Can algorithms Replace Expert Knowledge for Causal Inference? A Case Study on Novice Use of Causal Discovery.

BACKGROUND: With growing interest in causal inference and machine learning among epidemiologists, there is increasing discussion of causal discovery algorithms for guiding covariate selection. We present a case study of novice application of causal discovery tools and attempt to validate the results against a well-established causal relationship. METHODS: As a case study, we attempted causal discovery of relationships relevant to the effect of adherence on mortality in the placebo arm of the Coronary Drug Project (CDP) dataset. We used four algorithms available as existing software implementations and varied several model inputs. RESULTS: We identified 15 adjustment sets from 17 model parameterizations. When applied to a baseline covariate adjustment analysis, these 15 adjustment sets returned effect estimates with similar magnitude and direction of bias as prior published results. When using methods to control for time-varying confounding, there was generally more residual bias than compared to expert-selected adjustment sets. CONCLUSION: Although causal discovery algorithms can perform on par with expert knowledge, we do not recommend novice use of causal discovery without the input of experts in causal discovery. Expert support is recommended to aid in choosing the algorithm, selecting input parameters, assessing underlying assumptions, and finalizing selection of the adjustment variables.

Tobacco Cessation Scenarios Among Healthcare Profession Students: A Multidisciplinary Study

Background: It is acknowledged that the most effective means to contain the tobacco epidemic is to involve healthcare providers across various disciplines. The present study was undertaken to gain a comprehensive insight into various factors that determine the efficacy of multidisciplinary approaches in tobacco control. Methods: A cross sectional study design using a structured, pretested and self-administered questionnaire was employed in the present study, conducted among medical and dental interns and final year nursing students. Respondent demographics, knowledge, attitude, behaviour, perceived effectiveness and barriers, and willingness to participate in tobacco cessation were assessed. Results: A total of 268 subjects participated, with mean knowledge, attitude, behaviour, perceived effectiveness and barrier scores of 69. 7%, 89.0%, 72.0%, 80.6% and 88.6% respectively. There were significant differences among the mean scores of the study domains across the 3 disciplines. The majority (92.91%) of the respondents were willing to participate in tobacco cessation activities, but only 14.2% had previously received relevant training. Regression analysis revealed that the significant predictors of behaviour scores were gender, course, attitude and perceived effectiveness; those for willingness to undertake tobacco cessation activities were course, attitude, behaviour and perceived barriers. Conclusions: The study highlighted the willingness but low previous training among the participants and also identified factors that determine t behaviour and willingness to undertake tobacco cessation activities. The study emphasizes the need for modification in the policies pertaining to curricula of medical, dental and nursing training programs.

Insights into the state of radiation protection among a subpopulation of Indian dental practitioners

PURPOSE: Radiographs is an integral part of patient management in dentistry, despite their detrimental effects. As the literature pertaining to radiation protection among Indian dental practitioners is sparse, exploring such protection is needed. MATERIALS AND METHODS: All private dental practitioners in Mangalore, India were included in the study. A structured, pre-tested, self-administered questionnaire was employed to assess the knowledge, attitudes, practices, previous training, perceptions towards the need to spread awareness, and willingness to gain and implement knowledge about radiation hazards and protection. Information regarding each respondent's age, gender, education, and type and duration of practice was collected. RESULTS: Overall, 87 out of 120 practitioners participated in the study. The mean knowledge, attitude, and practice scores were 9.54+/-2.54, 59.39+/-7.01, and 5.80+/-3.19, respectively. Overall, 25.3% of the respondents had undergone training in radiation protection, 98.9% perceived a need to spread awareness, and 94.3% were willing to improve their knowledge. Previous training showed a significant correlation with age, sex, and duration of practice; attitude was significantly correlated with education and type of practice; and knowledge scores showed a significant correlation with type of practice. CONCLUSION: Although the knowledge and practices of respondents were poor, they had a positive attitude and were willing to improve their knowledge. Age, sex, and duration of practice were associated with previous training; education and type of practice with attitude scores; and type of practice with knowledge scores. The findings of this study suggest a policy is needed to ensure the adherence of dental practitioners to radiation protection guidelines.