October 2022 - The Epidemiology Monitor

Editor’s Note:

In this month’s issue

look at the

how current policies and approaches are impacting it In addition we take a dive into causal inference

of research and thoughts for the road ahead. Our article from the archives this month looks at the public perception of epidemiology .

We continue to provide you with our crossword series,

an overview of what we are reading

the public media, and upcoming events for epidemiologists. If you enjoy our crosswords, you’ll find the answers for last month’s puzzle on

.

both here

Finally, don’t miss

continue

throughout the US and beyond

Opioids: Reflections on the Impact of Policies and Current Impact of Public Health Approaches

Author: Madeline M. Roberts MPH, PhD

Updated: 10/20/2022 1:40 PM EST

The CDC and National Vital Statistics System mark three waves in U.S. opioid overdose deaths beginning in 1999 with prescription overdose deaths, moving into heroin overdose deaths in 2010, and synthetic opioid overdose deaths beginning in 2013. In 2016, deaths from opioid overdose reached over 42,000, a US record. In 2017, The Department of Health and Human services declared opioid misuse and related overdoses a public health emergency. The advent of COVID 19 and the corresponding challenges and disruptions to daily life has intensified the opioid crisis. In 2021, drug overdose deaths again reached record heights—this time over 107,000 deaths in one year. Currently, fentanyl and fentanyl tainted synthetic opioids are driving opioid overdose deaths (here, here, and here). Evidence and common practice among physicians for most of the mid 20th century was that opioids were not appropriate for chronic pain treatment because they could lead to misuse and addiction. However, opioid prescribing gradually became more common for cancer patients and for acute pain. In the mid 1990s, the American Pain Society began advocating for pain as the 5th Vital Sign. In 1999, The Veteran’s Health Administration included pain as the 5th Vital Sign in their pain management strategy. This was shortly followed by the Joint Commission on Accreditation of Healthcare Organizations releasing standards for the assessment and treating of pain. The 1990s marked an increase in the prescription of opioids, which grew substantially in the early 2000s.Overdose deaths began to climb during this time.

Hindsight of course offers the best vantage point, but perhaps the most striking part of this history is the overwhelming lack of quality evidence presented on long-term opioid use and dependence. The evidence base appears to have been repeated citation of relatively nonrobust studies (one example here). An excellent, concise history of opioid use and related literature can be found here. Approximately 75% of opioid abusers reported their first opioid was a prescription drug, and individuals and state and local governments have demanded accountability from pharmaceutical corporations. Major settlements (here and here) totaling around $32 billion were reached in early 2022 between drug corporations and the majority of US state and local governments.

Current strategies, approaches, resources

Recent evidence from the Stanford Lancet Commission on the North American Opioid Crisis projects 1,220,000 opioid related deaths by 2029, and shows that increasing naloxone (an opioid antagonist, which rapidly reverses opioid overdose) availability by 30% could avert 25% of opioid deaths. Other helpful interventions include pharmacotherapy, syringe exchange, psychosocial treatment, and prescription monitoring programs (PMPs). One public health approach, harm reduction, acknowledges that some ways of using drugs are safer than others and therefore aims to mitigate the harmful consequences for people using drugs as opposed to focusing on drug use cessation. One such strategy is overdose prevention centers (OPCs), which provide a safe

place to use pre-obtained drugs and trained staff prepared to intervene in the event of an overdose. This includes supervision of drug consumption as well as offering resources and services such as clean syringes, naloxone, and testing drugs for fentanyl. Importantly, people who use OPCs can receive or be linked to additional support services such as food and housing, medical support, and addiction treatment, among others. OPCs also emphasize social justice and dignity for people who use drugs who are often marginalized. New York opened the first OPCs in the United States on November 30, 2021, which saved dozens of lives within months of opening.

This commentary offers a thoughtful

summation of current evidence on OPCs, including their association with reduced public drug consumption and crime in the surrounding neighborhoods, as well as barriers and pushback in some areas. The authors also highlight the need for appropriate outcome measurements for OPCs so as to accurately reflect public health outcomes and objectives.

The opioid crisis is a multi-faceted, devastating story with reflection points for everyone from physicians and epidemiologists to policymakers, parents, and friends. Currently, evidence based interventions in this area do exist. We need all the bright minds and hands to continue this research and carry forward this work.

Causal Inference – Emerging Areas of Research and Thoughts for the Road Ahead

Author: Madeline M. Roberts, MPH, PhD

Causal inference, inferring what would have happened in the past had something been done differently, or what would be the future result if a current course of action is altered, is one of the central aims of epidemiology. Donald Rubin has written masterfully on the conceptual and mathematical history of causal inference in epidemiology and statistics beginning in 1925 with Sir Ronald Fisher positing that randomization should be the basis for causal inference. Rubin also notes that the future of causal inference is nearly inextricable from modern computing, including artificial intelligence and machine learning.

This month we wanted to highlight an exciting article in the October 2022 issue of The American Journal of Epidemiology. “The Future of Causal Inference” presents a non exhaustive, non ranked list of ten areas of emergent research in causal inference that have been gaining traction in recent years.

treatment and the outcome in variable selection to mitigate confounding when including such a large number of potential confounders.

2. Precision medicine, which the authors define as “using available data to determine what treatment is best for an individual and delivering it at the right time” has benefitted from advances in statistical methodology. Developments in this area involve determining both the optimal monitoring plan as well as the optimal intervention based on feedback from said monitoring plan. Future aims will involve microrandomized trials and mobile technology to tailor with even greater precision both interventions and delivery.

3. Causal machine learning where the aim is to predict what would happen if a specific aspect of the world changed, rather than trying to predict what will occur next in the world’s current state. This necessitates thoughtful study design and model selection before implementation.

It is noteworthy that the majority of these emerging areas of causal inference research are rooted in statistical learning methods. For current and rising epidemiologists, the pursuit of rigorous training and continued education in statistics and data analysis truly cannot be overemphasized. A synopsis of each area of emergent research follows.

1. High-dimensional data present a multitude of opportunities to explore a wider array of causal questions, however, subject to the “curse of dimensionality,” this comes with statistical challenges and the problem of high dimensional confounding. Emerging research in this area covers methods which consider both

4. Enriching randomized experiments with real-world data. While randomized experiments are the gold standard for study, they can be cost prohibitive and often include only a subgroup of the target population. One growing area of research, which the authors liken to a form of meta-analysis, focuses on how to combine evidence from both randomized experiments and observational studies. For example, taking treatment effect point estimates from a randomized control trial (RCT) and using observational study evidence to evaluate differences in the included and excluded participants of the RCT.

5. Algorithmic fairness and social responsibility. In view of evidence demonstrating bias in data sources and the resulting algorithms, new causal inference research emphasizes counterfactual thinking such as whether changing one feature affects model prediction and sensitivity analyses to evaluate whether bias exists from unmeasured factors.

6. Distributed learning. In view of the considerable computational workload that deep learning can necessitate, distributed learning can refer to distributing computational workload across many machines to achieve scalability. It can also refer to a privacy preservation approach when data is shared across different systems and populations wherein models can be fit to data without sharing the raw, granular data.

7. Causal discovery involves, under specific assumptions, using statistical methods and computational algorithms to find causal relationships and identify a directed acyclic graph (DAG) from observational data.

8. Interference and spillover. Knowing that the results of policy decisions in one area do not happen in isolation but rather “spillover” into neighboring areas, a growing area of causal inference research focuses on evaluating the causal effect of this spillover and defining estimands of interest.

9. Transportability involves whether study results from one specific population can be conveyed to another target population. Differences in factors between the two populations or geographic regions necessitate methods that can account for these differences, as well as generalize causal effects in complex settings.

10. Quasi-experimental devices aim to mitigate the ambiguity of associations in observational studies resulting from non randomized treatment. Emerging developments in quasi experimental devices include evidence factors, differential effects, and computerized construction of quasi experiments. Future work in this area will aim to apply statistical inference in quasi experimental devices as well as determine how to leverage quasi experimental devices in making causal inferences about many treatments working together.

*

With computational advances and the proliferation of data in so many fields, perhaps there has never been a more exciting time to be an epidemiologist. With these advances in statistical computing, rigorous study design and disclosing assumptions remain critically important for responsible research.

The

Articles From Our Archives

Ken Rothman Delivers 12th Annual Saward-Berg Lecture at the University of Rochester on the Public Perception of Epidemiology

Author: Roger Bernier, MPH, PhD

True or false? If there is a discrepancy between the results of a randomized clinical trial and those of observational studies, you should automatically consider the trial results correct and the observational results suspect.

According to Ken Rothman, Distinguished Fellow at the Research Triangle Institute and annual Saward-Berg lecturer at the University of Rochester, the answer is false. If you answered true to this statement you are falling prey to a common misperception about the value of different study designs, Rothman told the Rochester audience. In fact, randomized trials fall within the broader rubric of epidemiologic studies and share with other epidemiologic studies a broad array of concerns, he added.

Origins of Skepticism

Rothman traced the origins of some of the public reservations about epidemiologic findings to earlier critics of epidemiologic work such as Ralph Horwitz and Alvan Feinstein, who published papers in the New England Journal of Medicine in the late 1970’s questioning the link between estrogen and endometrial cancer. At the time, they blamed detection bias for the association. In later work, they criticized epidemiologic research more broadly, asserting that principles they believed were used to evaluate scientific results in general should also be applied to epidemiology.

Coffee and Pancreatic Cancer

Rothman mentioned another controversial finding, the report of a link between coffee and pancreatic cancer in the early 1980’s, which fueled subsequent public skepticism about the value of epidemiology. This skepticism came to be embodied in cartoons such as the one in the Cincinnati Enquirer showing a newscaster selecting the day’s Random Medical News from the New England Journal of Panic Inducing Gobbledygook. The newscaster spins wheels with chance alone determining which factor comes up, then which disease, then which affected population will randomly constitute the day’s news.

Cartoons

In a talk which he himself peppered with such cartoons and illustrations to make his point about public perceptions, Rothman showed his audience the now often used drawing of a tanker truck carrying potentially hazardous liquids with the following words inscribed on the rear of the tanker “The scientific community is divided. Some say this stuff is dangerous, some say it isn’t.”

The much referred to 1995 Science article by Gary Taubes entitled “Epidemiology Faces Its Limits” was criticized by Rothman for feeding public misperceptions about epidemiology by relying on out of context quotes and other journalistic devices.

Discrepant Findings

Of course, the main factor in public skepticism about epidemiology comes not so much from journalists’ errors or practices but from apparently discrepant findings between epidemiologic studies or between observational studies and randomized trials. Perhaps the most well known modern example of this type of discrepancy is the much publicized conflicting set results on hormone replacement therapy. In this example, cohort studies indicated that hormonal therapy could reduce risk of coronary heart disease, whereas trials showed either no effect or an adverse effect.

Other Explanations

According to Rothman, it was facile to ascribe differences in study results such as those relating to hormone replace therapy to a hierarchy of supposed reliability in study designs, casting doubt on the validity of any findings that did not emanate from randomized trials. He praised the work of Miguel Hernan, who showed that the discrepancies between the Nurses’ Health Study and the Women’s Health Initiative results could be largely explained by differences in the distribution of time since menopause and length of follow up, and that in the case of hormone replacement therary and CHD, the differences between experimental and non experimental studies reflected differences across study populations, rather than confounding problems or other internal biases.

Reasons For Discrepancies

In Rothman’s view, it is much more productive to ask why the discrepant results have been produced than to ascribe them automatically to study design issues. Some of the reasons that

may be operating to explain discrepancies between study results include differences in exposures or treatments, misinterpretation based on statistical significance testing, uncontrolled confounding, effect measure modification, random error, bias from intent to treat analysis, or other biases.

In fact, observational studies have positive features not found with trials such as lower cost, larger sample sizes, ability to examine relatively rare endpoints, fewer ethical barriers, inclusion of a wider range of patients, and evaluation of treatments in real world as opposed to artificial trial conditions.

Conclusion

In concluding, Rothman stated that differences across epidemiologic studies have often been ascribed to the study design itself instead of study flaws. He stated that if studies are well conducted and if they truly address the same question, different approaches should give similar results.

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Type of disease list every state and country has for public health surveillance

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COVID-19

What We're Reading This Month

Toxic

Profiled: Growing up on free school meals at one of the lowest performing state schools in the country, Dr. Raghib Ali went on to become a leading epidemiologist and OBE awardee. He’s determined to improve the life outcomes of children from poor backgrounds so that they too can reach their full potential. https://bit.ly/3DB6b7I

Awarded: The WKU College of Health and Human Services (CHHS) recently hosted a 20th anniversary celebration and recognized alumni for their achievements with the first annual CHHS Alumni Achievement Award. A 2003 graduate of CHHS with a Master of Public Health (MPH), one of the recipients, Mr. Jason Cummins, is the Director of Tennessee Department of Health TB Elimination Program, and was the first recipient of the CHHS Outstanding Graduate Student award.

Awarded: Dr. Katelyn Jetelina, author of Your Local Epidemiologist and editor & publisher of the EpiMonitor, with the National Academies top award for: Research Scientist: Early Career for her communications work. In awarding the prize the Academy stated: “Jetelina offers very concise and clearly written explanations from the unique (and invaluable) perspective of an early career epidemiologist who deals with the nuances relating to COVID infection, vaccination, and public health issues in an extremely effective way. The breadth of her influence and the importance of her work to many members of the public over the last two years…”

Honored: Wafaie Fawzi, Vikram Patel & John Quackenbush Three faculty members from Harvard T.H. Chan School of Public Health Wafaie Fawzi, Vikram Patel, and John Quackenbush have been elected to the National Academy of Medicine (NAM). Fawzi is the Richard Saltonstall Professor of Population Sciences and professor of nutrition, epidemiology, and global health. Patel is professor in the Department of Global Health and Population at Harvard Chan School as well as Pershing Square Professor of Global Health in the Department of Global Health and Social Medicine at Harvard Medical School. Quackenbush is the Henry Pickering Walcott Professor of Computational Biology and Informatics and chair of the Department of Biostatistics at Harvard Chan School, as well as professor in the Channing Division of Network Medicine, and professor at the Dana Farber Cancer Institute.

have

about yourself, a colleague, or a student?

Please help The Epidemiology Monitor keep the community informed by sending relevant news to

at

address for inclusion in our next issue. people@epimonitor.net

Passed: Dr. Genevieve E. ‘Gene’ Matanoski an epidemiologist and the longest-serving faculty member at the Johns Hopkins Bloomberg School of Public Health who was internationally known for her work in toxic exposure research, died of a heart attack Oct. 2 at Sinai Hospital. The Reisterstown resident was 92. Dr. Matanoski began her career at Hopkins in 1958 as a research associate in epidemiology and in 1976 became the ninth woman at Bloomberg to be appointed full professor with tenure. In 1978, she was the founding director of the occupational and environmental epidemiology training program, which she headed until 2010. https://bit.ly/3FpdQHL

Passed: Dr. Paula Braitstein passed away in Eldoret, Kenya. She was a Professor of Epidemiology at the Dalla Lana School of Public Health and cross appointed to the Department of Obstetrics and Gynecology in the Faculty of Medicine as well as an Adjunct Professor at Indiana University and Visiting Professor at Moi University. She started her career as an HIV treatment educator and activist in the community based HIV/AIDs movement. She was a CIHR Applied Public Health Chair and renowned expert in epidemiology, population health and planetary health. https://bit.ly/3TZItHD

Passed: Paul Wilkinson director of the British National Institute for Health and Care Research health protection research unit in environmental change and health, repeatedly urged his colleagues to “think big.” There was no time to waste, and he was hugely energetic. During his career, he led or was the co investigator on over 70 research projects, covering subjects ranging from energy efficient buildings and air and noise pollution to the impact of flooding on health, and speed restrictions on road injuries. https://bit.ly/3SDToFV

Honored Posthumously : The Pan American Health Organization (PAHO) has recognized the late epidemiologist Ms. Carla Gabriela Romero Pérez, from Bolivia, with the PAHO Award for Health Services Management and Leadership. Ms. Romero Pérez worked at Bolivia’s Ministry of Health and oversaw vector control programs. Conferring this year’s honour, the President of the 30th Pan American Sanitary Conference, Michael Pearson recognized the tireless work of Ms. Romero Pérez to strengthen efforts to combat arboviruses. https://bit.ly/3TH27Zk

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Near Term Epidemiology Event Calendar

Research Investigator MD/DO– Division of Health Services Research and Implementation Science (Open Rank)

The Department of Research and Evaluation (R&E), Kaiser Permanente Southern California (KPSC) is recruiting candidates for a Research Scientist/MD Investigator in the Division of Health Services Research and Implementation Science. This is an open rank Research Scientist (equivalent to an Assistant, Associate or Full Professor) position. This position is an ideal opportunity for a physician scientist to conduct and lead high quality health services research that results in improvements to patient care, with the option to maintain a part-time clinical practice with the Southern California Medical Group (SCPMG). Health services research can include the comparative effectiveness of delivery systems; patient centered care; health care for people with diverse backgrounds; as well as health care access, utilization, and dissemination and implementation of findings and practices. Current areas of high priority for KPSC include cancer care, cardiovascular health, mental health and wellness, and health equity across these domains.

Qualifications: Medical Doctoral Degree (MD) or Doctor of Osteopathic Medicine (DO) with post doctoral research training in health services, epidemiology, health economics, public health, healthcare administration, or related fields or equivalent training and mastery preferred. Competent in advanced research methods, including statistical techniques and study designs commonly used in health services research, implementation science, epidemiology, behavioral research, economics, or related fields. Experience or interest in partnering with operational leadership across broad clinical areas within a learning health system. Must be able to consistently demonstrate the knowledge, skills, abilities, and behaviors necessary to provide superior and culturally sensitive service to all.

The successful candidate will be expected to:

• Design, develop, and direct a blended internally and externally funded research program that is aligned with clinical practice resulting in the translation of results directly to patient care.

• Lead or co lead oversight of the Care Improvement Research Team (CIRT) embedded research portfolio (Research Scientist Levels II-III only).

• Collaborate with clinical investigators within R&E and with external investigators in health care and academic settings, to advance knowledge in the diagnosis, treatment, and outcomes for various conditions across diverse populations.

• Provide service to the scientific community through reviewing manuscripts for publication, serving on editorial boards, and grant review panels.

• Present at national and international scientific meetings.

• Maintain awareness of scientific developments within area of expertise, both in terms of new methodology and new research activities.

• Serve on and may chair departmental committees based on experience and expertise.

The candidate may also serve as a faculty in the Kaiser Permanente Bernard J. Tyson School of Medicine and have the opportunity to teach and mentor students. This position will include a core support package for the successful applicant that can be used to conduct pilot studies that leverage existing infrastructure to facilitate the development of an extramurally funded research program. This support includes staffing for administrative tasks, programming and analysis, and research support as well as funding for non personnel related costs.

KPSC is a leading integrated health care organization with 4.8 million members of diverse race/ethnicity living throughout Southern California. They are attended by over 7,800 physicians practicing in an integrated, pre paid delivery system that provides comprehensive health care and pharmaceutical benefits to members of the non-profit Kaiser Foundation Health Plan and Hospitals. KPSC has deployed an extensive clinical information system, including a fully automated medical record system. A description of R&E is available on the web (http://www.kp scalresearch.org/). The Department is located in Pasadena, a community of 143,000 residents and the home of the California Institute of Technology, the Rose Bowl, the Jet Propulsion Lab, and other historical and cultural sites. Information about the community can be found online at www.visitpasadena.com. Pasadena is in the San Gabriel Valley 15 minutes north of downtown Los Angeles in sunny southern California.

For more information or to apply for this position, please visit the Kaiser Permanente job website at http://www.kaiserpermanentejobs.org and search Job Numbers: 1078457 (Research Investigator I MD), 1078444 (Research Investigator II MD), or 1078430 (Research Investigator III MD) in the keyword field. Inquiries may be directed to Dr. Huong Nguyen at the research recruitment mailbox (email: Research-Recruitment@kp.org). Principals only.

KPSC is an Equal Opportunity/Affirmative Action Employer and offers a comprehensive compensation package, including employer paid medical, dental and coverage for eligible dependents. Competitive wages, generous paid time off and a comprehensive retirement plan are just part of the exceptional benefits offered to Kaiser Permanente employees.

Post-Doctoral Research Fellow, Infectious Disease Epidemiology

The Department of Research and Evaluation (R&E) of Kaiser Permanente Southern California (KPSC) is seeking a Post Doctoral Research Fellow interested in infectious disease epidemiology and vaccine safety and effectiveness.

The R&E of KPSC conducts high quality research involving large, diverse populations, providing timely evidence to decision makers and the public. The research team has expertise and experience in performing a vast array of infectious disease research, including vaccine research studies. Studies range from large, multisite epidemiologic studies on a variety of topics including antibiotic resistance, hospital infections, tuberculosis, COVID 19, and vaccine preventable diseases, to Phase IV vaccine post licensure observational studies. The research team works with partners from government, industry, academia, and other health care systems. Our vaccine research consists of topics including vaccine safety and effectiveness, vaccines in special populations (e.g., pregnant women, immunocompromised individuals), vaccine uptake and compliance with recommendations, and methodologies for vaccine studies. Findings from studies guide KPSC clinical care improvement efforts, as well as immunization policy and regulatory decisions and provide the public with information regarding risks and benefits of immunization.

Essential Responsibilities:







Designs, develops and directs well defined research with supervision from a R&E Research Scientist.

Prepares grant proposals and publications independently and collaboratively.

Provides consultation and direction to programmer/analysts with regard to data management and analysis strategies.

May perform subject assessments or chart reviews or provide direction to research support staff performing these tasks.

Submits abstracts to and presents papers at national scientific meetings.

Seeks consultation from research scientists for specific scientific and administrative issues.

Participates in R&E department meetings and projects as appropriate.

Preferred Qualifications:

Doctoral degree (Ph.D., Dr.P.H., M.D., Sc.D.) in epidemiology, preferably in infectious disease epidemiology, or clinical doctoral degree + master's degree with formal research training in epidemiology.

Track record of publication in the peer reviewed literature.

 Research experience in infectious disease epidemiology or vaccine safety and effectiveness.

 Competent in advanced research methods, including statistical techniques and study design commonly used in epidemiologic research or related fields.

KPSC is a leading managed health care organization with 4 million members of diverse race/ethnicity living throughout Southern California. They are attended by over 6,000 physicians practicing in an integrated, pre paid delivery system that provides comprehensive health care and pharmaceutical benefits to members of the non-profit Kaiser Foundation Health Plan and Hospitals. KPSC has deployed an extensive clinical information system, including a fully automated medical record system. A description of the Department of Research & Evaluation is available on the web (http://www.kp scalresearch.org/). It is the home to nearly 30 doctorally prepared investigators and over 400 support staff. The Department is located in Pasadena, a community of 143,000 residents and the home of the California Institute of Technology, the Rose Bowl, the Jet Propulsion Lab, and other historical and cultural sites. Information about the community can be found online at www.visitpasadena.com Pasadena is in the San Gabriel Valley 15 minutes north of downtown Los Angeles in sunny southern California.

This one-year renewable position (funding and performance dependent) will provide mentored experience in field work, proposal development and scientific publication, designed to prepare the incumbent for a productive career as an independent researcher.

KPSC is an Equal Opportunity/Affirmative Action Employer and offers a comprehensive compensation package, including employer paid medical, dental and coverage for eligible dependents. Competitive wages, generous paid time off and a comprehensive retirement plan are just part of the exceptional benefits offered to Kaiser Permanente employees.

For immediate consideration, interested candidates should submit their letter of interest, CV and references to Dr. Kristi Reynolds, Director of Epidemiologic Research (email: allan.slatkin@kp.org) and by Kaiser Permanente Job Posting 961068 Website (Click Here) or visit the Kaiser Permanente job website at https://www.kaiserpermanentejobs.org/ and search 961068 in the keyword field.

Post-Doctoral Research Fellow, Vaccine Safety and Effectiveness

The Department of Research and Evaluation (R&E) of Kaiser Permanente Southern California (KPSC) is seeking a Post Doctoral Research Fellow interested in infectious disease epidemiology and vaccine safety and effectiveness.

The KPSC Center for Vaccine Safety and Effectiveness Research high quality research involving large, diverse populations, providing timely evidence to decision makers and the public. The Center is part of the Department of Research & Evaluation, based in Pasadena, California. The research team has expertise and experience in performing a vast array of vaccine research studies, ranging from epidemiologic studies of vaccine preventable diseases to Phase IV post licensure observational studies. The research team works with partners from government, industry, academia, and other health care systems to conduct important research on topics such as vaccine safety and effectiveness, vaccines in special populations (e.g., pregnant women, immunocompromised individuals), vaccine uptake and compliance with recommendations, and methodologies for vaccine studies. Findings from the Center’s studies guide immunization policy and regulatory decisions and provide the public with information regarding risks and benefits of immunization.

Essential Responsibilities:

 Designs, develops and directs well defined research with supervision from a R&E Research Scientist.

 Prepares grant proposals and publications independently and collaboratively.

 Provides consultation and direction to programmer/analysts with regard to data management and analysis strategies.

 May perform subject assessments or chart reviews or provide direction to research support staff performing these tasks.

 Submits abstracts to and presents papers at national scientific meetings.



Seeks consultation from research scientists for specific scientific and administrative issues.

 Participates in R&E department meetings and projects as appropriate.



Preferred Qualifications:

Doctoral degree (Ph.D., Dr.P.H., M.D., Sc.D.) in epidemiology, preferably in infectious disease epidemiology, or clinical doctoral degree + master's degree with formal research training in epidemiology.

 Track record of publication in the peer reviewed literature.

 Research experience in infectious disease epidemiology or vaccine safety and effectiveness.

 Competent in advanced research methods, including statistical techniques and study design commonly used in epidemiologic research or related fields

KPSC is a leading managed health care organization with 4 million members of diverse race/ethnicity living throughout Southern California. They are attended by over 6,000 physicians practicing in an integrated, pre paid delivery system that provides comprehensive health care and pharmaceutical benefits to members of the non profit Kaiser Foundation Health Plan and Hospitals. KPSC has deployed an extensive clinical information system, including a fully automated medical record system. A description of the Department of Research & Evaluation is available on the web (http://www.kp-scalresearch.org/). It is the home to nearly 30 doctorally prepared investigators and over 400 support staff. The Department is located in Pasadena, a community of 143,000 residents and the home of the California Institute of Technology, the Rose Bowl, the Jet Propulsion Lab, and other historical and cultural sites. Information about the community can be found online at www.visitpasadena.com Pasadena is in the San Gabriel Valley 15 minutes north of downtown Los Angeles in sunny southern California.

This one year renewable position (funding and performance dependent) will provide mentored experience in field work, proposal development and scientific publication, designed to prepare the incumbent for a productive career as an independent researcher.

KPSC is an Equal Opportunity/Affirmative Action Employer and offers a comprehensive compensation package, including employer paid medical, dental and coverage for eligible dependents. Competitive wages, generous paid time off and a comprehensive retirement plan are just part of the exceptional benefits offered to Kaiser Permanente employees.

For immediate consideration, interested candidates should submit their letter of interest, CV and references to Dr. Kristi Reynolds, Director of Epidemiologic Research (email:sole.x.cardoso@kp.org) and by Kaiser Permanente Job Posting 1085595 Website (Click Here) or visit the Kaiser Permanente job website at https://www.kaiserpermanentejobs.org/ and search 1085595 in the keyword field.

Post-Doctoral Research Fellow, Cardiovascular Pharmacoepidemiology

The Department of Research and Evaluation (R&E) of Kaiser Permanente Southern California (KPSC) is seeking a Post Doctoral Research Fellow interested in pharmacoepidemiology and cardiovascular disease research.

Scientists in the Department of R&E conduct research involving large, diverse populations, providing timely evidence to decision makers and the public. The research teams have expertise and experience in performing a vast array of population based cardiovascular disease research and pharmacoepidemiology studies. Projects include large, multisite cardiovascular epidemiologic studies on prevention, incidence, treatment, medication adherence, comparative effectiveness/safety, health resource utilization, and outcomes research. The overarching goal of these studies is to use our large membership and extensive data to generate results that will improve care and contribute to scientific knowledge about cardiovascular outcomes.

The research teams work with partners from government, industry, academia, and other health care systems.

This one year renewable position (funding and performance dependent) will provide mentored experience in field work, proposal development and scientific publication, designed to prepare the incumbent for a productive career as an independent researcher.

Essential Responsibilities:

Designs, develops and directs well defined research with supervision from a R&E Research Scientist.

Prepares grant proposals and publications independently and collaboratively.

Provides consultation and direction to programmer/analysts with regard to data management and analysis.

May perform subject assessments or chart reviews or provide direction to research support staff performing these tasks.

Submits abstracts to and presents papers at national scientific meetings.

consultation from research scientists for specific scientific and administrative issues.

in R&E department meetings and projects as appropriate.

Qualifications:

Doctoral degree (Ph.D., Dr.P.H., Sc.D.) in epidemiology, preferably in pharmacoepidemiology or cardiovascular disease epidemiology, health economics and outcomes research, health services research, or a clinical doctoral degree (M.D., Pharm.D.) + master's degree with formal research training in epidemiology and/or biostatistics.

record of publication in the peer reviewed literature.

Research experience in epidemiology or biostatistics and track record of publishing in peer reviewed journals.

in advanced research methods, including statistical techniques and study design commonly used in epidemiologic research or related fields.

A description of the Department of Research & Evaluation is available on the web at http://kp.org/research It is home to 30+ doctorally prepared investigators and over 400 support staff. The Department is located in Pasadena, California, a community of 140,000 residents and the home of the California Institute of Technology, the Rose Bowl, the Jet Propulsion Lab, and other historical and cultural sites. Information about the community can be found at https://www.visitpasadena.com

KPSC is an Equal Opportunity/Affirmative Action Employer and offers a comprehensive compensation package, including employer paid medical, dental and coverage for eligible dependents. Competitive wages, generous paid time off and a comprehensive retirement plan are just part of the exceptional benefits offered to Kaiser Permanente employees.

For immediate consideration, interested candidates should submit their letter of interest, CV and references to Dr. Kristi Reynolds, Director of Epidemiologic Research (email:sole.x.cardoso@kp.org) and by Kaiser Permanente Job Posting 1085654 Website (Click Here) or visit the Kaiser Permanente job website at https://www.kaiserpermanentejobs.org/ and search 1085654 in the keyword field.

Assistant

Professor

http://epimonitor.net/2022-3550-Epidemiology-Job-Opening.htm

Statistical Programmer Clinical Research Data Manager

Boston University, Section of Rheumatology has an opening for a Statistical Programmer and Clinical Research Data Manager. The candidate will have the opportunity to join an internationally leading NIH funded research team of supportive and collaborative researchers that include faculty members, students, postdoctoral researchers, residents, fellows, and external collaborators.

This position is responsible for the systematic documentation, maintenance, and management of datasets including existing epidemiological cohort such as Multicenter Osteoarthritis Study (MOST) and clinical datasets among others. The candidate will carry out programming using R and SAS to perform statistical analysis of data for the Section’s research projects that include research studies with a focus in rheumatic and musculoskeletal disease. Other significant area of responsibility is to extract data and develop project specific analytic datasets from existing cohorts, large scale electronic health records, or administrative databases such as MarketScan or Medicare to meet the programming needs of senior programmers and other analysts, investigators, or external collaborators. The candidate would need to attend the Section’s regular meetings and communicate effectively with investigators on developing analysis plans. The candidate may need to train junior programmers or investigators. Other tasks may include development and analysis of preliminary data for grant applications, reporting and interpretation of data by writing summaries of statistical analyses and generating tables and graphs, writing abstracts and manuscripts, or presentation of findings in institutional, reginal, national, or international conferences.

The candidate needs to have a Master’s degree or higher in epidemiology, statistics, or quantitative sciences with 1 3 years of experience. Advanced R and SAS programming skills, familiarity with R Base and R packages, SAS Base and Macros, strong written and oral English language, and the ability to work independently and as a part of a team to meet deadlines in a fast paced multi project environment are required. Expertise in linear, non linear, survival analysis, and modeling of correlated data including mixed effects modeling are desired. Familiarity with causal inference methods and epidemiology concepts such as confounding and collider bias are preferred. Other competencies include experience in working with large insurance claims databases. Applicants must be legally authorized to work in the United States

This position will report to Chief, Section of Rheumatology (http://www.bumc.bu.edu/rheumatology/). Interested candidates should send CV to Dr. Jafarzadeh (srjafarz@bu.edu). Additional documents such as Cover Letter, programming samples, and one published paper sample are optional.

We are proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability status, protected veteran status, or any other characteristic protected by law.

Assistant / Associate Professor Tenure-Track

The Department of Epidemiology within the Geisel School of Medicine at Dartmouth, and the Dartmouth Cancer Center invites applications for a tenure track position as Assistant or Associate Professor. We seek applicants to lead an independent, innovative research program in cancer epidemiology, including but not limited to cancer prevention, etiology, early detection, survivorship, health disparities, molecular epidemiology, environmental epidemiology, or lifestyle/behavioral research. Dartmouth Cancer Center offers a dynamic and interactive environment with a commitment to research excellence. The faculty appointment will be in the Department of Epidemiology, with membership in the Cancer Population Sciences research program.

Dartmouth is highly committed to fostering a diverse and inclusive population of students, faculty, and staff. We seek applicants who work effectively with individuals from all backgrounds, including but not limited to: racial and ethnic minorities, women, those who identify with LGBTQ+ communities, persons with disabilities, are from lower income backgrounds, veterans, and first generation college graduates. Applicants should state in their cover letter how their teaching, research, service, and/or life experiences prepare them to advance Dartmouth’s commitments to diversity, equity, and inclusion.

Qualifications

Candidates must have a Ph.D. and/or M.D. degree and relevant postdoctoral research experience.

Application Instructions

Applicants should upload a cover letter, a curriculum vitae (without impact

a description of proposed research (3 pages or less), a teaching statement, and a statement on how their teaching, research, service, and/or life experiences prepare them to advance diversity, equity, and inclusion at Dartmouth through this interfolio https://apply.interfolio.com/99545 link. Three referees

provide letters of recommendation.

applications will begin on November 15th, 2022, and continue until the position

Epidemiology Monitor