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Everett Bailey
Everett Bailey

Person Of Interest 4x10 REPACK


Ideally, if we are to estimate incidence (incidence proportion or incidence rate), we would want to measure this in a sample of people who are truly at risk of developing the outcome of interest. So, in measuring incidence we would like to exclude anyone who was not at risk of developing disease, because they already had the disease or because they couldn't develop it. For example, if one wanted to estimate the risk of developing uterine cancer in postmenopausal women, we ideally would like to exclude women who had previously undergone hysterectomy (removal of the uterus), since they are no longer at risk of developing this particular type of cancer.




Person of Interest 4x10



Suppose we were interested in the problem of diabetes in a nursing home with 800 residents. We would begin by doing blood tests on all residents to determine which were diabetic. If 50 of the residents were diabetic initially, then the prevalence of diabetes at this point in time would be 50/800 = 0.0625. The standard way of expressing this would be to say that the prevalence was 62.5 per 1000 residents or 6.25 per 100 residents, or 0.0625%


Remember that a rate almost always contains a dimension of time. Therefore, the incidence rate is a measure of the number of new cases ("incidence") per unit of time ("rate"). Compare this to the cumulative incidence (incidence proportion), which measures the number of new cases per person in the population over a defined period of time. Because studies of incidence in epidemiology are conducted among groups of people as they move through time, the denominator is actually a combination of the number of people and the amount of time. This is expressed as person-time. The time units can be expressed in days, months, or years, but should be tied to the length of the study and aid interpretation of the results. The most frequently encountered expression is "person-years". The characteristics of cumulative incidence and incidence rate are illustrated in the examples below.


Six of ten subjects in each group experienced relief of pain, so the cumulative incidence of pain relief was 6/10 = 60% in each group. Whenever cumulative incidence is determined, one determines the proportion of subjects who experienced the outcome of interest during a block of time, without taking into account when subjects developed the outcome. Visually, however, it is clear that if we consider when subjects experienced relief, the rate was greater in the subjects receiving the new drug.


In the group receiving the new drug the times were 4x1 + 2 + 3+ 4x10= 49 hours for the group (person-hours). So the incidence rate of relief was 6/49 person-hours or on average 12.2 per 100 person-hours of observation. Note that once a subject experiences the outcome of pain relief, they are no longer considered to be under observation.


In the group receiving the old drug the times were 4x7 + 8 + 9 + 4x10= 85 hours for the group (person-hours). So the incidence rate of relief was 6/85 person-hours or on average 7.0 per 100 person-hours of observation. So, the rate of pain relief was greater in the group receiving the new drug.


Question: A participant in a prospective cohort study or a randomized clinical trial stops contributing additional "disease-free observation time" when they develop the outcome of interest or become lost to follow-up for any reason (death, failure to respond to phone calls, letters and emails, etc.). Does this mean that they are no longer in the study?


The incidence rate, however, can take these problems into account, because the denominator is the total "at risk" observation time contributed by all ten subjects. The column at the far right indicates each subject's "at risk" observation time, and the sum for the ten subjects was 26 years. So, the IR= 4/26 person-yrs = 0.15/person-year = 15/100 person-years of observation.


The red "X"s indicate when subjects had a heart attack; their exposure time at risk ends there, since having a first heart attack means that they were no longer at risk of having a first heart attack; they had the outcome of interest at that point. Subject #2 had a heart attack in 1990; subject #5 had one in 1984; subject #11 had one in 1988.


All of this information can be taken into account in order to compute the average rate at which heart attacks occur in this group of 12 men being treated with low-dose aspirin. We can do this in a way that is analogous to example #2 above. There were 3 heart attacks, and we divide this by the total amount of time that the men were exposed and at risk of developing a heart attack. For each man the exposure time at risk is the time from their entry into the study until one of three endpoints: a) the disease occurs, b) the subject is lost to follow-up, or c) the study concludes. The exposure time at risk for each man is shown in the column at the far right of the figure, and if we add these, the total exposure time for the group was 102 years. Therefore, the average rate at which the outcome occurred was 3/ 102 person-years of observed exposure time.


Women on postmenopausal hormones had an incidence rate of 30 events during 54,308.7 person years of follow-up, or 55.2 / 100,000 person-years. Women in the untreated group had 60 events during 51,477.5 person-years of follow-up - an incidence rate of 116.6 / 100,000 person-years.


In this study, incidence rates of MI (myocardial infarction) were compared among five groups of women based on their body mass index (BMI). There were certainly different numbers of women in the five groups, but for each group they computed the incidence rate by counting the number who developed MI and dividing by the group's total "at risk" time of observation. The result was then converted to the number per 100,000 person-years to facilitate comparison among the five groups.


The Cemetery and Funeral Bureau licenses, regulates, and investigates complaints against California funeral establishments, funeral directors, embalmers, apprentice embalmers, cemetery brokers, cemetery salespersons, cemetery managers, cremated remains disposers, crematories, crematory managers and the nearly 200 fraternal and private cemeteries in the State.


Details: A person may direct in writing the disposition of his or her remains and specify the funeral goods and services desired. Unless there is a written statement to the contrary that is signed and dated by the person, these directions may not be changed in any material way except as required by law.


(NOTE: Exceptions may apply in certain situations. You have the right to select a different person to make the decisions about your arrangements, if you wish. You may wish to consult with an attorney about including such instructions in your will or in another written document, such as a power of attorney for health care. Be sure to provide copies of your instructions to family members and keep your own copy in a place that can be easily accessed.)


Federal law requires funeral establishments to quote prices over the phone and to give you a General Price List (GPL) and a Casket Price List (CPL) when you ask in person about arrangements and prices. If the funeral establishment sells outer burial containers, it must also provide you prices for those containers, either as part of the GPL or on a separate price list. If the funeral establishment has a Web site, it must post the list of funeral goods and services that are required to be included in their GPL, pursuant to federal rule, and include a statement that the GPL is available upon request via a link from the home page, OR include the words "price information" or a similar statement that includes the word "price" with a link to the GPL.


The law does not require embalming. However, the person with the right to control disposition must accept or decline embalming by signing a specific form prescribed by the Bureau. Additionally, a funeral establishment must refrigerate an unembalmed body in its possession if burial or cremation does not take place within 24 hours. (See exception under Home Death Care.) As a practical matter, however, you may wish to authorize embalming if there will be a delay before a public viewing. Keep in mind that embalming does not prevent decomposition of a body.


California law requires retail casket sellers, when beginning any discussion of prices, to give customers a written price list of all caskets, alternative containers, and outer burial containers normally offered for sale and the price for each. In addition, if customers ask for the list in person or by phone, the retail casket seller must give them a written statement identifying caskets or containers by price, thickness of metal, type of wood or other construction, and by interior and color. Price, thickness, construction, and color information must also be included on a tag conspicuously attached to each casket. Prior to a sale, the seller must provide the buyer an itemized statement of all costs involved.


POD Account - Establish a Pay on Death (POD) Account with your bank, designating the funeral establishment or another person as the beneficiary of funds upon your death. Be sure to inform family members, the funeral establishment, your chosen executor, and your attorney of the provisions of the account. POD accounts may involve service fees, and interest earned is taxable. They may be canceled without penalty.


Funeral establishments and licensed cemeteries must present to the person making funeral arrangements for a deceased person a copy of any preneed agreement in their possession that is signed and paid for in full or in part.


The person who has the right to control the disposition of the body must sign a written authorization before cremation can proceed. This authorization, or a separate contract, indicates the location, manner, and time of disposition of the remains. It also includes an agreement to pay the costs for the cremation, for disposition of the cremated remains, and for any other services desired. (If you wish to arrange for your own cremation, you can legally sign the Declaration for Disposition of Cremated or Hydrolyzed Human Remains yourself.) 041b061a72


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