Experts In Epidemiology Research Articles

A Review of Epidemiological Research on Adverse Neurological Effects of Exposure to Ambient Air Pollution.

There is a growing body of epidemiological research reporting the neurological effects of ambient air pollution. We examined current evidence, identified the strengths and weaknesses of published epidemiological studies, and suggest future directions for research in this area. Studies were identified through a systematic search of online scientific databases, in addition to a manual search of the reference lists from the identified papers. Despite being a relatively new area of investigation, overall, there is mounting evidence implicating adverse effects of air pollution on neurobehavioral function in both adults and children. Further research is needed to expand our understanding of these relationships, including improvement in the accuracy of exposure assessments; focusing on specific toxicants and their relationships to specific health endpoints, such as neurodevelopmental disorders and neurodegenerative diseases; investigating the combined neurological effects of multiple air pollutants; and further exploration of genetic susceptibility for neurotoxicity of air pollution. In order to achieve these goals collaborative efforts are needed from multidisciplinary teams, including experts in toxicology, biostatistics, geographical science, epidemiology, and neurology.

Strategies to Improve Medication Adherence in Older Persons: Consensus Statement from the Senior Italia Federanziani Advisory Board.

Poor adherence to treatment regimens has long been recognized as a substantial roadblock to achieving better outcomes for patients. Non-adherence to medications affects the quality and length of life and has been associated with negative health outcomes and increasing healthcare costs. The problem of non-adherence is particularly troublesome in older patients who are affected by multiple chronic diseases and for this reason receive multiple treatments. To date, no single intervention strategy has been shown to be effective in improving adherence across all patients, conditions, and settings. Between September and October 2014, a group of experts in geriatrics, pharmacology, epidemiology, and public health applied a modified RAND appropriateness method to reach a consensus on the possible best interventions to improve adherence in older individuals. Seven interventions were identified, classified based on their target (patient, therapy, and public health/society): (1) Comprehensive Geriatric Assessment, (2) patient (and caregiver) education to improve patient empowerment, (3) optimization of treatment, (4) use of adherence aids, (5) physician and other healthcare professionals' education, (6) adherence assessment, (7) facilitating access to medicine by service integration. For each intervention, experts assessed (a) target population, (b) health professionals potentially involved in the intervention, (c) strategies/instruments needed for implementation, and (d) time of the intervention. Interventions that target adherence must combine different approaches targeting the complex aspects of older adults in a holistic approach. Tackling non-adherence, with its complexity, requires a multi-stakeholder patient-centred approach acting in a defined framework of interactions in which the different players may provide different services but are integrated with one another.

In memoriam: Dr. Andrew Czeizel.

In memoriam: Dr. Andrew Czeizel.

Concerted Uranium Research in Europe (CURE): toward a collaborative project integrating dosimetry, epidemiology and radiobiology to study the effects of occupational uranium exposure

The potential health impacts of chronic exposures to uranium, as they occur in occupational settings, are not well characterized. Most epidemiological studies have been limited by small sample sizes, and a lack of harmonization of methods used to quantify radiation doses resulting from uranium exposure. Experimental studies have shown that uranium has biological effects, but their implications for human health are not clear. New studies that would combine the strengths of large, well-designed epidemiological datasets with those of state-of-the-art biological methods would help improve the characterization of the biological and health effects of occupational uranium exposure. The aim of the European Commission concerted action CURE (Concerted Uranium Research in Europe) was to develop protocols for such a future collaborative research project, in which dosimetry, epidemiology and biology would be integrated to better characterize the effects of occupational uranium exposure. These protocols were developed from existing European cohorts of workers exposed to uranium together with expertise in epidemiology, biology and dosimetry of CURE partner institutions. The preparatory work of CURE should allow a large scale collaborative project to be launched, in order to better characterize the effects of uranium exposure and more generally of alpha particles and low doses of ionizing radiation.

Knowledge and Beliefs about Ebola Virus Disease (EVD) among Teachers in Ondo State Nigeria

This study examines teachers’ knowledge and beliefs about EVD. This study was conducted in selected secondary and primary schools in Nigeria. Data were obtained from 350 Teachers sampled randomly from Ikare (200) and Akungba (150) respectively. Fifty Teachers (30 Senior Teachers and 20 Junior Teachers) were selected from the seven schools making a grand total of 350 Teachers for the entire study. The instrument, graduated ended questions on demographic characteristics, knowledge, and beliefs about Ebola Virus Disease. The instrument was validated by a group of experts in Epidemiology, Demography and Medical Sociology in three universities. Out of 350 instruments administered, the Return-Rate at 88.6% (310) was reliable enough for the study population. During a Pre-test, a reliability value of 0.98 were collated, edited and with the use of SPSS Version 17. Findings show that the knowledge about EVD was relatively high and those different beliefs systems determine and influence the perceived health seeking behaviour. The need to under study health belief system of the people and incorporate them into the care and cure system is recommended for EVD, an epidemic too soon to be forgotten. DOI: 10.5901/mjss.2016.v7n3p451

Research Needs for Understanding the Biology of Overdiagnosis in Cancer Screening.

Many cancers offer an extended window of opportunity for early detection and therapeutic intervention that could lead to a reduction in cause-specific mortality. The pursuit of early detection in screening settings has resulted in decreased incidence and mortality for some cancers (e.g., colon and cervical cancers), and increased incidence with only modest or no effect on cause-specific mortality in others (e.g., breast and prostate). Whereas highly sensitive screening technologies are better at detecting a number of suspected "cancers" that are indolent and likely to remain clinically unimportant in the lifetime of a patient, defined as overdiagnosis, they often miss cancers that are aggressive and tend to present clinically between screenings, known as interval cancers. Unrecognized overdiagnosis leads to overtreatment with its attendant (often long-lasting) side effects, anxiety, and substantial financial harm. Existing methods often cannot differentiate indolent lesions from aggressive ones or understand the dynamics of neoplastic progression. To correctly identify the population that would benefit the most from screening and identify the lesions that would benefit most from treatment, the evolving genomic and molecular profiles of individual cancers during the clinical course of progression or indolence must be investigated, while taking into account an individual's genetic susceptibility, clinical and environmental risk factors, and the tumor microenvironment. Practical challenges lie not only in the lack of access to tissue specimens that are appropriate for the study of natural history, but also in the absence of targeted research strategies. This commentary summarizes the recommendations from a diverse group of scientists with expertise in basic biology, translational research, clinical research, statistics, and epidemiology and public health professionals convened to discuss research directions. J. Cell. Physiol. 231: 1870-1875, 2016. © 2015 Wiley Periodicals, Inc.

Global Consensus Recommendations on Prevention and Management of Nutritional Rickets.

Vitamin D and calcium deficiencies are common worldwide, causing nutritional rickets and osteomalacia, which have a major impact on health, growth, and development of infants, children, and adolescents; the consequences can be lethal or can last into adulthood. The goals of this evidence-based consensus document are to provide health care professionals with guidance for prevention, diagnosis, and management of nutritional rickets and to provide policy makers with a framework to work toward its eradication. A systematic literature search examining the definition, diagnosis, treatment, and prevention of nutritional rickets in children was conducted. Evidence-based recommendations were developed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system that describe the strength of the recommendation and the quality of supporting evidence. Thirty-three nominated experts in pediatric endocrinology, pediatrics, nutrition, epidemiology, public health, and health economics evaluated the evidence on specific questions within five working groups. The consensus group, representing 11 international scientific organizations, participated in a multiday conference in May 2014 to reach a global evidence-based consensus. This consensus document defines nutritional rickets and its diagnostic criteria and describes the clinical management of rickets and osteomalacia. Risk factors, particularly in mothers and infants, are ranked, and specific prevention recommendations including food fortification and supplementation are offered for both the clinical and public health contexts. Rickets, osteomalacia, and vitamin D and calcium deficiencies are preventable global public health problems in infants, children, and adolescents. Implementation of international rickets prevention programs, including supplementation and food fortification, is urgently required.

Porcine epidemic diarrhea virus introduction into the United States: Root cause investigation

Porcine epidemic diarrhea (PED) was identified in the United States in the spring of 2013, and professionals from many parts of the U.S. swine industry responded rapidly to understand and control the newly emerging disease. In less than two months, the disease had spread to more than 200 herds in thirteen states. Experts from the US Department of Agriculture (USDA) engaged in laboratory diagnostics, analytic support, epidemiology expertise, and data management to facilitate the effort. By 2014, a great deal had been learned about the disease; however, the question of how it entered the United States remained unanswered. In 2014, USDA formed an investigative group to address the question and leverage current knowledge with resources and partnerships not readily available to non-federal investigators. The group formed collaborations with other government and non-government organizations and individuals, and followed many avenues of inquiry; ultimately arriving at a small number of scenarios that describe possible mechanisms for PED introduction. For a scenario to be plausible, it had to explain: contamination of a person or product in the source country, its transit and entry to the United States, rapid dispersal across a wide geographic area, and exposure/infection of pigs. It had to be compatible with findings of swine herd investigations and research studies. Potential products had to have been imported legally during the time prior to the beginning of the epidemic, or delivered to the United States through prohibited channels. Follow-up studies were initiated to gather more evidence for the most plausible scenarios. Of the scenarios, flexible intermediate bulk containers (“feed totes”) used to transport bulk feed serving as fomites for movement of PED virus provided the simplest explanation for the accumulated findings of the investigation.

Letter from the New Editor-in-Chief: My Perspective on Environmental Health Perspectives.

Letter from the New Editor-in-Chief: My Perspective on Environmental Health Perspectives.

Molecular diagnostics and genetic characteristics of influenza A/H1N1 virus circulating in the territory of the West Kazakhstan in 2012–2014

No: 1437 Presentation at ESCV 2015: Poster 1 Molecular diagnostics and genetic characteristics of influenza A/H1N1 virus circulating in the territory of the West Kazakhstan in 2012–2014 N.G. Klivleoeva1,∗, G.V. Lukmanova1, T.I. Glebova1, M.G. Shamenova1, N.T. Saktaganov1, K.V. Duysenova2 1 Institute of Microbiology and Virology of the Ministry of Education and Science of the Republic of Kazakhstan, Kazakhstan 2 Atyrau Regional Center of Sanitary – Epidemiological Expertise, Kazakhstan Background: The purpose of this study was to analyze the molecular characteristics of influenza A/H1N1virus circulating in the territory of the West Kazakhstan in 2012–2014. Methods: Samples of clinicalmaterials (nasopharyngeal swabs) were collected in polyclinics and infectious diseases hospitals of the Atyrau oblast (West Kazakhstan) from people with symptoms ofARVI andpneumonia in the2012–2014period. The sampleswere tested by RT-PCR considering the results in the real-time mode and using AmliSens reagent kit produced by the Central Research Institute of Epidemiology (Moscow). Nucleotide sequences of HA andNA geneswere analyzed using the BlAST software (http://blast. ncbi.nlm.nih.gov), which allowed to determine the percentage of identity with the influenza virus isolates and strains available in the GenBank. PCR diagnostics of 337 clinical samples showed that the genetic material of influenza viruses was detected in 118 swabs (35% of the total number of samples tested). Influenza A/H1 viral RNA was detected in 27 samples (23.0% of the total number of positive samples), A/H3 viral RNA in 13 samples (11%). RNA of simultaneously both subtypes of influenza A virus (H1N1+H3N2) was also detected in six samples (5.0%). Influenza B viruses were not detected. These data suggest the influenza A epidemic of the mixed etiology with a predominance of influenza A/H1N1 virus. Molecular genetic characterization of the six A/H1N1 strains, isolated in the Atyrau region in 2012 and 2013, showed that these viruses by the hemagglutinin gene are similar to the reference strain A/swine/Guangdong/L3/2009 (H1N1) by 98-99%. When studying the NA gene sequence, it was established that isolates exhibited 99% identity with A/swine/Changhua/1993/2000 (H1N1), A/swine/USA/1976-M/1931 (H1N1) and A/swine/Guangdong/L3/2009 (H1N1), and 98% homology with A/swine/Iowa/1973 (H1N1). Two strains (A/Atyrau/880/12 and A/Atyrau/901/13), in addition to this, showed 99% identity with the classical swine viruses A/swine/Jamesburg/1942 (H1N1), A/swine/1931 (H1N1) and A/swine/Iowa/1973 (H1N1). The study of mutational changes in NA and M genes and comparative analysis of amino acid sequences in NA genes in comparison with a pandemic strain A/California/04/2009 (H1N1)v of American line and A/England/195/2009 (H1N1) of Eurasian line indicated that the Kazakhstan strains have more than 70 differences from the reference ones. Phylogenetic analysis showed that closely related strains of influenza virus belonging to the same cluster with the virus A/swine/Guandong/L3/2009 (H1N1), isolated in 2009 from swine in China, are circulating in the territory of the West Kazakhstan; the changes in HA gene do not lead to the changes in the antigen properties. In this way, the molecular biological analysis showed that the population of A/H1N1 strains of theWest Kazakhstan is genetically homogeneous, and within two epidemic seasons of the circulation has not undergone significant changes. http://dx.doi.org/10.1016/j.jcv.2015.07.057

Laparoscopic ventral/incisional hernia repair: updated Consensus Development Conference based guidelines [corrected

The Executive board of the Italian Society for Endoscopic Surgery (SICE) promoted an update of the first evidence-based Italian Consensus Conference Guidelines 2010 because a large amount of literature has been published in the last 4 years about the topics examined and new relevant issues. The scientific committee selected the topics to be addressed: indications to surgical treatment including special conditions (obesity, cirrhosis, diastasis recti abdominis, acute presentation); safety and outcome of intraperitoneal meshes (synthetic and biologic); fixing devices (absorbable/non-absorbable); abdominal border and parastomal hernia; intraoperative and perioperative complications; and recurrent ventral/incisional hernia. All the recommendations are the result of a careful and complete literature review examined with autonomous judgment by the entire panel. The process was supervised by experts in methodology and epidemiology from the most qualified Italian institution. Two external reviewers were designed by the EAES and EHS to guarantee the most objective, transparent, and reliable work. The Oxford hierarchy (OCEBM Levels of Evidence Working Group*. "The Oxford 2011 Levels of Evidence") was used by the panel to grade clinical outcomes according to levels of evidence. The recommendations were based on the grading system suggested by the GRADE working group. The availability of recent level 1 evidence (a meta-analysis of 10 RCTs) allowed to recommend that not only laparoscopic repair is an acceptable alternative to the open repair, but also it is advantageous in terms of shorter hospital stay and wound infection rate. This conclusion appears to be extremely relevant in a clinical setting. Indications about specific conditions could also be issued: laparoscopy is recommended for the treatment of recurrent ventral hernias and obese patients, while it is a potential option for compensated cirrhotic and childbearing-age female patients. Many relevant and controversial topics were thoroughly examined by this consensus conference for the first time. Among them are the issue of safety of the intraperitoneal mesh placement, traditionally considered a major drawback of the laparoscopic technique, the role for the biologic meshes, and various aspects of the laparoscopic approach for particular locations of the defect such as the abdominal border or parastomal hernias.

Which factors may determine the necessary and feasible type of effectiveness evidence? A mixed methods approach to develop an instrument to help coverage decision-makers

ObjectivesReimbursement decisions require evidence of effectiveness and, in general, a blinded randomised controlled trial (RCT) is the preferred study design to provide it. However, there are situations where a cohort...

Abstract 106: Defining an International Standard Set of Patient-centered Outcome Measures After Stroke

Background: Value-based healthcare delivery is a strategy to align patients, providers, and payers toward improving outcomes while reducing costs. We sought to define an international standard set of patient-centered, stroke health outcomes. Methods: We assembled an international expert panel representing patients, advocates, and physician experts in stroke outcomes, stroke registries, global health, epidemiology, and rehabilitation. A modified Delphi process was used to reach consensus recommendations for a Standard Set of outcome measures, baseline risk adjustment variables, and included populations for use in both low and high income countries. Results: Patients presenting to a hospital with ischemic stroke or intracerebral hemorrhage evaluated with brain imaging were selected as the required included population, with optional inclusion of transient ischemic attacks. Because of differences in ascertainment and imaging modalities, duration of symptoms and type of imaging are collected to allow for comparisons of homogeneous groups across various countries and practice settings. Basic functional status is assessed at prestroke baseline, index admission, discharge, 90 days, and 1 year thereafter. Co-morbidities and stroke severity are collected for risk adjustment. Symptomatic intracerebral hemorrhage after thrombolysis is the only complication captured, and many measures reflect patient-reported quality of life outcomes and priorities captured in the Patient Reported Outcomes Measurement Information System 10-question short form (PROMIS-10) and elements from existing registries. Conclusions: The stroke measure Standard Set is proposed for implementation to permit meaningful comparisons and increase value of stroke care worldwide using a simple, pragmatic strategy.

Good Practice of Secondary Data Analysis (GPS): guidelines and recommendations

In 2005, the Working Group for the Survey and Utilisation of Secondary Data (AGENS) of the German Society for Social Medicine and Prevention (DGSMP) and the German Society for Epidemiology (DGEpi) first published "Good Practice in Secondary Data Analysis (GPS)" formulating a standard for conducting secondary data analyses. GPS is intended as a guide for planning and conducting analyses and can provide a basis for contracts between data owners. The domain of these guidelines does not only include data routinely gathered by statutory health insurance funds and further statutory social insurance funds, but all forms of secondary data. The 11 guidelines range from ethical principles and study planning through quality assurance measures and data preparation to data privacy, contractual conditions and responsible communication of analytical results. They are complemented by explanations and practical assistance in the form of recommendations. GPS targets all persons directing their attention to secondary data, their analysis and interpretation from a scientific point of view and by employing scientific methods. This includes data owners. Furthermore, GPS is suitable to assess scientific publications regarding their quality by authors, referees and readers. In 2008, the first version of GPS was evaluated and revised by members of AGENS and the Epidemiological Methods Working Group of DGEpi, DGSMP and GMDS including other epidemiological experts and had then been accredited as implementation regulations of Good Epidemiological Practice (GEP). Since 2012, this third version of GPS is on hand and available for downloading from the DGEpi website at no charge. Especially linguistic specifications have been integrated into the current revision; its internal consistency was increased. With regards to contents, further recommendations concerning the guideline on data privacy have been added. On the basis of future developments in science and data privacy, further revisions will follow.

Health technology assessment of medical devices: What is different? An overview of three European projects

With the growing use and importance of health technology assessment (HTA) in decision making during recent years, health technology assessors, decision makers and stakeholders are confronted with methodological challenges due to specific characteristics of health technologies (e. g., pharmaceuticals, diagnostic tests, screening programs), their developmental environment, and their regulation process. Being aware of the necessity to use HTA as a policy instrument for sustainable health care systems in a regulatory environment of decentralized Conformité Européenne (CE) marking, the European Union (EU) is increasingly supporting the development of methods for the assessment of medical devices (MD) on different levels: within the scope of European research projects and within joint assessment activities of the member states of the European network for Health Technology Assessment (EUnetHTA). First, this article describes three projects: MedtecHTA-Methods for Health Technology Assessment of Medical Devices, a European Perspective Work Package 3 (WP3), Comparative Effectiveness of Medical Devices led by the University for Health Sciences, Medical Informatics and Technology (UMIT). Second, we discuss the experiences of the Ludwig Boltzmann Institute Health Technology Assessment (LBI HTA) with the joint production of rapid assessments of medical devices by several European HTA agencies within EUnetHTA. Third, a brief outline is given of the framework of joint methodological guideline elaboration by the EUnetHTA partner organizations because a guideline for therapeutic MD is also being developed here. We will describe aims, methods and some preliminary results of MedtecHTA and EUnetHTA Joint Action 2 Work Package 5 Strand B (WP5B) applying the HTA Core Model for Rapid Assessment for national adaptation and reporting, and give an overview of the development process of methodological guidelines within WP 7 of EUnetHTA Joint Action 2. Based on a literature review in MedtecHTA WP3 incremental development, context dependency and the physical mode of action of MD were identified as those characteristics making therapeutic MD different from drugs with regard to evaluation methods. In addition, regulation does not stipulate clinical trials. These characteristics were also identified as challenges for the production of joint assessments of MD within the HTA network EUnetHTA. Furthermore, adequate timing of assessment production, the variety of involved manufacturers, the non-transparent regulation process of MD in Europe and the often poor evidence base pose a challenge to EUnetHTA assessors. As a consequence, processes and methods for the joint production of rapid assessments must be continuously adapted and improved. Research on HTA methods for the assessment of MD tries to provide tools to deal with rapidly developing devices during evidence generation, dependence of clinical effectiveness of MD on user experience and context factors. There are also tools to integrate evidence from different sources adjusting for different levels of validity, but these methods are not established and need high epidemiological and statistical expertise. A framework for deciding whether additional evidence is needed to reduce uncertainty regarding safety, clinical effectiveness and cost-effectiveness will be adapted to MD. The whole process of evidence generation before and after market access has to be considered to provide an environment for conclusive HTA recommendations informing health care decision making. In Joint Action 2, EUnetHTA develops transparent processes for the early dialogue with stakeholders and fosters dissemination of appropriate HTA methods. In the case of MD, there are special accumulated needs for such efforts.

Assessment of congenital anomalies in infants born to pregnant women enrolled in clinical trials.

In 2011 and 2012, the Division of Microbiology and Infectious Diseases at the National Institute of Allergy and Infectious Diseases, National Institutes of Health, held a series of meetings to provide guidance to investigators regarding study design of clinical trials of vaccines and antimicrobial medications that enroll pregnant women. Assessment of congenital anomalies among infants born to women enrolled in these trials was recognized as a challenging issue, and a workgroup with expertise in epidemiology, pediatrics, genetics, dysmorphology, clinical trials, and infectious diseases was formed to address this issue. The workgroup considered 3 approaches for congenital anomalies assessment that have been developed for use in other studies: (1) maternal report combined with medical records review, (2) standardized photographic assessment and physical examination by a health professional who has received specific training in congenital anomalies, and (3) standardized physical examination by a trained dysmorphologist (combined with maternal interview and medical records review). The strengths and limitations of these approaches were discussed with regard to their use in clinical trials. None of the approaches was deemed appropriate for use in all clinical trials. Instead, the workgroup acknowledged that decisions regarding the optimal method of assessment of congenital anomalies will likely vary depending on the clinical trial, its setting, and the agent under study; in some cases, a combination of approaches may be appropriate. The workgroup recognized the need for more research on approaches to the assessment of congenital anomalies to better guide investigators in optimal design of clinical trials that enroll pregnant women.

Continuous Quality Improvement

The Magnifying GlassFigureWhen considering the program evaluation and quality improvement (QI) cycle for any process improvement, data collection and evaluation are essential. In measuring the journal’s performance, we use both quantitative and qualitative inputs. The qualitative measures emanate from the editorial esthetics, our reputation, and the significance of our professional activities in teaching and learning, using multimedia editorial delivery. The journal of Advances in Skin & Wound Care (ASWC) continues to be one of the most highly cited journals in our field. In 2011, ASWC made its debut into the current biomedical Journal Citation Reports by Thomson Reuters, with an initial impact factor (IF) ranking of 1.438. With this first IF rating (IFR), we also ranked 13th of 97 journals in the report’s “Science” category! On August 18, 2014, the journal’s IF ranking increased to 1.634.1 The IF is a measurement of the frequency by which an article in a scholarly journal is cited in a particular year. For example, in 2013, there were 134 IF cites and 82 citable items in ASWC, resulting in an impact score of 1.634. The impact score is considered by many to be a measure of a journal’s influence and prestige. Because wound care is interprofessional, it is therefore appropriate to compare ourselves with other journals that also cover wound care topics. Categorically, among dermatology journals (N = 61), ASWC ranks 46 in “Total Cites Rankings” and 28 in IFR; of surgically related journals (n = 202), ASWC Total Cites Rankings is 137, and the IFR is 85, and among nursing journals (n = 106), ASWC has a Total Cites Rankings of 34 and an IFR ranking of 20. In fact, our company publishes 5 of the top 25 ranked journals in the “Nursing” category of the 104 nursing titles represented.2 Our readers provide input to the process as well; some of the highlights of a recent readership survey conducted in August 2014 make the following observations: Eighty-four percent read at least half of every issue; 81% have a need to learn more about debridement methods, with more than three-fourths of our readership highly interested in the topic of “bacterial bioburden”; 78% state that the journal assists them in their practice’s decision making; readers rate the overall publication a 4.3 on a 5-point scale; and the majority feel the credibility rating of the journal’s information to be excellent. The Peer-Review Process We rely on our collegial team of authors, peer reviewers, editorial staff, internal education consultants who oversee the continuing education (CE) process, and the leadership of Wolters Kluwer Health. In September 2014, we had one of the most well-attended and productive editorial board meetings in recent memory. In my mind, this meeting exemplified the “plan-do-act-study cycle” of the continuous QI. The discussions began around metrics, which are made readily available through our robust online Editorial Manager (EM) program. We also measure the total number of manuscripts processed. For 2013, 116 manuscripts were processed. Of those, 74 were ultimately accepted after undergoing rounds of peer review with revisions, 42 were rejected after peer review, and a few were triaged for not meeting the journal’s criteria. The tempo of the editorial process has significantly hastened, again with credit to the editorial team, EM, and the peer reviewers. We track “time-to-decision” trends, and in 2013, the number of days from initial manuscript submission to final disposition was 71.5 days. The Peer Reviewers The peer reviewers do incredibly important work in this process. The EM process tracks metrics for the time allotted for a peer reviewer to provide feedback, usually 7 to 10 days. The reviewers are scored by several parameters, including days to review and feedback credibility (are the decisions matched with a cogent and helpful narrative?). Research shows that the reviewer on a given manuscript should spend no more than 2 hours in conducting the review.1 More than 2 hours diminishes the quality of the review. Our peer reviewers earn CE credits for achieving a peer-review score greater than 70 on their reviews. For each manuscript, we assign a minimum of 3 peer reviewers with expertise in the subject matter. In my opinion, we have the best peer reviewers in the world! Each and every reviewer contributes substantially to enhancing the quality of the final published manuscript. The research published on the subject of peer reviewers indicates that the quality of the journal and the review process depend on having reviewers with statistical and epidemiologic expertise on the panel.3 Although we recently recruited new reviewers in health economics and ethics, we are interested in additional candidates with expertise in nutrition, surgery, hyperbaric oxygen, biostatistics, and QI methodology. Please submit your resumes to [email protected].FigureRichard “Sal” Salcido, MD, EdD

Humanitarian Action: The Joint Church Aid and Health Care Intervention in the Nigeria-Biafra War, 1967–1970

International humanitarian aid played an important role in the Nigeria-Biafra War, 1967-70. Relief aid was organized under two major umbrella bodies — the International Committee of the Red Cross (ICRC) and the Joint Church Aid (JCA). The JCA received support from Catholic and Protestant churches while the ICRC, an established humanitarian agency, relied on donations from many governments as well as from the United Nations International Children’s Emergency Fund (UNICEF). This paper focuses on the formation of the JCA as a humanitarian organization and examines its efforts to provide health care for the war victims in Biafra. Though the JCA has not received adequate scholarly attention, its humanitarian aid in Biafra was the first of its kind in the developing world and involved the largest civilian airlift in history. As this paper argues, the JCA’s health care intervention in Biafra was restricted to minimal care because of a lack of essential medications, equipment, food, and epidemiological expertise. Despite these challenges, however, the JCA managed to provide basic health care to over ten million persons in Biafra during the war. Further, the organization succeeded in providing aid without creating long-term dependency.

Productivity losses because of morbidity attributable to fetal alcohol spectrum disorder in Canada: a demographic approach.

The purpose of this study was to estimate the productivity losses due to morbidity of individuals with fetal alcohol spectrum disorder (FASD). A demographic approach was used. Population estimates were calculated using data for the most recent available year (i.e., 2011) on the population of Canada by provinces, the labor force, unemployment rate, and the average weekly wage, all of which were obtained from Statistics Canada. To estimate the number of FASD cases in Canada in 2011, the prevalence of FASD, obtained from the available epidemiological literature, was applied to the general population of Canada. Assumptions made on the level of impairment that would affect the ability of individuals with FASD to participate in the workforce or reduce their productivity were based on data obtained from the current epidemiological literature and experts' opinions. To estimate the cost of FASD, a counterfactual scenario was used with an assumption that there is no one born with FASD in Canada. About 0.03% of the Canadian workforce experiences a loss of productivity because of FASD-attributable morbidity, which translates to aggregate losses ranging from $418 million Canadian dollars (CND) to $1.08 billion CND annually. FASD imposes a considerable economic toll on Canadian society and therefore requires more preventive efforts.

Assessing statistical competencies in clinical and translational science education: one size does not fit all.

Statistics is an essential training component for a career in clinical and translational science (CTS). Given the increasing complexity of statistics, learners may have difficulty selecting appropriate courses. Our question was: what depth of statistical knowledge do different CTS learners require? For three types of CTS learners (principal investigator, co-investigator, informed reader of the literature), each with different backgrounds in research (no previous research experience, reader of the research literature, previous research experience), 18 experts in biostatistics, epidemiology, and research design proposed levels for 21 statistical competencies. Statistical competencies were categorized as fundamental, intermediate, or specialized. CTS learners who intend to become independent principal investigators require more specialized training, while those intending to become informed consumers of the medical literature require more fundamental education. For most competencies, less training was proposed for those with more research background. When selecting statistical coursework, the learner's research background and career goal should guide the decision. Some statistical competencies are considered to be more important than others. Baseline knowledge assessments may help learners identify appropriate coursework. Rather than one size fits all, tailoring education to baseline knowledge, learner background, and future goals increases learning potential while minimizing classroom time.