An evaluation of small-area statistical methods for detecting excess risk: with applications in breast and colon cancer mortality in Scotland 1986-1995

The need to report data at small-area level is constantly increasingly. In a society which is both health-conscious and environmentally aware, statistics at small-area level have a high degree of political significance. This type of data is required to plan and implement regional policies and apportion health care in accordance to the differing needs of the population. Recent advances in computer power has brought many advances to this area of study. For all the advances in technology and methodology, the problem of small numbers consistently appears. Is there an excess risk or is it down to chance? This is a question which is paramount in small-area statistics and will be addressed in this thesis. An overview of the thesis is provided below: Chapter 1 introduces the concept of small-area statistics and some of the social and political issues connected with this topic. There is a discussion of the analysis of small-area health data and the principal ideas that need to be considered in a statistical, political and social sense in this area of work. The aims of ISD Scotland are introduced and how they can be linked to this field of study. Chapter 2 describes an overview of the methods used in small-area statistics. The chapter begins by firstly considering the Standardised Incidence Ratio (SIR) which is the technique mainly used in the basic analysis done by ISD Scotland. Other techniques are then considered, however not all of these techniques are directly comparable to each other. The strengths and weaknesses of these techniques in previous research are discussed to give an idea of how the techniques perform in different scenarios. Chapter 3 is a simulation study of three of the techniques discussed in Chapter 2, these being the SIR, Circular Spatial Scan and Flexibly-Shaped Spatial Scan. The reason for this simulation study is to evaluate these techniques on simulated data arising from real scenarios. The strengths and weaknesses of these techniques are then highlighted which will prove helpful when analysing the data in Chapter 4. Chapter 4 provides an analysis of the mortality of breast and colon cancer in Scotland in the ten-year time period from 1986 to 1995. Using data provided by ISD Scotland, the analysis is carried out to identity any potential mortality clusters in both diseases. Chapter 5 provides a conclusion to this research by providing a summary of findings of the thesis and gives recommendations based upon these findings. A discussion is also given for potential further study in this field that could provide some value to ISD Scotland as they look to other ways of analysing their small-area data

Interactions Between the Feed and Feeding Environment

This information was presented at the 2016 Cornell Nutrition Conference for Feed Manufacturers, organized by the Department of Animal Science In the College of Agriculture and Life Sciences at Cornell University. Softcover copies of the entire conference proceedings may be purchased at http://ansci.cals.cornell.edu/extension-outreach/adult-extension/dairy-management/order-proceedings-resources

Prevention of Group B Streptococcal Disease in the Newborn.

Group B streptococcus (GBS) is a leading cause of morbidity and mortality among newborns. Universal screening for GBS among women at 35 to 37 weeks of gestation is more effective than administration of intrapartum antibiotics based on risk factors. Lower vaginal and rectal cultures for GBS are collected at 35 to 37 weeks of gestation, and routine dindamycin and erythromycin susceptibility testing is performed in women allergic to penicillin. Women with GBS bacteriuria in the current pregnancy and those who previously delivered a GBS-septic newborn are not screened but automatically receive intrapartum antibiotics. Intrapartum chemoprophylaxis is selected based on maternal allergy history and susceptibility of GBS isolates. Intravenous penicillin G is the preferred antibiotic, with ampicillin as an alternative. Penicillin G should be administered at least four hours before delivery for maximum effectiveness. Cefazolin is recommended in women allergic to penicillin who are at low risk of anaphylaxis. Clindamycin and erythromycin are options for women at high risk for anaphylaxis, and vancomycin should be used in women allergic to penicillin and whose cultures indicate resistance to clindamycin and erytbromycin or when susceptibility is unknown. Asymptomatic neonates born to GBS-colonized mothers should be observed for at least 24 hours for signs of sepsis. Newborns who appear septic should have diagnostic work-up including blood culture followed by initiation of ampicillin and gentamicin. Studies indicate that intrapartum prophylaxis of GBS carriers and selective administration of antibiotics to newborns reduce neonatal GBS sepsis by as much as 80 to 95 percent