A hierarchical modelling approach to analysing longitudinal data with drop-out and non-compliance, with application to an equivalence trial in paediatric acquired immune deficiency syndrome

Longitudinal clinical trials with long follow-up periods almost invariably suffer from a loss to follow-up and non-compliance with the assigned therapy. An example is protocol 128 of the AIDS Clinical Trials Group, a 5-year equivalency trial comparing reduced dose zidovudine with the standard dose for treatment of paediatric acquired immune deficiency syndrome patients. This study compared responses to treatment by using both clinical and cognitive outcomes. The cognitive outcomes are of particular interest because the effects of human immunodeficiency virus infection of the central nervous system can be more acute in children than in adults. We formulate and apply a Bayesian hierarchical model to estimate both the intent-to-treat effect and the average causal effect of reducing the prescribed dose of zidovudine by 50%. The intent-to-treat effect quantifies the causal effect of assigning the lower dose, whereas the average causal effect represents the causal effect of actually taking the lower dose. We adopt a potential outcomes framework where, for each individual, we assume the existence of a different potential outcomes process at each level of time spent on treatment. The joint distribution of the potential outcomes and the time spent on assigned treatment is formulated using a hierarchical model: the potential outcomes distribution is given at the first level, and dependence between the outcomes and time on treatment is specified at the second level by linking the time on treatment to subject-specific effects that characterize the potential outcomes processes. Several distributional and structural assumptions are used to identify the model from observed data, and these are described in detail. A detailed analysis of AIDS Clinical Trials Group protocol 128 is given; inference about both the intent-to-treat effect and average causal effect indicate a high probability of dose equivalence with respect to cognitive functioning.     

Context of Acceptability of Topical Microbicides: Sexual Relationships

Domains central to the effects of sexual relationships on the acceptability of a vaginal protection method were explored in 14 focus groups and 38 in-depth interviews with women and men recruited from a health department's sexually transmitted infections (STI) and family planning clinics. Findings indicate that acceptability depended on a couple's relationship type, classified as serious, casual, or "new." Potential barriers to communication about product use may be overcome through direct or indirect covert use, depending on relationship type. More men than women thought women should always tell their partners if they use microbicides, regardless of relationship type. Results indicate the importance of the relationship context in understanding the likely acceptability of using microbicides, and perhaps any method of STI/HIV protection .     

A Nuclear Utility's Views on the Use of Probabilistic Risk Assessment

Probabilistic risk assessment (PRA) is a relatively new tool in the nuclear industry. The Reactor Safety Study started the present trend of conducting PRAs for nuclear power plants when it was published in 1975. Now, nine years later, those in the industry currently using PRA techniques are frequently asked the same question: Why should the nuclear utility industry, with so many accepted analytical tools already available, invest the time and manpower to develop a new technique with so many uncertainties?     

JÜRGEN HABERMAS AND THE RATIONALIZATION OF COMMUNICATIVE INTERACTION*

This paper analyzes J. Habermas's theory of “universal pragmatics” and examines the extent to which Habermas's ideal speech community is predicted upon a specific type of relationship between the individual and society. The ability of the theory of universal pragmatics to overcome the form of domination institutionalized by modern societies is questioned, and the argument is made that Habermas's radical program of emancipation is vitiated (1) by Habermas's conflation of “transcendental” and “situationally engaged” enlightenment and (2) by Habermas's inability to reintegrate practical-emancipatory and technical forms of reason. Habermas's idea of “communicative competence” replicates, rather than displaces, the “modern” solution to the problem of the relationship between the individual and society.     

Perverts or Heroes in the Post-Socialist “Cold War”: Formula Stories of Lesbian/Bisexual/Queer Women and Transgender People in Ukrainian Media

Subjectivities such as (what would be termed in English) lesbians, bisexual, and queer (LBQ) women and transgender people are contested topics in Ukraine. Linking Laclau and Mouffe's discourse analysis with Loseke's narrative approach, we reviewed eight national, text-based, journalistic media sources to read equivalence chains within the data as publicly available formula stories about LGBTQ+ people. Formula stories are not about actual people or typically told by LBQ women and transgender people themselves, but rather exist as publicly circulating stories for consumption by non-LGBTQ+ people. Our findings shore up previous evidence that homophobia and transphobia (including criminalization and pathologization) are commonly articulated in media outlets in Ukraine. Importantly, media outlets owned by Russia and the United States and stories about events outside of Ukraine contribute most to the formula stories circulating in Ukraine, demonstrating the continuing position of Ukraine as a fulcrum of geopolitical contestations in the post-socialist “cold war.” Analyzing sexual politics through formula stories illuminates ongoing transnational connections of imperialism and Europeanization to racialization, colonialism, and contestations of power. A video abstract is available at https://youtu.be/v3dCj0yYm_g .