Contextualising accounts of illness:Notions of responsibility and blame in white and South Asian respondents' accounts of diabetes causation

We undertook a secondary analysis of in-depth interviews with white (n = 32) and Pakistani and Indian (n = 32) respondents who had type 2 diabetes, which explored their perceptions and understandings of disease causation. We observed subtle, but important, differences in the ways in which these respondent groups attributed responsibility and blame for developing the disease. Whereas Pakistani and Indian respondents tended to externalise responsibility, highlighting their life circumstances in general and/or their experiences of migrating to Britain in accounting for their diabetes (or the behaviours they saw as giving rise to it), white respondents, by contrast, tended to emphasise the role of their own lifestyle 'choices' and 'personal failings'. In seeking to understand these differences, we argue for a conceptual and analytical approach which embraces both micro- (i.e. everyday) and macro- (i.e. cultural) contextual factors and experiences. In so doing, we provide a critique of social scientific studies of lay accounts/understandings of health and illness. We suggest that greater attention needs to be paid to the research encounter (that is, to who is looking at whom and in what circumstances) to understand the different kinds of contexts researchers have highlighted in presenting and interpreting their data. © 2007 Foundation for the Sociology of Health & Illness/Blackwell Publishing Ltd.

Shifting accountability:a longitudinal qualitative study of diabetes causation accounts

We undertook a longitudinal qualitative study involving of 20 patients from Scotland who had type 2 diabetes. We looked at their perceptions and understandings of why they had developed diabetes and how, and why, their causation accounts had changed or remained stable over time. Respondents, all of whom were white, were interviewed four times over a 4-year period (at baseline, 6, 12 and 48 months). Their causation accounts often shifted, sometimes subtly, sometimes radically, over the 4 years. The experiential dimensions of living with, observing, and managing their disease over time were central to understanding the continuities and changes we observed. We also highlight how, through a process of removing, adding and/or de-emphasising explanatory factors, causation accounts could be used as “resources” to justify or enable present treatment choices. We use our work to support critiques of social cognition theories, with their emphasis upon beliefs being antecedent to behaviours. We also provide reflections upon the implications of our findings for qualitative research designs and sampling strategies.

Dynamics of effectuation and causation in technology-based new ventures (INTERACTIVE PAPER)

The creation of new ventures is a process characterized by the need to decide and take action in the face of uncertainty, and this is particularly so in the case of technology-based ventures. Effectuation theory (Sarasvathy, 2001) has advanced two possible approaches for making decisions while facing uncertainty in the entrepreneurial process. Causation logic is based on prediction and aims at lowering uncertainty, whereas effectuation logic is based on non-predictive action and aims at working with uncertainty. This study aims to generate more fine-grained insight in the dynamics of effectuation and causation over time. We address the following questions: (1) What patterns can be found in effectual and causal behaviour of technology-based new ventures over time? And (2) How may patterns in the dynamics of effectuation and causation be explained?

Understanding dynamics of strategic decision-making in venture creation:a process study of effectuation and causation

This study draws upon effectuation and causation as examples of planning-based and flexible decision-making logics, and investigates dynamics in the use of both logics. The study applies a longitudinal process research approach to investigate strategic decision-making in new venture creation over time. Combining qualitative and quantitative methods, we analyze 385 decision events across nine technology-based ventures. Our observations suggest a hybrid perspective on strategic decision-making, demonstrating how effectuation and causation logics are combined, and how entrepreneurs’ emphasis on these logics shifts and re-shifts over time. We induce a dynamic model which extends the literature on strategic decision-making in venture creation.

Damages for breach of contract

This practical book deals solely with those damages arising as a breach of contract, where the aim of the damages is to place the plaintiff in the same position as if the contract had been performed. The book is split into three main parts: general principles such as limitations, causation, remoteness, mitigation and contributory negligence; specific breaches, such as sale of goods, supply of services, travel contracts and sale of land; and general issues and procedures. The only authoritative practitioner work focusing on this area, it provides a high-level, comprehensive and practical text.

Reforming damages for misrepresentation:the case for coherent aims and principles

Examines the basis on which damages for misrepresentation are awarded, suggesting that the underlying principles lack coherence, and calls for clarification of the law. Argues that there are valid policy considerations justifying a distinction between the basis of the award of damages for fraudulent misrepresentation and negligent misrepresentation. Explains why identification of the three stages in the process of awarding damages for misrepresentation are crucial to the application of the underlying legal principles of causation and remoteness at the right stage of the process. Reviews case law on lost opportunity damages for fraudulent misrepresentation, the application of loss of chance principles, and recovery of post-contract losses.

Issues of cause and control in patient accounts of Type 2 diabetes

Patients experience considerable difficulties in making and sustaining health-related lifestyle changes. Many Type 2 diabetes patients struggle to follow disease risk-management advice even when they receive extensive information and support. Drawing on a qualitative study of patients with Type 2 diabetes, the paper uses discourse analysis to examine their accounts about disease causation and disease management, and the implications for how they respond to their condition and health services advice. As it is a multifactorial disease, biomedical discourse around Type 2 diabetes is complex. Patients are encouraged to grasp the complicated message that both cause and medical outcomes related to their condition are partly, but not wholly, within their control. Discursive constructions identified from respondent accounts indicate how these two messages are deployed variously by respondents when accounting for disease causation and management. While these constructions (identified in respondent accounts as 'Up to me' and 'Down to them') are a valuable resource for patients, equally they may be deployed in a selective and detrimental way. We conclude that clear messages from health professionals about effective disease management may help patients to position themselves more effectively in relation to their condition. More importantly, they might serve to hinder the availability of inappropriate and potentially harmful patient positions where patients either relinquish responsibility for disease management or reject all input from health professionals. © The Author 2005. Published by Oxford University Press. All rights reserved.

Statnote 14: the correlation of two variables (Pearson's 'r')

Pearson's correlation coefficient (‘r’) is one of the most widely used of all statistics. Nevertheless, care needs to be used in interpreting the results because with large numbers of observations, quite small values of ‘r’ become significant and the X variable may only account for a small proportion of the variance in Y. Hence, ‘r squared’ should always be calculated and included in a discussion of the significance of ‘r’. The use of ‘r’ also assumes that the data follow a bivariate normal distribution (see Statnote 17) and this assumption should be examined prior to the study. If the data do not conform to such a distribution, the use of a non-parametric correlation coefficient should be considered. A significant correlation should not be interpreted as indicating ‘causation’ especially in observational studies, in which the two variables may be correlated because of their mutual correlations with other confounding variables.

Data analysis methods in optometry. Part 5: correlation

1. Pearson's correlation coefficient only tests whether the data fit a linear model. With large numbers of observations, quite small values of r become significant and the X variable may only account for a minute proportion of the variance in Y. Hence, the value of r squared should always be calculated and included in a discussion of the significance of r. 2. The use of r assumes that a bivariate normal distribution is present and this assumption should be examined prior to the study. If Pearson's r is not appropriate, then a non-parametric correlation coefficient such as Spearman's rs may be used. 3. A significant correlation should not be interpreted as indicating causation especially in observational studies in which there is a high probability that the two variables are correlated because of their mutual correlations with other variables. 4. In studies of measurement error, there are problems in using r as a test of reliability and the ‘intra-class correlation coefficient’ should be used as an alternative. A correlation test provides only limited information as to the relationship between two variables. Fitting a regression line to the data using the method known as ‘least square’ provides much more information and the methods of regression and their application in optometry will be discussed in the next article.

An analysis of fatal accidents in agriculture in Great Britain

The number of fatal accidents in the agricultural, horticultural and forestry industry in Great Britain has declined from an annual rate of about 135 in the 1960's to its current level of about 50. Changes to the size and makeup of the population at risk mean that there has been no real improvement in fatal injury incidence rates for farmers. The Health and Safety Executives' (HSE) current system of accident investigation, recording, and analysis is directed primarily at identifying fault, allocating blame, and punishing wrongdoers. Relatively little information is recorded about the personal and organisational factors that contributed to, or failed to prevent accidents. To develop effective preventive strategies, it is important to establish whether errors by the victims and others, occur at the skills, rules, or knowledge level of functioning: are violations of some rule or procedure; or stem from failures to correctly appraise, or control a hazard. A modified version of the Hale and Glendon accident causation model was used to study 230 fatal accidents. Inspectors' original reports were examined and expert judgement applied to identify and categorise the errors committed by each of the parties involved. The highest proportion of errors that led directly to accidents occurred whilst the victims were operating at the knowledge level. The mix and proportion of errors varied considerably between different classes of victim and kind of accident. Different preventive strategies will be needed to address the problem areas identified.

Is inflammation the cause of pre-eclampsia?

It has been proposed that either excessive inflammation or an imbalance in angiogenic factors cause pre-eclampsia. In the present review, the arguments for and against the role of inflammation and/or angiogenic imbalance as the cause of pre-eclampsia are discussed on the basis of the Bradford-Hill criteria for disease causation. Although both angiogenic imbalance and systemic inflammation are implicated in pre-eclampsia, the absence of temporality of inflammatory markers with pre-eclampsia challenges the concept that excessive inflammation is the cause of pre-eclampsia. In contrast, the elevation of anti-angiogenic factors that precede the clinical signs of pre-eclampsia fulfils the criterion of temporality. The second most important criterion is the dose-response relationship. Although such a relationship has not been proven between pro-inflammatory cytokines and pre-eclampsia, high levels of anti-angiogenic factors have been shown to correlate with increased incidence and disease severity, hence satisfying this condition. Finally, as the removal of circulating sFlt-1 (soluble Fms-like tyrosine kinase receptor-1) from pre-eclamptic patients significantly improves the clinical outcome, it fulfils the Hill's experiment principle, which states that removal of the cause by an appropriate experimental regimen should ameliorate the condition. In contrast, treatment with high doses of corticosteroid fails to improve maternal outcome in pre-eclampsia, despite suppressing inflammation. Inflammation may enhance the pathology induced by the imbalance in the angiogenic factors, but does not by itself cause pre-eclampsia. Development of therapies based on the angiogenic and cytoprotective mechanisms seems more promising.

Expert report writing in toxicology:forensic, scientific and legal aspects

Every year throughout the world, individuals' health is damaged by their exposure to toxic chemicals at work. In most cases these problems will resolve, but many will sustain permanent damage. Whilst any justified claim for compensation requires medical and legal evidence a crucial and often controversial component of this process is the establishment of a causal link between the individual's condition and exposure to a specific chemical or substance. Causation, in terms of how a substance or substances led the claimant to his or her current plight, can be difficult to establish and the main purpose of this book, is to provide the aspiring expert report writer with a concise, practical guide that uses case histories to illuminate the process of establishing causation in occupational toxicity proceedings. In summary: A practical, accessible guide to the preparation of balanced, scientifically sound expert reports in the context of occupational toxicology. Focuses on the scientist's role in establishing a causal link between exposure to toxins and an individual's ill health. Includes real-life case histories drawn from the Author's 15 years experience in this area to illustrate the principles involved. Expert Report Writing in Toxicology: Forensic, Scientific and Legal Aspects proves invaluable to scientists across a range of disciplines needing guidance as to what is expected of them in terms of the best use of their expertise and how to present their findings in a manner that is authoritative, balanced and informative.