Author: chris

Introduction

In the Canadian history, there has been a long debate and a lack of consensus on the legal status of cannabis. Since 1997, public opinion polls have found an increasing percentage of citizens believe “smoking marijuana should not be a criminal offence”. The newly elected liberal party of Canada addressed the issue with cannabis by stating “We will legalize, regulate, and restrict access to marijuana.” The Liberal Party removed the marijuana consumption and incidental possession from the Criminal Code. They promised to create stronger laws and focus on punishing more severely on those who provide marijuana to minors or sell it outside the new regulatory framework. New and appropriate federal and provincial excise taxes will also be applied on Marijuana. This is a huge leap from Canada’s traditional law of strictly prohibiting marijuana. The Liberal Party will face many obstacles when implementing this policy. In this paper, I will use normative and positive analysis to access the government intervention on legalizing marijuana. I will compare the new policy with the old one for fairness and effectiveness. I will also look into how the two policy affect different key stakeholders like special interest parties and consumers. Recommendation will be given after the analysis to either mitigate implementation risk or adjust policy.

Government Intervention

Normative Analysis

The Liberal Party believes Canada’s previous prohibition of marijuana did not prevent young people from using it, instead, it puts too many young Canadians into the criminal justice

system for minor offences. At the same time, it increased the cost of prosecuting those petty crimes. A normative comparison of the new policy with traditional policy will be made to access effectives. What should the government do to act in best interested of society. Under the traditional law, prohibit marijuana has led to a market failure. Some ineffectiveness comes from consuming marijuana led to impaired driving and car accidents and a large illegal market for selling marijuana. How much taxes has it gained and how much has it spend on prosecuting illegal marijuana’s? The new law aims to legalize and collect taxes on exercising marijuana, will that be sufficient to correct the negative externality? Will the taxes be low enough to turn people away from black markets? How will the pot industry change under the new relaxing policy? Another comparisons will be made for the fairness of the two policy. The tradition law punishes almost everyone who comes into contact with marijuana while the new law puts more focus on the ones that sell marijuana to the minors. By putting myself in different key stakeholders point of view, I will evaluate which one is for fair for young Canadians, marijuana consumers, sellers and the society. Colorado is one of the four cities in the United States that legalized marijuana. A brief comparison of Liberal’s policy and Colorado’s will be made to gather the effectiveness and fairness in an international standpoint.

Positive Analysis

It seems a majority of Canadians believe the government should relax the cannabis regulation. This section will focus on the public opinion poll to see what the government ought to do when dealing with marijuana. Legalized marijuana could change Canadian cities in different ways for the province has a say in determine how much tax they choose to exercise. Will the

new law be favored by majority of Canadians or will it cause public outrage.

This section will also discuss to what extent does the lobbyists have affected the liberal government’s decision. Bloc Pot, a Quebec pro-marijuana party also a major contributor to the Liberal Party, has seen their dreams of legalizing marijuana coming true. What are the strengths and weakness of this party and how will they benefit the society will be discussed in greater detail. There are also parties who strongly oppose to normalize marijuana. The Canadian chapter of Smart Approach to Marijuana is looking to push back on the pro-marijuana crowd. A detailed reasoning and their strengths and weakness will also be discussed in greater detail in this paper.

Recommendation

After the two analysis, I will gain a better understanding of whether legalizing marijuana will have more benefit or costs on society. If greater benefits are added to society, I will give out recommendations to the Liberal party on how to mitigate public outrage on those who are opposing to the law. If the analysis favors the traditional law, I will give out recommendations on what specific measures the Liberal Party can input on marijuana to exercise a stricter law.

My assessment involves creating a 50 minutes seminar lesson plan for ONE session (I will provide a sample for a different subject) aimed for an undergraduate year 2 mathematics students (The topic of that session can be anything related to what a second year undergraduate student would be taught e.g.. Complex analysis, Numerical methods etc).

Following this, I need to write a 2000 word piece which demonstrates consideration of the activities within the plan accompanied by appropriate rationale for their implementation. This aspect of the work must draw on relevant theory and literature, and demonstrate an appropriate level of criticality and analysis.

Assessment Criteria:

-Explain and justify the focus of your teaching plan with reference to your previous, current or future practice (10%)
-Comprehensive lesson plan clearly outlined (10%)
-Consideration of appropriate activities within your plan with rationale for their implementation (30%).
-Critical discussion throughout with appropriate application of theory/literature (30%).
-Clear, concise and logical development of the work with accurate referencing using a recognised referencing system (10%)
-Completion of a self assessment with marks and comments provided (10%)

Lastly, for the self-assessment criteria, I will attach a document that has to be completed,
to fulfil the last criteria. That is to consider how well you believe you have met each assessment criterion, and what mark you would give yourself for each. Also you should comment on what you have been able to do well and discuss whether there are areas you could develop further.

TO THE WRITER:
I THINK IT ALSO WORTHS MENTIONING THAT I HAD NO EXPERIENCE OF TEACHING A SEMINAR (ROUGHLY 20/30 STUDENTS).
PLEASE DO NOT HESITATE TO CONTACT ME IF YOU NEED ANY ADDITIONAL INFORMATION.

Individual Weekly Entries
Week 2 Entry

The content of this week’s journal consisted of numerous important key concepts that had a large impact on many countries in the past, and still continue to influence today. These concepts were looked at through the lecture and readings which include; Colonialism, Post-Colonialism, Modern Colonialism, Imperialism, Orientalism, and Civilising the Savage.

My initial perception of Colonialism was basically one colony wishing to move to a foreign land and expand their cultural norms in that place, but according to Loomba (2002) it is much more; it involves unforming or re-forming the communities that existed there already. In addition, such activity of change resulted to genocide, enslavement, warfare, and rebellions. Imperialism is another key concept that involves the taking over another community, but is highly motivated under a rule of an emperor. Therefore, if this notion of imperialism ceases to have an imperial centre that governs, then this will fail to fall under the category of Imperialism.

Orientalism is also a key concept, which involves looking through a lense that distorts the original view and aspects of eastern cultures. This also may refer to stereotypes, assumptions, and this approach to believe that such things happen due to the western imagination.

I believe that civilising the savage is a strand of colonialism because it involves this reforming, a change to conform to the perceived correct social norms.

Week 3 Entry

The Moreton-Robinson (2004) reading expressed contentious ideas, like this notion of Indigenous representations. Moreton-Robinson (2004) explains how aboriginals have often been represented as objects and also referred as the ‘known’, rather than being represented as subjects- also perceived as ‘knowers’. I believe that this concept of Indigenous representations can be seen as a method of ‘whiteness’, because these decisions about who is and how they are being represented is mainly coming from an Anglo centric background. Another key aspect that I found that was constantly occurring is this conception of ‘othering’ (Moreton-Robinson 2004). The separation and exclusions from the Indigenous other had created a racial hierarchy and placing whiteness at the top, which I found to give a heavily condescending feel, leaving the Indigenous disadvantaged from the start.
The view of Indigenous representations not only applies to Aboriginals, but includes all people who are Indigenous like the Ayoreo people (Glauser 2011). Glauser (2011) conducts an interview with an Ayoreo leader and mentions that the word ‘Indigenous’ is a white people’s word. In addition, I find that this Ayoreo leader is exposed by colonialism through words and representations, coming from white domination by the English (Moreton-Robinson 2004).

Week 4 Entry

After watching the film Samson and Delilah, I found that it mainly focussed on the negative impacts that some indigenous peoples face in remote communities and the difficulties that arise during the transition from rural areas to contemporary society.
The first concept that stood out for me was the notion of cultural commodification, when the white man collects Delilah’s Grandmas painting and sells them. Furthermore, by putting a price on their cultural artwork it then becomes a commodity, which may also lead to exploitation. This is exactly what he does when Delilah goes into town and discovers the man has been selling her Grandmas painting well over the price of the share that he gives back to them.
From this film I also recognised two main parts that highlighted the representation of culture and tradition. The first scene was when Delilah had cut her hair off after the death of her Grandma; the true purpose of this tradition was not depicted in the film, but may be perceived as a sign of respect. The second scene that demonstrated as a culture norm in these indigenous communities is the physical violence against Delilah, representing this feel of blaming and punishment.
The fact that Samson and Delilah did not speak during this film, may have been perceived as the overall voice of Indigenous peoples during colonialism. During colonialism the Indigenous peoples didn’t really have a voice to speak for themselves, and in this film where it demonstrates post-colonialism, it may also question the level of voice they have today.

Week 5 Entry

The main topic from the content in lecture 5 that stood out most for me was this sense of Identity and how it is conceptualised in contemporary society. One part of this identity that was highlighted in the lecture was ‘How we see ourselves and how others see us’, which I feel that relates to my personal identity. I am of Samoan decent, yet born in Australia and growing up in the western culture that comes with. Furthermore, in Australia the ‘other’ would initially see me as a Pacific Islander, whereas in Samoa, the ‘other’ would see me as a ‘White person’ from Australia with a western mentality. This notion of ‘How we see ourselves and how others see us’ is exactly what happens to me, but in contrast, I see myself as both identities in the present contemporary society.
According to Lucero (2013), contemporary identities are also being contested amongst native Indians residing in Denver, but do not actually fit the criteria as tribal members in a legal sense. In addition, American Indians have had a long history with the development of Denver (Lucero 2013). These developments involved ‘Urbanisation’, which Lucero (2013) contends that this is the very reason of decrease in emphasis on ‘Native American tribal identity’. Moreover, the effects of urbanisation can have large impacts upon indigenous peoples, like cultural dilution.
Week 6 Entry

Representation is one of the major key concepts in this week’s journal entry, not only on how the Indigenous is being represented, but also how the representation is being perceived by western cultures/Indigenous and the appropriateness. Meekison (2000) believes, it is important to remember that when non-Indigenous people use aboriginality in their representations and what they perceive to be in the nation’s interests, the reaction of the Indigenous is most likely going to be different, sometimes negative. This is an extremely important note for a non-indigenous person when it comes to marketing a native product, although a marketer’s job is to usually attract an audience, the last thing they should avoid is offending or maybe insulting their audience.
Another key concept is this notion of Aboriginals becoming a product of cultural commodification. Meekison (2000) states, Aboriginal people become victims by people commodifying them, their cultures and their histories. In addition, although Meekison (2000) suggests that the ‘white gaze’ has a large part in this approach of commodification, but it tends to question that the tourists getting immersed in aboriginality are also producers of cultural commodification. This has a negative impact because some indigenous may be exposed to exploitation and displacement.

Week 10 Entry

The article from Gulson and Parkes (2010) is really interesting as it addresses some controversial issues involving the relationships between indigenous peoples with land and the intervention of the federal Government. These issues involved policy incursions, crisis exploitation, and this attempt of reforming rural communities to this notion as what is perceived as ‘normalised’. In addition, the main issues were being caused from the Government with their heavy policy incursions. For example; a report from the federal government states that a removal of permits was needed, which will presumably reduce the levels of alcohol and child abuse, but no evidence was given that this would actually work (Gulson & Parkes 2010).
Furthermore, the government persisted to address what was “needed” for the Aboriginal people and change the way they live, which Mr William Tilmouth believed that this kind of legislation was the final step in removing their land, dignity and humanity. This notion of assimilation to me is a strand of post-colonialism that still impacts upon Indigenous peoples.
Week 8 Entry

The Australian museum is very interesting and significant with the vast variety of history and artefacts that is being displayed. In particular, the Indigenous section holds many significant events that took place, not only focussing on Indigenous, but also non-indigenous and their involvement. These historic events were being demonstrated through various communicative tools such as; visual- video, colourful artwork, big headings and descriptions; audio- indigenous peoples speaking through speakers, animal sounds; touch- the feel of artefacts.

I found the representations of Indigenous peoples in this museum is very educational and beneficial, but mainly focused for people who wanted to learn more about specific content of Indigenous Australians. Although there were many Indigenous facts and artefacts being displayed, I also discovered a sense of ownership and displacement of rights being contested. I am not entirely sure if everything in the museum has actually been approved from Indigenous peoples, but even if it has, not much legislation is also being displayed. In addition, the main issue I had in observing all this culture is who owns the right to put their cultural things on display. Although, this notion of preservation and conservation of culture is being stressed, personally I found it was a mischievous way of evading the sense of commodification.
Week 11 Entry

Prior to the visitation of The Royal Botanic Gardens I did not look at the website, until after the fieldtrip, which is important because it changes my perception afterwards.
Going to the gardens I was mainly looking for how landscape is being represented and what sites are deemed to be significant and why. My first observation was a large statue of Arthur Phillip, which straight away demonstrated the notion of colonialism. The statue of Arthur Phillip has being situated at the top quite large, surrounded by other statue figures; Neptune, Agriculture, Cyclops and Commerce and at the bottom of each side is a small aboriginal man. I was definitely baffled by this, but it was purely based around my interpretation of Indigenous representations. Furthermore it was quite difficult to find much involvement of Indigenous significance, as opposed to many of the first settlers’ historic statues. After visiting The Royal Botanic Gardens I had concluded to the lack of Indigenous involvement and representations. This then changed once I had visited their website as it shows various educational programs about Indigenous peoples, significance of People, Plants and Place, and heritage tours. The fact that this is not known until visiting the website still raises issues of appropriateness.

Final Compilation
INTRODUCTION
This reflection paper explores the contentious ideas that surround Indigenous peoples and their culture when it collides with other social impacts. The first issue that will be examined is the factors of globalisation and how it complicates indigenous cultural identities. The next issue that will be addressed is the relationships between Indigenous and Non-indigenous including how they differed in historical and contemporary societies. In these two issues I will also use content from my journal entries to draw information upon. A critical reflection on issues of cultural representations and consumption will also be looked at with the support of examples to give more understanding. Lastly an analysis of the case study ‘the block’ will be presented and how politics and power influence the mistreatment of indigenous people in regards to land management.
GLOBALISATION AND JOURNAL 3/4
Globalisation may refer to the multiplicity of linkages and interconnections that transcend societies that make up the modern world system (Berry 2008). Berry (2008) believes that it involves a process through events, decisions, and activities in one part of the world that can have significant consequences for individuals and communities in quite distant parts of the globe (p. 329). This concept of globalisation challenges indigenous cultural identities by raising the risk of being culturally commoditized.

According to Macleod (2006) cultural commodification is the process of turning culture into a commodity where it can be bought or sold. With the accelerating rise in globalisation, Indigenous identities are being transformed into a commodity for tourists to explore and satisfy their needs. The issue is that, not only does it deplete the authenticity; it exposes these indigenous cultures to exploitation. For example, entry three of the journal entries, I mention that in the film Samson and Delilah where the white man buys the Grandma’s painting for a very small price as opposed to the value he sells it at. This notion of exploitation through cultural commodification is a produce relating back to globalisation, hence how it has complexified indigenous cultural identities.
Another negative impact from globalisation that may affect indigenous cultural identities is the risk of losing culture. Hall (1996) argues that ‘in late modern times’ identities are ‘never singular but multiply constructed across different, often intersecting and antagonistic, discourses, practices and positions’. This refers to what is known as intersectionality of identities, which involves the sharing of different aspects of ourselves with numerous groups of people in a way which these may correlate or collide (Hall 1996). The problem I find with the thought of globalisation being associated with culture, as Anderson (1995) explains this perception of Indigenous peoples who have been de-cultured. I believe that too much intersectionality may deteriorate and to somewhat undermine the indigenous identity.

Although I am not an Indigenous person, entry four of my journals explain two of my personal identities; one being of Samoan background, the other being born and raised in Australia. In relation to the belief of losing culture due to the intersecting of identities, I only understand a minimum aspect of the Samoan language and cannot fluently speak the dialect. In contrast, English is my first language and I understand it very well. Moreover, this form of intersectionality stems back to the concept of globalisation, hence the reason it may be seen to complicate indigenous cultural identities. Furthermore, a common topic to consider is the relationships between indigenous and non-indigenous peoples through colonialism, post-colonialism, autonomy and self-determination.

COLONIALISM AND JOURNAL 1
In my first journal entry I describe my initial interpretation of what I thought colonialism was prior to learning the content of this unit, which were basically colonizers that moved to a foreign land and expanded their cultural norms around that place. Although colonialism was not the same process in different parts of the world, Loomba (2002) states that it involves unforming or reforming the communities that had existed there already. This notion of colonialism often led to genocide, enslavement, warfare, and rebellions.

In the context of historical relationships between indigenous and non-indigenous in Australia, it was very unequal having filled with a more superior/inferior sense. An example of this would be the stolen generations that were forced to assimilate and conform to the non-indigenous culture and the atrocities that followed. Further in my first journal entry I also wrote about the concept ‘civilising the savage’, which I believe is a strand of colonialism because it involves the reforming of the non-western world to conform to the western world. The Indigenous Australians in historical times were treated like these stereotyped savages.

In contrast, the relationships in the contemporary society between Indigenous and non-indigenous people have changed. On February 13th 2008, the Prime Minister at the time, Kevin Rudd apologised to all the indigenous peoples in hope of reconciliation and recovery (Welch 2008). He mentioned in the apology how the time has come for all Australians, those who are indigenous and those who are not to come together, truly reconcile and together build a truly great nation (Welch 2008).
The intention of the apology definitely had positive aims, but the effectiveness of the actual change it has done may be contested. Gilbert (1977) states that, Indigenous Australia underwent a rape of the soul so profound that the blight continues in the minds of most blacks today.

REPRESENTATION AND CONSUMPTION
The concepts cultural representation/consumption has created many conflicting ideas for indigenous and non-indigenous peoples. Hall (1997, p.1) states that representation is this notion that connects meaning and language to culture. It involves the use of language, signs and images which all stand for or represent things (Hall 2013). One of the main issues that I learnt about representation of Indigenous cultures is the approach of Meekison (2000). When non-indigenous people use indigeneity in their representations and what they perceive to be in the nation’s interests, the reaction of the Indigenous is most likely going to be different, sometimes negative.

For example, I watched a short video on YouTube that showed Indigenous Americans trying on Halloween costumes that were supposed to be ‘Indians’. Many of them were quite offended and a sense of ridicule was definitely felt towards these costumes. In addition, the words to describe these Indian costumes were; racist, inappropriate, silly, offensive, and uncomfortable. One of the Indigenous females goes on to explain that when making their cultural dress, every aspect and detail has a meaning and is not just some easy costume that can be made.

This issue can also be seen as a form of cultural appropriateness, which is a regular issue that is brought upon Indigenous peoples. Non-indigenous peoples often purchase these kinds of Indian costumes for parties or more commonly Halloween, not knowing that it is seen as a mockery from an Indigenous perspective. Additionally, like mentioned earlier, cultural appropriateness is usually challenged when non-indigenous people are doing the representing. Furthermore, when these negative impressions continue it undermines the culture of Indigenous peoples and creates inequality.

These contentious ideas that are being demonstrated originate back to the concepts of representation and consumption that form issues for indigenous peoples and their cultures.

CASE STUDY: THE BLOCK
One contentious case study that I felt where power and politics influence the mistreatment of indigenous peoples in relation to land management is ‘The Block’. Gulson and Parkes (2010) explain that ‘the Block’ was returned to Indigenous Australians in 1973 through the establishment of an Aboriginal Housing Company. Furthermore, the conflict lies with the Redfern Waterloo Authority, which is an urban development corporation whose statutory controls override Aboriginal ownership of housing in the Redfern area. The Redfern Waterloo Authority wanted to develop private housing and commercialise the area, further aiming to bring in a different sector of residents even at the cost of forcing Indigenous peoples out. This feel of trying to get the Indigenous peoples out of this area may be seen as gentrification and can be linked with condescending actions by the RWA.I believe that this plan demonstrates the level of power that the government have over the Indigenous peoples, which is a lot and relates back to the approach of inequality. In the Video we watched in the lecture, it shows the CEO of Aboriginal housing company just asking for a ‘fair go’.

Gulson and Parkes (2010) also address some controversial issues involving the relationships between indigenous peoples with land and the intervention of the federal Government. These issues involved policy incursions, crisis exploitation, and this attempt of reforming rural communities to this notion as what is perceived as ‘normalised’. In addition, the main issues were being caused from the Government with their heavy policy incursions. For example; a report from the federal government states that a removal of permits was needed, which will presumably reduce the levels of alcohol and child abuse, but no evidence was given that this would actually work (Gulson & Parkes 2010).

CONCLUSION
In conclusion, Indigenous peoples face numerous negative impacts when it comes to their culture and indigeneity being objectified. Additionally, this paper demonstrates; the level of impact globalisation has upon the indigenous communities, the opposing parameters colonialism has created, and the different perspectives on representation and consumption of Indigenous cultures. There is a need for more depth and detail to minimise the current issues surrounding indigenous peoples and cultures, and consider lessons that have been learnt from past mistakes.

REFERENCE LIST
Anderson, I 1995, Reclaiming Tru-ger-nan-ner: De-Colonising the Symbol, Speaking Positions: aboriginality, gender and ethnicity in Australian Cultural Studies, Melbourne.
Berry, J.W 2008, Globalisation and acculturation, International Journal of Intercultural relations, vol. 32, no. 4, pp. 328-336. DOI: 10.1016/j.ijintrel.2008.04.001
Gulson, KN & Parkes, RJ 2010, ‘From the barrel of the gun: policy incursions, land, and Aboriginal peoples in Australia’, Environment and Planning A, vol. 42, no. 2, pp. 300-13.
Hall, S 1996, Introduction: Who needs ‘Identity’? Questions of Cultural Identity, Sage, London.
Hall, S 2013, The Work of Representation, Cultural representations and signifying practices, The British Printing Company.
Loomba, A 2002, ‘Situating colonial and postcolonial studies’, in Colonialism/postcolonialism, Routledge, New York, NY, pp. 1-19.
Macleod, D 2006,Cultural commodification and Tourism: A very special relationship, Tourism Culture & Communication, vol.6, no.2, pp. 71-84, viewed 22nd October 2015, University of Western Sydney database, DOI: 10.3727/109983406777410580
Welch, D 2008, Kevin Rudd says sorry, The Sydney Morning Herald, 13th February, viewed 22nd October 2015, Google scholar database

Module 1 – Background
Introduction to Epidemiology: The Epidemiologic Approach
Required Readings
Coggon, D., Rose, G., & Barker, D.J.P. (2007) Epidemiology for the Uninitiated (4th edition). British Medical Journal. Retrieved May 22, 2012 from http://www.bmj.com/about-bmj/resources-readers/publications/epidemiology-uninitiated
Centers for Disease Control and Prevention. PulseNet. Retrieved Retrieved May 22, 2012 from http://www.cdc.gov/pulsenet/
Centers for Disease Control and Prevention Timeline for Reporting of E. coli Cases. Retrieved February 26, 2011. http://www.cdc.gov/ecoli/reportingtimeline.htm
OMRAN, A. (2005). The Epidemiologic Transition: A Theory of the Epidemiology of Population Change. Milbank Quarterly, 83(4), 731-757. doi:10.1111/j.1468-0009.2005.00398.x. Retrieved Retrieved May 22, 2012 from: http://onlinelibrary.wiley.com/doi/10.1111/j.1468-0009.2005.00398.x/pdf
Principles of Epidemiology. Retrieved Retrieved May 22, 2012 from University of Illinois at Chicago Web site: http://www.uic.edu/sph/prepare/courses/ph490/resources/epilesson01.pdf
DNA Fingerprinting. Retrieved May 22, 2012 from cphp.sph.unc.edu/focus/vol4/issue4/4-4LabTechniques_slides.ppt
Module 1 – Multiple causation
Introduction to Epidemiology: The Epidemiologic Approach
Multiple causation refers to the prerequisite that more than one factor must be present for disease to develop in a host. When a factor must be present for a disease to occur, it is called the agent of that disease. For example, HIV virus is the agent of AIDS. Although an agent is necessary, it is not sufficient to cause disease. Factors that may affect the development of disease can be classified into two groups:1) host factors and 2) environmental factors.
Host Factors
The state of the host is affected by genetic factors and past environmental exposures. These factors can affect the susceptibility of a host. For example, sickle celltrait (a genetic factor) is associated with a decreased risk of malaria. Past environmental exposures that affect susceptibility include specificimmunity, which is a state of altered responsiveness to a specific substance acquired through immunization or natural infection. Other environmental exposures be chemical in nature (e.g. cigarette smoking, asbestos).
Environmental Factors
Environmental factors can be categorized as biological, social, or physical. Biological factors include the agent of the disease, the place where the agent lives and multiplies (e.g.human beings, animals, soil), vectors that transmit disease (e.g. flies andmosquitoes), and antibiotics. Social factors include the technical level of medical care, health codes controlling environmental hazards, and social customs. For example, the custom of serving chicken tataki (undercooked chicken) may expose an individual to infectious agents, such as Salmonellaor Campylobacter. Physical factorsinclude heat, light, air, water, radiation, gravity, atmospheric pressure, andchemical agents. When weather conditions cause masses of air pollution to be trapped for several days, inhabitants can be exposed to noxious substancesthat can lead to chronic diseases.
Ecologic Models
Ecological models have been developed to illustrate the ways in which these interactions influence the occurrence of disease. Two commonly used models include the epidemiologic triangle and the web of causation.
The epidemiologic triangle consists of three components: host, environment, and agent. A change in any of the components will affect the equilibrium by increasing or decreasing the frequency of disease. For example, individuals exposed to the “common cold” virus may not all become ill because of differences in nutrition or stress (host factors).
The web of causation is often used to explain conditions that have not been linked to specific agents. In this model, more emphasis is placed on the multiplicity of interactions between the host and environment, rather than the agent. According to this model, conditions develop as a result of chains of causation in which each link represent a complex web of antecedents.
Module 1 – Outbreak Detection
Introduction to Epidemiology: The Epidemiologic Approach
Escherichia coli O157:H7 was first identified as a human pathogen in 1982 in the United States of America, following an outbreak of bloody diarrhea associated with contaminated hamburger meat. Sporadic infections and outbreaks have since been reported from many parts of the world,including North America, Western Europe, Australia, Asia, and Africa. Although other animals are capable of carrying and transmitting theinfection, cattle are the primary reservoir for E. coli O157:H7. Implicated foods are typically those derived from cattle (e.g., beef,hamburger, raw milk); however, the infection has also been transmitted through contact with infected persons, contaminated water, and other contaminated food products.
Infection with E. coli O157:H7 is diagnosed by detecting the bacterium in the stool. Most laboratories that culture stool do not routinely test for E. coli O157:H7, but require a special request from the health care provider. Only recently has E. coli O157:H7 infection become nationally notifiable in the U.S. Outside the U.S., reporting is limited to a few but increasing number of countries.
In the last week of June 1997, a certain state department of community health in the US noticed an increase in laboratory reports of E. coli O157:H7 infection. Fifty-two infections had been reported that month, compared with 18 in June of 1996. In preliminary investigations, no obvious epidemiologic linkages between the patients were found. The increase in cases continued into July.
Laboratory subtyping can help determine if an increased number of isolates of the same bacterial species results from a common source outbreak. Subtyping methods are based on selected biologic and/or geneticcharacteristics of bacteria that tend to differ between isolates of the same species. In a common source outbreak, however, isolates typically arise from the same parent organism. These isolates will be similar to each other with respect to these biologic and genetic characteristics and have similar subtyping results.
One subtyping method is DNA “fingerprinting” by Pulsed Field Gel Electrophoresis (PFGE). In DNA fingerprinting, the bacterial DNA is cut into pieces. The pieces are separated by placing them in a jelly-like substance (i.e., the gel), acting as a sieve, to which a pulsing electric fieldis applied. The electric field drives the DNA pieces across the gel over a period of hours. The smaller pieces move through the gel more quickly and the larger pieces more slowly resulting in a separation of the DNA into distinct bands. The bands are made to fluoresce and are read under ultraviolet illumination. This DNA“fingerprint” resembles a bar code. (Figure 1)

Figure 1. Typical DNA banding pattern resulting from PFGE.
Different DNA composition will result in different PFGE banding patterns. Bacteria descended from the same original parent will have virtually identical DNA and their DNA fingerprints will be in distinguishable. Identification of a cluster of isolates with the same PFGE pattern suggests that they arose from the same parent and could be from the same source.
Similar DNA fingerprints alone, however, are insufficient to establish a linkage between isolates and a common source outbreak. An epidemiologic investigation is necessary to demonstrate that there is a common source and to identify it. To be most useful, PFGE subtyping needs to be performed on a routine basis, in realtime, so that results are available (and reviewed) soon after a case is first detected.
Figure2. PFGE results on E. coli O157:H7 isolates, June-July 1997.

Typically, a PFGE “pattern” is defined as having the same banding pattern but including up to one band difference. By this definition, isolates #2, 3, 4, 6, and 7 are indistinguishable by these PFGE results. (Isolate #4 differs by one band.)
DNA finger printing, performed during the second week of July showed that 17 of the first 19 E. coli O157:H7 isolates from June-July were indistinguishable. They did not match any fingerprints from a convenience sample of isolates frompatients with E. coli O157:H7 infection before May.
Based on the PFGE findings, it was suspected the cases of E. coli O157:H7 infection resulted from a common source. On July 15, an investigation was initiated.
Module 1 – Natural History of Disease
Introduction to Epidemiology: The Epidemiologic Approach
Natural History refers to the course of disease over time, unaffected by treatment. Each disease has its own natural history, which occurs through a sequence of stages:
Stage of Susceptibility
During this stage,the disease has not developed, but the presence of risk factors favor its occurrence. For example, high serum cholesterol levels increase the probability of coronary heart disease and would therefore be considered a risk factor.
Stage of Presymptomatic Disease
Duringthis stage,  the disease process has begun, but there are no detectablesymptoms. For example, atherosclerosis (hardening of the arteries) occurring before any signs of disease would be considered presymptomatic disease.
Stage of Clinical Disease
Recognizable symptoms occur during this stage of disease. This stage is often subdivided further for better case management and epidemiologic studies.
Stage of Disability
Some diseases resolve completely and do not reach this stage. However, there are a number of conditions that leave a person temporarily or permanently disabled. For example, stroke can lead to paralysis.
Levels of Prevention
Preventing the natural history of a disease from occurring is an important objective inpublic health. The levels of prevention include:
Primary Prevention
This level of prevention refers to altering susceptibility or reducing exposure tosusceptible individuals (during the stage of susceptibility). Primary prevention includes general health promotion (e.g. good nutrition, adequate rest, sex education) and specific protective measures (e.g.immunization, environmental sanitation).
Secondary Prevention
This level of prevention refers to early detection and treatment of disease (during the pre-symptomatic and clinical stage) . At this prevention level, it is sometimes possible to either cure disease or slow its progression, prevent complications, limit disability, and prevent transmission of infectious disease.
Tertiary Prevention
This level of prevention refers to the alleviation of disability resulting from disease and attempts to restore effective functioning (during the disability stage).
Module 1 – Mechanisms Of Disease Transmission
Introduction to Epidemiology: The Epidemiologic Approach
The method by which an infectious agent escapes a reservoir and enters a host is referred to as mechanism of transmission. There are two main types of transmission: direct transmission and indirect transmission. In direct transmission, an infectious agent is immediately transferred from one infected host or reservoir to another. Direct transmission includes not only direct contact, such as kissing, but also spray by droplets through sneezing and coughing onto the mucous membranes of others. Droplet spread is classified as direct transmission because it occurs over short distances–the droplets travel a few feet before falling to the ground.
There are three types of indirect transmission: vehicleborne, vectorborne, and airborne. Vehicleborne transmissionis indirect contact through inanimate objects, such as bedding, toys, surgical instruments, and contaminated food. In vectorborne transmission,the infectious agent is transmitted by an intermediary (usually an insect) to a susceptible host. In airborne transmission, two types of particles may be spread through the air–dusts and droplet nuclei. Dusts are particles of varying size that result from resuspension of particles that have settled on floors or bedding as well as particles blown by the wind.
Coccidioidomycosis is an example of a disease that is spread by airborne transmission of fungal spores. Droplet nuclei are very tiny particles that may be suspended in the air for long periods of time. They represent the dried residue of droplets from coughing, sneezing, or the aerosolization of infective materials.
Infectivity
Infectivity is defined as the ability of the agent to invade and multiply (produce infection in a host). An example of a disease with high infectivity would be measles; a disease with low infectivity would be leprosy. Techniques for evaluating infectivity include speed that an agent spreads through a population and proportion of close contacts who become infected.
Immunity
Immunogenicity is defined as the infection’s ability to produce specific immunity. Immunogenicity can be affected by host factors such as age, nutrition, dose, and virulence of infection.
Herd immunity is defined as the resistance of a group to invasion and spread of an infectious agent, based on the immunity of a high proportion of individual members of the group. Herd immunity is believed to be an important factor in the dynamics of propagated epidemics. Factors that are conducive to the development of large-scale person-to-person epidemics include the introduction of an agent to a population that has never been exposed previously and a large number of susceptible individuals with close contact(e.g. prisons, convalescent homes).
Incubation Period
The time interval between the exposure of an agent and the onset of illness is referred to as the incubation period. During epidemics of unknown pathogens, the incubation period is frequently used to rule out the likely etiologic agent.
Module 1 – Reservoirs
Introduction to Epidemiology: The Epidemiologic Approach
Reservoirs are defined as the living organisms or inanimate matter (e.g. soil) where an infectious agent lives and multiplies. The concept of the reservoir is important in infectious disease because the reservoir is the component of the cycle where an infectious agent can survive indefinitely. Humans are the main reservoir for most of the viral and bacterial respiratory diseases. Vertebrate animals are reservoirs for diseases such as brucellosis (from cows, pigs, and goats), anthrax (from sheep), leptospirosis (from rodents), and rabies (from dogs, bats, and other animals). These diseases that are acquired from animals are known as zoonoses.
Module 1 – Variations in Severity
Introduction to Epidemiology: The Epidemiologic Approach
An infectious disease may havea wide variety of clinical symptoms, ranging from no symptoms to severe clinical illness or death. Diseases such as tuberculosis have a high proportion of asymptomatic individuals (referred to a slow pathogenicity), while diseases such as measles have a high proportion of symptomatic infections and a small percent of severe or fatal illness. Diseases such as the African hemorrhagic fevers caused by Marburg and Ebolavirus are very severe and usually fatal. For diseases with low pathogenicity, only a small fraction of cases are often diagnosed and reported.
Module 1 – Case
Introduction to Epidemiology: The Epidemiologic Approach
Case Assignment
Your task for this case assignment:
Using the materials in the module homepage and in the background section, please address the following:
⦁ Define and describe the field of Epidemiology (1/2 page)
⦁ Define and explain epidemiologic transition and describe the factors involved in epidemiologic transition (1 page)
⦁ Say we suspect a relationship between a specific dietary factor and heart disease. Can you think of ways of epidemiologically assessing whether indeed the dietary factor is a determinant of heart disease? (1/2 page)
⦁ Which types of diseases do you think pose a greater risk for the population of the United States: infectious diseases or chronic diseases. Please explain (1/2-1 page)
Assignment Expectations
Length: Case assignments should be at least 3 pages (750 words) in length.
References: At least two references must be included from academic sources (e.g. peer-reviewed journal articles). Required readings are included. Quoted material should not exceed 10% of the total paper (since the focus of these assignments is critical thinking). Use your own words and build on the ideas of others. When material is copied verbatim from external sources, it MUST be enclosed in quotes. The references should be cited within the text and also listed at the end of the assignment in the References section (APA format recommended).
Organization: Subheadings should be used to organize your paper according to question
Format: APA format is recommended for this assignment. See Syllabus page for more information on APA format.
Grammar and Spelling: While no points are deducted, assignments are expected to adhere to standards guidelines of grammar, spelling, punctuation, and sentence syntax. Points may be deducted if grammar and spelling impact clarity.
The following items will be assessed in particular:
⦁ Achievement of learning objectives for case assignment
⦁ Relevance (e.g. all content is connected to the question)
⦁ Precision (e.g. specific question is addressed. Statements, facts, and statistics are specific and accurate).
⦁ Depth of discussion (e.g. present and integrate points that lead to deeper issues)
⦁ Breadth (e.g. multiple perspectives and references, multiple issues/factors considered)
⦁ Evidence (e.g. points are well-supported with facts, statistics and references)
⦁ Logic (e.g. presented discussion makes sense, conclusions are logically supported by premises, statements, or factual information)
⦁ Clarity (e.g. writing is concise, understandable, and contains sufficient detail or examples)
⦁ Objectivity (e.g. avoid use of first person and subjective bias)

Module 1 – SLP
Introduction to Epidemiology: The Epidemiologic Approach
A Multistate Outbreak of E. coli 0157:H7
For your session-long project, you will conduct an epidemiologic investigation of an outbreak of E. coli 0157:H7. The grade for the SLP is based on the depth of your work and your ability to analyze the information, generate hypotheses about the source of the outbreak and mode of transmission. This means that the student is focusing on those factors of importance to disease transmission, control, and prevention. A public health perspective will be advanced within the assignment.
Click here to read the background information specific for the module 1 SLP THE MODULE 1 OUTBREAK DETECTION (This is included above)
Your Task for this modular component
Please answer these questions
⦁ What could account for the increase in cases?
⦁ Compare the DNA fingerprints in Figure 2 from seven of the E. coli O157:H7 cases. Each isolate has its own vertical lane (i.e., column). Controls appear in lanes #1, 5, and 10. Which isolates appear similar? In your opinion was DNA typing necessary in this case? Why?
SLP Assignment Expectations
Length: SLP assignments should be at least 2 pages (500 words) in length.
References: At least two references must be included from academic sources (e.g. peer-reviewed journal articles). Required readings are included. Quoted material should not exceed 10% of the total paper (since the focus of these assignments is critical thinking). Use your own words and build on the ideas of others. When material is copied verbatim from external sources, it MUST be enclosed in quotes. The references should be cited within the text and also listed at the end of the assignment in the References section (APA format recommended).
Organization: Subheadings should be used to organize your paper according to question
Format: APA format is recommended for this assignment. See Syllabus page for more information on APA format.
Grammar and Spelling: While no points are deducted, assignments are expected to adhere to standards guidelines of grammar, spelling, punctuation, and sentence syntax. Points may be deducted if grammar and spelling impact clarity.
The following items will be assessed in particular:
⦁ Achievement of learning objectives for SLP assignment
⦁ Relevance (e.g. all content is connected to the question)
⦁ Precision (e.g. specific question is addressed. Statements, facts, and statistics are specific and accurate).
⦁ Depth of discussion (e.g. present and integrate points that lead to deeper issues)
⦁ Breadth (e.g. multiple perspectives and references, multiple issues/factors considered)
⦁ Evidence (e.g. points are well-supported with facts, statistics and references)
⦁ Logic (e.g. presented discussion makes sense, conclusions are logically supported by premises, statements, or factual information)
⦁ Clarity (e.g. writing is concise, understandable, and contains sufficient detail or examples)
⦁ Objectivity (e.g. avoid use of first person and subjective bias)

Module 2 – Background
Measuring Health and Disease
Required Readings
Coggon, D., Rose, G., & Barker, D.J.P. (2007) . Quantifying Disease in Populations in Epidemiology for the Uninitiated (4th edition). British Medical Journal. Retrieved on May 22, 2012 from: http://www.bmj.com/about-bmj/resources-readers/publications/epidemiology-uninitiated
Supercourse: Rates, Ratios, and Proportions. (n.d.). Retrieved on May 22, 2012 from: University of Pittsburgh Web site: http://www.pitt.edu/~super1/lecture/lec0441/001.htm
Centers for Disease Control and Prevention. E Coli. Retrieved on May 22, 2012 from: http://www.cdc.gov/ecoli/index.html
A case definition is a standard set of criteria for deciding whether an individual should be classified as having the disease of interest. You may wish to review:
Centers for Disease Control and Prevention. Case Definition E. Coli. Retrieved on May 22, 2012 from: http://wwwn.cdc.gov/NNDSS/script/conditionsummary.aspx?CondID=48
Optional Reading
Shiga Toxin–producing Escherichia coli, New Mexico, USA, 2004–2007. Emerging Infectious Diseases Retrieved on May 22, 2012 from: http://www.cdc.gov/eid/content/15/8/1289.htm
Module 2 – Descriptive Epidemiology and Hypothesis Generation
Measuring Health and Disease
The incubation period for E. coli O157:H7 ranges from 3-8 days with a median of 3-4 days. The infection often causes severe bloody diarrhea and abdominal cramps, but can also cause a nonbloody diarrhea or result in no symptoms. In some persons, particularly children under 5 years of age and the elderly, the infection can cause a complication called hemolytic uremic syndrome, in which the red blood cells are destroyed and the kidneys fail. About 2-7% of infections lead to this complication.
For this outbreak investigation, a case was defined as diarrhea (at least 3 loose bowel movements a day) and/or abdominal cramps in a resident of the state with onset of symptoms between June 15 and July 15 and a stool culture yielding E.coli O157:H7 with the outbreak strain PFGE pattern.
Of the initial 38 persons who met the case definition, 26 (68%) were female with amedian age of 31 years. (Table 1)
Table1. Age group and gender distribution for persons with E. coli O157:H7 infection and the outbreak PFGE pattern, June 15 – July 15, 1997. (N=38)
Age group (years) Gender TOTAL
Male Female
0-9 2 (17%)* 2 (8%) 4 (11%)
10-19 2 (17%) 3 (12%) 5 (13%)
20-39 3 (25%) 9 (35%) 12 (32%)
40-59 2 (17%) 8 (31%) 10 (26%)
60+ 3 (25%) 4 (15%) 7 (18%)
TOTAL 12 (101%) 26 (101%) 38 (100%)
*percentages refer to column totals.
The 38 cases of E. coli O157:H7 infection meeting the investigation case definition were reported from 10 counties. On set of illness occurred from mid-June to mid-July, peaking on June 22.
From July 16 – 19, hypothesis-generating interviews were undertaken with seven patients. These patients lived in four different counties and ranged in age from 5-69 years. Three of the patients were female.
Hypothesis-generating interviews revealed that most cases had consumed lettuce and alfalfa sprouts in the week before they became ill. No single restaurant or social event was identified in common.
APPENDIX 1. Distribution of E. coli O 157:H7 cases reported to FoodNetSites* by age group and gender, United States, 1997. (N=340)
Age group (years) Gender TOTAL
Male Female
0-<1 5 (3%) 5 (3%) 10 (3%)
1-9 77 (48%) 77 (43%) 154 (45%)
10-19 36 (22%) 18 (10%) 54 (16%)
20-29 10 (6%) 20 (11%) 30 (9%)
30-39 6 (4%) 12 (7%) 18 (5%)
40-49 7 (4%) 5 (3%) 12 (4%)
50-59 7 (4%) 17 (10%) 24 (7%)
60+ 14 (9%) 24 (13%) 38 (11%)
TOTAL 162 (100%) 178 (100%) 340 (100%)
*Foodborne Diseases Active Surveillance Network (FoodNet) is a collaborative project between CDC, the U.S. Department of Agriculture (USDA), the Food and Drug Administration (FDA), and selected state and local health departments. In 1997, FoodNet conducted population based active surveillance for confirmed cases of Campylobacter, Escherichia coli O157, Listeria,Salmonella, Shigella, Vibrio, and Yersinia infectionsin Minnesota, Oregon, and selected counties in California, Connecticut, and Georgia (total population: 16.1 million).
Module 2 – Case
Measuring Health and Disease
Case Assignment
As part of a State Budget and Appropriations Subcommittee, you have been charged with reviewing health data of local health jurisdictions and establishing priorities for funding for the upcoming fiscal year.
After reviewing the following information
Eagle Rock County San Marino County Baldwin County
Population
2,490,653 299,658 250,765
>65 years 372,166 99,885 2,857
Total Population 2,862,819 399,543 253,622
Number of Deaths
4955 900 1854
>65 yrs 9,845 3,700 455
Total Deaths 14,800 4,600 2,309
Cause of Death
Coronary Heart Disease 6,200 1,800 790
Cancer 3,300 1,000 429
Homicide 3,100 800 450
Motor Vehicle Accident 2,200 1,000 640
Case Assignment
Your task is to answer these questions:
⦁ Calculate and compare the crude and age-specific death rates for each of the three counties (refer to the information Crude, Specific, and Adjusted Rates in the module homepage). Based on the crude death rate, which county appears to have the greatest need for funding? Does the age-specific death rate change your view regarding which county has a greater need for funding? Explain. Why is it possible to have a low crude rate and higher age-specific death rates?
⦁ Calculate and compare the cause-specific death rates (Use the information at http://www.pitt.edu/~super1/lecture/lec0441/001.htm from your background readings). For this, combine data from all counties. Based on the data provided, what do you think are the main health priorities?
Assignment Expectations
Length: Case assignments should be at least 2 pages (500 words) in length.
References: At least two references must be included from academic sources (e.g. peer-reviewed journal articles). Required readings are included. Quoted material should not exceed 10% of the total paper (since the focus of these assignments is critical thinking). Use your own words and build on the ideas of others. When material is copied verbatim from external sources, it MUST be enclosed in quotes. The references should be cited within the text and also listed at the end of the assignment in the References section (APA format recommended).
Organization: Subheadings should be used to organize your paper according to question
Format: APA format is recommended for this assignment. See Syllabus page for more information on APA format.
Grammar and Spelling: While no points are deducted, assignments are expected to adhere to standards guidelines of grammar, spelling, punctuation, and sentence syntax. Points may be deducted if grammar and spelling impact clarity.
The following items will be assessed in particular:
⦁ Achievement of learning objectives for case assignment
⦁ Relevance (e.g. all content is connected to the question)
⦁ Precision (e.g. specific question is addressed. Statements, facts, and statistics are specific and accurate).
⦁ Depth of discussion (e.g. present and integrate points that lead to deeper issues)
⦁ Breadth (e.g. multiple perspectives and references, multiple issues/factors considered)
⦁ Evidence (e.g. points are well-supported with facts, statistics and references)
⦁ Logic (e.g. presented discussion makes sense, conclusions are logically supported by premises, statements, or factual information)
⦁ Clarity (e.g. writing is concise, understandable, and contains sufficient detail or examples)
⦁ Objectivity (e.g. avoid use of first person and subjective bias)
Module 2 – SLP
Measuring Health and Disease
A Multistate Outbreak of E. coli 0157:H7
Click here to read the Module 2 SLP background THE MODULE 2 READING is included above

Session Long Project
Please answer these questions:
⦁ What are the advantages and disadvantages of the case definition?
⦁ Describe and compare the age and gender distribution of E. coli O157:H7 cases from this outbreak and those reported from U.S. FoodNet sites in 1997.
⦁ What kinds of questions would you ask in the hypothesis-generating interviews?
⦁ Given your knowledge about E. coli O157:H7, the descriptive epidemiology of the initial cases, and the results of hypothesis-generating interviews, outline the information available at this point on the source of the outbreak and mode of transmission
SLP Assignment Expectations
Length: SLP assignments should be at least 2 pages (500 words) in length.
References: At least two references must be included from academic sources (e.g. peer-reviewed journal articles). Required readings are included. Quoted material should not exceed 10% of the total paper (since the focus of these assignments is critical thinking). Use your own words and build on the ideas of others. When material is copied verbatim from external sources, it MUST be enclosed in quotes. The references should be cited within the text and also listed at the end of the assignment in the References section (APA format recommended).
Organization: Subheadings should be used to organize your paper according to question
Format: APA format is recommended for this assignment. See Syllabus page for more information on APA format.
Grammar and Spelling: While no points are deducted, assignments are expected to adhere to standards guidelines of grammar, spelling, punctuation, and sentence syntax. Points may be deducted if grammar and spelling impact clarity.
The following items will be assessed in particular:
⦁ Achievement of learning objectives for SLP assignment
⦁ Relevance (e.g. all content is connected to the question)
⦁ Precision (e.g. specific question is addressed. Statements, facts, and statistics are specific and accurate).
⦁ Depth of discussion (e.g. present and integrate points that lead to deeper issues)
⦁ Breadth (e.g. multiple perspectives and references, multiple issues/factors considered)
⦁ Evidence (e.g. points are well-supported with facts, statistics and references)
⦁ Logic (e.g. presented discussion makes sense, conclusions are logically supported by premises, statements, or factual information)
⦁ Clarity (e.g. writing is concise, understandable, and contains sufficient detail or examples)
⦁ Objectivity (e.g. avoid use of first person and subjective bias)
Module 3 – Background
Descriptive and Analytic Epidemiology
If you cannot locate an article in one set of databases (e.g., EBSCO), try to locate it in ProQuest.
Required Readings
A guide to research methods. Evidence based medicine and study designs at Suny Downstate Medical Center. Retrieved on May 22, 2012 from: http://library.downstate.edu/EBM2/2100.htm
Coggon, D., Rose, G., & Barker, D.J.P. (2007) Case Control and Cross-Sectional studies in Epidemiology for the Uninitiated (4th edition). British Medical Journal. Retrieved on May 22, 2012 from: http://www.bmj.com/about-bmj/resources-readers/publications/epidemiology-uninitiated
Centers for Disease Control and Prevention (2012). Lesson 1: Introduction to Epidemiology, Section 6: Descriptive Epidemiology. In Principles of Epidemiology in Public Health Practice, 3rd Edition. Retrieved March 7, 2013 at http://www.cdc.gov/osels/scientific_edu/ss1978/lesson1/Section6.html
Case Control Studies. Universigty of Pitssburg Supercourse. Retrieved on May 22, 2012 from: http://www.pitt.edu/~super1/lecture/lec8591/index.htm
Optional Readings
Schoenbach, V.J., Rosamond, V.D., Understanding the fundamentals of epidemiology. An evolving text. UNC School of Public Health. Retrieved on May 22, 2012 from: http://www.epidemiolog.net/evolving/TableOfContents.htm
Supercourse: Epidemiologic Design I: Focus on Descriptive Study. Retrieved on May 22, 2012 from: University of Pittsburgh Web site http://www.pitt.edu/~super1/lecture/lec0551/index.htm
Module 3 – Case
Descriptive and Analytic Epidemiology
Case Assignment
Below is epidemiologic data collected on an unknown pathogen.
Your task for this case assignment:
⦁ Describe these data by person, place, and time (i.e. descriptive epidemiology). For more information on descriptive epidemiology, please refer to the Module 3 ⦁ Home Page.
⦁ Provide possible explanations for the pattern of this disease.
Figure 1: Incidence Rate of Unknown Disease by Age and Gender

Figure 2: Geographical Distribution of Unknown Disease in the United States

Figure 3: Incidence Rate of Unknown Disease by State
Figure 4: Frequency of Unknown Disease by Month of Onset

Figure 5: Frequency of Unknown Disease by Year

Assignment Expectations
Length: Case assignments should be at least 3 pages (750 words) in length.
References: At least two references must be included from academic sources (e.g. peer-reviewed journal articles). Required readings are included. Quoted material should not exceed 10% of the total paper (since the focus of these assignments is critical thinking). Use your own words and build on the ideas of others. When material is copied verbatim from external sources, it MUST be enclosed in quotes. The references should be cited within the text and also listed at the end of the assignment in the References section (APA format recommended).
Organization: Subheadings should be used to organize your paper according to question
Format: APA format is recommended for this assignment. See Syllabus page for more information on APA format.
Grammar and Spelling: While no points are deducted, assignments are expected to adhere to standards guidelines of grammar, spelling, punctuation, and sentence syntax. Points may be deducted if grammar and spelling impact clarity.
The following items will be assessed in particular:
⦁ Achievement of learning objectives for case assignment
⦁ Relevance (e.g. all content is connected to the question)
⦁ Precision (e.g. specific question is addressed. Statements, facts, and statistics are specific and accurate).
⦁ Depth of discussion (e.g. present and integrate points that lead to deeper issues)
⦁ Breadth (e.g. multiple perspectives and references, multiple issues/factors considered)
⦁ Evidence (e.g. points are well-supported with facts, statistics and references)
⦁ Logic (e.g. presented discussion makes sense, conclusions are logically supported by premises, statements, or factual information)
⦁ Clarity (e.g. writing is concise, understandable, and contains sufficient detail or examples)
⦁ Objectivity (e.g. avoid use of first person and subjective bias)
Module 3 – SLP
Descriptive and Analytic Epidemiology
Designing an Epidemiologic Study to Test the Hypothesis
To test the hypothesis on the source of the outbreak, a case-control study was conducted from July 21-27. Thirty-one of the initial 38 persons meeting the original case definition (i.e., those not used in hypothesis generating interviews) were included as cases. It was decided that two controls would be selected for every case and would be matched to the case by age group (0-<2 years, 2-<5 years, 5-<12 years, 12-<18 years, 18-<60 years, and 60+ years) and gender.
The investigators identified controls for the study using sequential digit dialing. Exposure information among cases was collected for the 7 days before onset of illness. For controls, exposure information was collected for the 7 days before the interview and for the 7 days before the onset of illness in the matching case.
Twenty-seven case-control sets were interviewed; the remaining case-patients could not be reached.
Session Long Project
Please answer these questions:
⦁ How would you define controls for this study? What methods might be used to identify controls?
⦁ Do you agree with the investigators’ decision to match on age group and gender? Why or why not?
⦁ Over what time period would you examine exposures to possible risk factors for cases? For controls?
SLP Assignment Expectations
Length: SLP assignments should be at least 2 pages (500 words) in length.
References: At least two references must be included from academic sources (e.g. peer-reviewed journal articles). Required readings are included. Quoted material should not exceed 10% of the total paper (since the focus of these assignments is critical thinking). Use your own words and build on the ideas of others. When material is copied verbatim from external sources, it MUST be enclosed in quotes. The references should be cited within the text and also listed at the end of the assignment in the References section (APA format recommended).
Organization: Subheadings should be used to organize your paper according to question
Format: APA format is recommended for this assignment. See Syllabus page for more information on APA format.
Grammar and Spelling: While no points are deducted, assignments are expected to adhere to standards guidelines of grammar, spelling, punctuation, and sentence syntax. Points may be deducted if grammar and spelling impact clarity.
The following items will be assessed in particular:
⦁ Achievement of learning objectives for SLP assignment
⦁ Relevance (e.g. all content is connected to the question)
⦁ Precision (e.g. specific question is addressed. Statements, facts, and statistics are specific and accurate).
⦁ Depth of discussion (e.g. present and integrate points that lead to deeper issues)
⦁ Breadth (e.g. multiple perspectives and references, multiple issues/factors considered)
⦁ Evidence (e.g. points are well-supported with facts, statistics and references)
⦁ Logic (e.g. presented discussion makes sense, conclusions are logically supported by premises, statements, or factual information)
⦁ Clarity (e.g. writing is concise, understandable, and contains sufficient detail or examples)
⦁ Objectivity (e.g. avoid use of first person and subjective bias)
Module 4 – Background
Measures of Association
Required Readings
Centers for Disease Control and Prevention (CDC). (2009) Outbreak of Salmonella serotype Saintpaul infections associated with eating alfalfa sprouts – United States, 2009. MMWR Morb Mortal Wkly,;58(18):500-3. Retrieved on May 22, 2012 from: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5818a4.htm
Meirik O., Cohort and case control studies. Retrieved May 22, 2012 from: http://www.gfmer.ch/Books/Reproductive_health/Cohort_and_case_control_studies.html
Spitalnic S (2006). Risk Assessment II: Odds Ratio. Hospital Physician, 2006 Jan: 23-26. Retrieved May 22, 2012, from http://www.turner-white.com/memberfile.php?PubCode=hp_jan06_odds.pdf
Redbook: Toxicological Principles for the Safety Assessment of Food Ingredients. U.S. Department of Health and Human Services, Food and Drug Administration, Center for Food Safety and Applied Nutrition July 2000; Updated July 2007. Retrieved May 22, 2012 from http://www.fda.gov/downloads/Food/GuidanceRegulation/UCM222779.pdf
Supercourse, Epidemiology, the Internet and Global health. Different kinds of Epidemiologic Designs. Retrieved May 22, 2012, from University of Pittsburgh Web site http://www.pitt.edu/~super1/lecture/lec0571/index.htm
Supercourse, Epidemiology, the Internet and Global health. Epidemiologic Design II, Focus on Analytic Study Retrieved May 22, 2012, from University of Pittsburgh Web site http://www.pitt.edu/~super1/lecture/lec0561/index.htm
Optional Reading
Redbook: Toxicological Principles for the Safety Assessment of Food Ingredients. U.S. Department of Health and Human Services, Food and Drug Administration, Center for Food Safety and Applied Nutrition July 2000; Updated July 2007. Retrieved May 22, 2012 from http://www.fda.gov/Food/GuidanceComplianceRegulatoryInformation/GuidanceDocuments/
FoodIngredientsandPackaging/Redbook/default
Module 4 – How to calculate an odds ratio
Measures of Association
A2x2 table is used to calculate an odds ratio:
Disease No Disease
Exposed a b
Unexposed c d
The formula for odds ratio is:
Odds ratio = (a xd)/(b x c)
If a researcher selects 50 Lyme disease cases and 100 unmatched controls for a case-control study, and the results indicated that 45 cases and 10 controls recently hiked in a national forest, the odds ratio would be calculated as follows:
Cases Controls Total
Hiking 45 10 55
No Hiking 5 90 95
Total 50 100 150
Odds ratio = (45 x 90) ÷ (10 x 5) = 81
Module 4 – How to calculate a relative risk
Measures of Association
A2x2 table is used to calculate a relative risk:
Disease No Disease
Exposed a b
Unexposed c d
The formula for relative risk is:
Relativerisk = (a/(a+b)) ÷ (c/(c+d))
If 5000 smokers and 5000 non-smokers were selected for a cohort study, and the results of the study indicated that 50 of the 5000 smokers developed lung cancer and 2 of the 5000 non-smokers developed cancer, relative risk would be calculated as follows:
Lung cancer No lung cancer Total
Smokers 50 4950 5000
Non-smokers 2 4998 5000
Total 52 9948 10,000
Relative risk = (50/5000) ÷(2/5000) = 25
Module 4 – Case
Measures of Association
Case Assignment
As an epidemiologist for the County Disease Control Office, you are investigating an outbreak that occurred at a restaurant. The predominant symptoms included vomiting (81%), nausea (76%), and diarrhea (76%). The average incubation period was five hours with an average duration of 19 hours. Items consumed among the ill included prime rib, baked potato with butter, and green salad with dressing.
Figure 1:
FOOD ITEMS PERSONS WHO ATE SPECIFIED FOOD PERSONS WHO DID NOT EAT SPECIFIED FOOD
Ill Not Ill Total Ill Not Ill Total
Prime Rib 18 3 21 3 5 8
Baked Potato 19 4 23 2 4 6
Green Salad 18 9 27 1 1 2
Figure 2:
Food Item 95% Confidence Interval
Prime Rib 1.4 – 65.7
Baked Potato 1.6 -218.5
Green Salad .10 – 42.9
Case Assignment
Your task for this case assignment is to answer these questions:
⦁ What type of study was used for this investigation? Explain.
⦁ What would be the appropriate measure of association for this study?
⦁ Calculate the food-specific attack rates and calculate the measure of association between illness and each food item.
⦁ What does a confidence interval mean, and which 95% confidence intervals are statistically significant?
⦁ What do the results indicate regarding the likely source of exposure?
Assignment Expectations
Length: Case assignments should be at least 2 pages (500 words) in length.
References: At least two references must be included from academic sources (e.g. peer-reviewed journal articles). Required readings are included. Quoted material should not exceed 10% of the total paper (since the focus of these assignments is critical thinking). Use your own words and build on the ideas of others. When material is copied verbatim from external sources, it MUST be enclosed in quotes. The references should be cited within the text and also listed at the end of the assignment in the References section (APA format recommended).
Organization: Subheadings should be used to organize your paper according to question
Format: APA format is recommended for this assignment. See Syllabus page for more information on APA format.
Grammar and Spelling: While no points are deducted, assignments are expected to adhere to standards guidelines of grammar, spelling, punctuation, and sentence syntax. Points may be deducted if grammar and spelling impact clarity.
The following items will be assessed in particular:
⦁ Achievement of learning objectives for case assignment
⦁ Relevance (e.g. all content is connected to the question)
⦁ Precision (e.g. specific question is addressed. Statements, facts, and statistics are specific and accurate).
⦁ Depth of discussion (e.g. present and integrate points that lead to deeper issues)
⦁ Breadth (e.g. multiple perspectives and references, multiple issues/factors considered)
⦁ Evidence (e.g. points are well-supported with facts, statistics and references)
⦁ Logic (e.g. presented discussion makes sense, conclusions are logically supported by premises, statements, or factual information)
⦁ Clarity (e.g. writing is concise, understandable, and contains sufficient detail or examples)
⦁ Objectivity (e.g. avoid use of first person and subjective bias)
Module 4 – SLP
Measures of Association
PART IV – Analysis and Interpretation
In the case-control study, the odds ratio for alfalfa sprouts was 29, with the 95% confidence interval 7.5 – 545.2.
Session Long Project
Answer these questions
⦁ Is this odds ratio statistically significant? Please explain.
⦁ Do you think there is a causal relationship between exposure (eating alfalfa sprouts) and disease? Please explain (using the applicable criteria under “Does Association Mean Causality” in your modular homepage)
SLP Assignment Expectations
Length: SLP assignments should be at least 2 pages (500 words) in length.
References: At least two references must be included from academic sources (e.g. peer-reviewed journal articles). Required readings are included. Quoted material should not exceed 10% of the total paper (since the focus of these assignments is critical thinking). Use your own words and build on the ideas of others. When material is copied verbatim from external sources, it MUST be enclosed in quotes. The references should be cited within the text and also listed at the end of the assignment in the References section (APA format recommended).
Organization: Subheadings should be used to organize your paper according to question
Format: APA format is recommended for this assignment. See Syllabus page for more information on APA format.
Grammar and Spelling: While no points are deducted, assignments are expected to adhere to standards guidelines of grammar, spelling, punctuation, and sentence syntax. Points may be deducted if grammar and spelling impact clarity.
The following items will be assessed in particular:
⦁ Achievement of learning objectives for SLP assignment
⦁ Relevance (e.g. all content is connected to the question)
⦁ Precision (e.g. specific question is addressed. Statements, facts, and statistics are specific and accurate).
⦁ Depth of discussion (e.g. present and integrate points that lead to deeper issues)
⦁ Breadth (e.g. multiple perspectives and references, multiple issues/factors considered)
⦁ Evidence (e.g. points are well-supported with facts, statistics and references)
⦁ Logic (e.g. presented discussion makes sense, conclusions are logically supported by premises, statements, or factual information)
⦁ Clarity (e.g. writing is concise, understandable, and contains sufficient detail or examples)
⦁ Objectivity (e.g. avoid use of first person and subjective bias)
Module 5 – Background
Screening for Diseases
Required Readings
Loong, TZ (2003). Understanding sensitivity and specificity with the right side of the brain.
British Medical Journal (International edition), 327, 716-720. Retrieved on May 22, 2012 from ProQuest. This is the attachment.

Dechet A (2005). Foodborne Illness Outbreaks and Sprouts. FDA Public Meeting: 2005 Sprout Safety. Centers for Disease Control and Prevention. Retrieved May 22, 2012 from www.fda.gov/ohrms/dockets/dockets/05n0147/05n-0147-ts00001-dechet.ppt
Supercourse, Epidemiology, the Internet and Global health. Screening and Disease Prevention. Retrieved May 22, 2012 from University of Pittsburgh Web site Screening and Disease Prevention. (n.d.). http://www.pitt.edu/~super1/lecture/lec0721/index.htm
PATH (2008). Accuracy of Diagnostic Tests. Retrieved May 22, 2012 from http://sites.path.org/dx/rapid-dx/performance/

University of Washington (nd). Epidemiology Glossary ; Retrieved May 22, 2012 from http://depts.washington.edu/physdx/eglossary.html
Lalkhen, AG and McCluskey, A (2008). Clinical tests: sensitivity and specificity. Contin Educ Anaesth Crit Care Pain; 8(6): 221-223 doi:10.1093/bjaceaccp/mkn041. Retrieved March 7, 2013 at http://ceaccp.oxfordjournals.org/content/8/6/221.full
For the SLP
While the assignment may be based on a real case, the questions can refer to any outbreak that involved sprouts and E. coli 0157:H7. Knowing the specific pathogen (its characteristics, transmission) and the specific food, how could have the contamination occurred? You are asked to think about a possible point of contamination and about measures of control. Here is another potentially useful reference:
World Health Organization (2011). Enterohaemorrhagic Escherichia coli (EHEC). Retrieved May 22, 2012 from http://www.who.int/mediacentre/factsheets/fs125/en/
Optional Reading
Gray RH, Makumbi F, Serwadda D, et. al. (2006) Limitations of rapid HIV-1 tests during screening for trials in Uganda: diagnostic test accuracy study. BMJ, 335(7612):188. Retrieved on May 22, 2012 from http://www.bmj.com/highwire/filestream/378714/field_highwire_article_pdf/0.pdf
Module 5 – SLP Background
Screening for Diseases
PART V – Other Investigations
Tracebacks of food are often necessary to identify sources of contamination and quickly limit a public health threat by removing these sources. One purpose of a traceback is to ascertain the distribution and production chain for a food product so that an effective recall can be undertaken. Tracebacks can also clarify the point or points at which the implicated food was likely to have become contaminated and help determine how to prevent similar outbreaks in the future. Epidemiologic tracebacks can accomplish each of these goals, but are different from the more detailed, regulatory tracebacks which follow rules of legal evidence.
An epidemiologic traceback usually begins with the information available at the time of purchase of the implicated food item and extends back to the very beginning of its production. All production steps, from harvest to consumption, are examined.
Full tracebacks leading to formal product recalls can be time-consuming and result in many dead-ends. Pertinent information and records are often missing or poorly maintained. Traceback efforts may require hundreds of hours of tedious work and may extend to other states and countries.
MDCH and CDC decided to do an epidemiologic traceback of the alfalfa sprouts implicated in the Michigan outbreak.
Of the 16 patients who ate sprouts for whom the source of the sprouts could be traced, 15 led to a single sprouting facility, facility A in Michigan; in the remaining traceback, the patient could have eaten sprouts from either facility A or facility B in Michigan. (Figure 4) Facility A and B were the only facilities that sprouted alfalfa seed in the state. Sprouts grown by facility A at the time of the outbreak came from two lots of seed: one from Idaho and one from Australia.
At this point, the investigators became aware of a concurrent outbreak of E.coli O157:H7 infection in Virginia. CDC subtyped the strains from Virginia and identified the same PFGE pattern as in the Michigan outbreak. A case-control study conducted by the Virginia Department of Health (VDH) linked the concurrent outbreak of O157:H7 infections to alfalfa sprouts.
In Virginia, the source of sprouts could be traced for 13 patients; all led to one sprouting company in Virginia. (Figure 4) The Virginia sprouting company was using a single lot of seed harvested in Idaho –the same lot as the one used at facility A in Michigan. Traceback of the seed to the distributor identified it as part of a17,000 pound lot of which 6,000 pounds still remained.
Figure 4. Traceback results of the E.coli O157:H7 investigation of alfalfa sprouts in Michigan (MI) and Virginia(VA), 1997.
The implicated seed lot was a blend of 5 lots from fields of four farmers and was harvested between 1984 and 1996. The seed processor and the farmers were located in Idaho.
Inspection of the alfalfa fields revealed three possible sources of contamination: cattle manure, irrigation water, and deer feces. Although manure is not normally applied to alfalfa fields in Idaho, cattle feed lots were common in this area and the alfalfa fields of one farmer were adjacent to a feed lot. Manure may have leaked or been illegally dumped onto the alfalfa fields or run-off water from neighboring fields, contaminated by manure, may have been used to irrigate the alfalfa fields. In addition, three of four farmers occasionally saw deer in their fields and one field was situated next to a wildlife refuge.
The seed from each of the farmers was harvested and mechanically cleaned at the same seed processing plant. The seeds were then placed in 50 lb. bags. No further processing occurred. Most of the seed was produced to plant alfalfa fields (e.g., to produce hay for livestock feed); the relatively small amount of seed used for sprouting was not handled any differently than the raw agricultural commodity seed.
Note:*A 1988 outbreak of Salmonella Saint Paul infections in Europe was linked to mung bean sprouts. A small 1990 cluster of Salmonella Anatum infections in the United States was suspected to be linked to one grower’s alfalfa sprouts, but the source of contamination was not determined. A 1994 Salmonella Bovismorbificans outbreak in Finland and Sweden was traced to Australian alfalfa seed. In 1995, it was concluded that sprouts caused an international outbreak of Salmonella Stanley, affecting persons in more than 17 states in the United States and Finland. In that same year, another multinational outbreak of salmonellosis (due to S. entericaserotype Newport) was linked to alfalfa seeds after an increase in infections was detected in Oregon and British Columbia. In 1996, almost 10,000 cases of E. coli O157:H7 occurred among school children in Japan. The outbreak was ultimately shown to be caused by radish sprouts grown from seed imported from the U.S.
Part VI Control
The implicated seed lot was not distributed to any other sprouting companies in or outside the United States. The remaining 6,000 lbs. of seed was immediately removed from the marketplace. A sample of 500 grams of seed was cultured directly, and the same amount was sprouted and then cultured; neither yielded E. coli O157:H7.
The Idaho Division of Food and Drugs held meetings at which public health officials explained to seed growers the need to protect alfalfa and other seeds used in sprouting from contamination during growing, harvesting, and packing. Both MDCH and the VDH made public television and radio announcements about the risk of contaminated sprouting seeds and recommended that persons at high risk for complications from E. coli O157:H7 infection not eat sprouts.
The Center for Food Safety and Quality Enhancement began working with the sprout industry to identify ways to make sprouts safer for human consumption. In tests with artificially inoculated seed, treating the seed by soaking it in a chlorine solution* (2000 ppm hypochlorite in 57-60EC water) at the time of sprouting reduced the level of contamination by a thousand-fold. Irradiation has also been tested and appears to work well in decontaminating sprout seeds. However, this treatment leads to diminished sprouting ability and has not been approved by the FDA.
*Chemical treatment with a hypochlorite solution is a U.S. Food and Drug Administration (FDA) approved treatment of foods.
Module 5 – Case
Screening for Diseases
Assignment Overview
Infection with the human immunodeficiency virus (HIV) is routinely diagnosed by detecting the presence of specific antibodies in the patient’s serum. Although the presence of the virus itself can be now be detected (i.e. polymerase chain reaction [PCR] to measure plasma HIV RNA, or “viral load”), these tests remain expensive and require laboratory techniques that are not routinely available. The diagnosis of HIV infection begins with an enzyme immunoassay (EIA). The optical density (OD) of the patient’s EIA is compared to a control specimen (OD ratio). If the OD ratio is – above the established cutoff for that control sample on repeat testing the specimen is termed “repeatedly reactive”. The EIA is relatively sensitive, fast, simple and inexpensive which makes it an appropriate screening test. However, if one examines the ODs for a large group of samples from patients with and without true HIV infection you can see that there is some overlap in their EIA results if a value of A is used for the cutoff:

Hypothetical distribution of OD ratios for patients with and without HIV infection.
Hypothetical distribution of OD ratios for patients with and without HIV infection.
Patients with HIV infection are depicted with blue, thick line,those without HlV with red, thin line.
Where a cutoff is drawn to determine a diagnostic test result may be somewhat arbitrary.
Case Assignment
Answer these questions:
⦁ What would be the impact on this test’s sensitivity if you moved the cutoff for a positive result from A to B? What about specificity? What would happen to sensitivity and specificity if you moved the cutoff from A to C? Where would you put the cutoff for this test? What is the relationship between sensitivity and specificity for any given test?
⦁ Where would the director of the Blood Bank who is screening donated blood for HIV antibody want to put the cutoff? What would be the potential problem caused by this decision? Where would an investigator enrolling high-risk patients in a clinical trial for an experimental, potentially toxic antiretroviral draw the cutoff? What would be the potential problem caused by this decision? In your answer please detail possible ethical and legal issues of possible concern.
Assignment Expectations
Length: Case assignments should be at least 2 pages (500 words) in length.
References: At least two references must be included from academic sources (e.g. peer-reviewed journal articles). Required readings are included. Quoted material should not exceed 10% of the total paper (since the focus of these assignments is critical thinking). Use your own words and build on the ideas of others. When material is copied verbatim from external sources, it MUST be enclosed in quotes. The references should be cited within the text and also listed at the end of the assignment in the References section (APA format recommended).
Organization: Subheadings should be used to organize your paper according to question
Format: APA format is recommended for this assignment. See Syllabus page for more information on APA format.
Grammar and Spelling: While no points are deducted, assignments are expected to adhere to standards guidelines of grammar, spelling, punctuation, and sentence syntax. Points may be deducted if grammar and spelling impact clarity.
The following items will be assessed in particular:
⦁ Achievement of learning objectives for case assignment
⦁ Relevance (e.g. all content is connected to the question)
⦁ Precision (e.g. specific question is addressed. Statements, facts, and statistics are specific and accurate).
⦁ Depth of discussion (e.g. present and integrate points that lead to deeper issues)
⦁ Breadth (e.g. multiple perspectives and references, multiple issues/factors considered)
⦁ Evidence (e.g. points are well-supported with facts, statistics and references)
⦁ Logic (e.g. presented discussion makes sense, conclusions are logically supported by premises, statements, or factual information)
⦁ Clarity (e.g. writing is concise, understandable, and contains sufficient detail or examples)
⦁ Objectivity (e.g. avoid use of first person and subjective bias)

Module 5 – SLP
Screening for Diseases
Please answer the questions
⦁ Knowing the pathogen and its characteristics (including modes of transmission) where do you think was the most likely point of contamination in the production of the sprouts? In inspecting the alfalfa fields and harvesting process, what possible points of contamination should be considered?
⦁ What interventions/control measures would you suggest? Why?
⦁ In preparing a report of this investigation what possible strengths and limitations should be discussed?”
SLP Assignment Expectations
Length: SLP assignments should be at least 2 pages (500 words) in length.
References: At least two references must be included from academic sources (e.g. peer-reviewed journal articles). Required readings are included. Quoted material should not exceed 10% of the total paper (since the focus of these assignments is critical thinking). Use your own words and build on the ideas of others. When material is copied verbatim from external sources, it MUST be enclosed in quotes. The references should be cited within the text and also listed at the end of the assignment in the References section (APA format recommended).
Organization: Subheadings should be used to organize your paper according to question
Format: APA format is recommended for this assignment. See Syllabus page for more information on APA format.
Grammar and Spelling: While no points are deducted, assignments are expected to adhere to standards guidelines of grammar, spelling, punctuation, and sentence syntax. Points may be deducted if grammar and spelling impact clarity.
The following items will be assessed in particular:
⦁ Achievement of learning objectives for SLP assignment
⦁ Relevance (e.g. all content is connected to the question)
⦁ Precision (e.g. specific question is addressed. Statements, facts, and statistics are specific and accurate).
⦁ Depth of discussion (e.g. present and integrate points that lead to deeper issues)
⦁ Breadth (e.g. multiple perspectives and references, multiple issues/factors considered)
⦁ Evidence (e.g. points are well-supported with facts, statistics and references)
⦁ Logic (e.g. presented discussion makes sense, conclusions are logically supported by premises, statements, or factual information)
⦁ Clarity (e.g. writing is concise, understandable, and contains sufficient detail or examples)
⦁ Objectivity (e.g. avoid use of first person and subjective bias)
Answer questions separately in a paragraph each with a cited source for each
1 Explain the importance of epidemiology for informing scientific, ethical, economic and political discussion of health issues.

2 Please choose an infectious disease (e.g. TB) and list which disease you have chosen. Then, please identify key sources of data that can be used to detect and control this disease in non-endemic countries.  In your view are these sources of data sufficient?

3 Descriptive epidemiology involves examining the patterns of disease by person, place, and time.  Descriptive epidemiology may also be used to distinguish a natural outbreak from an intentional outbreak (i.e. bioterrorism).  In the American Anthrax Outbreak of 2001 (http://www.ph.ucla.edu/epi/bioter/detect/antdetect_intro.html), what were the initial epidemiologic clues that indicated that the outbreak may have been intentional?

4 Foodborne disease is a significant problem as discussed in this article:  http://wwwnc.cdc.gov/eid/article/3/4/97-0414_article.htm  According to this article, what are some of the factors contributing to this problem and what strategies would you propose to address this problem?

5 One of the problems in medicine and epidemiology today is the emergence of superbugs or multi-resistant bacteria.  What are some of the factors that have contributed to antibiotic resistance?  What strategies would you propose to address this problem?
CDC (2011) Antimicrobial Resistance Posing Growing Health Threat. Retrieved from http://www.cdc.gov/media/releases/2011/p0407_antimicrobialresistance.html
Optional reading:
CDC (2010) Antibiotic Resistance and the Threat to Public Health, Statement of Thomas Frieden, M.D., M.P.H. before Committee on Energy and Commerce Subcommittee on Health United States House of Representatives. Retrieved from ttp://www.cdc.gov/drugresistance/pdf/FriedenTestimony42810.pdf

<br>
Unit IV Mini Project<br>
<br>
Write a report discussing the sampling design for the proposal.<br>
Describe the sampling procedures (convenience, quota, simple random) that will yield the best results for your research objective and justify your rationale for choosing the procedure(s). Include the following information:<br>
1. Research the objective.<br>
2. Description of the population: Process for identifying the target population and selecting the sampling frame.<br>
3. Identify the different types of biases that are likely to occur, and explain what steps you will take to minimize them.<br>
4. Conclusion: Highlight the major points discussed in the previous sections. Be sure to relate the information back to the purpose and relevance of the research.<br>
<br>
You must use correct APA formatting when writing your paper. All references used, including the textbook, must be cited.<br>
<br>
Please follow the subject done by orders numbers# Unit I 81543635 and Unit II 81543635.

QUESTION# 1 AGREE OR DISAGREE WITH THE STUDENTS AND WHY?
Integer programming generates integer solution values for model variables. Linear programming consists of linear relationships that represent decisions with given objectives and constraints. Linear programming models assume non-integers (not whole numbers) while integer programming models allow for integers that are rounded off (Taylor III, 2011). Integer programming is concerned with optimization problems in which some of the variables are required to take on discrete values. Rather than allow a variable to assume all real values in a given range, only predetermined discrete values within the range are permitted. In most cases, these values are the integers, giving rise to the name of this class of models. Models with integer variables are very useful. Situations that cannot be modeled by linear programming are easily handled by integer programming. Primary among these involve binary decisions such as yes-no, build-no build or invest-not invest. Although one can model a binary decision in linear programming with a variable that ranges between 0 and 1, there is nothing that keeps the solution from obtaining a fractional value such as 0.5, hardly acceptable to a decision maker. Integer programming requires such a variable to be either 0 or 1, but not in-between. Unfortunately integer programming models of practical size are often very difficult or impossible to solve. Linear programming methods can solve problems orders of magnitude larger than integer programming methods. A typical mathematical program consists of a single objective function, representing either a profit to be maximized or a cost to be minimized, and a set of constraints that circumscribe the decision variables.

QUESTION# 2 AGREE OR DISAGREE WITH THE STUDENTS AND WHY?
“Reflection to date” Please respond to the following:
• In a paragraph, reflect on what you’ve learned in this course.  Identify the most interesting, unexpected, or useful thing you’ve learned, and explain how it can be applied to your work or daily life in some manner.

<br>
Hi, my paper consists of 2 essay questions. <br>
<br>
Q1 requires 2 pages with 10 references from only journals please, Q2 requires 2 pages with references only from journals. <br>
<br>
Q1. THE START ACTIVE STAY ACTIVE 2010 CHIEF MEDICAL OFFICER’S GUIDELINE STATE THAT CHILDREN SHOULD ACCRUE 60 MINUTES OF MODERATE TO VIGOROUS PHYSICAL ACTIVITY EVERY DAY, AND MINIMISE THE TIME BEING SPENT SEDENTARY. CRITICALLY DISCUSS THIS GUIDELINE.<br>
<br>
<a href=”https://Q2.CRITICALLY” target=”_blank”>Q2.CRITICALLY</a> DISCUSS PHYSICAL ACTIVITY INTERVENTIONS THAT DRAW ON SELF-DETERMINATION THEORY IN THEIR DESIGN.<br>
<br>
NOTE: BOTH ANSWERS REQUIRE CLEAR INTEGRATION OF SUPPORTING EVIDENCE AND CONSIDERATION OF HEALTH OF INDIVIDUAL AND COMMUNITY LEVELS.<br>
<br>
I WILL UPLOAD MARKING CRITERIA AND INFO FOR BOTH QUESTIONS<br>
<br>
THANK YOU

Text and graphic warnings on cigarette packages

http://www.who.int/bulletin/volumes/87/8/09-069575/en/
An important health communication intervention
Theories in social and health psychology, supported by empirical studies, have demonstrated the superiority of using pictures and imagery over text-only messages in health communication. Since the 1950s, many research studies have demonstrated that “fear appeals” are effective in motivating health behavior change (e.g. quitting), especially if paired with information about how to avoid the fearful consequences (e.g. where to find help about quitting).
Effectiveness of warnings
research studies that support the use of pictorial warnings, notably in the European Union. Taken as a whole, the research on pictorial warnings show that they are: more likely to be noticed than text-only warning labels; more effective for educating smokers about the health risks of smoking and for increasing smokers’ thoughts about the health risks; and associated with increased motivation to quit smoking.
A recent analysis of data from the ITC Four Country Survey compared the impact of the introduction of pictorial warnings in Australia in 2005 to that of the introduction of larger text-only warnings in the United Kingdom in 2003. Cognitive and behavioral indicators of label impact that are predictive of quit intentions and quit attempts (e.g. forgoing cigarettes because of the labels; thinking about the health risks of smoking) increased to a greater extent among smokers after the Australian pictorial warnings were introduced than they did in the United Kingdom after enhanced text-only warnings were introduced. Pictorial warnings are also cited by former smokers as an important factor in their attempt to quit and have been associated with increases in the use of effective cessation services, such as toll-free telephone “help lines”. Although all warnings are subject to wear-out over time, pictorial warnings have also been shown to sustain their effects longer than text-only warning labels.
Pictorial warnings were rated by all groups as being more effective than text-only warning labels for motivating smokers to quit.
No adverse consequences
The tobacco industry has suggested that the use of large pictures may reduce the effectiveness of health warnings and could actually lead to increases in smoking behavior.
However, there is no evidence that pictorial warnings lead to boomerang effects. An analysis of data from the ITC Four Country Survey found that the Australian pictorial warnings, introduced in 2005, led to greater avoidant behaviors (e.g. covering up the pack, keeping it out of sight, or avoiding particular labels), compared to Canada, the United Kingdom, and the USA. Importantly, those smokers who engaged in avoidant behaviors were no less likely to intend to quit or to attempt to quit,8 replicating the findings of a study of the Canadian warnings. Thus, although pictorial warnings can lead to avoidance and defensive reactions, such reactions are actually indicators of positive impact.
Smokers support warnings
Research shows that smokers want to see more health information on cigarette packages. Data from ITC surveys of smokers from 10 countries in 2006 shows that the percentage of smokers who want to see more information on cigarette packages is greater than the percentage of smokers who want to see less information – even in countries where pictorial warning labels had already been introduced.

Graphic pictures can significantly enhance the effectiveness of warning labels. In many countries, the warning label is the only sustained population-level mechanism by which governments inform their people about the harms of cigarettes and other tobacco products and, in those countries, the evidence-based inclusion of pictures could potentially lead to greater impact. For decades, the tobacco industry has taken advantage of the package as a venue for creating positive associations for their product. The use of graphic pictures is an important means of replacing those positive associations with negative associations, which is far more appropriate given the devastating impact of tobacco products on global health.
Fong GT. The International Tobacco Control Policy Evaluation Project: Evaluating global tobacco policies of the Framework Convention on Tobacco Control [plenary presentation]. In: 8th Asia Pacific Conference on Tobacco or Health (APACT), Taipei, October 2007.
Cunningham R. Cigarette package warning size and use of pictures: international summary. Ottawa: Canadian Cancer Society; 7 July 2009. Available from: http://www.tobaccolabels.ca/labelima/healthwarn [accessed on 13 July 2009].
Fong GT. What we know and don’t (yet) know about the impact of tobacco control policies: an in-progress summary from the ITC Project. In: Invited public health and epidemiology plenary lecture, Society for Research on Nicotine and Tobacco, Dublin, Ireland, April 2009.
Borland R, Wilson N, Fong GT, Hammond D, Cummings KM, Yong HH, et al. Impact of graphic and text warnings on cigarette packs: findings from four countries over five years. Tob Control 2009. Published online.

http://www.tobaccolabels.ca/countries/united-kingdom/

The United Kingdom implemented their current health warnings policy to place pictorial health warnings on cigarette packages by October 2008 in 2007, as a result of the European Commission labeling directive. Including the border, health warnings will be required to 43% of the front and 53% of the back of all cigarette packages. Overall, 48% of the pack space is appropriated to health warnings. The United Kingdom will rotate a set of 15 images.
http://www.tobaccolabels.ca/wp/wp-content/uploads/2013/12/Canada-2011-Canadians-Welcome-New-Graphic-Warnings-on-Cigarette-Packages-Cdn-Public-Opinion-Poll.pdf

Canadian Public Opinion Poll

Canadians Welcome New Graphic Warnings on Cigarette Packages
A majority of Canadians (60%) believe the images are about right, while one-in-four (24%) would have preferred more graphic imagery, and only 12 per cent think the images are too graphic.
82% support having health warnings on tobacco products.
60% think the new more graphic images that will be featured in cigarette packages are “about right.
48% think the images will be effective in convincing smokers to quit.
http://www.tobaccolabels.ca/wp/wp-content/uploads/2013/12/Australia-2011-Smokers-recall-of-Australian-graphic-cigarette-packet-warnings-and-awareness-of-associated-health-effects-BMC-Pub-Health-Miller.pdf

Smokers’ recall of Australian graphic cigarette packet warnings & awareness of associated health effects, 2005-2008.
This study also examines the varying impact of different warnings, to see whether warnings with visceral images have greater impact on smokers’ beliefs than other images.
l graphic pack warnings have had the intended impact on smokers. Some have greater impact than others. The implications for policy makers in countries introducing similar warnings are that fresh messaging and visceral images have the greatest impact.
Cigarette packet warnings are an important form of health communication to consumers. Australia’s graphic health warnings were designed to provide “a strong and confronting message to smokers about the harmful health consequences of tobacco products and convey the ‘quit’ message every time a person reaches for a cigarette”.
Theories of consumer behavior and social psychology predict that a number of predisposing variables influence behavior and the probability of behavioral change, with people’s beliefs being an important contributor [4-7]. Consumer behavior theory holds that behavior change, such as stopping smoking, can be induced by increasing consumer perception that the behavior is a ‘problem’ for them, requiring behavioral modification . By increasing a person’s belief that smoking leads to negative health consequences, pack warnings could change the consumer’s satisfaction with his/her current status as a smoker and induce (or increase) his/her desire to quit, increasing the chances that sh/he would try to quit.
http://www.tobaccolabels.ca/wp/wp-content/uploads/2013/12/India-2011-Are-current-tobacco-pictorial-warnings-in-India-effective-Asian-Pacific-J-Cancer-Prev-Oswal-et-al.pdf

Are Current Tobacco Pictorial Warnings in India Effective?
Methodology: To understand people’s attitude towards the pictorial warning and their understanding of the pictures, a study was planned in two phases. The first phase was qualitative with focus group discussion and second, a population based survey for validating the findings. Results: The findings of the study suggested that the mandated pictorial warnings do not serve the desired purpose since they are not properly understood.
The results of both the focus group discussions and the field survey indicate that most people have seen text and pictorial warnings on smokeless and smoking tobacco products, but that they lack relevance to the text messages. Irrespective of education the early proposed pictorial warnings by the government were more effective than the currently implemented warnings.

http://www.tobaccolabels.ca/wp/wp-content/uploads/2013/12/USA-2010-Understanding-how-graphic-pictorial-warnings-work-on-cigarette-packaging-J-Pub-Policy-Mktg-Kees-et-al.pdf

Understanding How Graphic Pictorial Warnings Work on Cigarette Packaging

Many of the pictorial cigarette warnings use graphic visuals that may evoke fear related to the consequences of smoking (Physicians for a Smoke-Free Canada 2010). Although some researchers argue that gruesome pictorial warnings on packages denigrate and shame adult consumers, which may reduce warning effectiveness (Wilson et al. 2009), public health messages have long used negative-consequence themes in the form of fear appeals to generate attention and motivate action in attempts to persuade users to change destructive behaviors.
more graphic pictures are predicted to have favorable effects on intentions to quit smoking through the level of fear evoked, highly graphic pictures may have a negative impact on copy test variables, such as message recall and package attitude. We expect that smokers will have less favorable evaluations of cigarette packages that contain graphic pictures reminding them of the health consequences of smoking than packages that contain less graphic warnings.
predicts that increasing the graphic depiction of the pictorial warnings will result in stronger intentions to quit smoking. indicate that the pictorial warning manipulation had a significant, positive effect on smokers’ intentions to quit smoking.

http://www.tobaccolabels.ca/wp/wp-content/uploads/2013/12/UK-2010-Evaluating-the-impact-of-picture-health-warnings-on-cigarette-packets-Evaluation-Report-Wardle-et-al.pdf

Evaluating the impact of Picture Health Warnings on Cigarette Packets

Support for and awareness of the picture health warnings was high. Almost all people in England believe that the warnings are necessary, impart important information and are credible. The impact of the picture health warnings so far, has been modest, at least in changing behaviour. Among adults, there was agreement that the pictures made smoking seem less attractive and that the pictures put people off smoking. Smokers were more likely to report that the warnings messages made them think about their smoking behaviour and thought about quitting smoking after the pictures warnings were introduced.
Impact of picture health warnings
the impact of the picture health warnings was much more modest among young people than adults. In part, this is to be expected. Smoking prevalence is lower among young people aged 13-17 than adults and therefore this age group has lower exposure to the messages, particularly the back of packet messages.
The Smoking, Drinking and Drug Use Survey (SDD) has demonstrated that 61% of young people aged 11-15 source their cigarettes by being given them from other people. Furthermore, in October 2007, the legal age to purchase cigarettes was increased from 16 to 18 making it more difficult for young people to buy cigarette packets.

Compare and contrast the relationship between Earned Value Management, Project Procurement, and the overarching effect the two have on the project’s budget. For your paper, use your project and related industry selected for previous assignments as an example. Your paper should include the following:
Examination of labor versus procurement,
actual costs,
over and under stating costs, and
steps to employing earned value.
To better demonstrate your comparison, provide a minimum of 5-8 examples of how you feel EVM calculations could be effected by problem procurements.

Support your paper with minimum of five (5) scholarly resources. In addition to these specified resources, other appropriate scholarly resources, including older articles, may be included.

Length: 5-7 pages not including title and reference pages

Examine the literature in your topic area and identify five articles published within the past five years that investigate mediating, moderating, or independent variables in an attempt to contribute to theory in the topic area. Write a paper in which for each article, you:

Describes the theory the researchers explore. What are the key constructs in the theory? How are they related? Identify which ones are cause, effect, mediating, or moderating constructs. How are the constructs operationalized?
Briefly describe the study, including the number of participants and research methods.
Briefly describe the statistical analyses used
Briefly described the findings and how the researchers interpreted them and their contribution to theory.

Using some or all of the five articles, argue for a gap in the knowledge in the topic area and briefly describe a study involving mediator and or moderator variables that can contribute to theory.

Support your paper with a minimum of 5 resources. In addition to these specified resources, other appropriate scholarly resources, including older articles, may be included.

Length: 5-7 pages not including title and reference pages
References: Minimum of 5 scholarly resources.