In recent years, there have been increased calls for epidemiology to provide evidence that is relevant to policymakers. To meet these calls, a prominent approach uses the potential outcomes framework of causation and focuses on estimation of intervention effects in future target populations (future intervention effects) using results from epidemiologic studies (realized effects). This approach entails a number of assumptions that merit further investigation in the literature, including most fundamentally whether future intervention effect estimates are considered by policymakers to be the only epidemiologic evidence of direct policy relevance. Additionally, several assumptions are required for even internally valid realized effects to be unbiased estimates of future intervention effects, but the mechanisms by which they may be violated and the potential impact of violations remain under development in the literature. To advance understanding of what it means to use epidemiologic evidence to inform policy, and improve the utility and relevance of such data for policymakers, the overarching goal of this dissertation was to investigate several assumptions related to the methodological problem of future intervention effect estimation. To demonstrate real-world relevance and utility of the work for applied research, a case study focused on estimation of the future effect of depression treatment on antiretroviral adherence. First, a structured review of antiretroviral treatment guidelines and their methodological references tested the assumption that intervention effect estimates represent the totality of policy-relevant epidemiologic evidence; the review revealed a strong emphasis on estimation of intervention effects in target populations, but countered the assumption that they were the only types of evidence that should be considered “policy-relevant.” Subsequently, two simulation studies examined the impact of violations of particular assumptions needed for realized effects (effects from epidemiologic studies) to be unbiased estimates of future intervention effects. The first study showed that even when using the results of an intervention study (e.g. a randomized controlled trial), non-exchangeability between the study and target populations can develop over time, resulting in large under- or over-estimates of the future intervention effects over long time intervals. The second study examined the implications of using effects of harmful exposures to estimate effects of interventions to remove the exposures (e.g. attributable risks), and showed that such estimates may be substantially biased due to violations of the treatment variation irrelevance assumption, when real interventions differ from hypothetical ones due to unremovable consequences of exposures or unintended consequences of intervention. Overall, this dissertation contributes to the literature by clarifying the larger conceptual approaches to generalizing or transporting evidence to future target populations, and by showing the potential impact of violations of certain assumptions required to interpret results from epidemiologic studies as future intervention effects.

Introduction Symptoms are universally experienced and can be bothersome. There have been comparatively few studies of common symptoms in the UK general population. As a result, little is known about the current epidemiology of common symptoms in the UK. There are major methodological challenges to conducting an epidemiological study of common symptoms in the community. Current knowledge about the most appropriate methodological tools for collecting and interpreting data on symptoms is limited. A range of methods has been used in previous studies, but the most appropriate method is not known. An evaluation of the different methods that could be used for investigating common symptoms in the community was therefore required. Aims The overall aim of this study was to investigate and compare the use of different approaches to collecting epidemiological data on common symptoms, with a view to developing an evidence-base for the use of these different approaches. Methods A general review of methods used in epidemiological studies and a comprehensive review of methods used in previous epidemiological studies of symptoms were undertaken. The reviews informed the development of symptoms survey. Symptoms survey was conducted to collect epidemiological data on common symptoms in the community. A total of 1179 individuals was approached from four GP practices in the Aberdeen area and sent an invitation letter, information sheet and consent form. Potential participants were requested to select at least two data collection instruments from four options (postal questionnaire, diary, online questionnaire and telephone interview). All the instruments collected the same data (presence of symptoms, severity of symptoms, management of symptoms and quality of life). This allowed a direct comparison of the data collected by the various measures. Those agreeing to participate in the study were sent one of their chosen instruments in phase one of the study and a second (but different) one of their chosen instruments in phase two, which was conducted three weeks later.

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Thesis (Ph. D.)--Civil and Environmental Engineering, Georgia Institute of Technology, 2008. / Committee Chair: Aral, Mustafa; Committee Member: Guan, Jiabao; Committee Member: Kim, Seong Hee; Committee Member: Luo, Jian; Committee Member: Uzer, Turgay.

Vita. / Digitized by Kansas Correctional Industries

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The sources of gentamicin resistant pseudomonads and enterobacteria were studied in detail. A total of 1703 gentamicin resistant gram negative bacilli (GRGNB) isolated from patients, staff and their immediate environment were studied over a 6 month period . Of these 954 were isolated from clinical specimens obtained from patients and 540 from their immediate environment. A furthur 209 stains were isolated from the staff members who were responsible for the care of these patients. Pseudomonas aeruginosa; pyocin type 1 phage type F7 and .serotype 11 was the commonest isolate. It constituted 24,9% of all isolates in this study. This organism was distributed in all the wards investigated and was isolated throughout the 6 month study period. This strain, therefore, appears to be part of the "resident'' flora of King Edward Vlll Hospital for it was found on patients, staff and their immediate environment. Among the Enterobacteriaceae, Klebsiella pneumoniae was the commonest isolate and made up 13,6 % of all isolates. All the isolates obtained in this study were resistant to five of more antibiotics tested (gentamicin, tobramycin, kanamycin, streptomycin, carberricillin, polymyxin B amikacin and sisomicin). Of 310 staff members screened 25,2% harboured GRGNB on their hands. Among patients the commonest source of GRGNB was stool which yielded 141 (14,8 %) of the clinical isolates. Of the environmental sources studied, sinks harboured 87 (14%) GRGNB. The isolates from the environment and staff members were identical to patient strains. The significance of these findings is discussed. / Thesis (Fellowship of the Society of Medical Laboratory Technologists of South Africa)-University of Natal, Durban, 1985.

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Made available in DSpace on 2014-08-13T14:51:01Z (GMT). No. of bitstreams: 0 Previous issue date: 2014-02-20Bitstream added on 2014-08-13T17:59:35Z : No. of bitstreams: 1 000776589.pdf: 2857888 bytes, checksum: d897ae9d66a070240898f1eb97648046 (MD5) / Introdução: O melanoma cutâneo é o mais agressivo dos cânceres de pele. Sua incidência vem aumentando em todo o mundo e vários fatores têm sido atribuídos a este aumento. Estudos sobre o melanoma cutâneo com base em dados de registros populacionais são escassos no Brasil. Objetivos: Descrever os coeficientes de incidência (1996-2011) por melanoma cutâneo na cidade de Jaú, segundo: sexo, ano de diagnóstico, faixa etária, localização anatômica, estadio e tipo histológico. Descrever os coeficientes de mortalidade (1996-2011) por melanoma cutâneo na cidade de Jaú, segundo: sexo, ano do óbito e faixa etária. Analisar a tendência dos coeficientes de incidência (1996-2011), segundo: ano de diagnóstico, sexo e estadio. Analisar a tendência dos coeficientes de mortalidade (1996-2011) por melanoma cutâneo na cidade de Jaú, segundo: ano do óbito e sexo. Métodos: Foram analisados 162 casos novos de melanoma cutâneo diagnosticados no período de 1996 a 2011 fornecidos pelo Registro de Câncer de Base Populacional de Jahu e 39 óbitos por melanoma cutâneo ocorridos entre 1996 e 2011 fornecidos pelo Sistema de Informações sobre Mortalidade do Ministério da Saúde (SIM-MS). Foram calculados os coeficientes bruto e padronizado de incidência e de mortalidade, foi analisada a tendência destes coeficientes através do modelo de regressão. Resultados: O coeficiente médio de incidência (1996-2011) para o sexo feminino foi de 5,1 por 100.000 e para o sexo masculino foi de 4,8 por 100.000. Ambos não apresentaram tendência de crescimento ou queda no período (estabilidade). O coeficiente médio de mortalidade (1996-2011) para o sexo feminino foi de 1,4 por 100.000 e para o sexo masculino foi de 2,2 por 100.000, ambos também não apresentaram tendência de crescimento ou queda. Os coeficientes de incidência para os casos diagnosticados na fase inicial da doença, estadio 0, apresentaram tendencia de crescimento (r2=0,73; ... / Introduction: The cutaneous melanoma is the most aggressive of the skin cancers. Its incidence is increasing all over the world and many factors are being assigned to this increase. Studies on cutaneous melanoma based on population-based registries are scarce in Brazil. Objectives: Describe the incidence rates (1996-2011) by cutaneous melanoma in the city of Jaú, according: sex, year of the diagnosis, age, anatomic location, stage and histological type. Describe the mortality coefficients (1996-2011) by cutaneous melanoma in the city of Jaú, according: sex, year of death and age. Analyze the tendency of the incidence coefficients (1996-2011), according: year of diagnosis, sex and stage. Analyze the tendency of the mortality coefficients (1996-2011) by cutaneous melanoma in the city of Jaú, according: year of death and sex. Methods: 162 new cases of cutaneous melanoma diagnosed in the period from 1996 to 2011 were analyzed and they were provided by the Population-Based Cancer Registry of Jaú and 39 deaths by cutaneous melanoma occurred between 1996 and 2011 provided by the Mortality Information System of the Ministry of Health (SIM-MS). The crude and the standardized coefficients of incidence and mortality were calculated, the tendency of those coefficients were analyzed through the regression model. Results: The average incidence coefficient (1996-2011) for the feminine sex was 5.1 from 100,000 and for the masculine sex was 4.8 from 100,000. Both didn’t present tendency of increasing or decreasing in the period (stability). The average mortality coefficient (1996-2011) for the feminine sex was 1.4 from 100,000 and for the masculine sex was 2.2 from 100,000, both also didn’t present tendency of increasing or decreasing. The incidence coefficients for the cases diagnosed in the initial phase of the disease, stage 0, presented growing tendency (r2=0.73; p=0.03) and the cases of stage I and II, presented decreasing tendency (r2=0.98; ...