Multiparameter evidence synthesis in epidemiology and medical decision-making: current approaches

Summary.  Alongside the development of meta-analysis as a tool for summarizing research literature, there is renewed interest in broader forms of quantitative synthesis that are aimed at combining evidence from different study designs or evidence on multiple parameters. These have been proposed under various headings: the confidence profile method, cross-design synthesis, hierarchical models and generalized evidence synthesis. Models that are used in health technology assessment are also referred to as representing a synthesis of evidence in a mathematical structure. Here we review alternative approaches to statistical evidence synthesis, and their implications for epidemiology and medical decision-making. The methods include hierarchical models, models informed by evidence on different functions of several parameters and models incorporating both of these features. The need to check for consistency of evidence when using these powerful methods is emphasized. We develop a rationale for evidence synthesis that is based on Bayesian decision modelling and expected value of information theory, which stresses not only the need for a lack of bias in estimates of treatment effects but also a lack of bias in assessments of uncertainty. The increasing reliance of governmental bodies like the UK National Institute for Clinical Excellence on complex evidence synthesis in decision modelling is discussed.     

Spatial variation in soil inorganic nitrogen across an arid urban ecosystem

We explored variations in inorganic soil nitrogen (N) concentrations across metropolitan Phoenix, Arizona, and the surrounding desert using a probability-based synoptic survey. Data were examined using spatial statistics on the entire region, as well as for the desert and urban sites separately. Concentrations of both NO₃-N and NH₄-N were markedly higher and more heterogeneous amongst urban compared to desert soils. Regional variation in soil NO₃-N concentration was best explained by latitude, land use history, population density, along with percent cover of impervious surfaces and lawn, whereas soil NH₄-N concentrations were related to only latitude and population density. Within the urban area, patterns in both soil NO₃-N and NH₄-N were best predicted by elevation, population density and type of irrigation in the surrounding neighborhood. Spatial autocorrelation of soil NO₃-N concentrations explained 49% of variation among desert sites but was absent between urban sites. We suggest that inorganic soil N concentrations are controlled by a number of ‘local’ or ‘neighborhood’ human-related drivers in the city, rather than factors related to an urban-rural gradient.     

A Bayesian Adjustment for Covariate Misclassification with Correlated Binary Outcome Data

Estimated associations between an outcome variable and misclassified covariates tend to be biased when the methods of estimation that ignore the classification error are applied. Available methods to account for misclassification often require the use of a validation sample (i.e. a gold standard). In practice, however, such a gold standard may be unavailable or impractical. We propose a Bayesian approach to adjust for misclassification in a binary covariate in the random effect logistic model when a gold standard is not available. This Markov Chain Monte Carlo (MCMC) approach uses two imperfect measures of a dichotomous exposure under the assumptions of conditional independence and non-differential misclassification. A simulated numerical example and a real clinical example are given to illustrate the proposed approach. Our results suggest that the estimated log odds of inpatient care and the corresponding standard deviation are much larger in our proposed method compared with the models ignoring misclassification. Ignoring misclassification produces downwardly biased estimates and underestimate uncertainty.     

Generations,Identities, and the Collective Memory of Che Guevara1

Has the image of Che Guevara lost its power to evoke radical politics in the face of pervasive commodification? The commercialization of this 1960s political icon has called into question the power of the market to shape collective memories. Meanwhile, antisystemic movements of the left continue to erect his image at protest events. In light of this contest over how Che Guevara is remembered, we investigate, using data from a survey of Spanish citizens, who is most likely to recall him. We find qualified support for the theory of generational imprinting—Che is more often recalled by those generations who saw him rise to prominence during their formative years, although prominent as a collective symbol rather than as a living person. Our results also corroborate the claim that historical figures or events are more salient for, and therefore more likely to be remembered by, some subgenerational units than others. Thus, although the younger generations are in general more likely than their elders to recall Che, he is most frequently remembered by the highly educated leftists who espouse postmaterialist and posttraditionalist values and identify more with their local regions than with the nation of Spain. These patterns suggest that, in contrast to the dire predictions of mass culture theorists, the memory of Che Guevara has become increasingly tied to markers of social, ethnic‐regional, and political identity.     

Gender and the 'New Paradigm' of Health

This article provides a critical review of literature on the relationship between gender and the 'new paradigm' of health. An overview of the feminist critique of health is given, from the Women's Health Movement of the late 1960s and early feminist debates about medicalisation, to more recent discussions about structural inequalities between men and women, eating disorders, and AIDS. I then go on to explore the feminist response to the so-called 'new paradigm' of health (an approach that emphasises health promotion, individual responsibility for health, and body-monitoring). Arguments that health promotion initiatives target women and confirm their position as principal guardians of health within the family are considered, as well as literature on the breast cancer awareness campaign. I then explore the growing body of literature on masculinity and health, and its account of the relationship between gender and current ideas about healthiness. Finally, I offer up some suggestions for the direction a new feminist critique of health might take.     

Overcoming the Effects of Variation in Infant Speech Segmentation: Influences of Word Familiarity

Previous studies have shown that 7.5‐month‐olds can track and encode words in fluent speech, but they fail to equate instances of a word that contrast in talker gender, vocal affect, and fundamental frequency. By 10.5 months, they succeed at generalizing across such variability, marking a clear transition period during which infants' word recognition skills become qualitatively more mature. Here we explore the role of word familiarity in this critical transition and, in particular, whether words that occur frequently in a child's listening environment (i.e., “Mommy” and “Daddy”) are more easily recognized when they differ in surface characteristics than those that infants have not previously encountered (termed nonwords). Results demonstrate that words are segmented from continuous speech in a more linguistically mature fashion than nonwords at 7.5 months, but at 10.5 months, both words and nonwords are segmented in a relatively mature fashion. These findings suggest that early word recognition is facilitated in cases where infants have had significant exposure to items, but at later stages, infants are able to segment items regardless of their presumed familiarity.     

Form Perception of Partly Occluded Shapes in 4‐Month‐Old Infants

Two habituation experiments were conducted to investigate how 4‐month‐old infants perceive partly occluded shapes. In the first experiment, we presented a simple, partly occluded shape to the infants until habituation was reached. Then we showed either a probable completion (one that would be predicted on the basis of both local and global cues) or an improbable completion. Longer looking times were found for the improbably completed shape (compared to probable and control conditions), suggesting that the probable shape was perceived during partial occlusion. In the second experiment, infants were habituated to more ambiguous partly occluded shapes, where local and global cues would result in different completions. For adults, the percept of these shapes is usually dominated by global influences. However, after habituation the infants looked longer at the globally completed shapes. These results suggest that by the age of 4 months, infants are able to infer the perceptual completion of partly occluded shapes, but for more ambiguous shapes, this completion seems to be dominated by local influences.