Directed acyclic graphs: An under-utilized tool for child maltreatment research

Background: Child maltreatment research involves modeling complex relationships between multiple interrelated variables. Directed acyclic graphs (DAGs) are one tool child maltreatment researchers can use to think through relationships among the variables operative in a causal research question and to make decisions about the optimal analytic strategy to minimize potential sources of bias. Objective: The purpose of this paper is to highlight the utility of DAGs for child maltreatment research and to provide a practical resource to facilitate and support the use of DAGs in child maltreatment research. Results: We first provide an overview of DAG terminology and concepts relevant to child maltreatment research. We describe DAG construction and define specific types of variables within the context of DAGs including confounders, mediators, and colliders, detailing the manner in which each type of variable can be used to inform study design and analysis. We then describe four specific scenarios in which DAGs may yield valuable insights for child maltreatment research: (1) identifying covariates to include in multivariable models to adjust for confounding; (2) identifying unintended effects of adjusting for a mediator; (3) identifying unintended effects of adjusting for multiple types of maltreatment; and (4) identifying potential selection bias in data specific to children involved in the child welfare system. Conclusions: Overall, DAGs have the potential to help strengthen and advance the child maltreatment research and practice agenda by increasing transparency about assumptions, illuminating potential sources of bias, and enhancing the interpretability of results for translation to evidence-based practice

Prevalence of Injuries Among Medicaid Enrolled Infants Prior to Child Abuse and Neglect

Prior research has identified common injuries among children who experience child maltreatment; however, most of this work has focused on inpatient settings and has excluded many cases of neglect. This study examines the prevalence of injuries that occur prior to a diagnosis of child maltreatment, as well as the proportion of children with well-child visits prior to the injury and child maltreatment diagnosis. Based on a secondary analysis of Medicaid data from four states, we found that among infants with 12 months of continuous enrollment (N = 4817), 30.6% of those diagnosed with maltreatment were previously diagnosed with an injury. Among infants diagnosed with child maltreatment, 88.4% had at least one well-child visit prior to the maltreatment diagnosis. Among children with a maltreatment diagnosis and a prior injury, 84% had at least one well-child visit preceding the injury. These results indicate that most children had at least one well-child visit prior to being diagnosed with child maltreatment or an injury, indicating opportunities for prevention

Classification of maltreatment-related mortality by Child Death Review teams: How reliable are they?

Accurate estimation of the incidence of maltreatment-related child mortality depends on reliable child fatality review. We examined the inter-rater reliability of maltreatment designation for two Alaskan Child Death Review (CDR) panels. Two different multidisciplinary CDR panels each reviewed a series of 101 infant and child deaths (ages 0–4 years) in Alaska. Both panels independently reviewed identical medical, autopsy, law enforcement, child welfare, and administrative records for each death utilizing the same maltreatment criteria. Percent agreement for maltreatment was 64.7% with a weighted Kappa of 0.61 (95% CI 0.51, 0.70). Across maltreatment subtypes, agreement was highest for abuse (69.3%) and lowest for negligence (60.4%). Discordance was higher if the mother was unmarried or a smoker, if residence was rural, or if there was a family history of child protective services report(s). Incidence estimates did not depend on which panel's data were used. There is substantial room for improvement in the reliability of CDR panel assessment of maltreatment related mortality. Standardized decision guidance for CDR panels may improve the reliability of their data

Association of Restrictive Housing During Incarceration With Mortality After Release

Importance: Restrictive housing, otherwise known as solitary confinement, during incarceration is associated with poor health outcomes. Objective: To characterize the association of restrictive housing with reincarceration and mortality after release. Design, Setting, and Participants: This retrospective cohort study included 229 274 individuals who were incarcerated and released from the North Carolina prison system from January 2000 to December 2015. Incarceration data were matched with death records from January 2000 to December 2016. Covariates included age, number of prior incarcerations, type of conviction, mental health treatment recommended or received, number of days served in the most recent sentence, sex, and race. Data analysis was conducted from August 2018 to May 2019. Exposures: Restrictive housing during incarceration. Main Outcomes and Measures: Mortality (all-cause, opioid overdose, homicide, and suicide) and reincarceration. Results: From 2000 to 2015, 229 274 people (197 656 [86.2%] men; 92 677 [40.4%] white individuals; median [interquartile range (IQR)] age, 32 years [26-42]), were released 398 158 times from the state prison system in North Carolina. Those who spent time in restrictive housing had a median (IQR) age of 30 (24-38) years and a median (IQR) sentence length of 382 (180-1010) days; 84 272 (90.3%) were men, and 59 482 (63.7%) were nonwhite individuals. During 130 551 of 387 913 incarcerations (33.7%) people were placed in restrictive housing. Compared with individuals who were incarcerated and not placed in restrictive housing, those who spent any time in restrictive housing were more likely to die in the first year after release (hazard ratio [HR], 1.24; 95% CI 1.12-1.38), especially from suicide (HR, 1.78; 95% CI, 1.19-2.67) and homicide (HR, 1.54; 95% CI, 1.24-1.91). They were also more likely to die of an opioid overdose in the first 2 weeks after release (HR, 2.27; 95% CI, 1.16-4.43) and to become reincarcerated (HR, 2.16; 95% CI, 1.99-2.34). Conclusions and Relevance: This study suggests that exposure to restrictive housing is associated with an increased risk of death during community reentry. These findings are important in the context of ongoing debates about the harms of restrictive housing, indicating a need to find alternatives to its use and flagging restrictive housing as an important risk factor during community reentry

Measuring the aspect ratio renormalization of anisotropic-lattice gluons

Using tadpole inproved actions we investigate the consistency between different methods of measuring the aspect ratio renormalization of anisotropic-lattice gluons for bare aspect ratios \chi_0=4,6,10 and inverse lattice spacing in the range a_s^{-1}=660-840 MeV. The tadpole corrections to the action, which are established self-consistently, are defined for two cases, mean link tadpoles in Landau gauge and gauge invariant mean plaquette tadpoles. Parameters in the latter case exhibited no dependence on the spatial lattice size, L, while in the former, parameters showed only a weak dependence on L easily extrapolated to L=\infty. The renormalized anisotropy \chi_R was measured using both the torelon dispersion relation and the sideways potential method. We found good agreement between these different approaches. Any discrepancy was at worst 3-4% which is consistent with the effect of lattice artifacts that for the torelon we estimate as O(\a_Sa_s^2/R^2) where R is the flux-tube radius. We also present some new data that suggests that rotational invariance is established more accurately for the mean-link action than the plaquette action.Comment: LaTeX 18 pages including 7 figure