Bypassing the selection rule in choosing controls for a case-control study

Objectives It has been argued that in case–control studies, controls should be drawn from the base population that gives rise to the cases. In designing a study of occupational injury and risks arising from long-term illness and prescribed medication, we lacked data on subjects' occupation, without which employed cases (typically in manual occupations) would be compared with controls from the general population, including the unemployed and a higher proportion of white-collar professions. Collecting the missing data on occupation would be costly. We estimated the potential for bias if the selection rule were ignored. Methods: We obtained published estimates of the frequencies of several exposures of interest (diabetes, mental health problems, asthma, coronary heart disease) in the general population, and of the relative risks of these diseases in unemployed versus employed individuals and in manual versus non-manual occupations. From these we computed the degree of over- or underestimation of exposure frequencies and exposure ORs if controls were selected from the general population. Results: The potential bias in the OR was estimated as likely to fall between an underestimation of 14% and an overestimation of 36.7% (95th centiles). In fewer than 6% of simulations did the error exceed 30%, and in none did it reach 50%. Conclusions: For the purposes of this study, in which we were interested only in substantial increases in risk, the potential for selection bias was judged acceptable. The rule that controls should come from the same base population as cases can justifiably be broken, at least in some circumstances. <br/

Mortality from infectious pneumonia in metal workers: a comparison with deaths from asthma in occupations exposed to respiratory sensitizers

Introduction: national analyses of mortality in England and Wales have repeatedly shown excess deaths from pneumonia in welders. During 1979-1990 the excess was attributable largely to deaths from lobar pneumonia and pneumonias other than bronchopneumonia, limited to working-aged men, and apparent in other metal fume-exposed occupations. We assessed findings for 1991-2000 and compared the mortality pattern with that from asthma in occupations exposed to known respiratory sensitizers.Methods: the Office of National Statistics supplied data on deaths by underlying cause among men aged 16-74 years in England and Wales during 1991-2000, including age and last held occupation. We abstracted data on pneumonia for occupations with exposure to metal fume and on asthma for occupations commonly reported to surveillance schemes as at risk of occupational asthma. We estimated expected numbers of deaths by applying age-specific proportions of deaths by cause in the population to the total deaths by age in each occupational group. Observed and expected numbers were compared for each cause of death.Results: among working-aged men in metal fume-exposed occupations we found excesses of mortality from pneumococcal and lobar pneumonia (54 deaths vs. 27.3 expected) and from pneumonias other than bronchopneumonia (71 vs. 52.4), but no excess from these causes at older ages, or from bronchopneumonia at any age. The attributable mortality from metal fume (45.3 excess deaths) compared with an estimated 62.6 deaths from occupational asthma.Conclusion: exposure to metal fume is a material cause of occupational mortality. The hazard deserves far more attention than it presently receive

Characterisation and airborne deployment of a new counterflow virtual impactor inlet

A new counterflow virtual impactor (CVI) inlet is introduced with details of its design, laboratory characterisation tests and deployment on an aircraft during the 2011 Eastern Pacific Emitted Aerosol Cloud Experiment (E-PEACE). The CVI inlet addresses three key issues in previous designs; in particular, the inlet operates with: (i) negligible organic contamination; (ii) a significant sample flow rate to downstream instruments (∼15 l min^(−1)) that reduces the need for dilution; and (iii) a high level of accessibility to the probe interior for cleaning. Wind tunnel experiments characterised the cut size of sampled droplets and the particle size-dependent transmission efficiency in various parts of the probe. For a range of counter-flow rates and air velocities, the measured cut size was between 8.7–13.1 μm. The mean percentage error between cut size measurements and predictions from aerodynamic drag theory is 1.7%. The CVI was deployed on the Center for Interdisciplinary Remotely Piloted Aircraft Studies (CIRPAS) Twin Otter for thirty flights during E-PEACE to study aerosol-cloud-radiation interactions off the central coast of California in July and August 2011. Results are reported to assess the performance of the inlet including comparisons of particle number concentration downstream of the CVI and cloud drop number concentration measured by two independent aircraft probes. Measurements downstream of the CVI are also examined from one representative case flight coordinated with shipboard-emitted smoke that was intercepted in cloud by the Twin Otter

The History, Development and Impact of Computed Imaging in Neurological Diagnosis and Neurosurgery: CT, MRI, and DTI

A steady series of advances in physics, mathematics, computers and clinical imaging science have progressively transformed diagnosis and treatment of neurological and neurosurgical disorders in the 115 years between the discovery of the X-ray and the advent of high resolution diffusion based functional MRI. The story of the progress in human terms, with its battles for priorities, forgotten advances, competing claims, public battles for Nobel Prizes, and patent priority litigations bring alive the human drama of this remarkable collective achievement in computed medical imaging

Maintained physical activity and physiotherapy in the management of distal upper limb pain – a protocol for a randomised controlled trial (the arm pain trial)

&lt;b&gt;Background&lt;/b&gt;&lt;p&gt;&lt;/p&gt; Distal upper limb pain (pain affecting the elbow, forearm, wrist, or hand) can be non-specific, or can arise from specific musculoskeletal disorders. It is clinically important and costly, the best approach to clinical management is unclear. Physiotherapy is the standard treatment and, while awaiting treatment, advice is often given to rest and avoid strenuous activities, but there is no evidence base to support these strategies. This paper describes the protocol of a randomised controlled trial to determine, among patients awaiting physiotherapy for distal arm pain, (a) whether advice to remain active and maintain usual activities results in a long-term reduction in arm pain and disability, compared with advice to rest; and (b) whether immediate physiotherapy results in a long-term reduction in arm pain and disability, compared with physiotherapy delivered after a seven week waiting list period.&lt;p&gt;&lt;/p&gt; &lt;b&gt;Methods/Design&lt;/b&gt;&lt;p&gt;&lt;/p&gt; Between January 2012 and January 2014, new referrals to 14 out-patient physiotherapy departments were screened for potential eligibility. Eligible and consenting patients were randomly allocated to one of the following three groups in equal numbers: 1) advice to remain active, 2) advice to rest, 3) immediate physiotherapy. Patients were and followed up at 6, 13, and 26 weeks post-randomisation by self-complete postal questionnaire and, at six weeks, patients who had not received physiotherapy were offered it at this time. The primary outcome is the proportion of patients free of disability at 26 weeks, as determined by the modified DASH (Disabilities of the Arm, Shoulder and Hand) questionnaire.&lt;p&gt;&lt;/p&gt; We hypothesise (a) that advice to maintain usual activities while awaiting physiotherapy will be superior than advice to rest the arm; and (b) that fast-track physiotherapy will be superior to normal (waiting list) physiotherapy. These hypotheses will be examined using an intention-to-treat analysis.&lt;p&gt;&lt;/p&gt; &lt;b&gt;Discussion&lt;/b&gt;&lt;p&gt;&lt;/p&gt; Results from this trial will contribute to the evidence base underpinning the clinical management of patients with distal upper limb pain, and in particular, will provide guidance on whether they should be advised to rest the arm or remain active within the limits imposed by their symptoms

Arm Pain Trial : Study materials

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Individual and Combined Effects of Job Strain Components on Subsequent Morbidity and Mortality

Supplemental Digital Content is available in the text.Non peer reviewe

Reactive Uptake and Photo-Fenton Oxidation of Glycolaldehyde in Aerosol Liquid Water

The reactive uptake and aqueous oxidation of glycolaldehyde were examined in a photochemical flow reactor using hydrated ammonium sulfate (AS) seed aerosols at RH = 80%. The glycolaldehyde that partitioned into the aerosol liquid water was oxidized via two mechanisms that may produce aqueous OH: hydrogen peroxide photolysis (H_(2)O_(2) + hν) and the photo-Fenton reaction (Fe_(II) + H_(2)O_(2) + hν). The uptake of 80 (±10) ppb glycolaldehyde produced 2–4 wt % organic aerosol mass in the dark (k_(H)* = (2.09–4.17) × 10^6 M atm^(–1)), and the presence of an OH source increased the aqueous uptake by a factor of 4. Although the uptake was similar in both OH-aging mechanisms, photo-Fenton significantly increased the degree of oxidation (O/C = 0.9) of the aerosols compared to H_(2)O_(2) photolysis (O/C = 0.5). Aerosol organics oxidized by photo-Fenton and H_(2)O_(2) photolysis resemble ambient “aged” and “fresh” OA, respectively, after the equivalent of 2 h atmospheric aging. No uptake or changes in particle composition occurred on dry seed aerosol. This work illustrates that photo-Fenton chemistry efficiently forms highly oxidized organic mass in aerosol liquid water, providing a possible mechanism to bridge the gap between bulk-phase experiments and ambient particles