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.     

Sport and disability: Pistorius does not fit with the categories

Oscar Pistorius presents a major issue to sports organisations, as exposed in the media. First and foremost, media wrongly perceive him as the first disabled athlete to participate in the Olympic Games. Second, they openly question the legitimacy of his participation mainly based on the inequity introduced by his prosthetic legs. Content analysis, in English and French, of written press, International Association of Athletics Federations (IAAF) and Court of Arbitration for Sport (CAS) texts, from 2004 to 2012, confirms that Pistorius presents a new puzzle to sports organizations. This is partly because they are not able to determine whether his performances are a result of his body strength or if they are biased by his artificial limbs. Furthermore, when he is competing against able-bodied athletes, sports organizsations put him in a ‘monstrous’ position. Similarly, while categorising him as an ‘athlete’ they do not grant him the characteristic feature of this category: certified comparability of performances to ultimately establish ranks.     

Factors that Determine or Influence Managerial Innovation in Public Contexts: The Case of Local Performance Management

The use of Performance-Based Management (PBM) by French public organizations has sharply accelerated over the last few years. Moreover, very few studies have analyzed this change. The object of this article is thus to conduct an in-depth analysis of the dynamics of managerial innovation in three French local authorities via the study of the factors that foster the adoption and implementation of PBM by this type of organization. We demonstrate a tendency to overestimate the explanatory power of the neo-institutionalist theories. Indeed, our analysis illustrates a balanced vision of the human, technical and contextual factors at the origin of this type of managerial innovation.     

Participatory Art as a Social Practice of Commoning to Reinvent the Right to the City

The right to the city is a concept that helps rethink spatial–social dynamics, which has recently reinvigorated the field of organization studies. Following Lefebvre and considering the failure of both the market and the state, other scholars pinpoint the need to rethink social–spatial and geographical–historical relations. They do so by theorizing the city as a host for urban commons. Collective and non-commodified, these spatial–social experiences need to be constantly reproduced and preserved through commoning practices in the struggle against spatial injustice. A case study shows that a civil society organization (CSO) uses participatory art to (re)produce urban commons at the level of a local community and to redress partially spatial injustice. We theorize participatory art-making as a social practice of commoning, i.e., a process of organizing for the commons—collective art-based activities to serve a community—and of the common—to (re)produce a community while performing them. Such commoning practices are not only about sharing urban resources but also about using and experiencing differently urban spaces. By making participatory artworks in public spaces and co-designing street furniture with residents of poor areas, TDA helps to better cope with the tensions between residents and local authorities and between amateurs and professional artists. By negotiating the long-term implementation of these creative artworks in the public space with public authorities, TDA has fostered the empowerment of inhabitants as they have experienced citizens’ reappropriation of some public spaces in Marseille.     

Polanyi,Hayek and embedded neoliberalism

ABSTRACT

Written originally on the seventieth anniversary of the publication of Friedrich von Hayek’s The Road to Serfdom and Karl Polanyi’s The Great Transformation, this article critically analyses how the ideas of Hayek and Polanyi have been deployed to understand neoliberalism. It argues that dominant scholarly interpretations tend to miss the significance of each thinker to an understanding of neoliberalism, as well as some of the key dynamics of neoliberal forms of capitalist regulation. Drawing upon the work of Polanyi, the article advances the concept of embedded neoliberalism. From the 1970s neoliberal regulations became deeply embedded in a series of institutions, class relations and ideological norms. This helps to explain both the durability of neoliberalism, and the onset of crisis in 2008. In this context, Hayek’s ideas are best understood as providing a malleable set of concepts underpinning neoliberal ideology, rather than the chief causal agent in the neoliberal transformation of states and economies.     

Factors related to attitudes toward diversity in Australia,Malaysia, and Puerto Rico

In this study, we tested social identity complexity theory (Roccas & Brewer, 2002) in relation to attitudes toward diversity and the associated variables of patriotism, nationalism, religiosity, aggression, and sense of self (well-being) in a cross-cultural study of 398 Malaysian, 239 Australian, and 201 Puerto Rican students. Puerto Ricans reported the most positive attitudes toward diversity, followed by Australians, and finally Malaysians. For Puerto Ricans, pro-diversity attitudes were predicted by a positive correlation with constructive patriotism and a negative correlation with blind patriotism. For Australians, pro-diversity attitudes were predicted by a positive association with constructive patriotism, a negative association with traditional nationalism, and a negative association with physical aggression. For Malaysians, pro-diversity attitudes were predicted by positive relationships with all of the following variables: constructive patriotism, traditional nationalism, verbal aggression, hostility, and the need to bolster self through idealizing others. These results support social identity complexity theory and partially support associated predictions for Australians, Puerto Ricans, and some of the predictions for Malaysians. The results are explained in terms of local cultural contexts that may not easily be understood by a simple understanding of the variables that were measured.     

Endless Pressure: Life on a Low Income in Austere Times

Much has been written that details the decline in living standards following the ‘credit crunch’ in the UK. It remains that we understand to a lesser degree the lived reality of poverty through the Great Recession and into the era of austerity. This article draws on testimonies of 62 participants from low income households conducted in three different areas of the UK during 2012–13 to document the pressures that this period brought to bear on these households. According to these testimonies, the experience of poverty intensified in key respects: first, participants reported feeling, more than ever before, that they were ‘existing, rather than living’ due to the meagre budgets they were forced to live on; second, the precarious nature of work and social security contributed to a sense of insecurity that was all pervasive in our participants' lives; third, due to the pejorative political rhetoric and media coverage of poverty, our participants felt that their lives were placed under increased scrutiny which deleteriously impacted their wider relationships and sense of belonging. Our analysis demonstrates the profound consequences for those living on low incomes of the continued shift to residual forms of state welfare and the increased reliance on the ‘Big Society’ as a means to deal with the pressures identified in this article.     

Psychological Distress,Couple Interactions,and Parenting: A Dyadic Analysis of African American Couples

Parental depression is a well‐established risk factor for couple conflict and ineffective or hostile parenting (M. C. Lovejoy, P. A. Graczyk, E. O'Hare, & G. Neuman, 2000; L. M. Papp, M. C. Goeke‐Morey, & E. M. Cummings, 2007). Although research suggests that caregiver depression may impact parenting indirectly via increased conflict between couples (e.g., R. D. Conger et al., 2002), few studies take into account the behaviors of both caregivers in exploring these relations. The goal of the current study is to employ an actor–partner mediator model to examine the complex relations among psychological distress, negative couple interactions, and parenting. Using a sample of 162 African American couples with children, we find evidence that the psychological distress of each caregiver has an effect on couple interactions for both men and women. The effects from each caregivers' distress to parenting are mainly indirect through the interactional behaviors of the mother toward the father, consistent with the father vulnerability hypothesis (e.g., E. M. Cummings, M. Goeke‐Morey, & J. Raymond, 2004).     

Life Course Changes in Smoking by Gender and Education: A Cohort Comparison Across France and the United States

Widening of educational disparities and a narrowing female advantage in mortality stem in good part from disparities in smoking. The changes in smoking and mortality disparities across cohorts and countries have been explained by an epidemic model of cigarette use but are also related to life course changes. To better describe and understand changing disparities over the life course, we compare age patterns of smoking in three cohorts and two nations (France and the US) using smoking history measures from the 2010 French health barometer (N = 20,940) and the 2010 US National Health Interview Survey Sample Adult File (N = 20,444). The results demonstrate statistically significant widening of gender and educational differences from adolescence to early and middle adulthood, thus accentuating the disparities already emerging during adolescence. In addition, the widening disparities over the life course have been changing across cohorts: age differences in educational disparities have grown in recent cohorts (especially in France), while age differences in gender disparities have narrowed. The findings highlight the multiple sources of inequality in smoking and health in high-income nations.