In This Issue:

-3- Salt Reduction

Advocates Disagree

-5- Pandemic Potential

Under CDC Scrutiny

-10- What

Epidemiologists Are Saying

-11-

What We’re Reading

-12- Jobs

Check our online

Job Bank for more offerings

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May 2013

Volume

Thirty Four

Number Five

IOM Report Further Stokes Controversy About Guidelines For Daily Salt Consumption

A report by an expert panel of the Institute of Medicine asked to examine recent studies that have looked at the effect of sodium consumption on actual health outcomes and not just on blood pressure has reached an unexpected conclusion. In its front page story, the New York Times says the report “undercuts years of public health warnings.” Not surprisingly,

the report provoked rapid responses from salt reduction advocates such as the American Heart Association and the Center for Science in the Public Interest (see related story, this issue).

Body of Evidence

To understand the report and the -Salt continued on pg 2

Proposal To List Asbestos Under The Rotterdam Convention Fails To Gain Necessary Support

A proposal to require under the Rotterdam Convention that countries exporting asbestos obtain informed consent from importing countries failed for the fourth time in less than a decade to garner the necessary votes from delegates to the recent Conference of Parties meeting in Geneva. Seven countries, India, Kazakhstan, Kyrgyzstan, Russia, Ukraine, Vietnam, and Zimbabwe blocked the proposal which required a consensus to pass, according to a

report by Bloomberg BNA.

Science Speaks Prior to the meeting, the Chemical Review Committee made up of 31 scientific experts responsible for assessing the scientific evidence on asbestos and other chemicals had determined that asbestos qualified to be placed on the list. A landmark collaboration by a consortium of -Asbestos continues on page 8

Too Much Sodium Is Bad, Too Little May Be Harmful, And The Right Amount Is Unknown

Science Is Losing All Around The World, Says Advocate

“no rationale for anyone to aim for

sodium levels below 2,300 milligrams per

day” The Epidemiology Monitor

ISSN (0744-0898) is published monthly (except August) by Roger Bernier, Ph.D., MPH at 2300 Holcomb Bridge Rd, Ste 103-295, Roswell, GA 30076, USA. All rights reserved. Reproduction, distribution, or translation without written permission of the publisher is strictly prohibited. Advertising Rates Full Page $995 7.5”w x 10” h Half Page $595 7.5”w x 5” h Quarter Page $295 3.75”w x 5” h Typesetting: $50 Ad Discounts: 10% off ads run 2 consecutive months 20% off ads run 3 or more consecutive months. Advertising Sales Ron Aron 770.670.1946 ron.aron@epimonitor.net All checks must be in U.S.D, drawn on a bank with a U.S. address on the check. Contact Us The EpiMonitor 2300 Holdomb Bridge Rd Ste. 103-295 Roswell, GA 30076 USA 678.361.5170 / Phone call or email for Fax# office@epiMonitor.net

-Salt continued from pg 1 reactions to it, it is helpful to describe the different components of the IOM report. According to Brian Strom, University of Pennsylvania epidemiologist who chaired the committee, the expert panel reviewed new evidence from 38 studies, 25 of them on cardiovascular disease (CVD) outcomes and 13 others on various health conditions. Based on this body of recent work, the IOM found support for a positive relationship between higher levels of intake and risk of CVD. This much was not surprising since it is consistent with existing guidelines urging Americans to reduce sodium intake below their current average of 3,400mg per day. However, Strom told the Epi Monitor that while those with higher consumption had worse CVD outcomes as expected, based on the well-established effects of sodium on blood pressure, the beneficial effect remained in the lower salt group when blood pressure was controlled for. Clearly, there is more to learn about the relationship between diet and cardiovascular outcomes.

Optimal Level of Consumption If consumption at excess levels is associated with worse health outcomes, the obvious question is about the optimal level of consumption. The answer to this question has been provided by the existing 2010 Dietary Guidelines for Americans. These set a goal of less than 2,300mg per day based on data showing that

blood pressure can be increased at levels above that amount. And an even lower target level of 1,500mg/per day was set for Americans who may be at higher risk, such as African Americans, people 51 years or older, persons with hypertension, diabetes, or chronic kidney disease. Since such a large percentage of all Americans fall in these categories, the lower limit has been set as a target level for the general population by the American Heart Association.

Surprising Conclusion The surprising result from the IOM is the conclusion that the evidence is insufficient to demonstrate either a decreased or an increased risk of adverse health outcomes at consumption levels below 2,300mg/per day. At consumption levels between 1,500-2,300mg/per day, the committee actually found evidence of harm for some of the subgroups in which lower levels are recommended, although most of that evidence is subject to methodologic limitations. In the end, the committee did not find on the basis of actual health outcomes that higher risk groups should have recommended levels that are any different from or lower than the general population. According to the Times, what the committee said amounts to “no rationale for anyone to aim for sodium levels below 2,300 milligrams per day.” -Salt continues on page 7

2

“…the studies on which they were based had methodological

flaws.”

“…the committee was boxed in by a

narrow charge…”

Some of the major sources of current recommendations to lower sodium consumption below 2,300mg/per day have been quick to respond to the recent Institute of Medicine Report on Salt (see related story). The American Heart Association, (AHA) which recommends that Americans eat no more than 1,500 mg/per day says, in a May 14th statement “the report is missing a critical component—a comprehensive review of well-established evidence which links too much sodium to high blood pressure and heart disease.” [Editor’s Note: The IOM report includes a chapter entitled “Sodium Intake and Intermediate Markers for Health Outcome”] The AHA says that strategies are needed to lower consumption below the 3,400 mg/ per day average, and since the majority of the sodium which Americans consume comes from processed foods, federal regulations are needed to limit the amount of sodium in foods. This was the primary strategy endorsed by the IOM back in 2010 in a report by a different committee, as described below.

Flawed Studies The AHA goes on to point out that many of the studies of actual health outcomes were done on sick patients rather than the general population, there are inconsistencies in some of the studies that the IOM reviewed, and that blood pressure is a suitable indicator for heart disease. An AHA spokesman, Dr Elliott Antman, told the

New York Times the AHA rejects the IOM’s conclusions “because the studies on which they were based had methodological flaws.” In striking contrast, one IOM committee member told the Times that more recent studies were actually more careful and rigorous than those the IOM had relied on for earlier recommendations in 2005. In its statement, the AHA added that “a recent review of current research conducted by the American Heart Association concluded that people who don’t currently have high blood pressure will benefit from consuming less than 1,500 mg of sodium daily because less dietary sodium will significantly reduce the rise in blood pressure that occurs as we age.” However, according to our sources, far less than 1% of the population ingests 1500 mg/ per day at present.

Another Response

The Center for Science in the Public Interest (CSPI) in its statement did not disagree with the IOM conclusion as much as its mandate. According to CSPI, “the committee was boxed in by a narrow charge to examine only studies that looked at hard endpoints like heart attacks and strokes. Because of flaws in those studies, the committee did not conclude that low sodium intakes intakes are harmful.” This is an -Advocates continued on page 4

3

Advocates For Salt Reduction Are Quick To Find Fault If Not To Disagree With The IOM Findings Focus On Specific Target Levels Of Consumption May Be Misplaced

4

people to reduce sodium intake without an evidence-based goal is problematic. According to Brian Strom, chairman of the IOM committee which issued the report and who spoke with The Epidemiology Monitor, the current average level of salt consumption has not changed in decades. The New York Times article notes that the average consumption of 3,400 milligrams is about the same around the world, though Strom questioned this observation, especially for Asia. In any case, given the seemingly intractable nature of current consumption patterns, does it make sense to publish recommended levels for individuals and expect them to change behavior to achieve these levels? How many persons actually know what their consumption levels are, asked Strom. He confessed that he does not know his levels and guesses that most people are in the same boat. He also questioned how feasible it is for individuals, even those on strict regimens which avoid processed foods, to actually achieve some of the lower levels that have been targeted by health advocacy groups.

Feasible Strategies

These issues raise questions about whether current strategies focused on consumption levels for individuals are feasible. Consumers do not have direct control over how much sodium is added to foods. If not, perhaps consumption levels should be determined by manufacturers at the instigation of - Advocates continues on page 6

-Advocates continued from page 3 accurate statement, but omits the fact that the committee found no evidence for benefit and some evidence suggesting risk of adverse health outcomes for high risk persons at consumption levels between 1,500 and 2,300mg/ per day.

Red and Green Zones The CSPI discussed the IOM results by describing green (safe) and red (dangerous) zones of consumption. In so doing, it does not disagree with the IOM, but states that “the committee found too little evidence to say whether the safest intake—the green zone—is below 2,300 milligrams a day or below 1,500 milligrams a day.” It said most Americans are deep in a red zone of 3,500-4,000 milligrams per day, and added “Whether we aim for 2,300 or 1,500 milligrams a day is irrelevant until we move down out of the red zone.”

Analogy With Weight Loss For the general public and readers of the report, this situation brings to mind an analogy with weight loss. If a person is considered obese at over 300 pounds, how much sense does it make to argue whether the person’s ideal weight is below 170, below 190, between 170-190, or perhaps below some higher level such as 200? The bottom line - weight loss is desirable, and what the actual goal is or should be are important, but perhaps not the highest priority concerns.

Implementation Challenges Still, a national effort to convince

“Whether we aim for 2,300 or 1,500 milligrams

a day is irrelevant until we move down out of the red

zone.”

“He confessed that he does not know his levels and guesses that most people are

in the same boat.”

5

New Avian Influenza and Corona Virus Strains With Pandemic Potential Under Close Watch By Disease Control Authorities

A new avian influenza A virus (H7N9) outbreak which has caused 131 human laboratory confirmed infections in China, including 36 deaths (28% case fatality), and a novel coronavirus outbreak focused in Saudi Arabia but involving three other middle Eastern and three European countries with a total of 41 cases and 20 deaths (49% case fatality) are being watched closely by national and international disease control agencies. Both viruses are considered to have pandemic potential, although there has been no sustained human to human transmission of the new avian influenza virus, and the novel coronavirus has resulted in only limited transmission. All three of the European index cases had a direct or indirect connection with the Middle East. Novel (New) Coronavirus (nCoV) According to the Centers for Disease Control and Prevention, the new coronavirus is different from any other coronavirus that has been previously found in people. The new coronavirus belongs to the same family of viruses that caused the SARS outbreak about a decade ago, however, it is not the same virus which caused SARS. There have been no new cases of SARS since 2004. Infections with the new coronavirus are called Severe Acure Respiratory Infections (SARI) and usually

manifest with fever, cough, and shortness of breath. Six clusters of cases have been reported, some of them retrospectively after the outbreak and new virus were recognized, according to CDC. The earliest cluster was of 2 cases associated with cases of illness among hospital workers in Amman Jordan in April 2012 more than a year ago. A second cluster of 4 individuals in a household occurred in Saudi Arabia in October 2012. A third cluster of 3 family members occurred in the United Kingdom early this year. This cluster showed that person to person transmission can occur. In February this year, a second cluster of 2 family contacts took place in Saudi Arabia. In May 2013, the third cluster in Saudi Arabia and the fifth cluster overall was linked to a health care facility. This cluster has been the largest so far with 21 cases and 9 deaths, including two cases among health care providers. The sixth cluster involved 2 cases in France this month, one of whom had traveled to the United Arab Emirates. The mode of transmission in these clusters is not yet clear and could -Avian continued on page 6

“…the new coronavirus is different from

any other coronavirus that

has been previously found

in people.”

An Evolving Situation With Much To Learn, Says CDC

No Travel Restrictions Yet Advised By The World Health Organization

epidemiology.

“…there are many

implementation challenges to

global detection and control and no one is taking

things for granted.”

“This is the first

time human infection with avian influenza

of the H7N9 subtype has been

detected.”

-Avian continued from page 5 involve droplet spread or direct contact. Also, the reservoir and route of transmission are still a mystery. Laboratory work has revealed that the new virus is most closely related to coronaviruses detected in bats. An extensive recap of the SARS outbreak first published in Science on March 15, 2013 described lessons learned from that outbreak which many believe places the world in a better position than it was at the time of the SARS outbreak. Surveillance is better, lab tests are available to better identify new pathogens, new international rules make reporting procedures more clearcut, and there may be a realization that collaboration is essential when new diseases emerge with global threat potential. Yet, there are many implementation challenges to global detection and control and no one is taking things for granted. For example, questions about the timeliness of reporting of the new infection have been raised already because of a three month delay, according to Science. Influenza Virus This is the first time human infection with avian influenza of the H7N9 subtype has been detected. Most cases of human infection with avian influenza H7N9 have been among middle-aged and older men, according to WHO, and most have been clinically severe illnesses. The main sources of exposure and routes of transmission remain unclear, however the virus is genetically similar to that found in animals in

live bird markets, most cases report a history of exposure to chickens, and the virus has been found in chickens in live bird markets. In this outbreak, only two family clusters have been reported and there is no evidence of sustained human to human transmission. However, if genetic changes lead to greater transmissibility, then the likelihood of community spread would also increase. Lab evidence to date suggests that milder infections are not occurring on a large numbers of persons. Nevertheless, CDC reports that it is taking steps to be ready for the possibility that this virus may become fully transmissible between people. ■ - Advocates continued from page 4 the government, as currently recommended by the AHA, CSPI and by the IOM in 2010. In that report, the IOM described a recommended strategy as setting national standards for the sodium content of foods and gradual changes in food that remain palatable to consumers. In that scenario, population levels could be decreased without the challenges of requiring individual decisions on all food items and individual monitoring of salt consumption. A similar strategy has been used to place fluoride in water, iodine in salt, and folic acid in bread, breakfast cereals, and other foods. For salt, consumers might still have to make choices and select lower sodium foods, but the food choices would contain less sodium as per new national standards. ■

6

7

-Salt continued from page 2

Implications of the Data The committee was asked to do its review of the evidence by the Centers for Disease Control and Prevention and to discuss the implications of the new evidence for population based strategies to gradually reduce sodium intake. First, the committee reaffirmed the soundness of the existing strategy to lower “excessive” dietary sodium intakes but not to lower them to 1,500mg/per day for either the general population or higher risk groups. Thus, readers of the report can conclude that too much sodium is bad and too little could be harmful. The harmful range for actual health outcomes could potentially be somewhere between 1,500 to 2,300mg/ per day, and more research is needed on the effect of consumption levels in that range, according to the IOM.

What To Do? Thus, readers are left to conclude that the current guidelines calling for Americans to reduce their consumption to below 2,300 and possibly to 1,500 are not supported by the current evidence on health outcomes, but that the evidence does support reaching some level below “excessive levels” which might include the current average consumption of 3,400 milligrams per day. In short, consume less, but perhaps not as much less as you have been told up to now.

Optimal Level Challenges The Committee was not mandated to specify what the target limit for sodium consumption should be, and Strom told the Times “the data on the health effects of sodium were too inconsistent for the committee to say what the upper limit of sodium consumption should be.” Even the Vice President of Science and Research at the Salt Institute, who is described in a recent Atlantic article as believing that less salt is not always better, admits that he doesn’t know what the right amount is, according to the Atlantic.

Measurement Challenges

While measuring exposures to drugs is difficult, Strom told the Monitor based on his work in pharmacoepidemiology, measuring diet is even more difficult. There are multiple ways to measure the exposures, and each type of measure has its issues. And comparing measures across studies is difficult because studies have measured different things. New dietary guidelines are scheduled for 2015 he said, and it will be up to the group preparing those to issue a clear cut point for salt consumption. ■

“…consume less, but perhaps not as much less as you have been

told up to now.”

“Even the Vice President of Science and

Research at the Salt

Institute…admits that he doesn’t know what the

right amount is.”

Find Epidemiology job openings throughout

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8

- Asbestos continued from pg 1 epidemiology societies last July reviewed the evidence on asbestos and issued a joint statement calling for a global ban on the mining, use, and export of all forms of asbestos. [http://www.jpc-se.org/position.htm]

Stark Example The body of scientific information and the consensus expressed in the scientific community about the dangers of asbestos were no match for the political and economic interests and lobbying efforts of the six countries which blocked the proposal, according to Kathleen Ruff, a founder of Righton Canada and an advocate for a ban on asbestos. “I think the asbestos issue and the Rotterdam Convention provide a stark example of the difficulties that must be faced and overcome, if gains are to be achieved in the world today in protection of public health.”

Obstacles for Science In a telephone interview and email exchange with The Epidemiology Monitor, Ruff said “ It is of critical importance that epidemiologists put forward the scientific evidence and make policy recommendations. But that is not sufficient. We are not facing a benign situation where scientific evidence and sound policy recommendations are examined on their merit. Instead, we face a situation where vested economic and political interests aggressively and determinedly engage in campaigns to undermine, distort and corrupt the scientific debate and have enormous resources to influence and control public health policy to their benefit

If gains are to be made, they must be fought for. This undermining of public health policy has to be strongly, repeatedly, actively and publicly challenged.”

Tactics The list of tactics used to defeat the proposal are numerous according to asbestos advocates, and they include holding sham scientific conferences, creating collaborations of pro-asbestos scientists with the International Agency for Research on Cancer to gain credibility, distributing misinformation about asbestos, slurring scientists who speak up against misinformation, and using arguments in the debate which are outside the scope and mandate of the Rotterdam Convention.

Remedies In an article in the April issue of this newsletter, Jon Samet described the challenges of data translation in the 21st century and urged epidemiologists to become more engaged in the policy process. His prescription for change, involving 1) quantifying uncertainty, 2) enhancing the informativeness of research for decision- making, 3) changing evidence evaluation schemes, and 4) preparing researchers for translation seems timid compared to that offered by Ruff who has been on the front lines of advocacy for many years. Ruff argues that because scientists have had the privilege of an education, they have an obligation to defend the integrity of that sphere. When scientists see corruption, staying silent is not neutral but -Asbstos continues on page 9

“We are not facing a benign situation where

scientific evidence and sound policy

recommendations are examined on

their merit.”

“…because scientists have

had the privilege of an education, they have an obligation to defend the

integrity of that sphere.”

. -Asbestos continued from page 8 complicit, according to Ruff. Scientists need to get out of their comfort zone, she adds.

Specific Actions To Take Asked about specific actions that epidemiologists and other scientists should take in the policy process, Ruff had several suggestions. She pointed quickly to the value of sound science despite its not being totally sufficient. “It is critical to put forward sound scientific information, on the one hand, and it is important to present this information in ways that the public and policy makers can understand,” said Ruff.

Out of the Comfort Zone These activities can be considered still within the comfort zone for scientists. However, because opponents are not playing by the rules of the game and act in bad faith, she says, it is essential for scientists to go to bat in the public arena and stand up and be counted. “Challenge misinformation and misconduct,” Ruff adds, “and name names and institutions that pervert science, and hold people accountable.” Ruff told the Epidemiology Monitor that “science is losing all around the world.” She gave examples political and economic interests trumping science in the tar sands controversy in Canada, on climate change worldwide, and on the failure to list paraquat at the Rotterdam Convention because of political and economic interests in Guatemala.

Ruff said country governments which support the Rotterdam Convention could exert more pressure on the countries blocking the listing of asbestos. In some cases the blocking countries may be receiving funds for public health activities from the countries in favor of listing asbestos. Donor countries can ask why they should send funds for public health to countries using asbestos to make people sick.

Speaking Truth To Power Perhaps Ruff’s entire prescription for achieving greater use of science in policy making could be summed up by a phrase she uses often in her discussion. “It takes a lot of courage,” she told the Monitor, “but scientists need to speak truth to power.”

Need for Champions Her prescription for change is reminiscent of the strategy articulated by Matthew Myers, President of the Campaign for Tobacco Free Kids, in a presentation given to the Young Epidemiology Scholars program last year. Myers said there needs to be active opposition to forces that create a lack of political will to act on the science. According to Myers, people make a difference and behind every public health victory is a champion or a group of champions providing the essential leadership element. Unless individuals and scientists feel strongly enough about the need to translate evidence into policy, then it won’t happen, according to Myers. ■ 9

“It takes a lot of courage…but scientists need

to speak truth to power.”

“there needs to be active

opposition to forces that

create a lack of political will to

act on the science.”

10

Below are some recent quotes from epidemiologists which have appeared in the news.

Michael Alderman, Albert Einstein College of Medicine, making an unusually strong assertion in Science about the new IOM report on salt which failed to find solid evidence that eating less salt as recommended by current guidelines produces better health outcomes. “This smashes the paradigm that lower is better”

Katherine Flegal, National Center for Health Statistics, as quoted in Nature on the controversy surrounding her findings that some overweight persons actually have better health outcomes. Her data, she added, are not intended to send a message. “I work for a federal statistical agency. Our job is not to make policy, it’s to provide accurate information to guide policy makers and other people who are interested in these topics.”

Walter Willett, Harvard University, commenting critically in the same Nature article above about Flegal’s conclusions. “You hear it so often, people say: ‘I read something one month and then a couple of months later I hear the opposite. Scientists just can’t get it right’. We see that time and time again being exploited, by the soda industry, in the case of obesity, or by the oil industry, in the case of global warming.”

Julie Gerberding, former CDC Director and now president of the vaccine division at Merck, delivering the convocation address to graduates of the School of Public Health at Boston University. “You’re being commenced into the invisible profession---one that is absolutely vital to the health and well-being of people around the world, but one that is usually unnoticed unless there’s a catastrophic outbreak or some other public health emergency and something goes awry.”

What Epidemiologists Are Saying

What We’re Reading

Below are some of the most widely read and shared items we have posted recently on Facebook accompanied by our Editor’s Note for each one.

Income Inequality [Editor's Note: All epidemiologists are aware of the role of poverty and income inequality on health. This is one of the most compelling presentations I have ever seen about the disparities in wealth in the US. See it and you will not forget it.] http://tinyurl.com/cwskxya

Myth and John Snow [Editor's Note: Here from Snow author Sandra Hempel is a short account of what is fact and what is myth as regards what John Snow actually accomplished during the Broad Street outbreak. Bottom line: If myth has been helpful in celebrating Snow, it's no bad thing.] http://tinyurl.com/q5q5x9p

Zombies in Grad School [Editor's Note: This is not the epidemiology graduate school work I remember. These 31 epi grad students took an unusual exam.] http://tinyurl.com/qzj7uws

Our Feel-Good War on Breast Cancer [Editor's Note: Is there such a thing as over-awareness about a disease such that a person's thinking about risks and benefits is distorted? This NY Times Sunday magazine issue focused on breast cancer screening is an impressive piece of journalism and raises the question about all the pink around us. It is a good read.] http://tinyurl.com/peydj8g

Have you read something recently that you think other epidemilogists would enjoy ? Please forward the link to editor@epimonitor.net and we’ll review it for potential publication on our Facebook page and in the next issue of The Epidemiology Monitor.

11

Epidemiology Job Bank - Recent Additions 12

Note: Jobs with a number in parentheses after the position name indicates multiple openings.

Location Position Employer Contact

NY Faculty – Microbiome, Microbiology Albert Einstein College of Medicine t@einstein.yu.edu

CA Faculty – Populations Sciences (4) Stanford University rhaile@stanford.edu

TN PostDoc – Molecular & Genetic Epi Vanderbilt University bethanie.rammer@vanderbilt.edu

TX Faculty / Chair - Epidemiology Univ. N. Texas Health Science Ctr david.sterling@unthsc.edu

AK Multiple Positions Inst. For Circumploar Health Studies http://www.epimonitor.net/2012-1492.htm

TN TT[- Physician Researcher Univ. TN – Health Science Center ssatterfield@uthsc.edu

MI Specialist - Research Michigan State University http://www.epimonitor.net/2012-1491.htm

MI TT Faculty – Cancer Epi (2) University of Michigan bfoxman@umich.edu

CA Director, Epidemiology Dr. Susan Love Resch Foundaton jobs@dslrf.org

NY Chair, Public Health Sciences Univ. Rotchester – Schl of Med. http://www.epimonitor.net/2012-1462.htm

CA Chair, Dept of Pub. Health Sciences UC Davis http://www.epimonitor.net/2012-1468.htm

TX Faculty- Dept of Epi (multiple) MD Anderson Cancer Center http://www.epimonitor.net/2012-1488.htm

MN Faculty – Pub Hlth Informatics Univ. MN – Schl of Pub. Health http://www.epimonitor.net/2012-1487.htm

TX Cancer Epidemiologists Baylor College of Medicine mbondy@bcm.edu

PA Dir, Epi Research Geisinger Health System http://www.epimonitor.net/2012-1423.htm

For full details on these and other job openings: http://epimonitor.net/JobBank.htm

Advertise your job with us: Ron Aron 770.670.1946 / ron.aron@epimonitor.net

Directions for posting a job with the Epidemiology Monitor In order to create an effective job posting we need the following information from you. Failure to provide this may mean we are unable to post your job.

Reqd Opt Description X Full job title X Exact job location (city & state) X Job description or web link for online description X Job poster’s name, email and phone X Full employer name X Hiring contact name & phone

X Hiring email address or web link for online applications X Compensation X Minimum hiring requirements

X Duration of listing X Type of ad – web or print

Once you have all this information in hand please proceed to: http://tinyurl.com/bt9hcww to begin the process of posting your job opening.

Robert Wood Johnson University Hospital (RWJUH) is a 600-bed academic medical center and the principal hospital of UMDNJ-Robert Wood Johnson Medical School in New Brunswick, NJ. RWJUH is an innovative leader in advancing state-of-the-art care. Its Centers of Excellence include cardiovascular care from minimally invasive heart surgery to transplantation, cancer care, and women’s and children’s care. The hospital is a Level 1 Trauma Center and serves as a national resource in its ground-breaking approaches to emergency preparedness.

RWJUH is currently in search of a Director, Infection Prevention to join our team. This role is responsible for the Infection Prevention Department and reports to the Assistant Vice President, Patient Safety/Quality/Transplant Services. Responsibilities for this position include, but are not limited to the following:

• Coordinate hospital infection prevention activities related to the strategic initiatives and departmental goals

• Coordinate the functions of the infection prevention committee including the annual risk assessment, development of the annual infection prevention plan and annual appraisal.

• Ensures the Infection Prevention staff are trained in hospital epidemiology principles and responsible for the surveillance, analysis, and reporting of nosocomial infections.

• Coordinate the development of policies and procedures to ensure rigorous infection control standards that meet the Joint Commission, OSHA, NJ Department of Health, and Center for Disease Control requirements.

• Coordinate ongoing activities related to the publically reported CDC implementation of performance improvement initiatives to improve patient care

• Provides ongoing forma hospital wide education regarding infection prevention practices and issues

• Collaborate with Employee Health and all hospital departments regarding exposure to communicable diseases and coordinates the reporting to regulatory agencies for patients and employees as required

Qualified candidates will have Master's degree in appropriate health field i.e. Microbiology, Nursing or Epidemiology or equivalent required. A valid NJ RN license with current certification in Infection Control (CIC). Appropriate clinical experience with 6-8 years in infection prevention and control required. 3+ years in a management/supervisory capacity in a health care setting required. Must be knowledgeable in fields related to infection control, microbiology, patient care practices, clinical infectious diseases, pathology, statistics and epidemiology and education. To be considered for this opportunity please apply online at: www.rwjuh.edu/careers

Postdoctoral Position-Occupational Epidemiology

A postdoctoral position is available for a motivated individual to collaborate on occupational epidemiology projects as part of an expert team in the Department of Environmental and Occupational Health at the Drexel University School of Public Health in Philadelphia. The candidate will have a doctoral degree in a relevant discipline, such as epidemiology and/or exposure assessment for occupational/environmental studies. A background in occupational health and experience working with case-control data are beneficial, but not required. The successful candidate will have strong communication skills, the ability to manage and manipulate large datasets of diverse structures, excellent analytical capabilities, and programming expertise in SAS. Additional experience with programming in R would be advantageous. The postdoctoral fellow will collaborate and earn co-authorship on a large, international, multicenter project, and will also have the opportunity to develop and lead ancillary project(s) of an etiologic or methodologic nature. The position is funded for 2 years, and we offer a comprehensive compensation package. Drexel University has a vibrant, growing School of Public Health, and Philadelphia is one of the most diverse and culturally rich cities in the US, with a relatively affordable cost of living compared to other major metropolitan areas. Please send inquiries to Dr. Anneclaire De Roos at aderoos@drexel.edu. To apply, please visit www.drexeljobs.com and search for Post-Doctoral Fellow, requisition #5272. Please include a statement of interest, CV, and contact information for 3 references.

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Director of the Program for Aging, Trauma & Emergency Care (PATEC)

The University of Maryland School of Medicine seeks a full-time faculty member at the Associate or Full Professor rank to be the inaugural Director of the Program for Aging, Trauma, and Emergency Care (PATEC). The Director will draw on outstanding campus resources to create an interdisciplinary translational research center of excellence dedicated to ground-breaking research to improve older adults’ trauma and emergency care outcomes. Its nationally and internationally recognized strengths in aging, trauma, and emergency care make the School of Medicine well-positioned to become a national leader in geriatric trauma and emergency care. With multiple NIH awards in aging and trauma, the School is home to: ► The Center for Research on Aging and its four NIA- and VA-funded center of excellence in aging including: ■ Baltimore Hip Studies, the largest program of research on hip fracture recovery in the world;

■ Gerontology Research, Education, and Clinical Center (GRECC);

■ NIA Claude D. Pepper Older Americans Independence Center;

■ VA Maryland Exercise and Robotics Center of Excellence (BERCE) in stroke rehabilitation.

► The Program in Trauma is home to: ■ The Shock, Trauma and Anesthesiology Research Organized Research Center (STAR-ORC).

■ The only multidisciplinary dedicated physician group that cares for injury in the United States. The group practices at the UM Medical Center’s world class R Adams Crowley Shock Trauma Center:

• The nation’s largest trauma center • An international standard-setter for injury care and one of the most sophisticated pre-

hospital systems in the country. • Partnered with the Maryland Institute for Emergency Medical Services Systems to provide

sophisticated expert medical care.

■ The National Study Center for Trauma and EMS, a leader in NIH- and other federally funded traffic safety research staffed by nationally known epidemiologists, physicians, statisticans, and database coordinators.

► The Department of Emergency Medicine (DEM) is home to: ■ More than 75 board-certified or board-eligible faculty physicians, including some of the nation’s most

accomplished clinicians, teachers, and leaders in emergency medicine who staff the emergency departments at four Baltimore hospitals, in addition to the University of Maryland Medical Center.

■ Outstanding clinical education and research opportunities at the four affiliated hospitals which oversee the care of approximately 182,000 patients / year.

■ A rapidly growing research enterprise.

► Strong infrastructural support in health services research. ► Multiple collaborative opportunities with faculty from the Schools of Pharmacy, Nursing, Dentistry, Social Work, and

Law on the UM health campus, and the University of Maryland Health System.

The Program for Aging, Trauma, and Emergency Care joins the clinical and research expertise of the Center for Research on Aging, the Center for Shock, Trauma and Anesthesiology Research (STAR), and the Department of Emergency Medicine. It brings together more than 40 clinicians and researchers from the Schools of Medicine, Nursing, Pharmacy, and Social Work at the University of Maryland and the University of Maryland, Baltimore County to identify interdisciplinary approaches to improving the outcomes of older adults from bench to bedside to community. More information about PATEC can be found at: http://tinyurl.com/boqk87v The Director will be expected to bring national vision and leadership to PATEC, mobilize and coordinate scientists whose interdisciplinary research can benefit older people in emergency departments and trauma centers; and attract funding to build the Program. The successful candidate for the position should have a PhD and/or MD degree with substantial experience conducting interdisciplinary research, a solid record of extramural research funding, and demonstrated leadership capabilities. Candidates from all disciplines are welcome to apply, and should have a successful record of clinical and / or epidemiological research in areas such geriatrics / gerontology, emergency medicine, anesthesiology, trauma / injury, or preventive medicine. Compensation and support will be competitive. Applications of a cover letter, CV and three references should be submitted to lklein@epi.umaryland.edu . Confidential correspondence related to this position may be directed to Jay Magaziner, Ph.D., M.S. Hyg., chair of the search committtee at 410-706-2406 or jmagazin@epi.umaryland.edu The University of Maryland, Baltimore is an Equal Opportunity, Affirmative Action Employer. Minorities, women, veterans and individuals with disabilities are encouraged to apply.

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Cancer Epidemiologists

The Dan L. Duncan Cancer Center at Baylor College of Medicine in Houston, Texas is seeking cancer/molecular epidemiologists at all academic levels. The Center has considerable resources to expand the program in Cancer Prevention and Population Sciences, and the successful candidates will have an important role in the continued growth of this program. The individuals will have the opportunity to collaborate with other epidemiologists, geneticists, biologists, and clinicians in the Cancer Center and its affiliated hospitals. Previous research experience, history of successful peer-reviewed grant funding, and a relevant publication record are required. The candidate will be expected to develop an independent research program with peer-reviewed funding Salary and start-up package will be commensurate with qualifications and prior experience. Interested candidates should submit curriculum vitae, a summary of past work, a brief outline of future plans, and the names of at least three individuals who will provide letters of support. Open until filled. Applications: Melissa Bondy, Ph.D., Associate Director for Cancer Prevention and Population Sciences Program, Baylor College of Medicine, One Baylor Plaza, BCM 600, Houston, Texas 77030 or email to mbondy@bcm.edu.

Baylor College of Medicine is an Equal Opportunity/Affirmative

Action/Equal Access Employer.

Professor of Epidemiology Harvard School of Public Health

Department of Epidemiology The Department of Epidemiology of the Harvard School of Public Health (HSPH) invites application from distinguished scholars for a tenured faculty position as professor of epidemiology . The successful candidate will provide leadership in expanding the department’s role as a center for clinical epidemiologic research and training. Areas of interest include comparative effectiveness research (CER) and methods development, patient-centered out-comes research, and evidence-based practice. The successful candidate will facilitate deparmental engagement in these areas with similar efforts within HSPH, Harvard Medical School, and Harvard teaching hospitals. He or she will be expected to conduct empirical research in clinical epimeniology/CER and to participate actively in teaching and in the direction of training programs in this area. Candidates should poreferably hold a medical degree, as well as graduate-level training in epidemiology or substantial experience with the application or development of epidemiologic methods in clinical research. The ideal candidate will have demonstrated excellence in research, teaching, intellectual leadership, and rogram development. A strong record of externally funded research is highly desirable.

Please email the following materials by August 30th

, 2013, and any questions, to the search committee at:

EPI_SEARCH@hsph.harvard.edu

• Cover letter

• Curriculum vitae

• Research Statement

HARVARD │SCHOOL OF PUBLIC HEALTH

The Harvard School of Public Health is committed to increasing the diversity of its faculty and particularly encourages aplications from women and minority candidates.

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