Multilevel structural equation models for longitudinal data where predictors are measured more frequently than outcomes : an application to the effects of stress on the cognitive function of nurses

Funded by Chief Scientist Office, Scotland. Grant Number: CZH/4/394 Economic and Social Research Council grant as part of the National Centre for Research Methods. Grant Number: RES-576-25-0032

Patterns of weight change after the diagnosis of type 2 diabetes in Scotland and their relationship with glycaemic control, mortality and cardiovascular outcomes: a retrospective cohort study

Acknowledgements The authors would like to thank the Scottish Diabetes Research Network Epidemiology Group for granting permission to use this database. They also thank the data management team in the University of Aberdeen who were the initial conduit for access to these data and also provided validation to the various data cleaning criteria applied. Jeremy J Walker, University of Edinburgh, was invaluable for the original funding application and initial exploration of data. HSRU is funded by the Chief Scientist Office of the Scottish Government Health and Social Care Directorates. Funding Chief Scientist Office (CSO) reference number: CZG/2/571.

Essays on the Role of Government Incentives in the Private Provision of Social Goods

The economic rationale for public intervention into private markets through price mechanisms is twofold: to correct market failures and to redistribute resources. Financial incentives are one such price mechanism. In this dissertation, I specifically address the role of financial incentives in providing social goods in two separate contexts: a redistributive policy that enables low income working families to access affordable childcare in the US and an experimental pay-for-performance intervention to improve population health outcomes in rural India. In the first two papers, I investigate the effects of government incentives for providing grandchild care on grandmothers’ short- and long-term outcomes. In the third paper, coauthored with Manoj Mohanan, Grant Miller, Katherine Donato, and Marcos Vera-Hernandez, we use an experimental framework to consider the the effects of financial incentives in improving maternal and child health outcomes in the Indian state of Karnataka.

Grandmothers provide a significant amount of childcare in the US, but little is known about how this informal, and often uncompensated, time transfer impacts their economic and health outcomes. The first two chapters of this dissertation address the impact of federally funded, state-level means-tested programs that compensate grandparent-provided childcare on the retirement security of older women, an economically vulnerable group of considerable policy interest. I use the variation in the availability and generosity of childcare subsidies to model the effect of government payments for grandchild care on grandmothers’ time use, income, earnings, interfamily transfers, and health outcomes. After establishing that more generous government payments induce grandmothers to provide more hours of childcare, I find that grandmothers adjust their behavior by reducing their formal labor supply and earnings. Grandmothers make up for lost earnings by claiming Social Security earlier, increasing their reliance on Supplemental Security Income (SSI) and reducing financial transfers to their children. While the policy does not appear to negatively impact grandmothers’ immediate economic well-being, there are significant costs to the state, in terms of both up-front costs for care payments and long-term costs as a result of grandmothers’ increased reliance on social insurance.

The final paper, The Role of Non-Cognitive Traits in Response to Financial Incentives: Evidence from a Randomized Control Trial of Obstetrics Care Providers in India, is coauthored with Manoj Mohanan, Grant Miller, Katherine Donato and Marcos Vera-Hernandez. We report the results from “Improving Maternal and Child Health in India: Evaluating Demand and Supply Side Strategies” (IMACHINE), a randomized controlled experiment designed to test the effectiveness of supply-side incentives for private obstetrics care providers in rural Karnataka, India. In particular, the experimental design compares two different types of incentives: (1) those based on the quality of inputs providers offer their patients (inputs contracts) and (2) those based on the reduction of incidence of four adverse maternal and neonatal health outcomes (outcomes contracts). Along with studying the relative effectiveness of the different financial incentives, we also investigate the role of provider characteristics, preferences, expectations and non-cognitive traits in mitigating the effects of incentive contracts.

We find that both contract types input incentive contracts reduce rates of post-partum hemorrhage, the leading cause of maternal mortality in India by about 20%. We also find some evidence of multitasking as output incentive contract providers reduce the level of postnatal newborn care received by their patients. We find that patient health improvements in response to both contract types are concentrated among higher trained providers. We find improvements in patient care to be concentrated among the lower trained providers. Contrary to our expectations, we also find improvements in patient health to be concentrated among the most risk averse providers, while more patient providers respond relatively little to the incentives, and these difference are most evident in the outputs contract arm. The results are opposite for patient care outcomes; risk averse providers have significantly lower rates of patient care and more patient providers provide higher quality care in response to the outputs contract. We find evidence that overconfidence among providers about their expectations about possible improvements reduces the effectiveness of both types of incentive contracts for improving both patient outcomes and patient care. Finally, we find no heterogeneous response based on non-cognitive traits.

Nvidia, matrox, paper? - Undergraduate game design tools in the humanities and social sciences

Eschewing costly high-tech approaches, this paper looks at the experience of using low-tech approaches to game design assignments as problem based learning and assessment tool over a number of years in undergraduate teaching. General game design concepts are discussed, along with learning outcomes and assessment rubrics in line with Blooms Taxonomy based on evidence from students who had no prior experience of serious game play or design. Approaches to creating game design based assessments are offered.

Practices and outcomes of self-treatment with helminths based on physicians' observations.

The successful use of helminths as therapeutic agents to resolve inflammatory disease was first recorded 40 years ago. Subsequent work in animal models and in humans has demonstrated that the organisms might effectively treat a wide range of inflammatory diseases, including allergies, autoimmune disorders and inflammation-associated neuropsychiatric disorders. However, available information regarding the therapeutic uses and effects of helminths in humans is limited. This study probes the practices and experiences of individuals 'self-treating' with helminths through the eyes of their physicians. Five physicians monitoring more than 700 self-treating patients were interviewed. The results strongly support previous indications that helminth therapy can effectively treat a wide range of allergies, autoimmune conditions and neuropsychiatric disorders, such as major depression and anxiety disorders. Approximately 57% of the self-treating patients observed by physicians in the study had autism. Physicians reported that the majority of patients with autism and inflammation-associated co-morbidities responded favourably to therapy with either of the two most popular organisms currently used by self-treaters, Hymenolepis diminuta and Trichuris suis. However, approximately 1% of paediatric patients experienced severe gastrointestinal pains with the use of H. diminuta, although the symptoms were resolved with an anti-helminthic drug. Further, exposure to helminths apparently did not affect the impaired comprehension of social situations that is the hallmark of autism. These observations point toward potential starting points for clinical trials, and provide further support for the importance of such trials and for concerted efforts aimed at probing the potential of helminths, and perhaps other biologicals, for therapeutic use.

What Does Board Capital Really Bring to the Table? Exploring the Effect of Directors’ Human and Social Capital on Effective Governance During International Expansion

What constitutes effective corporate governance? Which director characteristics render boards effective at positively influencing firm-level performance outcomes? This dissertation examines these questions by taking a multilevel, multidisciplinary approach to corporate governance. I explore the individual-, team-, and firm- level factors that enable directors to serve effectively as strategic resources during international expansion. I argue that directors’ international experience improves their ability to serve as effective strategic consultants and resource providers to firms during the complex internationalization process. However, unlike prior research, which tends to assume that directors with the potential to provide important resources uniformly do so, I acknowledge contextual factors (i.e. board cohesiveness, strategic relevance of directors’ experience) that affect their propensity to actually influence outcomes. I explore these issues in three essays: one review essay and two empirical essays. In the first empirical essay, I integrate resource dependence theory with insights from social-psychological research to explore the influence of board capital on firms’ cross-border M&A performance. Using a sample of cross-border M&As completed by S&P 500 firms from 2004-2009, I find evidence that directors’ depth of international experience is associated with superior pre-deal outcomes. This suggests that boards’ deep, market-specific knowledge is valuable during the target selection phase. I further find that directors’ breadth of international experience is associated with superior post-deal performance, suggesting that these directors’ global mindset helps firms in the post-M&A integration phase. I also find that these relationships are positively moderated by board cohesiveness, measured by boards’ internal social ties. In the second empirical essay, I explore the boundary conditions of international board capital by examining how the characteristics of firms’ internationalization strategy moderate the relationship between board capital and firm performance. Using a panel of 377 S&P 500 firms observed from 2004-2011, I find that boards’ depth of international experience and social capital are more important during early stages of internationalization, when firms tend to lack market knowledge and legitimacy in the host markets. On the other hand, I find that breadth of international experience has a stronger relationship with performance when firms’ have higher scope of internationalization, when information-processing demands are higher.

Please Stop Rubbing Your Relationship In My Face(book): An Investigation of Online Romantic Social Comparison

It is well-documented that social networking sites such as Facebook set the stage for social comparison. Such comparison has been linked to a number of negative outcomes including envy, negative moods, and lower self-esteem. The present research aims to extend current understanding of online social comparison by investigating how it pertains to romantic relationships. I hypothesized that for individuals high in attachment anxiety (compared to those low in this construct), online romantic social comparison might be related to negative consequences—which, in the current project, was operationalized as lower mood/affect and state self-esteem. Further, I hypothesized that there would be an interaction between attachment anxiety and relationship insecurities on these negative outcomes, such that the expected difference of attachment anxiety would be more pronounced under conditions priming relationship insecurities, relative to a control condition. Two experiments were conducted, one of which focused on single individuals, and the second focusing on individuals who were themselves in dating relationships. The paradigms of each entailed experimental manipulation of a key relationship-related variable (for single individuals, pessimism for future relationships; for dating individuals, the presence or absence of rejection threat), subsequent exposure to romantic content from Facebook, and finally, measures of affect and state self-esteem. I discovered partial support for the hypothesis that some single individuals—particularly those with higher, rather than lower, attachment anxiety—do indeed report feeling more negative moods and lower state self-esteem following exposure to romantic online content, in contrast to single individuals who had instead viewed neutral online content. The association between attachment anxiety and negative outcome was especially pertinent if individuals had been primed to believe that their own future romantic prospects were grim, or if attention had been drawn to their singleness. Among dating individuals, less support for hypotheses was found; however, exploratory post-hoc analyses revealed a promising (albeit weak) trend indicating that reinvestigation of the current hypotheses would be prudent.

A Framework for Citizen-Centred Social Statistics and Analysis (Working Paper 48)

Economic policy-making has long been more integrated than social policy-making in part because the statistics and much of the analysis that supports economic policy are based on a common conceptual framework – the system of national accounts. People interested in economic analysis and economic policy share a common language of communication, one that includes both concepts and numbers. This paper examines early attempts to develop a system of social statistics that would mirror the system of national accounts, particular the work on the development of social accounts that took place mainly in the 60s and 70s. It explores the reasons why these early initiatives failed but argues that the preconditions now exist to develop a new conceptual framework to support integrated social statistics – and hence a more coherent, effective social policy. Optimism is warranted for two reasons. First, we can make use of the radical transformation that has taken place in information technology both in processing data and in providing wide access to the knowledge that can flow from the data. Second, the conditions exist to begin to shift away from the straight jacket of government-centric social statistics, with its implicit assumption that governments must be the primary actors in finding solutions to social problems. By supporting the decision-making of all the players (particularly individual citizens) who affect social trends and outcomes, we can start to move beyond the sterile, ideological discussions that have dominated much social discourse in the past and begin to build social systems and structures that evolve, almost automatically, based on empirical evidence of ‘what works best for whom’. The paper describes a Canadian approach to developing a framework, or common language, to support the evolution of an integrated, citizen-centric system of social statistics and social analysis. This language supports the traditional social policy that we have today; nothing is lost. However, it also supports a quite different social policy world, one where individual citizens and families (not governments) are seen as the central players – a more empirically-driven world that we have referred to as the ‘enabling society’.

El movimiento social de 1995 en Francia contra el neoliberalismo

Las movilizaciones de noviembre-diciembre de 1995 en Francia contra el Plan Juppé fueron la primera gran revuelta en un país europeo contra el neoliberalismo. Con los trabajadores del sector público como eje de la protesta el movimiento se desplegó en base a la articulación combinada de huelgas y manifestaciones. Las reivindicaciones sectoriales se articularon en un discurso más general de defensa del servicio público y el interés general. Noviembre-diciembre de 1995 marcó el inicio de un ciclo de movilizaciones contra el neoliberalismo en Francia que testimonió su creciente pérdida de legitimidad.

The discrepancy between social isolation and loneliness as a clinically meaningful metric: findings from the Irish and English longitudinal studies of ageing (TILDA and ELSA)

Objective
Scant evidence is available on the discordance between loneliness and social isolation among older adults. We aimed to investigate this discordance and any health implications that it may have.

Method
Using nationally representative datasets from ageing cohorts in Ireland (TILDA) and England (ELSA), we created a metric of discordance between loneliness and social isolation, to which we refer as Social Asymmetry. This metric was the categorised difference between standardised scores on a scale of loneliness and a scale of social isolation, giving categories of: Concordantly Lonely and Isolated, Discordant: Robust to Loneliness, or Discordant: Susceptible to Loneliness. We used regression and multilevel modelling to identify potential relationships between Social Asymmetry and cognitive outcomes.

Results
Social Asymmetry predicted cognitive outcomes cross-sectionally and at a two-year follow-up, such that Discordant: Robust to Loneliness individuals were superior performers, but we failed to find evidence for Social Asymmetry as a predictor of cognitive trajectory over time.

Conclusions
We present a new metric and preliminary evidence of a relationship with clinical outcomes. Further research validating this metric in different populations, and evaluating its relationship with other outcomes, is warranted.

NI health and social care inequalities monitoring system (HSCIMS) - health inequalities in Northern Ireland: key facts 2015

This key facts publication provides an interim update to the NI health & social care inequalities monitoring system (HSCIMS) regional reports which are published every other year. It presents a summary of the latest position and inequality gaps between the most deprived areas and both the least deprived areas and the NI average in addition to a regional comparison with rural areas for a range of health outcomes included within the HSCIMS series, in addition to the health survey Northern Ireland (HSNI).

Anti-VEGF treatment of patients with diabetic macular edema : Studies of visual acuity, macular edema and patient-reported outcomes

The aim of this thesis was to describe and evaluate visual acuity, macular edema and patientreported outcomes (PRO) following anti-VEGF treatment of diabetic macular edema (DME) patients in a real-world setting. Using a longitudinal study design, a cohort of DME patients was followed from baseline to 1 year after treatment start. Data were collected from two eye clinics at two county hospitals. Social background characteristics, medical data and PRO were measured before treatment initiation, at four month and after 1 year. A total of 57 patients completed the study. Mean age was 69 years and the sample was equally distributed regarding sex. At baseline, the patients described their general health as low. One year after treatment initiation, 30 patients had improved visual acuity and 27 patients had no improvement in visual acuity. The patients whose visual acuity improved reported an improvement in several subscales in patient-reported outcome measures (PROM), which was in contrast to the group that experienced a decline in visual acuity, where there was no improvement in PROM. Outcomes from the study can be useful for developing and providing relevant information and support to patients undergoing this treatment.

Social Capital in Jordan: Wasta in Employment Selection

Social capital has emerged as a concept of great interest and potential to help understand and explain how social structures and networks impact political, social and business practices at the collective and individual levels. The basic premise is: investment in social relations will yield expected returns. Extant research has largely focused on the West; our knowledge of how social capital plays out in the Middle East is limited. We marry social capital with ‘wasta’, the strong family and tribal based connections secured in networks in the Arab world, and investigate HR managers’ perceptions of wasta in employment selection in Jordan. Often use of wasta in employment selection is related to favouritism and nepotism and the many negative outcomes of not adhering to merit-based selection. Through in-depth interview data we reveal a more nuanced and multifaceted view of wasta in employment selection. When examined through the social capital lens six distinct themes emerge: (i) wasta as an enabler to get jobs, (ii) wasta as social ties/ solidarity, (iii) wasta as a method to transfer/ attain information, (iv) wasta as a guide in decision-making, (v) wasta as an exchange, and (vi) wasta as pressure. Our findings confirm that at times wasta grants individuals unfair access to employment that is beyond their qualifications, skills, knowledge and/ or abilities. However, organisational context is relevant. In banking, not all roles are open to wasta. Where the possible negative impact on the organisation poses too great a risk HR managers feel able to resist even strong wasta. Context also emerges as being of key importance with regards to the background and business model of an organisation. Family businesses tend to operate wasta more frequently and extensively using tribal connections, religious networks and geographical area based networks as a key source in hiring. Despite globalisation and international nature of banking, wasta and tribalism feature strongly in daily business conduct in Jordan. Our paper illuminates the positive effects of wasta, e.g.as a method to transfer information, together with discussion on the dangers of ‘cloning’, a (lack of diversity), and the dangers of an incompetent workforce .

Mapping social values of ecosystem services: What is behind the map?

A growing interest in mapping the social value of ecosystem services (ES) is not yet methodologically aligned with what is actually being mapped. We critically examine aspects of the social value mapping process that might influence map outcomes and limit their practical use in decision making. We rely on an empirical case of participatory mapping, for a single ES (recreation opportunities), which involves diverse stakeholders such as planners, researchers, and community representatives. Value elicitation relied on an individual open-ended interview and a mapping exercise. Interpretation of the narratives and GIS calculations of proximity, centrality, and dispersion helped in exploring the factors driving participants’ answers. Narratives reveal diverse value types. Whereas planners highlighted utilitarian and aesthetic values, the answers from researchers revealed naturalistic values as well. In turn community representatives acknowledged symbolic values. When remitted to the map, these values were constrained to statements toward a much narrower set of features of the physical (e.g., volcanoes) and built landscape (e.g., roads). The results suggest that mapping, as an instrumental approach toward social valuation, may capture only a subset of relevant assigned values. This outcome is the interplay between participants’ characteristics, including their acquaintance with the territory and their ability with maps, and the mapping procedure itself, including the proxies used to represent the ES and the value typology chosen, the elicitation question, the cartographic features displayed on the base map, and the spatial scale.

Constructing stability landscapes to identify alternative states in coupled social-ecological agent-based models

The resilience of a social-ecological system is measured by its ability to retain core functionality when subjected to perturbation. Resilience is contextually dependent on the state of system components, the complex interactions among these components, and the timing, location, and magnitude of perturbations. The stability landscape concept provides a useful framework for considering resilience within the specified context of a particular social-ecological system but has proven difficult to operationalize. This difficulty stems largely from the complex, multidimensional nature of the systems of interest and uncertainty in system response. Agent-based models are an effective methodology for understanding how cross-scale processes within and across social and ecological domains contribute to overall system resilience. We present the results of a stylized model of agricultural land use in a small watershed that is typical of the Midwestern United States. The spatially explicit model couples land use, biophysical models, and economic drivers with an agent-based model to explore the effects of perturbations and policy adaptations on system outcomes. By applying the coupled modeling approach within the resilience and stability landscape frameworks, we (1) estimate the sensitivity of the system to context-specific perturbations, (2) determine potential outcomes of those perturbations, (3) identify possible alternative states within state space, (4) evaluate the resilience of system states, and (5) characterize changes in system-scale resilience brought on by changes in individual land use decisions.