Quantifying the improvement in sepsis diagnosis, documentation, and coding: the marginal causal effect of year of hospitalization on sepsis diagnosis.

PURPOSE To quantify the coinciding improvement in the clinical diagnosis of sepsis, its documentation in the electronic health records, and subsequent medical coding of sepsis for billing purposes in recent years. METHODS We examined 98,267 hospitalizations in 66,208 patients who met systemic inflammatory response syndrome criteria at a tertiary care center from 2008 to 2012. We used g-computation to estimate the causal effect of the year of hospitalization on receiving an International Classification of Diseases, Ninth Revision, Clinical Modification discharge diagnosis code for sepsis by estimating changes in the probability of getting diagnosed and coded for sepsis during the study period. RESULTS When adjusted for demographics, Charlson-Deyo comorbidity index, blood culture frequency per hospitalization, and intensive care unit admission, the causal risk difference for receiving a discharge code for sepsis per 100 hospitalizations with systemic inflammatory response syndrome, had the hospitalization occurred in 2012, was estimated to be 3.9% (95% confidence interval [CI], 3.8%-4.0%), 3.4% (95% CI, 3.3%-3.5%), 2.2% (95% CI, 2.1%-2.3%), and 0.9% (95% CI, 0.8%-1.1%) from 2008 to 2011, respectively. CONCLUSIONS Patients with similar characteristics and risk factors had a higher of probability of getting diagnosed, documented, and coded for sepsis in 2012 than in previous years, which contributed to an apparent increase in sepsis incidence.

English and French causal connectives in contrast

Discourse connectives are often said to be language specific, and therefore not easily paired with a translation equivalent in a target language. However, few studies have assessed the magnitude and the causes of these divergences. In this paper, we provide an overview of the similarities and discrepancies between causal connectives in two typologically related languages: English and French. We first discuss two criteria used in the literature to account for these differences: the notion of domains of use and the information status of the cause segment. We then test the validity of these criteria through an empirical contrastive study of causal connectives in English and French, performed on a bidirectional corpus. Our results indicate that French and English connectives have only partially overlapping profiles and that translation equivalents are adequately predicted by these two criteria.

Car, parce que, puisque’ revisited: Three empirical studies on French causal connectives

In French, a causal relation is often conveyed by the connectives car, parce que or puisque. Since the seminal work of the Lambda-l Group (1975), it has generally been assumed that parce que, used to relate semantic content, contrasts with car and puisque, both used to connect either speech act or epistemic content. However, this analysis leaves a number of questions unanswered. In this paper, I present a reanalysis of this trio, using empirical methods such as corpus analysis and constrained elicitation. Results indicate that car and parce que are interchangeable in many contexts, even if they are still prototypically used in their respective domain in writing. As for puisque, its distribution does not overlap with car, despite their similar domains of use. I argue that the specificity of puisque with respect to the other two connectives is to introduce a cause with an echoic meaning.

Expanding Our Grasp: Causal Knowledge and the Problem of Unconceived Alternatives

I argue that scientific realism, insofar as it is only committed to those scientific posits of which we have causal knowledge, is immune to Kyle Stanford’s argument from unconceived alternatives. This causal strategy (previously introduced, but not worked out in detail, by Anjan Chakravartty) is shown not to repeat the shortcomings of previous realist responses to Stanford’s argument. Furthermore, I show that the notion of causal knowledge underlying it can be made sufficiently precise by means of conceptual tools recently introduced into the debate on scientific realism. Finally, I apply this strategy to the case of Jean Perrin’s experimental work on the atomic hypothesis, disputing Stanford’s claim that the problem of unconceived alternatives invalidates a realist interpretation of this historical episode.

Economics and Ideology: Causal Evidence of the Impact of Economic Conditions on Support for Redistribution and Other Ballot Proposals

There is a large literature demonstrating that positive economic conditions increase support for incumbent candidates, but little understanding of how economic conditions affect preferences for parties and for particulars of their platforms. We ask how exogenous shifts to the value of residents. human capital affect voting behavior in California neighborhoods. As predicted by economic theory, we find that positive economic shocks decrease support for redistributive policies. More notably, we find that conservative voting on a wide variety of ballot propositions--from crime to gambling to campaign finance--is increasing in economic well being.

Evaluation of the causal pathways through which subjective norms influence mammography intention and stage of change in a national sample of women veterans

Few studies have investigated causal pathways linking psychosocial factors to each other and to screening mammography. Conflicting hypotheses exist in the theoretic literature regarding the role and importance of subjective norms, a person's perceived social pressure to perform the behavior and his/her motivation to comply. The Theory of Reasoned Action (TRA) hypothesizes that subjective norms directly affect intention; while the Transtheoretical Model (TTM) hypothesizes that attitudes mediate the influence of subjective norms on stage of change. No one has examined which hypothesis best predicts the effect of subjective norms on mammography intention and stage of change. Two statistical methods are available for testing mediation, sequential regression analysis (SRA) and latent variable structural equation modeling (LVSEM); however, software to apply LVSEM to dichotomous variables like intention has only recently become available. No one has compared the methods to determine whether or not they yield similar results for dichotomous variables. ^ Study objectives were to: (1) determine whether the effect of subjective norms on mammography intention and stage of change are mediated by pros and cons; and (2) compare mediation results from the SRA and LVSEM approaches when the outcome is dichotomous. We conducted a secondary analysis of data from a national sample of women veterans enrolled in Project H.O.M.E. (H&barbelow;ealthy O&barbelow;utlook on the M&barbelow;ammography E&barbelow;xperience), a behavioral intervention trial. ^ Results showed that the TTM model described the causal pathways better than the TRA one; however, we found support for only one of the TTM causal mechanisms. Cons was the sole mediator. The mediated effect of subjective norms on intention and stage of change by cons was very small. These findings suggest that interventionists focus their efforts on reducing negative attitudes toward mammography when resources are limited. ^ Both the SRA and LVSEM methods provided evidence for complete mediation, and the direction, magnitude, and standard errors of the parameter estimates were very similar. Because SRA parameter estimates were not biased toward the null, we can probably assume negligible measurement error in the independent and mediator variables. Simulation studies are needed to further our understanding of how these two methods perform under different data conditions. ^

Utilization behavior of the elderly in an HMO: A causal analysis

Planning and providing health care services for the elderly represents a major challenge to the health care system. One part of that challenge is the identification of those factors which determine the utilization of services by this population. The purpose of this study is to explain the use of health care services by elderly subscribers in a prepaid group health plan, using the theoretical framework developed by Andersen and Aday. The impact of the predisposing, enabling and need factors on utilization was modelled through a structural equation approach using LISREL. The data were derived from Kaiser-Permanente's Medicare Prospective Payment Project, August 1980-December 1982. Need factors, in general, were the most significant determinants of utilization, with the predisposing and enabling factors found to be secondary but necessary links in the causal chain. The model was fitted to the data from the youngest age group (65-74 years) and then evaluated for goodness of fit in the two older groups (75-84 and 85+ years). Implications of the study's findings and suggestions for further modelling the utilization behavior of the elderly are discussed. ^

Instrumental variable method for the causal relationship between soluble receptor for advanced glycation end-products (sRAGE) and risk of pancreatic cancer

This thesis project is motivated by the potential problem of using observational data to draw inferences about a causal relationship in observational epidemiology research when controlled randomization is not applicable. Instrumental variable (IV) method is one of the statistical tools to overcome this problem. Mendelian randomization study uses genetic variants as IVs in genetic association study. In this thesis, the IV method, as well as standard logistic and linear regression models, is used to investigate the causal association between risk of pancreatic cancer and the circulating levels of soluble receptor for advanced glycation end-products (sRAGE). Higher levels of serum sRAGE were found to be associated with a lower risk of pancreatic cancer in a previous observational study (255 cases and 485 controls). However, such a novel association may be biased by unknown confounding factors. In a case-control study, we aimed to use the IV approach to confirm or refute this observation in a subset of study subjects for whom the genotyping data were available (178 cases and 177 controls). Two-stage IV method using generalized method of moments-structural mean models (GMM-SMM) was conducted and the relative risk (RR) was calculated. In the first stage analysis, we found that the single nucleotide polymorphism (SNP) rs2070600 of the receptor for advanced glycation end-products (AGER) gene meets all three general assumptions for a genetic IV in examining the causal association between sRAGE and risk of pancreatic cancer. The variant allele of SNP rs2070600 of the AGER gene was associated with lower levels of sRAGE, and it was neither associated with risk of pancreatic cancer, nor with the confounding factors. It was a potential strong IV (F statistic = 29.2). However, in the second stage analysis, the GMM-SMM model failed to converge due to non- concaveness probably because of the small sample size. Therefore, the IV analysis could not support the causality of the association between serum sRAGE levels and risk of pancreatic cancer. Nevertheless, these analyses suggest that rs2070600 was a potentially good genetic IV for testing the causality between the risk of pancreatic cancer and sRAGE levels. A larger sample size is required to conduct a credible IV analysis.^

Causal Salud, interrupción legal del embarazo, ética y derechos humanos.

FLASOG

Interrupción legal del embarazo por la causal violación: enfoques de salud y jurídicos.

Secretaría Técnica y Asistente: Silvina Ramos con la colaboración de Agustina Ramón Michel

Aborto no punible. Causal violencia sexual en la Argentina. Marco normativo

Presentación en el Seminario Acceso al aborto para mujeres sobrevivientes de violencia sexual. Guatemala, el 28 y 29 de octubre de 2014.