Public Perceptions of Health Risks from Polluted Coastal Bathing Waters: A Mixed Methodological Analysis Using Cultural Theory

This article explores public perceptions of, and attitudes toward, possible health risks from polluted coastal bathing waters in the United Kingdom. Cultural theory is applied in the present analysis, using a mixed methodology of quantitative analysis from interviews and qualitative interpretation of focus group discussions to provide insights into how different cultural solidarities view a number of issues. These include risks to health; attitudes toward regulation; public consultation and information provision; and trust, blame, and accountability applied to different stakeholders in the bathing-water-quality debate. The results show that individuals' standpoints can be represented on a number of dimensions, consistent with cultural theory, including perceptions of power and authority, beliefs in the efficacy of collective action, and acceptance or rejection of incremental change as opposed to radical solutions. The discussion focuses both on methodological and substantive issues related to the use of cultural theory as a research tool, and on policy recommendations arising from this research.     

Outliers in multilevel data

This paper offers the data analyst a range of practical procedures for dealing with outliers in multilevel data. It first develops several techniques for data exploration for outliers and outlier analysis and then applies these to the detailed analysis of outliers in two large scale multilevel data sets from educational contexts. The techniques include the use of deviance reduction, measures based on residuals, leverage values, hierarchical cluster analysis and a measure called DFITS. Outlier analysis is more complex in a multilevel data set than in, say, a univariate sample or a set of regression data, where the concept of an outlying value is straightforward. In the multilevel situation one has to consider, for example, at what level or levels a particular response is outlying, and in respect of which explanatory variables; furthermore, the treatment of a particular response at one level may affect its status or the status of other units at other levels in the model.     

Multilevel modelling of the geographical distributions of diseases

Multilevel modelling is used on problems arising from the analysis of spatially distributed health data. We use three applications to demonstrate the use of multilevel modelling in this area. The first concerns small area all-cause mortality rates from Glasgow where spatial autocorrelation between residuals is examined. The second analysis is of prostate cancer cases in Scottish counties where we use a range of models to examine whether the incidence is higher in more rural areas. The third develops a multiple-cause model in which deaths from cancer and cardiovascular disease in Glasgow are examined simultaneously in a spatial model. We discuss some of the issues surrounding the use of complex spatial models and the potential for future developments.     

Natural cubic splines for the analysis of Alzheimer's clinical trials

Mixed model repeated measures (MMRM) is the most common analysis approach used in clinical trials for Alzheimer's disease and other progressive diseases measured with continuous outcomes over time. The model treats time as a categorical variable, which allows an unconstrained estimate of the mean for each study visit in each randomized group. Categorizing time in this way can be problematic when assessments occur off-schedule, as including off-schedule visits can induce bias, and excluding them ignores valuable information and violates the intention to treat principle. This problem has been exacerbated by clinical trial visits which have been delayed due to the COVID19 pandemic. As an alternative to MMRM, we propose a constrained longitudinal data analysis with natural cubic splines that treats time as continuous and uses test version effects to model the mean over time. Compared to categorical-time models like MMRM and models that assume a proportional treatment effect, the spline model is shown to be more parsimonious and precise in real clinical trial datasets, and has better power and Type I error in a variety of simulation scenarios.