April 2013 - The Epidemiology Monitor

Rapid Epidemiologic Investigation And Public Health Action Credited With Dramatically Saving Lives In Fungal Meningitis Outbreak The 20 state outbreak of fungal meningitis which erupted last September has become the largest outbreak of health care associated infections in the US. More than 300 professionals from CDC and thousands of public health professionals nationally were involved, according to CDC epidemiologist Benjamin Park, speaking at the annual Epidemic Intelligence Service (EIS) April

conference in Atlanta.

As of late April 2013, 733 cases and 53 deaths have been reported with the largest number reported from Michigan, Tennessee, and Indiana.

Caused by the rare mold exserohilum rostratum, the clinical disease was completely new and there was zero clinical experience in dealing with -Rapid continued on pg 2

Brainstorming Session Produces Unconventional Ideas For Fighting Obesity An interesting and possibly unique brainstorming session with experts and non-experts in nutrition targeted at uncovering new ways to fight childhood obesity was sponsored and held recently at the Robert Wood Johnson Foundation. The event was organized by a consulting firm called The Greatest Good. The only rule for the session was that no idea was off limits.

The Catastrophe There was quick agreement among the

group that obesity is a serious problem illustrated vividly by the prevalence of childhood obesity which has tripled in 40 years.

Currently, 17% of children and adolescents are obese, and 66% of adults are overweight or obese, according to the participants. The situation was characterized as “catastrophic� and also expensive.

Some 20% of health care spending can be accounted for by obesity, and that health care spending is itself -Obesity continues on page 9

In This Issue: -3Langmuir Lecture

by Samet -5Snow Celebration Showcases Expanding Use of Epi -6Notes on People -7Lancet Honors Snow -11Jobs

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April 2013 Volume Thirty Four Number Four

-Rapid continued from pg 1 “Doing preliminary math with these figures was very worrisome”

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it, according to CDC’s Tom Chiller who helped coordinate the guidance given to clinicians.

It has been called a “catastrophic event” and “disturbing tragedy” by CDC epidemiologists Beth Bell and Rima Khabbaz writing in a recent issue of JAMA.

public, and developing and disseminating treatment guidance as the outbreak continued to unfold.

According to CDC, 99% of patients were warned in less than one month of the immediate need to seek medical care. Also, CDC’s meningitis outbreak pages were accessed more than a million times during the outbreak.

Case Fatality Rates

Early Worries State and federal agency speakers at a special lunchtime session of the EIS conference noted that the data on the first few cases suggested a high case fatality rate. Also, previous outbreaks linked to spinal injection with contaminated products had found case fatality rates in excess of 40%.

After rapid identification of the source of the outbreak as contaminated methylprednisolone acetate prepared by the New England Compounding Center in Framingham Massachusetts, investigators discovered that almost 14,000 persons had been exposed and were at risk of invasive fungal infection. Doing preliminary math with these figures was very worrisome as it appeared the US was facing a potential for hundreds of cases and deaths from the outbreak.

The Good News The good news according to Bell and Khabbaz is that scores of cases and deaths appear to have been averted by interventions such as discontinued use of the suspect medication, notification of at-risk patients, communicating with the eveloping and disseminating

The most compelling evidence for the effectiveness of public health interventions comes from the “dramatic decrease in the 30 day case fatality rate among patients diagnosed with meningitis after the outbreaks was recognized and public health action initiated,” according to Bell and Khabbaz. That case fatality rate fell from approximately 40% before outbreak detection to below 7% after the outbreak response. The overall CFR with both groups of cases before and after outbreak detection included is 7% as of late April 2013.

Lives Saved Also speaking at the conference, Tennessee’s health care epidemiologist Marion Kainer stated that she had reliable data on which estimate the value of rapid public health actions and was able to document very convincingly that at least 99 cases were prevented and 69 deaths averted in that state alone.

According to CDC’s Park, over 100 lives were saved nationally as a result of the efforts to achieve early -Rapid continues on page 8

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Langmuir Lecture By Samet Says Policy Approaches Are Evolving And Epidemiologists Should Be Engaged “Snow Model” In Which Facts Speak For Themselves No Longer Applies “He believed in the democratic tradition that making the facts known to those who need them is the basis for achieving effective action,” and “…it is the epidemiologists’ function to get the facts to the decision makers.”

than facts is needed, according to Samet, and he encouraged epidemiologists to adopt new models for thinking about epidemiology and the policy process, and to play new roles in it.

Quoting William Farr, an early pioneer in epidemiology, in the first instance, and Alexander Langmuir, the father of shoeleather epidemiology, in the second instance is how the University of Southern California’s Jonathan Samet began his Langmuir lecture at the 86th annual meeting of the American Epidemiological Society in East Lansing Michigan in late March.

Snow Model in Action

A key objective for Samet’s talk was to depict the conceptual model of the research and policy or data translation process which has guided epidemiologists since about the time of John Snow and the removal of the Broad Street pumphandle.

This model, which Samet labeled the Snow model for the Langmuir lecture, and which has been referred to as the “public health model”, consists of five steps-1) identifying the problem, 2) gathering data, 3) analyzing and interpreting the evidence, 4) translating from evidence to action, and 5) surveillance or continued tracking of the problem. The underlying assumptions behind this model are that decision makers are listening to the facts, and the facts will speak for themselves about what public health action should be taken.

Whether or not the Snow model ever pertained quite as straightforwardly as implied is beside the point for Samet. A second key objective of his talk was to demonstrate that the Snow model no longer characterizes the evolving real-world of policy making today. Something more

Samet used the example of tobacco and lung cancer to walk his audience through the five steps of the Snow model and how they were carried out for that exposure/disease combination.

While uncertainty about the evidence provided by epidemiologists has always been part of the assessment of evidence, that assessment process in today’s world has become more complicated by the involvement of more activists, greater attention to costs, attention to more political considerations, and by attacks on the quality of evidence itself, Samet told the group.

In using the Snow model today to help decide about potential public health actions, the strategies are to conduct more studies, carry out systematic reviews, and communicate the findings.

However, for each of these steps which can help to tip the balance in favor of taking or not taking public health action, counter strategies are being used by special interests to question the very existence of problems, conduct bad studies, attack the methods used in good studies, provide alternative interpretations of findings, and discredit findings---all to block action.

“The underlying assumptions behind this model are that decision makers are listening to the facts”

“he encouraged epidemiologists to adopt new models for thinking about epidemiology and the policy process”

Samet described the activities of tobacco companies and of industries wanting to block ozone standards -Samet continued on page 4

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-Samet continued from page 3

“Did John Snow break the pump handle?”

required by the Clean Air Act as examples of the new realities facing 21st century epidemiologists. Samet cited several recent books with titles such as “Merchants of Doubt”, and “Doubt Is Their Product” to buttress his observations about the current policy process.

What To Do About It? One option would be for epidemiologists to take more direct action to bring about evidence-based public health interventions. Samet cited a recent editorial in the Journal of the World Public Health Nutrition Association which claims that John Snow actually succeeded in removing the Broad Street pump not by the force of his data, but rather by taking the law into his own hands, defying the decision makers, and breaking off or removing the handle himself from the Broad Street pump.

Samet asked provocatively, “Did John Snow break the pump handle?”

“Power concedes nothing without a demand. It never did and never will…”

Is that what it would take? The same editorial quotes Frederick Douglass, “Power concedes nothing without a demand. It never did and never will…”

The editorial asks if public health professionals are too polite for the good of their cause.

While not asking the same question about epidemiologists, and not advocating defiance on their part to get things done for public health, Samet told his audience that researchers could be doing a better job in bringing the data to the policy process. He called for 1) quantifying uncertainty, 2) enhancing the informativeness of research for decisionmaking, 3) changing evidence evaluation schemes, and 4) preparing researchers for translation.

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Core Responsibilities Samet put forth that epidemiologists may have core responsibilities in communicating to stakeholders and decision makers, assuring that their evidence is interpreted correctly, monitoring the policy process, and engaging in the policy process.

Assuming these responsibilities are core, he identified roles for epidemiologists in the process as experts, consultants, committee members, stakeholder representatives, and as participants in the policy process.

In addition to these more proactive stances, Samet suggested that additional efforts to create a new policy process model might address additional training in policy translation, the creation of translation specialists such as was suggested recently by Dowdy and Pai in Epidemiology (1), conducting surveillance for the use of evidence, adopting new roles for professional organizations, and creating new partnerships.

Conclusion In his concluding remarks, Samet reminded the audience that epidemiology is important for policy, times have changed since Snow and even since Langmuir, policy approaches are evolving, and epidemiologists should be involved in their evolution.

References: 1. Epidemiology 2012; 23(6) :927-8 ■

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Snow Celebration Showcases The Expanding Use Of Epidemiology To Investigate Non-Health Problems Should Epidemiology Be Seen As A Social Science Rather Than A Medical Discipline?

Celebrations marking the 200th anniversary of the birth of John Snow have revealed some surprising new ideas and perspectives about “the father of epidemiology”. One example is the recent two-day meeting held on April 11-12 at the London School of Hygiene and Tropical Medicine entitled “Snow’s legacy: epidemiology today and tomorrow.”

In addition to the normal fare which can be heard at epidemiology meetings such as talks about causation, surveillance, infectious agents, and/or public health, the London meeting included speakers on the use of epidemiology to study financial networks, violence, economic development, crime, and even education.

What Is Epidemiology Anyway?

According to Paul Fine, one of the organizers of the meeting, a key purpose was to “expand on the conventional” and showcase the variety of applications of epidemiology. The presentations succeeded in raising questions about the boundaries of epidemiology, according to Fine. He added “after all, the term disease is not part of the original meaning of ‘epi’ and ‘demos’, the root words of epidemiology.”

In preparing for the meeting, Fine noted the field of epidemiology has evolved from an initial focus on infectious disease such as cholera, to chronic diseases, to health related

events other than disease, and now its methods are being applied to an ever widening group of population phenomena and social challenges such as those noted above. “Where do you draw the line between epidemiology and these other disciplines which use similar methods”, asked Fine. Some of these new disciplines such as crime science even go so far as to claim Snow as a pioneer in their fields as well.

“after all, the term disease is not part of the original meaning of ‘epi’ and ‘demos’”

Conference Speakers A review paper based on the abstracts from the meeting has already appeared in The Lancet in early April entitled “John Snow’s legacy: epidemiology without borders”. Among the presentations which expanded the conventional thinking about the use of epidemiology was one by Chicago’s Gary Slutkin. He described his use of epidemiologic concepts such as mode of transmission to better understand and prevent homicides.

Robert May discussed financial networks and noted that the rise in financial assets and subsequent crash of financial markets resemble very closely the epidemic curves one sees with measles or other infections. Using the concept of superspreaders derived from infectious disease epidemiology, investigators are better able to prevent problems in some banks -Snow continued on page 6

“Where do you draw the line between epidemiology and these other disciplines”

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-Snow continued from page 5 from spreading to others in the financial system. May stated that society owes Snow and others more than is often realized.

“society owes Snow and others more than is often realized”

epidemiology.

“Immense opportunities exist for rigorous educational randomized controlled trials”

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Richard Wortly describes how Snow’s mapping of disease has helped to create “situational crime prevention” in which crime scientists map the distribution of crime around “environmental crime generators” and create prevention strategies accordingly.

Carole Torgerson described the relevance of epidemiology in the field of education by focusing on the need for clinical trials in this field.

“Immense opportunities exist for rigorous educational randomized controlled trials”, said the speaker. In contrast, Angus Deaton said the increasing use of randomized controlled trials in economics to study economic development has proven unhelpful. Trials have limitations of their own (they do not help to understand underlying mechanisms of action), and often have not been well designed in studying economic development.

In concluding the review paper, the authors/speakers at the event note that “Almost all self-described epidemiologists nowadays work within the health arena, and this is the focus of most of the societies, journals, and courses that carry the name epidemiology. The range of applications evident in these contributions might encourage some of these institutions to consider broadening their remits. In so doing, they may contribute more directly to,and learn from, the non-health-

related areas that use the language and methods of epidemiology to address many important problems now facing the world. ■

Notes on People Honored: Laurence Kolonel, University of Hawaii Professor, with an award for excellence in cancer epidemiology and prevention given by the American Association for Cancer Research and the American Cancer Society. Kolonel was to be honored and speak in Washington DC in early April on a topic entitled “Advancing Epidemiologic Research: Studies in ‘Special’ Populations.”

Profiled: Susan Baker, Johns Hopkins School of Public Health injury epidemiologist, in the spring issue of the Johns Hopkins Magazine. Baker has made a long career of studying injuries and her large body of work made it legitimate for epidemiologists to work in the field, according to one of her colleagues. Baker is still active studying fatalities caused by fires and sightseeing flights.

Profiled: Ross Brownson, Washington University in St Louis, by the University’s Newsroom. The article traces Brownson’s career through both public health and academic work. According to the article, “And it is his demeanor — calm, amiable, unflappable — that, when combined with his experience in both the public sector and academia, makes him uniquely situated to effect real change in public health from his office as codirector of the Prevention Research Center in St. Louis.” [ http://tinyurl.com/crfznma ]

The Lancet Honors John Snow For 200th Anniversary With A Revised Obituary And Other Articles The Lancet has published four separate papers offering perspectives and commentary about the work of John Snow, his legacy, and the impact on epidemiology today (April 13, 2013).

One of these is a review paper based on the abstracts of the celebration of Snow’s life held at the London School of Hygiene and Tropical Medicine in mid April (see related article this issue). What follows is a recap of the other papers, including a new obituary for Snow written for The Lancet by Snow author Sandra Hempel.

New Obituary for Snow The new obituary for John Snow is in effect an apology for the way The Lancet handled his original brief obituary in 1858 with no mention of epidemiology and cholera, and for the erroneous editorial criticisms of Snow which the journal made on more than one occasion. The new editorial also recounts the major elements of Snow’s contributions to epidemiology and adds many interesting details about his personal life (e.g., he had a talent for telling funny anecdotes).

The assessment of Snow’s work which proved to be the most incisive was not that of The Lancet and its editor but that of a medical officer who said in a letter, “although ephemeral criticism has been uniformly against him, yet I venture confidently to predict, that the facts which have been brought to light by his indefatiguable industry will prove to posterity that he was by far the most important investigator of the subject of cholera who has yet appeared.”

Singular Man In a perspectives paper entitled “The Singular Science of John Snow”, Nigel Paneth from Michigan State Univesity and Paul Fine from the London School trace Snow’s thinking and contributions on anesthesia as well as cholera. The authors characterize Snow’s science work as “creative and productive” and reflecting a “singular, unified scientific approach”. What comes through in the paper is that Snow was truly “one of a kind”, and this uniqueness in multiple domains helped him to make the contributions he is known for.

“he was by far the most important investigator of the subject of cholera who has yet appeared”

Epidemiology for the People In a third commentary by Paul Fine and colleagues at the London School, entitled “Epidemiology---A Science For The People”, the authors comment on the evolution, influence, and expanding scope of epidemiology as a discipline. They trace the evolution of epidemiology from its focus on infectious diseases to what today is a much wider set of applications. The authors attribute this wider use to what they describe as a shift in thinking and emphasis in epidemiology towards the logic of problem solving.

“a shift in thinking and emphasis in epidemiology towards the logic of problem solving”

This shift is perhaps not surprising to those who have always considered the problem-solving mindset as the key ingredient of the epidemiologist, and and Snow the scientist was considered -Lancet continues on page 8

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“it is rare that public health professionals can point with such certainty to a concrete number of lives saved”

-Rapid continued from page 2

-Lancet continued from pg 7

diagnosis and treatment. He added it is rare that public health professionals can point with such certainty to a concrete number of lives saved as a result of prevention efforts. Given the Tennessee data, the CDC estimate may be low since a total of 20 states were involved.

a practical problem solver by Paneth and Fine in their description of his “singular” nature.

Simply Said A simpler way of stating the impact of public health actions was presented in a CDC infographic on the outbreak which stated “despite the number of cases increasing, the death rate dramatically decreased thanks to swift public health action.”

Earlier Article An article appeared in this newsletter last year describing how right thinking and right action by clinicians, epidemiologists, and public health officials helped to save lives. Now we have a fuller picture as evidenced by the case fatality rates of just how effective the public health response has been.

“the death rate dramatically decreased thanks to swift public health action”

Use this link to read the original article entitled“Clinician and Epidemiologist Are Praised For Alertness and Shoe-Leather Detective Work In Finding Cause Of Fungal Meningitis Outbreak.” http://tinyurl.com/czoutew ■

The authors conclude that it is to society’s advantage that the methods of epidemiology be applied as broadly as possible to a wide range of societal as well as individual human ills. Epidemiology is considered so relevant and useful in fact that the authors propose it should be incorporated as part of the science course requirements for all high school students. Viewed in this way, epidemiology literacy should be a key component of population-wide science literacy, and explains the title of this commentary which presents epidemiology as a science for the people. ■ Worldwide epi job listings: http://tinyurl.com/cy6k3fu

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- Obesity continued from pg 1 20% of the Gross Domestic Product. In short, the participants found “lots of reasons to address obesity.”

Some of the more unusual solutions brought forth included: 1. Restrict unhealthy foods to certain designated sections or locations in supermarkets.

2. Abolish sucrose and fructose. The idea is to simply take these ingredients “off the face of the earth,” said the contributor.

3. Eliminate tax deductions for the portion of food company expenses that do marketing to children 4. Create a national campaign that focuses on how soft drinks kill people.

This will create pressure on the companies that make these products to change their ways. In short, shame the companies into making changes.

5. Eliminate all marketing such as that on billboards and television. Sequester the marketing to certain places so that people would have to opt-in to access marketing messages rather than have them disseminated without consent.

According to this idea, persons would have to actively go out to get the information they wanted for various products or items.

6. Incentivize parents to create a more healthy home environment for eating by altering work-based health insurance or welfare benefits.

7. Hold the educational system accountable for making progress in educating about nutrition and providing physical activity.

8. Shift the paradigm and terminology from “obesity” to “malnutrition” because the term obesity carries too much negative baggage at this time.

9. Create a public awareness campaign focused on the wide variety of negative outcomes that all derive from one thing---obesity.

Show how 1 thing causes 100 bad things.

10. Send notices to all the homes of parents telling them about the prevalence and dangers of “metabolic derangement”, another substitute term for obesity with potentially more traction than the current term.

“Create a national campaign that focuses on how soft drinks kill people.”

11. Focus on “healthy eating” and fostering positive behaviors instead of “obesity” since the obesity focus also produces eating disorders.

12. Conduct a community trial in which unhealthy food is taxed and healthy food is not to see how much it would cost to nudge people away from unhealthy choices.

13. Create a piece of “caloric monitoring jewelry” such as a bracelet that persons could wear and while eating would register in real time how many calories they are consuming. Since people learn better when the response to an action is more immediate, this real time feedback would help modify eating behavior. As it is, the negative consequences of overeating are not immediately apparent.

“Create a piece of “caloric monitoring jewelry”

14. Introduce non-reproducing -Obesity continues on page 10

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-Obesity continued from page 9 parasites into the body such as tapeworms which could consume any excess calories people ingested.

People could continue to eat, companies could continue to sell food, and the tapeworm would prevent weight gain.

“People could take a whiff and lose their desire to eat.”

15. Create revolting smelling matter such as dried vomit that could be placed in jars. People could take a whiff and lose their desire to eat.

Economos, who studies obesity and childhood nutrition at Tufts ; Steven Gortmaker of the Harvard School of Public Health; Nobel laureate Daniel Kahneman; Harvard economist David Laibson; RWJF Health Group senior vice president Jim Marks; Brian Mullaney, co-founder of Smile Train and WonderWork; Eric Oliver, a political scientist at the University of Chicago who has written a book about obesity; and Mary Story from the School of Public Health at the University of Minnesota. ■

Final Note

“experts in nutrition seemed to favor more environmental or macro level changes”

In a thought-provoking observation at the end of the podcast, the hosts noted that the non-nutrition experts who participated in the session tended to be more sympathetic to solutions which require more individual self-control or exercise of personal responsibility, while the experts in nutrition seemed to favor more environmental or macro level changes. No one could describe what the mechanism might be that would explain this dichotomy if indeed it was real.

To listen to the 37-minute podcast on freakonomics radio, visit : http://tinyurl.com/cdpaysu According to the site, the participants in the brainstorming session were:

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Peter Attia, a former surgeon who now runs a nonprofit focused on nutrition; Kelly Brownell from the Rudd Center For Food Policy & Obesity at Yale; Geoffrey Canada of Harlem Children’s Zone; Bill Dietz, the former director of the Division of Nutrition, Physical Activity, and Obesity at the CDC: Chris

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Director of the Program for Aging, Trauma & Emergency Care (PATEC) The University of Maryland School of Medicine seeks a full-time faculty member at the Associate or Full Professor rank to be the inaugural Director of the Program for Aging, Trauma, and Emergency Care (PATEC). The Director will draw on outstanding campus resources to create an interdisciplinary translational research center of excellence dedicated to ground-breaking research to improve older adults’ trauma and emergency care outcomes.

Its nationally and internationally recognized strengths in aging, trauma, and emergency care make the School of Medicine well-positioned to become a national leader in geriatric trauma and emergency care. With multiple NIH awards in aging and trauma, the School is home to:

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The Center for Research on Aging and its four NIA- and VA-funded center of excellence in aging including: Baltimore Hip Studies, the largest program of research on hip fracture recovery in the world; ■ Gerontology Research, Education, and Clinical Center (GRECC); ■ NIA Claude D. Pepper Older Americans Independence Center; ■ VA Maryland Exercise and Robotics Center of Excellence (BERCE) in stroke rehabilitation.

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The Program in Trauma is home to: The Shock, Trauma and Anesthesiology Research Organized Research Center (STAR-ORC).

■ The only multidisciplinary dedicated physician group that cares for injury in the United States. The group practices ■

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at the UM Medical Center’s world class R Adams Crowley Shock Trauma Center: • The nation’s largest trauma center • An international standard-setter for injury care and one of the most sophisticated prehospital systems in the country.

• Partnered with the Maryland Institute for Emergency Medical Services Systems to provide sophisticated expert medical care.

The National Study Center for Trauma and EMS, a leader in NIH- and other federally funded traffic safety research staffed by nationally known epidemiologists, physicians, statisticans, and database coordinators.

The Department of Emergency Medicine (DEM) is home to: More than 75 board-certified or board-eligible faculty physicians, including some of the nation’s most ■ ■ ■

accomplished clinicians, teachers, and leaders in emergency medicine who staff the emergency departments at four Baltimore hospitals, in addition to the University of Maryland Medical Center.

Outstanding clinical education and research opportunities at the four affiliated hospitals which oversee the care of approximately 182,000 patients / year.

A rapidly growing research enterprise.

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Strong infrastructural support in health services research.

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Multiple collaborative opportunities with faculty from the Schools of Pharmacy, Nursing, Dentistry, Social Work, and Law on the UM health campus, and the University of Maryland Health System.

The Program for Aging, Trauma, and Emergency Care joins the clinical and research expertise of the Center for Research on Aging, the Center for Shock, Trauma and Anesthesiology Research (STAR), and the Department of Emergency Medicine. It brings together more than 40 clinicians and researchers from the Schools of Medicine, Nursing, Pharmacy, and Social Work at the University of Maryland and the University of Maryland, Baltimore County to identify interdisciplinary approaches to improving the outcomes of older adults from bench to bedside to community. More information about PATEC can be found at: http://tinyurl.com/boqk87v The Director will be expected to bring national vision and leadership to PATEC, mobilize and coordinate scientists whose interdisciplinary research can benefit older people in emergency departments and trauma centers; and attract funding to build the Program.

The successful candidate for the position should have a PhD and/or MD degree with substantial experience conducting interdisciplinary research, a solid record of extramural research funding, and demonstrated leadership capabilities. Candidates from all disciplines are welcome to apply, and should have a successful record of clinical and / or epidemiological research in areas such geriatrics / gerontology, emergency medicine, anesthesiology, trauma / injury, or preventive medicine.

Compensation and support will be competitive. Applications of a cover letter, CV and three references should be submitted to lklein@epi.umaryland.edu . Confidential correspondence related to this position may be directed to Jay Magaziner, Ph.D., M.S. Hyg., chair of the search committtee at 410-706-2406 or jmagazin@epi.umaryland.edu The University of Maryland, Baltimore is an Equal Opportunity, Affirmative Action Employer. Minorities, women, veterans and individuals with disabilities are encouraged to apply.

EPIDEMIOLOGY JOB BANK Postdoctoral Position-Occupational Epidemiology A postdoctoral position is available for a motivated individual to collaborate on occupational epidemiology projects as part of an expert team in the Department of Environmental and Occupational Health at the Drexel University School of Public Health in Philadelphia.

The candidate will have a doctoral degree in a relevant discipline, such as epidemiology and/or exposure assessment for occupational/environmental studies. A background in occupational health and experience working with case-control data are beneficial, but not required. The successful candidate will have strong communication skills, the ability to manage and manipulate large datasets of diverse structures, excellent analytical capabilities, and programming expertise in SAS. Additional experience with programming in R would be advantageous. The postdoctoral fellow will collaborate and earn coauthorship on a large, international, multicenter project, and will also have the opportunity to develop and lead ancillary project(s) of an etiologic or methodologic nature. The position is funded for 2 years, and we offer a comprehensive compensation package.

Drexel University has a vibrant, growing School of Public Health, and Philadelphia is one of the most diverse and culturally rich cities in the US, with a relatively affordable cost of living compared to other major metropolitan areas. Please send inquiries to Dr. Anneclaire De Roos at aderoos@drexel.edu. To apply, please visit www.drexeljobs.com and search for Post-Doctoral Fellow, requisition #5272. Please include a statement of interest, CV, and contact information for 3 references.

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The Institute for Circumpolar Health Studies (ICHS) (http://www.ichs.uaa.alaska.edu/) is a public health research institute within the College of Health at the University of Alaska Anchorage (UAA). The focus of the Institute is research and policy development in public health and health systems. Prospective research focuses are the social and physical determinants of Alaskan population health (including access to quality health care, addiction to alcohol, tobacco, and other substances, diet and nutrition, and global climate change).

Research Manager

PN: 0066245

https://www.uakjobs.com/applicants/Central?quickFind=80491

Post Doctoral Fellow

PN: 0066297

https://www.uakjobs.com/applicants/Central?quickFind=80572

CAAS Director

PN: 0065341

The Center for Alcohol and Addictions Studies (CAAS) was established by the Board of Regents in 1972 to address the problem of substance abuse in Alaska. The Center is housed within the Institute for Circumpolar Health Studies (ICHS).

https://www.uakjobs.com/applicants/Central?quickFind=79130

Biostatistician The National Academy of Sciences seeks a scientist to fill a biostatistics position at the Radiation Effects Research Foundation (RERF) in Hiroshima, Japan.

Primary responsibilities are statistical consulting on the design of radiation research protocols and analysis of research data in consultation with RERF epidemiologists, clinical researchers, and laboratory scientists, with additional independent research on related statistical methodologies and applications.

Please visit: http://tinyurl.com/6umootf EOE, M/F/D/V

Opportunities This Month 11 – Univ. MD / Dir. PATEC 12 – Drexel Univ. / PostDoc Occupational Epi 12– Univ. Alaksa Anchorage / Multiple 13 – UC Davis / Chair – Pub. Health Sciences 14 – UTMB / PostDoc – Womens Repro Health 14 – Emory/ Career MPH 14 - NAS / Biostatistician 15 - Geisinger Health / Dir. Epi Research 16 - Baylor / Cancer Epidemiologists 16 – UC Davis / Faculty – Violence Epi

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Cancer Epidemiologists The Dan L. Duncan Cancer Center at Baylor College of Medicine in Houston, Texas is seeking cancer/molecular epidemiologists at all academic levels. The Center has considerable resources to expand the program in Cancer Prevention and Population Sciences, and the successful candidates will have an important role in the continued growth of this program. The individuals will have the opportunity to collaborate with other epidemiologists, geneticists, biologists, and clinicians in the Cancer Center and its affiliated hospitals. Previous research experience, history of successful peer-reviewed grant funding, and a relevant publication record are required. The candidate will be expected to develop an independent research program with peer-reviewed funding Salary and start-up package will be commensurate with qualifications and prior experience. Interested candidates should submit curriculum vitae, a summary of past work, a brief outline of future plans, and the names of at least three individuals who will provide letters of support. Open until filled.

New Endowed Faculty Position In Violence Epidemiology University of California, Davis, School of Medicine The Violence Prevention Research Program in the Department of Emergency Medicine is seeking to fill a faculty position at the Associate or Full Professor in Residence level. Its focus is on the design and execution of large-scale observational and experimental research into violence and its prevention. This faculty member will serve as VPRP’s Associate Director and as the Vice Chancellor’s Chair in Violence Prevention, an endowed position.

The Vice Chancellor’s Chair will conduct independent research, collaborative research, teaching, and mentoring. Applicants must possess a doctoral degree in epidemiology, medicine, or a related discipline. There must be an established record of independent and collaborative research on violence or injury, including demonstrated experience in the design, conduct, and reporting of large-scale observational and/or experimental studies. The position is open to both clinicians and non-clinicians.

Please see the full announcement at: http://tinyurl.com/c3zswp5

Applications: Melissa Bondy, Ph.D., Associate Director for Cancer Prevention and Population Sciences Program, Baylor College of Medicine, One Baylor Plaza, BCM 600, Houston, Texas 77030 or email to mbondy@bcm.edu.

Baylor College of Medicine is an Equal Opportunity/Affirmative Action/Equal Access Employer.

Review of applications will begin in March 2013 and will continue until position is filled. Applicants should send a cover letter outlining their qualifications and areas of interest; a CV; and contact information for five references to Garen J. Wintemute, MD, MPH, at gjwintemute@ucdavis.edu .