Methodological developments in constructing casual diagrams with counterfactual analysis of adolescent alcohol harm

Background and aims: Causal diagrams, or Directed Acyclic Graphs (DAGs), are mathematically formulated networks of nodes (variables) and arrows which rigorously identify adjustment sets for statistical models. They are thus promising tools for improving statistical analysis in health and social sciences. However, a lack of pragmatic yet robust guidance for building DAGs has been identified as problematic for their use in applied research. This thesis aims to contribute an example of such guidance in the form of a novel research method, and to demonstrate this method’s utility by applying it to observational data. Design: This thesis introduces ‘Evidence Synthesis for Constructing Directed Acyclic Graphs’ (ESC-DAGs) as a protocol for building DAGs from research evidence. It is demonstrated here in the context of parental influences on adolescent alcohol harm and the resulting DAGs are used to inform analysis of data from the Avon Longitudinal Study of Parents and Children (ALSPAC). Methods: ESC-DAGs integrates evidence synthesis principles with classic and modern perspectives on causal inference to produce complex DAGs in a systematic and transparent way. It was applied here to a subset of literature identified from a novel review of systematic reviews, which identified 12 parental influences on adolescent alcohol harm. ESC-DAGs was then further applied to the ALSPAC data to produce a ‘data integrated DAG’. The outcome measure was the Alcohol Use Disorders Identification Test (AUDIT) administered to adolescent participants at age 16.5 years. Nine parental influences were measured, alongside 22 intermediates (variables lying on the causal pathway between parental influences and AUDIT score). The DAGs were then used to direct two stages of analysis: 1) weighting and regression techniques were used to estimate Average Causal Effects (ACEs) for each parental influence and intermediate; and 2) causal mediation analysis was used to decompose the effect of maternal drinking on adolescent AUDIT score to estimate Natural Indirect Effects (NIEs) for the intermediates and the other parental influences. Findings: Evidence for an ACE was found for each parental influence. Parental drinking, low parental monitoring, and parental permissiveness towards adolescent alcohol use had larger effects that were more robust to sensitivity analysis. Several peer and intrapersonal intermediates had higher effects. There was little evidence of an NIE of maternal drinking through other parental influences. There were substantial NIEs for substance-related behaviours of the adolescent and their peers. Conclusions: ESC-DAGs is a promising tool for using DAGs to improve statistical practices. The DAGs produced were transparent and able to direct various forms of data analysis in an immediate sense while differentiating between a comparatively large volume of confounders and other covariates. Future development is possible and should focus on efficiency, replicability, and integration with other methods, such as risk of bias tools. ESC-DAGs may thus prove a valuable platform for discussion in the DAG and wider quantitative research communities. The statistical analyses were performed with methods that were novel to the literature and findings triangulated with the wider evidence base. Mediation analysis provided novel evidence on how parental drinking influences adolescent alcohol harm

Informalities of urban space, street trading and policy in the city of Bulawayo, Zimbabwe.

Doctoral Degree. University of KwaZulu-Natal, Durban.As cities in the global South undergo rapid informalisation, their respective governments have utilised technocratic and modernist “spatial rationalities” to regulate this urban process. Evidently, through use of plans, grids, by-laws, modernist discourses, Bulawayo’s city authorities in Zimbabwe have in past years construed the existence of informality in its city centre as discordant with the aesthetics of a “world class” city. This negative characterisation of Bulawayo’s informal sector is extended to its participants who are normatively described as an “undesirable” and “chaotic” group to be controlled and sometimes excluded from the cityscape. However, this thesis argues that Bulawayo’s deindustrialisation and Zimbabwe’s economic malaise has necessitated the informalisation of urban space which is epitomised by a pronounced presence of street traders on the cityscape. Indeed, Bulawayo’s economic downturn has given some street traders the impetus and legitimacy to violate urban laws and encroach on urban public spaces, remaking them into viable resources to cope with the effects of unemployment. Consequently, this thesis examines how the informalisation of Bulawayo’s urban space has shaped and reconfigured the “everyday” and “lived” interactions between city authorities and street traders in managing informality. It further seeks to examine how the informalisation of urban space in the context of Bulawayo’s deindustrialisation impacts the way its citizens and city officials understand and reimagine Bulawayo’ urbanity, work, and spatiality. Using responses extracted from 41 participants comprising street traders, city officials and representatives of civic organizations, the theoretical works of Foucault (1994), Lefebvre (1974), and Gramsci (1971), and historical analysis, the thesis shows that in the context of regulating informality, interactions between city authorities and street traders have been characterised by contestations, negotiations and sometimes collaborations. On one hand, the Bulawayo’s city authorities operating under a politically violent “state” have responded to urban informality with brute force (raids and evictions). On the other hand, Bulawayo’s street traders have resisted these evictions through picketing, litigations, and sit-ins at the mayor’s office to challenge policies that preclude them from realising their right to the city. They have further demonstrated through campaigns and workshops how street trading is crucial to generating household income, promoting work independence and developing a localised solidarity economy. In negotiating this contested terrain, the thesis demonstrates that Bulawayo’s city authorities have sometimes shown sympathy towards the plight of street traders, embraced them as part of the city’s urban reality. Further, they recognise the important role street trading plays in sustaining urban livelihood, tackling unemployment and contributing to the city fiscus. As such, Bulawayo’s city authorities have revised some of the exclusionary urban planning policies that prevented an integration of informal trade into the mainstream local economy. Additionally, while raids and evictions have been regarded as important methods of managing street trading, Bulawayo city authorities have sought to use other strategies that are less violent and intimidating. This thesis utilises the works of Foucault (1994) on “governmentality” Lefebvre (1974) on “the production of space”, and Gramsci on “hegemony and consent” (1971) to argue that in situations where raids have proven to be violent, city authorities have utilised vending bays, discourses of “cleanliness” visually projected on street signs and billboards to control street traders’ illegal conduct and contain informality from a distance. The thesis also argues that the transformation of Bulawayo from being an industrial city to what Mlambo (2017) refers to as a vendor city has also meant that people’s perceptions of Bulawayo as a place of work have radically changed. Accordingly, the deindustrialization of Bulawayo coupled with the entrenchment of informality has seen the participants in this study rework their social identities and challenge the meaning of work and urban citizenship. While participants in this study argued that street trading fostered work independence, they noted that income and social insecurity associated with informal work makes them susceptible to poverty. Some participants described street trading as an activity characterised by multiple forms of exclusions such as raids, evictions, and shortages of vending spaces that impede their right to the city. This thesis also demonstrates that theories of urbanity still require reworking in the context of the global South city to encompass the experiences of crisis and deindustrialisation outside of the rural/urban dyad and the linearity of development that assumes only modernity through industrialisation

New Fundamental Technologies in Data Mining

The progress of data mining technology and large public popularity establish a need for a comprehensive text on the subject. The series of books entitled by "Data Mining" address the need by presenting in-depth description of novel mining algorithms and many useful applications. In addition to understanding each section deeply, the two books present useful hints and strategies to solving problems in the following chapters. The contributing authors have highlighted many future research directions that will foster multi-disciplinary collaborations and hence will lead to significant development in the field of data mining

Creed vs. Deed: Secession, Legitimacy, and the Use of Child Soldiers

The use of child soldiers has troubled human rights activists, policy-makers, and local communities for decades. Although rebellions around the world routinely use children in their activities, many do not. Despite its overwhelming importance for conflict resolution, the topic of child soldiers remains understudied. My research blends classic rational choice and constructivist themes to develop an explanation for when child soldiers will be used, and when they will be avoided. The likelihood of child recruitment is influenced by the value of international opinion; this is determined by the groups\u27 long-term goals. Secessionist rebellions desire to have their own state. However, statehood is jealously guarded by the international community and is only granted under extreme circumstances. The use of child soldiers has been condemned around the world as a crime against humanity, and it can curtail international support. Thus, secessionists should be the least likely rebel type to use child soldiers out of a concern to appear legitimate. Opportunistic rebellions face few constraints in their recruitment efforts. They do not desire international support because their long-term goal is the same as their short term goal: profit. Instead of refraining from using children in order to curry favor with external parties, they will abduct, adopt, and abuse children because they are cheaper to employ than adults. Opportunists are unconcerned with losing legitimacy or reducing the chances of victory. Therefore, they should be the most likely to use child soldiers. Concern for costs can affect all rebels. As duration grows, constraints over long-term legitimacy diminish. Therefore, all rebellions should be more likely to use child soldiers as duration increases. I test my theory quantitatively by looking at 103 rebel groups active between 1998-2008. I explore rebellions in Somalia, Colombia, Afghanistan and Sudan to further elucidate the causal mechanisms. There is considerable empirical support for the theory. These results offer policy-relevant conclusions in the areas of rehabilitation and conflict resolution. More importantly, they offer a workable strategy to curb the use of child soldiers in civil war

Sars

SARS (Acute Respiratory Syndrome) first presented itself to the global medical community as a case of atypical pneumonia in one small Chinese village in November 2002. Three months later the mysterious illness rapidly spread and appeared in Vietnam, Hong Kong, Toronto and then Singapore. The high fatality rate and sheer speed at which this disease spread prompted the World Health Organization to initiate a medieval practice of quarantine in the absence of any scientific knowledge of the disease. Now three years on from the initital outbreak, SARS poses no major threat and has vanished from the global media. Written by a team of contributors from a wide variety of disciplines, this book investigates the rise and subsequent decline of SARS in Hong Kong, mainland China and Taiwan. Multidisciplinary in its approach, SARS explores the epidemic from the perspectives of cultural geography, media studies and popular culture, and raises a number of important issues such as the political fate of the new democracy, spatial governance and spatial security, public health policy making, public culture formation, the role the media play in social crisis, and above all the special relations between the three countries in the context of globalization and crisis. It provides new and profound insights into what is still a highly topical issue in today’s world

GENERIC DRUG REPURPOSING FOR PANDEMIC RESPONSE: ALPHA-1 ADRENERGIC RECEPTOR ANTAGONISTS FOR THE PREVENTION OF SEVERE COVID-19 SYMPTOMS

COVID-19 became a serious threat to public health seemingly overnight in early 2020. Vaccine prospects were at least a year away, and off-label drug use presented the best near-term treatment options. Based on prior research in mice where certain alpha-1-AR antagonists were used to disrupt cytokine release syndrome, alpha-1-AR antagonists became candidates for use as a prophylactic treatment for individuals infected with SARS-COV-2. We first studied alpha-1-AR antagonist use in large, historic insurance claims databases, focusing on two diseases with COVID-19 similarities: acute respiratory distress and pneumonia. We then conducted a follow-on study in a Veterans Health Administration cohort diagnosed with COVID-19. Both studies served to build the body of evidence necessary to evaluate specific alpha-1-AR antagonists in a randomized controlled trial, which is currently ongoing at the time of this writing. Properly executing retrospective pharmacoepidemiological studies requires knowledge scattered across the literature, which led to the publication of a flood of drug-repurposing studies of variable quality. Recognizing this, our community of experts came together to capture a set of best practices for credible analyses in a how-to guide for retrospective pharmacoepidemiological analyses. We believe the relevant skill sets are abundant among the larger data science community, but a lack of familiarity with health care data sets, common clinical and billing practices, and basic epidemiology and causal inference principles sets a trap from which many flawed studies could emerge. Our how-to guide, structured as 10 rules to follow, serves to promote increased rigor by walking researchers through both the 'what to do' and the 'how to do it' they will need to produce a credible retrospective pharmacoepidemiological analysis. In a follow-on research effort aiming to explore a common pitfall of retrospective analyses, we investigated the role of disease severity and associated unmeasured confounding in a common study design for the diabetes drug metformin, which has been hypothesized as a candidate for COVID-19 repurposing. We introduce a "complementary cohort design" in which a second cohort is selected for an expected reversal of the bias suspected in the primary cohort. Through extensive negative control outcome experiments, we show that common study designs for metformin, and potentially many other drugs, are susceptible to worrisome unmeasured confounding, leading to results that likely contain significant bias in favor of metformin treatment. This body of work serves two purposes: (1) inform potential randomized controlled trials of specific alpha-1-AR antagonists for COVID-19 repurposing, and (2) promote more rigorous retrospective pharmacoepidemiological analyses by providing a comprehensive how-to guide and illustrating a pitfall many common study designs do not actively avoid. The COVID-19 pandemic prompted this research, but we believe both the alpha blocker hypothesis and our methodological recommendations for observational studies have applications for future respiratory illnesses and drug studies, respectively

Sonic Skills

It is common for us today to associate the practice of science primarily with the act of seeing—with staring at computer screens, analyzing graphs, and presenting images. We may notice that physicians use stethoscopes to listen for disease, that biologists tune into sound recordings to understand birds, or that engineers have created Geiger tellers warning us for radiation through sound. But in the sciences overall, we think, seeing is believing. This open access book explains why, indeed, listening for knowledge plays an ambiguous, if fascinating, role in the sciences. For what purposes have scientists, engineers and physicians listened to the objects of their interest? How did they listen exactly? And why has listening often been contested as a legitimate form of access to scientific knowledge? This concise monograph combines historical and ethnographic evidence about the practices of listening on shop floors, in laboratories, field stations, hospitals, and conference halls, between the 1920s and today. It shows how scientists have used sonic skills—skills required for making, recording, storing, retrieving, and listening to sound—in ensembles: sets of instruments and techniques for particular situations of knowledge making. Yet rather than pleading for the emancipation of hearing at the expense of seeing, this essay investigates when, how, and under which conditions the ear has contributed to science dynamics, either in tandem with or without the eye

Sars

SARS (Acute Respiratory Syndrome) first presented itself to the global medical community as a case of atypical pneumonia in one small Chinese village in November 2002. Three months later the mysterious illness rapidly spread and appeared in Vietnam, Hong Kong, Toronto and then Singapore. The high fatality rate and sheer speed at which this disease spread prompted the World Health Organization to initiate a medieval practice of quarantine in the absence of any scientific knowledge of the disease. Now three years on from the initital outbreak, SARS poses no major threat and has vanished from the global media. Written by a team of contributors from a wide variety of disciplines, this book investigates the rise and subsequent decline of SARS in Hong Kong, mainland China and Taiwan. Multidisciplinary in its approach, SARS explores the epidemic from the perspectives of cultural geography, media studies and popular culture, and raises a number of important issues such as the political fate of the new democracy, spatial governance and spatial security, public health policy making, public culture formation, the role the media play in social crisis, and above all the special relations between the three countries in the context of globalization and crisis. It provides new and profound insights into what is still a highly topical issue in today’s world

Efficient Decision Support Systems

This series is directed to diverse managerial professionals who are leading the transformation of individual domains by using expert information and domain knowledge to drive decision support systems (DSSs). The series offers a broad range of subjects addressed in specific areas such as health care, business management, banking, agriculture, environmental improvement, natural resource and spatial management, aviation administration, and hybrid applications of information technology aimed to interdisciplinary issues. This book series is composed of three volumes: Volume 1 consists of general concepts and methodology of DSSs; Volume 2 consists of applications of DSSs in the biomedical domain; Volume 3 consists of hybrid applications of DSSs in multidisciplinary domains. The book is shaped upon decision support strategies in the new infrastructure that assists the readers in full use of the creative technology to manipulate input data and to transform information into useful decisions for decision makers

An analysis of nursing error among licensed nurses working in North Carolina using the taxonomy of error root cause analysis and practice responsibility database

Healthcare error is a persistent challenge for clinicians, administrators, regulators, and policy makers. Researchers argue that the number of errors originally cited by Institute of Medicine’s (IOM) landmark report, To Err is Human: Building a Safer Health System (1999) were grossly underestimated and that despite concerted efforts aimed to mitigate error in healthcare settings, error remains a persistent and difficult problem to combat. Given the pervasiveness of this phenomenon, informed research is needed to discover why errors persist; informing interventions expressly created to reduce the incidence of error. Nurses are the largest provider of healthcare services in the United States (U.S. Bureau of Labor Statistics, 2013), and their surveillance across all healthcare settings is critical in efforts to improve patient safety by reducing errors. The purpose of this study was to examine the association of demographic and environmental factors on the prevalence of nursing errors resulting in patient harm among licensed nurses who violated the North Carolina Nursing Practice Act (NC NPA) between years 2011 and 2015. Exploration of nurse error through analysis of existing data from the Taxonomy of Error Root Cause Analysis and Practice Responsibility (TERCAP) database was important to identify patterns of error, risk factors, and systems issues that have contributed to practice breakdown. This cross-sectional study was guided by the Organizational Accident Causation Model. The model explains how latent and active failures contribute to the work conditions facilitating unsafe acts to occur. Nurse demographics (age, gender, educational preparation, and nursing tenure), organizational factors (shift worked, work environment, and history of prior employer discipline) and commission of a medication error (active failure) were assessed for their association with error resulting in patient harm through Chi-square tests and logistic regression (N=544). Findings revealed that error resulting in patient harm and commission of a medication error resulting in patient harm was significantly associated with the variables of age and work environment. Results also revealed that nurses = 50 years of age were found to be significantly associated with commission of a medication error that resulting in patient harm. Gender and work environment were found to be significant predictors of error resulting in patient harm with male nurses have lower odds of committing error resulting in patient harm than female nurses. Nurses who worked in ‘other’ work environments (non-traditional work settings) had lower odds of committing error resulting in patient harm when compared with nurses working in the hospital setting. Nurses working in ‘other’ work environments also had lower odds of committing medication errors resulting in patient harm when compared with nurses who worked in hospital settings. This study’s examination of relationships among organizational work environment factors, nurse demographics, and error resulting in patient harm among nurses practicing in North Carolina has implications for nursing regulation and clinical practice. Study findings provided nurses working in direct care roles information for consideration as they engage in their self-reflective activities to evaluate and enhance their personal practice while meeting continuing competence requirements of the state of North Carolina. Findings can serve as a catalyst for enhanced information sharing between nurse employers and the North Carolina Board of Nursing regarding remediation efforts for suspected violations of the Nursing Practice Act and nursing administrators can utilize findings to provide their staffs with focused education on contributing factors to nursing error while also evaluating work environments with a fuller appreciation of the needs of older nurses