Unleaded: Three Essays on The Socio-Economic Effects of Lead Exposure

Chapter 1: Does lead pollution increase crime? We perform the first meta-analysis of the effect of lead on crime, pooling 542 estimates from 24 studies. The effect of lead is overstated in the literature due to publication bias. Our main estimates of the mean effect sizes are a partial correlation of 0.16, and an elasticity of 0.09. Our estimates suggest the abatement of lead pollution may be responsible for 7–28% of the fall in homicide in the US. Given the historically higher urban lead levels, reduced lead pollution accounted for 6–20% of the convergence in US urban and rural crime rates. Lead increases crime, but does not explain the majority of the fall in crime observed in some countries in the 20th century. Additional explanations are needed. Chapter 2: How does lead pollution affect birth outcomes? Does a mother’s lead exposure increase the risk of child death? Does it lower the infant’s birthweight (a proxy for later health outcomes)? We test these hypotheses by examining an intervention in the Scottish water supply, which reduced water lead levels and blood lead levels in Scotland’s largest two cities. In our main estimates, we use a staggered difference-in-differences design estimated with two-way Mundlak pooled OLS. We do not find the lead reduction interventions reduced birthweights. However, we do find that they may have had a large effect on infant deaths. Our main estimates suggest lead reduction accounts for 0.3-0.1 percentage points decrease in deaths in Glasgow and a 0.7-0.1 percentage points decrease in deaths in the Alnwickhill water plant supplied area of Edinburgh. However, these results are not robust to alternative specifications, and therefore can only be taken as weak evidence of an effect. Chapter 3: Does lead pollution harm educational achievement? And are the marginal effects greater at low or high levels of lead? We use exogenous variation in lead pollution from water treatment in Glasgow, Scotland, combined with within-household sibling differences, to estimate the effect of lead on education. We compare pre- and post-treatment sibling differences between treated and control areas with difference-in-differences estimation. We find a clear dose-response relationship. Treated areas with low prevalence of lead piping show no change compared to a control group. In contrast, high lead pipe prevalence areas show improvement in educational outcomes. Our findings indicate that countries and areas with very high levels of lead can expect large educational gains from even small amounts of lead abatement, while those with already low levels of lead can expect much lower marginal improvements

Culture and risk : perception and acceptability of risk of Riba in banking among teachers in Bahrain

The purpose of this thesis was to provide insights into the consumer's perception of the risk of Riba (the Islamic prohibition of baking interest) and its influence on consumer's bank patronage. In Bahrain, the Conventional and the Interest-free banks operate side by side representing different philosophies of business and operation. Selecting a conventional bank requires Muslim customers to negotiate the risk of jeopardizing religious convictions, and selecting an Interest-free bank requires customers to adjust to possibilities of losing some of their convenience, time, services quality, and perhaps their money. Specifically, this study explored the interaction of risk perception (ethical and performance) with the banking patronage and a host of attitudinal and behavioural correlates in banking among the Bahraini customers. The study surveyed a random sample of customers from the population of Muslim teachers by means of Questionnaires. Risks of ethical, ideological and religious nature were identified These were new risks that extended the perceived risk research. Findings were reported about the public reaction to Riba as a threat and customers' concerns about it. The analysis also used attitudes, beliefs and world views, worrying, sin perception, religious orientation, Riba charactenstics, banking knowledge, social relations and contexts, as well as the risk handling activities to explore their influences on the perceived risks and banking patronage

For the sake of development? Municipal government and local development in Emilia-Romagna and Turin (1945-1975)

This paper (1) examines two areas of Italy, with very different political subcultures and production systems,with the aim of making a comparative analysis of the role of local government policies in stimulating growth processesover the thirty-year post war period.Historians now agree that the policies of Italian local governments were a major factor in the processes ofeconomic growth and the spread of social services. They acted through a highly varied mix of policies, includingregulatory processes (town planning, coordinated local programming, etc.), operations enabling institutions to providethe local environment with specific public goods (industrial estates, business services etc.) as well as redistributionpolicies (i.e. the setting up and spread of local welfare systems and local tax systems).This influential steering role of local administrations, marked in some cases by the gradual inception ofspecific institutional authoritativeness, was not distributed uniformly over the whole of Italy and there were significantasymmetries between areas.A comparative analysis is made of the "Emilia-Romagna model" of local government, controlled by an ItalianCommunist hegemony in a context of small and medium sized firms, and the model of the city of Turin, which was basedon an industrial Ford model because of the presence of the Fiat factory. The two models are compared from theperspective of actors and their different interests. Our aim is to gauge the nature and intensity of the local institutionalactions that accompanied and promoted the processes of development

Separator fluid volume requirements in multi-infusion settings

INTRODUCTION. Intravenous (IV) therapy is a widely used method for the administration of medication in hospitals worldwide. ICU and surgical patients in particular often require multiple IV catheters due to incompatibility of certain drugs and the high complexity of medical therapy. This increases discomfort by painful invasive procedures, the risk of infections and costs of medication and disposable considerably. When different drugs are administered through the same lumen, it is common ICU practice to flush with a neutral fluid between the administration of two incompatible drugs in order to optimally use infusion lumens. An important constraint for delivering multiple incompatible drugs is the volume of separator fluid that is sufficient to safely separate them. OBJECTIVES. In this pilot study we investigated whether the choice of separator fluid, solvent, or administration rate affects the separator volume required in a typical ICU infusion setting. METHODS. A standard ICU IV line (2m, 2ml, 1mm internal diameter) was filled with methylene blue (40 mg/l) solution and flushed using an infusion pump with separator fluid. Independent variables were solvent for methylene blue (NaCl 0.9% vs. glucose 5%), separator fluid (NaCl 0.9% vs. glucose 5%), and administration rate (50, 100, or 200 ml/h). Samples were collected using a fraction collector until <2% of the original drug concentration remained and were analyzed using spectrophotometry. RESULTS. We did not find a significant effect of administration rate on separator fluid volume. However, NaCl/G5% (solvent/separator fluid) required significantly less separator fluid than NaCl/NaCl (3.6 ± 0.1 ml vs. 3.9 ± 0.1 ml, p <0.05). Also, G5%/G5% required significantly less separator fluid than NaCl/NaCl (3.6 ± 0.1 ml vs. 3.9 ± 0.1 ml, p <0.05). The significant decrease in required flushing volume might be due to differences in the viscosity of the solutions. However, mean differences were small and were most likely caused by human interactions with the fluid collection setup. The average required flushing volume is 3.7 ml. CONCLUSIONS. The choice of separator fluid, solvent or administration rate had no impact on the required flushing volume in the experiment. Future research should take IV line length, diameter, volume and also drug solution volumes into account in order to provide a full account of variables affecting the required separator fluid volume

Smoking and Second Hand Smoking in Adolescents with Chronic Kidney Disease: A Report from the Chronic Kidney Disease in Children (CKiD) Cohort Study

The goal of this study was to determine the prevalence of smoking and second hand smoking [SHS] in adolescents with CKD and their relationship to baseline parameters at enrollment in the CKiD, observational cohort study of 600 children (aged 1-16 yrs) with Schwartz estimated GFR of 30-90 ml/min/1.73m2. 239 adolescents had self-report survey data on smoking and SHS exposure: 21 [9%] subjects had “ever” smoked a cigarette. Among them, 4 were current and 17 were former smokers. Hypertension was more prevalent in those that had “ever” smoked a cigarette (42%) compared to non-smokers (9%), p\u3c0.01. Among 218 non-smokers, 130 (59%) were male, 142 (65%) were Caucasian; 60 (28%) reported SHS exposure compared to 158 (72%) with no exposure. Non-smoker adolescents with SHS exposure were compared to those without SHS exposure. There was no racial, age, or gender differences between both groups. Baseline creatinine, diastolic hypertension, C reactive protein, lipid profile, GFR and hemoglobin were not statistically different. Significantly higher protein to creatinine ratio (0.90 vs. 0.53, p\u3c0.01) was observed in those exposed to SHS compared to those not exposed. Exposed adolescents were heavier than non-exposed adolescents (85th percentile vs. 55th percentile for BMI, p\u3c 0.01). Uncontrolled casual systolic hypertension was twice as prevalent among those exposed to SHS (16%) compared to those not exposed to SHS (7%), though the difference was not statistically significant (p= 0.07). Adjusted multivariate regression analysis [OR (95% CI)] showed that increased protein to creatinine ratio [1.34 (1.03, 1.75)] and higher BMI [1.14 (1.02, 1.29)] were independently associated with exposure to SHS among non-smoker adolescents. These results reveal that among adolescents with CKD, cigarette use is low and SHS is highly prevalent. The association of smoking with hypertension and SHS with increased proteinuria suggests a possible role of these factors in CKD progression and cardiovascular outcomes

ESICM LIVES 2017 : 30th ESICM Annual Congress. September 23-27, 2017.

INTRODUCTION. Unplanned readmission to intensive care is highly undesirable in that it contributes to increased variance in care, disruption, difficulty in resource allocation and may increase length of stay and mortality particularly if subject to delays. Unlike the ICU admission from the ward, readmission prediction has received relatively little attention, perhaps in part because at the point of ICU discharge, full physiological information is systematically available to the clinician and so it is expected that readmission should be largely due to unpredictable factors. However it may be that there are multidimensional trends that are difficult for the clinician to perceive that may nevertheless be predictive of readmission. OBJECTIVES. We investigated whether machine learning (ML) techniques could be used to improve on the simple published SWIFT score [1] for the prediction of unplanned readmission to ICU within 48 hours. METHODS. We extracted systolic BP, pulse pressure, heart and respiration rate, temperature, SpO2, bilirubin, creatinine, INR, lactate, white cell count, platelet count, pH, FiO2, and total Glasgow Coma Score from ICU stays of over 2000 adult patients from our hospital electronic patient record system. We trained our own custom multidimensional / time-sensitive algorithmic ML system to predict failed discharges defined as either readmission or unexpected death within 48 hours of discharge. We used 10-fold cross validation to assess performance. We also assessed the effect of augmenting our system by transfer learning (TL) with 44,000 additional cases from the MIMIC III database. RESULTS. The SWIFT score performed relatively poorly with an AUROC of around 0.6 which our ML system trained on local data was also able to match. However when augmented with an additional dataset by TL, the AUROC for the ML system improved statistically and clinically significantly to over 0.7. CONCLUSIONS. Machine learning is able to improve on predictors based on simple multiple logistic regression. Thus there is likely to be information in the trends and in combinations of variables. A disadvantage with this technique is that ML approaches require large amounts of data for training. However, ML approaches can be improved by TL. Basing prediction models on locally derived data augmented by TL is a potentially novel approach to generating tools that customised to the institution yet can exploit the potential power of ML algorithms. REFERENCES [1] Gajic O, Malinchoc M, Comfere TB, et al. The Stability and Workload Index for Transfer score predicts unplanned intensive care unit patient readmission: initial development and validation. Crit Care Med. 2008;36(3):676–82. Grant Acknowledgement This work was internally funded