Experimental epidemiology involves controlled studies in which researchers introduce an intervention and observe its effects. Randomized controlled trials are considered the gold standard, as they randomly assign subjects to study and control groups to limit bias. This allows investigators to determine cause-and-effect relationships. Key features of randomized controlled trials include developing a study protocol, selecting and randomizing a population, implementing an intervention for the study group, following up with both groups, and assessing outcomes to compare results. Well-designed randomized controlled trials provide the strongest evidence for evaluating health interventions and establishing epidemiological relationships.
Observingthedistributionofdiseaseorhealth related events in human population.
• Identify the characteristics with which the disease is associated.
• Basically 3 questions are asked who, when and where.
• Who means the person affected, where means the place and when is the time distribution.
Observingthedistributionofdiseaseorhealth related events in human population.
• Identify the characteristics with which the disease is associated.
• Basically 3 questions are asked who, when and where.
• Who means the person affected, where means the place and when is the time distribution.
Measurements of morbidity and mortality
At the end of the session, the students shall be able to
List the basic measurements in epidemiology
Select an appropriate tools of measurement
Measure morbidity & mortality
Perform standardization of rates
This presentation will help to get an insight into Epidemiological methods and describes details of Descriptive epidemiology. It will be useful to medical researcher as an initial input.
RANDOMIZED CONTROL trials
an assessment method
questions validity and applicability of many preventive and therapeutic procedures
reference Park's Preventive and social medicine
Measurements of morbidity and mortality
At the end of the session, the students shall be able to
List the basic measurements in epidemiology
Select an appropriate tools of measurement
Measure morbidity & mortality
Perform standardization of rates
This presentation will help to get an insight into Epidemiological methods and describes details of Descriptive epidemiology. It will be useful to medical researcher as an initial input.
RANDOMIZED CONTROL trials
an assessment method
questions validity and applicability of many preventive and therapeutic procedures
reference Park's Preventive and social medicine
Steps in conducting a RCT
1. Drawing up a protocol
2. Selecting Reference & Experimental population
3. Randomization
4. Manipulation or Intervention
5. Follow up
6. Assessment of outcome
1. Drawing up a protocol
Aims and objectives of the study
Questions to be answered
Criteria for the selection of study and control groups
Size of the sample & allocation of subjects in both groups
Treatment to be applied - when, where, how
Standardization of working procedures and
Schedules as well as responsibilities of persons involved in the trial up to the stage of evaluation of outcome of the study.
2. Selecting Reference and Experimental Populations
Reference or target population - Population to which the findings of the trial, if found successful, are expected to be applicable (Eg: drugs, vaccines, etc.)
Experimental or Study population
Derived from the Reference population
Has same characteristics as the Reference population
Actual population that participates in the experimental study
Must give informed consent - Should be qualified or eligible for the trial
3. Randomization
Heart of the control trial
Procedure:
Participants are allocated into study and control groups
Eliminates bias and allows comparability
By random allocation every individual gets an equal chance for being allocated in to either groups.
4. Manipulation/ Intervention
Having formed the study and control group, the next step is to intervene or manipulate the study (experimental) group by deliberate application or withdrawal or reduction of a suspected causal factor
Eg: Drug, Vaccine, Dietary component, a habit
5. Follow up
Implies examination of the experimental and control group subjects at defined intervals of time in a standard manner, with equal intensity, under the same given circumstances in the same time frame till final assessment of outcome.
Attrition:
Inevitable losses to follow up (death, migration, loss of interest)
6. Assessment
a. Positive results:
Reduced incidence or severity of disease
Reduced cost to health service
Appropriate outcome in the study
b. Negative results:
Increased severity or frequency of side effects
Complications
Deaths
BIAS:
Any systematic error in the determination of association and outcome.
Bias may arise from errors of assessment of outcome due to human element
Subjective bias
Observer bias
Evaluation bias
1. Subjective Bias:
Participants, subjectively feel better or report improvement if they knew they were receiving a new form of treatment. This is known as “Subject variation”.
2. Observer Bias:
Investigator measuring the outcome of a therapeutic trial may be influenced if he knows beforehand the particular procedure or therapy to which the patient has been subjected.
3. Evaluation Bias:
Investigator may subconsciously give a favorable report of the outcome of the trial.
Blinding:
1. Single Blind Trial: Participant
2. Double Blind: Partcipant + Investigator
3. Triple Blind: Participant + Investigator + Data Analyzer
The randomised controlled trial (RCT) .pptxPRITIBISANE
Randomized controlled trials (RCT) are prospective studies that measure the effectiveness of a new intervention or treatment.
Randomization reduces bias and provides a rigorous tool to examine cause-effect relationships between an intervention and outcome
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
2. Experimental Studies
• Experimental studies are ones where researchers
introduce an intervention and study the effects
under the direct control of the investigator”
• The study in which an investigator manipulates or
controls one or more independent variables and
observes the effect on dependent variables.
3. Unique Features of Experiment
• Experiments provide strongest evidence about the
existence of a cause-effect relationship.
4. Aims of Experimental Epidemiology
❏ To provide “Scientific proof” of etiological or risk
factors which may permit the modification or control
of those diseases.
❏ To provide a method of measuring the effectiveness
and efficiency of health services for the prevention,
control and treatment of disease and improve the heath
of the community.
7. ”An epidemiological experiment in which
subjects in a population are randomly allocated
into groups, usually called study and control
groups to receive and not receive an
experimental preventive or therapetuic
procedure, maneuver, or interventition”
John M.Last, 2001
Randomized Controlled Trials
8. • ”Gold standard” in epidemiological research
• Makes study groups comparable
• Prevents selection bias
Randomized Controlled Trials
10. Steps Involved In Randomized Controlled Trials Are
As Follows :
1. Drawing up a protocol
2. Selecting reference and experimental
populations( Study Population)
3. Randomization
4. Intervention or Manipulation
5. Follow up
6. Assessment of outcome
11. Drawing up a protocol
• Drawing up a Protocol specifies :
Aims and objectives of study
Questions to be answered
Criteria for selection of study and control groups
Size of the sample
12. Procedures for allocation of subjects into study and
control groups
Treatment to be applied-when ,where & how
Schedules as well as responsibilities of parties
involved in the trial up to the outcome of the study
Drawing up a protocol…
13. Selecting reference and experimental
populations
• The experimental population is selected from the
reference population. The results of experimental
population if found successful, it is applied for the
reference population.
14. • Experimental population
• The actual group in which the trial is conducted
• Representive of the reference population
• Possibility for accurate follow up of information
during the trial( stable group )
16. Selection of study population
• Participants must be fully informed
- Purpose
- Procedure
• Risks
• Benefits
• Willing to participate
• Informed consent
• Screened for eligibility
• Inclusion criteria
• Exclusion criteria
17. Randomization is a statistical procedure by which
the participants are allocated into groups usually
called “Study” and “Control” groups, to receive or
not to receive an experimental, preventive or
therapeutic procedure or intervention.
Radomization
18. • Random = governed by chance
• Randomization = allocation of individuals to groups
by chance
• Each sampling unit has the same chance of selection
Radomization
19. Randomization
- Heart of the control trial
- Procedure: Participants are allocated into study
and control groups
- Both groups should be alike with regards to
certain variables that might affect the outcome of
the experiment
- Best done by using table of random numbers
21. Intervene or manipulate the study group:
Experimental group
• Application, withdrawal or reduction of suspected
causal factor
e.g. drug, vaccine, habit
Control group
• no intervention, usual care, placebo
Intervention
22. Examination of experimental and control groups at
defined interval of time,
in a standard manner,
with equal intensity,
in the same time frame
until the final assesment of OUT COME
Follow-up
23. • Some losses to follow up are inevitable such as death,
migration, loss of interest- "Attrition "
• Possible reasons for non-adherence
• Developing side effects
• Forgetting to take medication
• Withdrawing consent
• Decide alternative treatment
• Health issues: treatment contraindicated
• Extent of non-adherence is related to length of study time
Attrition:
24. This is the final step of the trial. The outcome may
be positive or negative. During the assessment of the
outcome, bias is inevitable.
Positive (Benifits) and Negative (side effects etc..)
results are compared in both groups.
If there is difference, Test of Significance is applied
to find out the significance.
Assessment
BIAS ARISE FROM ERRORS OF ASSESMENT OF THE OUTCOME
30. Types of Randomized controlled trials
Clinical trials
Preventive trials
Risk factor trials
Cessation experiments
Trial of etiological agents
Evaluation of health services
31. 1. Clinical Trial
- Concerned with evaluating therapeutic agent,
mainly drugs
eg. Evaluation of beta-blockers in reducing
cardiovascular mortality
32. 2. Preventive Trials:
- Trial of primary preventive measures eg.
Vaccines
- Analysis of preventive trials must result in clear
statement about benefits to community, risk
involved and cost to health
33. 3. Risk Factor Trials:
- Investigator intervenes to interrupt the usual
sequence in the development of disease for
those individuals who have risk factor for
developing the disease
- Primary prevention of CHD using clofibrate to
lower serum cholesterol
34. 4. Cessation Experiment:
- An attempt is made to evaluate the termination
of a habit which is considered to be causally
related to disease
- Cigarette smoking and lung cancer
35. 5. Trials of Etiological Agents:
- To confirm or refute an etiological hypothesis
6. Evaluation of Health Services:
- To evaluate effectiveness and efficiency of health
services
- Domiciliary treatment of Pulmonary Tuberculosis was as
effective as the more costlier hospital or sanatorium
treatment
36. • Ethical issues
• Feasibility
• Problems of finding sufficiently large eligible
sample size
• Costs
• Expensive
Unique problemes of intervetion studies
37.
38.
39.
40.
41.
42.
43.
44.
45. APPLICATION OF
EPIDEMIOLOGY
To describe the spectrum of disease.
To describe the natural history of disease.
To formulate Community Diagnosis
To Describe the clinical picture of a disease
To Identify the factors that increase or decrease of disease
To Identify precursor of disease & syndrome
Test the efficacy of intervention strategies
Investigation the epidemic of unknown disease
Evaluate public health programme
Elucidate the mechanism of disease transmission