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    Legal Medicine

    Copyright:

    © All Rights Reserved
    Download as PDF or read online from Scribd
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    31 views23 pages

    Case Studies in Forensic Epidemiology - Sana Loue

    Uploaded by

    T Cel Mrmg
    Legal Medicine

    Copyright:

    © All Rights Reserved
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    Marijuana, ts Uses and is Ragulation 1 | By 18, Ca Study Fight The Meal Us of Marijuana 1 Ti i 1 | eee CASE STUDIES IN eS = FORENSIC EPIDEMIOLOGY | Index ‘ 199 Dr. a) Morfemasror eg Formac 6 CHAPTER 1 Epidemiology in the Courtroom Dissonant Goals, Divergent Processes eolceeeae neater abn tae ca re SS OSes oe ae heer EPIDEMIOLOGY AND LAW: DISSONANT GOALS ‘Wit ncasing equoncy, pl Judge, avers, and jis eymaks, sesgsa pein aig nai eliy wen fce ib the felton ofc lw for dma lated in conn. ‘vith inus alge to have accra ae the ot of spect ‘od for the daterination of calpelity In eri’ proe Instance, the Feod and Drug Administration (FDA) slid on epdemile gal studies in eqitng that uanufatras place a waming ael om spi ‘ots to inion potetal consumer ofthe aseclton between Reese) rome and aspiin use (Novick, 1607, Sola, 1860). Epidemiology we tn the festioat inguin involving numerous exporaes, saree Agen Grange, Sndecin, tampons, aliaat iene inplent, and tabucce (8 ‘Agen! Orange Products Lisi Litigation, 4986 lar Bendctnitigaton 19as; Kekm w Procler ond Gamble Manufacturing Company, 3805 Flupacick snd Shalnwald, 196: Giants, la, Bro, Hanae, a1 Bao 4006; Sanders, 199; Schush 1067-And knowlodga of the epidemiology FIV infection has provide the base fr the fonmlaton tad pssge of TOLLS get tm, ee rag tnt a sloutes ciminaliing sexual relaons between HiWinfoted individuals Andother withotdsclosue of th insviual's HIV nope However, ths everintensing rellance on epidealogis! Migs as nef theses rte development of leant pole nde aun of “pte ead bars has not bom nconowers Wars have sted te and slrseys for chat they se 8 lat eeprd of enc ijt in favor of esis solutions and the salstcon of ter an Sess (Angell 1990) Legal scholars hee punted thes chars wit ‘helrovm aay of he anaes inherent in the media and aps {cedainy sytensDrsces Wagee and Gann 607) Acerngy a Undeanding ofthe diferent gots between opidemsgy and Is rt “alto amevelinton of wth how piemsoogeal ding thos Uilized inthe context of Ugatln, rulemaking, or policy devlojent Tune Hate Beeman asl sbeerve This requirement, and neod, for tho fine solution of disputes is reflected in various aga pincpls. tnviuals bly to bing egal ction Sgaist another pry foro llgedseong ie coafined toa spect time ‘Spe bythe imposition of ttt of intations i ampli not it ‘ted within prtecived pore of ine the ability toe and recover abt ges Is fever lost Iti irmlvant tothe appietion ofthe tute of [atone theta the tine te period elo enpte ea iogl palace the ‘atte of limitation Isto run out, tho sta of scent knoeodge with spect tothe slleged cause ofthe alleged njry in fe. The Lge eanept ‘of re udicota means that nce isl decison hes bee vendre y tha courts in «parelar matter, the eas cannot be r-inttated find Rowe Je, 104) Suppose fr eatane, ht andl contracted a patislar form of eancar da to exposiza to a specie mb. "tance withvhich he came ito epuar onict Beau it was dumped io 4 nesbysver bys polluting corporation. The exigial ay finds, need on {0 he acetic eldence tat ie presented both for sod asthe ca, ‘hat thr na fink betwoen the polhiton and bi canoer an dene a ‘award. This judgment is armed on appl Five yours ltr, thn gre ‘ment oes 2 pot indicating tat there, ned, ik Betwoen ie pr {Ucar substance na esrtain typ of eaenr. Th gonman ent no go ‘back int cour liming that he should bo able tet his caso be-ase the Sloe of weenie knoedge ha prove. He ae slay had hie da in Many scientists have impli i nat exphicily,esgnized te aco: rnance in purpae btvoon to a dating. Hb, fr nets, he ea ‘cteriatd ianc asa starch for absolute and immtabe rb Te ca tei te Cina oes progress. ut it ous not end” Qube, 1281: 234). As « eonsquence, ever! aeetsshnve recommended, more o ls vigorvs the sepa Son of th twe spews Rothman, for instance hs Expand hat ‘salle hi nb ny yma hal wih m- ‘oto on sno ply play he i its i ps er Poole ht adopted similar poston: {Seed os mo ath ean et te bw wih ope tt ape 6 Just the dtcpins of law and sconce deine “Truth” diferent, so, too, do they utilize diferent proceduce for tho deteraistion of tat "Truth" used ir ae a syn for conation, EPIDEMIOLOGY AND LAW: DIVERGENT PROCESSES (Causation in Epidemiology Background Epidemiology sch to answer such questions a "Why do soe pol cont carta illnsses mare Hoqueny than sts” and “Why docs ‘pec aes roger more pil in some pple cone oe! alt eft ocala rach eentans et Pe eterzinizn. * ae ‘Pare detente posts specie of cause ad specific of effect, ‘ingens ope ingen hs pli th tr under wanton eh easy ad ace ‘rause of that disease. : adores ut Rech Femi ofthe Gxt fr disse easly, ic toosimed pare détenniniem ‘klein, Kupper 0), Koehis work on tubercle rode the ase ar his Fe tefinnmants of enuition citer to ncude ive eens “Tr Ana tture must be etited inal cae ofthe disse Te Teste tt be hewn ob nd to Tings ronal ber microamansns 13d inks enna thease pao. sa ase Meenas Ue culate ante the deed ae ted on all arse peodute which could be ‘aul sient ts. The phe tstedmicornism st be Imocted nto st Tod tise annals mut then dla the same syaptoms ‘She rginl dsesnd sil (atr, 1985) sete SUNG ae cree ire te orton vise deere lente ict ot eg wea amen stead al Rothman eoplsins tis ode as follows: - Soaps age Sse ta anon ae ‘ect ting atin a Hes, the mode! recogaizes bath that echo of factors, rete hon & single guns my produce an ett and tata spelfic efit may be the Jrelealofteiot uses The eength ofa spite cael Gtr depends {ipon the lative provlence of component esbies acon, evn Zou) TE ay conse song cxse fe compemenary cnoses ae common iRotimcn 0b, Two component castes of sulci eran re sald tbe {art nha thls Joint ae exes tho ur of thei sept tots (Gahan 1576, As an exp, individuals exposed Lo eibrsos are ut ~ Ineied nike amcor ifthy iso smoke (mond Slik, & Soliman, 1979). “Ths woe deterians:= model, however, also esis etations ‘ve areuten unable to ant ll of the earponents of cufciet cause [Rostann 109 Consequentepidtsologtewtlze govt theory bd sista ehgues to ase the zsk of dias rvulng erm expo ‘Soret hypothsaed causa (ctor (Rothan, 1906) Wee. 1290), x sting at Conrm : ‘ring an inductive approach, Hl bas envncitod theta to by con sidered in identifying causal associations: (1) stent (2) consistency. 3) pacity (2) torpor (belgie gait (6) pani cabo the: experimental evidence and (o}enlogy Mora, 1981) Each of Ute eens aucussd bey below. The "stent of an asocntion between the pute causal aco and the effec I capendent om th of other component "uses Tie cferon encompasses wo separate sss: the requecy with (ehicn ss fe or un inveigtion I found in cases of spe dena nd the feguoney with whieh the factor acer the shoes af the ease (Saree, 150) “Canestoney fore o tue ropeatd ateuvation ofan asi Sinton tofsen the putative eau factor and healt i varied popu fione a varics pains fn time and andor dillrent cheamstnces (Sus {00 Inconsistency however. doer ot nocesarly neat a cys reo Uinshipbrcruesall cad omapanete mast exit to bring soot the llc, ‘id rome rut be absent "Spacey afr to the asciation betwen ose gous en single fet (Rtzan, 198) il epecticly ex {tetsu coping he ip ofthis patent "Rl, 6s). que tht the emu prce: the ele 0 tue: (eatin 1288) altowph a doserrponse curve, o Moa rain” ‘eon by cots, doe not bees fade anton te te Stee of enfants agus tht he Eypetsaed ale esi between he cau fra the fsb idol nie ‘Tso ted by th eo ou Baal t any plat I ie . egustat port etl wantin Const wih ries te aaron snd bly othe date ngeson. ‘Speier iy rate appli “Aig Teo cone Rew aah oe Eversons dng en hth delet ay provid night ther Sibi ness eae 0) "ere ts be conned in rating whoter hr ext «caus sur-sion utwoon sept espana stds spec eto ‘rw fore lade the sul deg the moar oul foot {nly chev stsece shaun ane of bir nd eofnding se to whi str aud tenascin wld tve bet uct tnd fie i sen nd nt ah of hs semen eed ‘An Overview of Research Design ‘pdemlgl esearch cn bo classified into throe major typos: expe ‘mont quae experimartal, and abeevational With sch typ of serch. ‘vat fifrat deren canbe tilted. Each a thee ype seca ‘ely belo, followed by a Sizcuson of pei stay dies xprimental reach oles, but not lays, inwolas the randoms "Tho osment groupe ae also own a study sme, to whlch ndiviunl re randomly allocated in order roreeoive under veto oaont toup) r= Shenae tne sr co 5). Randomtaton i ona ‘rod esnail ar sfogurd pant solection bis and as nsrance against Seiden bia (Gor, 2961), 10 ensue tht both ous ar epee tive ofthe population as. whole or that both groupe are amar a all espace excpt the trstmen that nde ta. Expert studies co ‘Une nthe aberatory are urullyof lative short duration and ae fen ‘wed to tat etiologic hypothe, to eatimete treatment effects, oo era Ine the wlfiney of an fotrwention (Klinbaum, Kupper, & Morgans 1902. ‘nia iter experimental studies of mach lager durstion They ‘ave banned to asthe opidomiolgle gold stindad for ensalty Inference (Gny-Donald & Hour. 1988: 685). They ae wsually conducted {ots he efficacy of spa intarvanton ttt tage hypoteres or to esate lang term ils eft. Hoth the experimental group and the ‘nto group consist of stents who have sry been lagnosed withthe ‘isae f beret ora ik ofthe dacaeofiterest na lina tak Snvolving a provotion. Adaonally, the patient mur have agra wo be randomized to one of the sudy ams Cllcl Wal often vile double nding shoeby nether tho invite conducting heady noe the pas {nthe aly know who inthe ueeuuent group and who isin the 2oup (Sen, 1993) ‘Commnity intervention ae alga sally f longer duation. They ae tes insted toto ie elccy and the elfcivenas of particular held TExpetinental studies ofr nervous adventaget, ching te abil ‘trough anomlzstion, to conel fr extancous facts tha nay be eat to the ostame under examination, Untorunatay, the sdy population ‘ultimately seleced through this process may not be comparable othe tpt Population with respect te important chance. (Quasi-txpeimental Research Custos inhyadh pte yt a AY nse ate ‘manipubte the dy facto na experimen (Quastaxperimets ae moet often conded in nelinic or aborty sng Foley te Comm «4 oes etiolge hypotoss, 1 erat th efficacy ofan intervention ecto smal thelong emesis efit af an interno, Pass eondectal a thy progam and pli aera sr an door lo the eval of oe bar ileenton oan anf th tn eae te ention lear. Kupper & Morpnstern, 12 Quat-espertnents fener slr andl expensive than exponent stl However, tho investigir hs less conta over he infloeno of extraneaus sk actos ‘eto the cf rndonsation (lab, Kupper & Morgner, 100), The fl ‘sng scoala provide an exam» qunl-esperinenta ts Asse frigeancs, ht expt pris fostcdee ep tebe a pote risk factor forth development of specie reepatory nesees Esporte othe pestlds io parialar community fs wiqlteu, oo As etsve ssn ercltrean the consquent eachiget es Stance ints sol end th watt ale Residents ef the all ening sea sv ofered eopporcaity to elect abet on af ofthe resents let {roma ad the cers chee ove The ers ofeach gree then flloves over meto sues the eft of te cttnuingespono aes hero an be development ofthe rapiatory limes question. If ie nd been perinent rather than aquat-espermont, tho iets woul tne been sacdorized wo the expe, Instend, the Tide parspants ‘wade the ov dons wth espe to the continuing expos. Observational Studies : Oberon sae the nos oqueny iin typeof yin « -pidémiolog. Unlike experinestlandquastesperinental sei, they de> net inva he maciultin of they fcr I some cae, map tion ofthe exosure understudy slg be thy snd epaly problem ale For iatsen, poring soy papants oa sie na oho ie ub satin is os ost Scethiclecsatepe=ipant oul dleaelyexoced to curpctd tak of han, Lglsticcy sucha stady would be pblemate beets of oe long fllawc Toga ead desi. {an Sia Cn su an cond psp tel odie require the entiation and a ‘Bbeaion of nity Tat cteorie sccordog fo ‘thee y ave havent ben exposed tothe ator understudy. ach {Goup is llowed over ime is ort obprve the umber of 0 csp {ennui voto ha en ith pop ne eae evod afte Kelsey, Thompeon vane 1988) ‘Nurous dfiies may send prospective studies, ire indivi sie nady ae oe cx th er nde stay sd nth ‘En nleny ota exposure maybe del to seria As an cramp ‘cohort sy to examine the elect of an ecapational expec would Sonsist of pup exposed tothe sabtenca undo tudy aad goup that Sar not expend Depending pon he particular industry and conngratin ‘like workplaces however se members ofthe group classified as une [owed uy fac have been exposed to small pours of he satan. Etcondalthugh indie eel into the stay maybe bleed to bs fe of tho dno, the dense process a nf, Reve conmonced 0 fone bt maybe undetectable by diagnose methods and tooth avll- the This God be to for insane, nso volving cancer chao Dtrela, sd « minimem len of time flowing expomure nay be Feyuredtoallow gbilogicall sppropists induction tno, as walla as xyoetperad of tine afer coeaton but before seve detection atest pliod In stuns wee we do ot have complete knowledge of tbe ction ad latency prods yamat dk assumption about he legs of thas tine otinan, 196), Fourth, prospective cabot also require {aie sample sizes and are ofen gute costly (ele, Thompson, & Eva, 150) fiat conslderedeTege-omple sia” vans depending upon > ‘isan under stad. the expoar ender ly and varius ober factor) Fh the chic of compargn poup of wnexposed individuals may be igs dificult oo, we tend to tink of loa a Belng preset ce hea ‘Bitcinedeeses such high lod presen oocar log apccrum, ng eaefesin of tnaiidul seve of not anand mare x. lx ey, Thompeon, Eves, 106) Indvioals n a prospoctive ahora ae to be llowed oer ine “inven some individual ny drop ot of the dy of be ot lw ‘pT Toray Bersted dens stato, ary producing bis ie measurement of disse Kel, Thomsen, & Eva, 180) tle {0 images tnt ar someone bcos progress or, tha be ors ‘ay nl want to undergo a pst examination cr respond to questions Teiting tothe es. Informmtion on other oxtranoousvarlables ht may ‘Mfc the eae may not be avaliable (Kase, Thompson, vans, 1886), lanier af ‘ewspenah tie im nvm asl cbt ‘Toquie the identification. of individeals based on thelr past axposure nd, thc often oP 8 el sine ovspecne et degen ohn wef or etnies of Deraptmnsgone ale pega ok sie they cheney | Snolndyoxtag deat ay aout compte to ‘ni rot hn prapecne hot sy, Hate sla | Sots de bower hess ifeaersy resect ‘inline ns soos and meee en ean erties enundng eal and icles cig individ eg ine Dept acs best in ao dsp shot ular sor fea ay teat etoes es inet expo atte tnengeed pp Aten cana ‘hor say amining he lation btecn espera olny et pine abe davelpment of pte une dra might ia oto women fos pi tn 20 ye otter her any ero fan specie atime Standrdeloped in hare wi Ga Sat ge hve oe bein Grs-connal Suds. Unlike cet sins which fallow individuals Uhrough tin stor essing them bed on their exposure sas, cate- toni! suis rquie the lasliatan of individuals onthe as of tet faent disace state and then exanin thls pst exposure tothe factor of Intret Case-contol desig: has ben wed t investigate dessa oink (Dye, Stic Goodman, & Arman, 1004); t deaifysocopatonl sik Tacos (Checkoway t Dents, 184 in gente epdemcoge suis (Whoury & Beaty 1908 for inde’ sinstion in dexrgaphy (Kat, 1980 | ‘oovalatevacclanton eflectiveneand vain fescy(Cassnck. 1984) {eval eaten and program ees (Sally, 1994) and to emduate the | cacy of sraning ats Wale, 1) Car-cotol studies ae mont se | {alin evalsting re factor or ese bess and for dseses of rep one ‘Wit dsese of slow nett mast ficult seein wheter pe ‘ular factor conebuted fodiens ction or sss sere enmiche ‘mont of the disease procs Kelsey, Thompeon, & Bra, 1980 "The soc ofa easoconl sy regres elton of hs cases (the Alsace group sd he convo (Us aaeiceased goss fm espero Ueto. t sould be cious that oro enlectng te casey, the inven {ptor mut dino whet consists ses coneoptuall This is hates sing Stark ari appt, pastels when tense condom fsa neve tnd relatively unstudied entity (Caky & Stolle, 1093), For insane, Gaso-onuol desig war utlized ina moter of studies tht atempted to ‘letermine whether an association eat btwoonslicne best implants and the deselopment ofan cutimmane diorter (eng, 499; Hitmen, etna, an Hoffman, 1013: Si 198). However the agnosia of Tuma ajucant disease” ter dt role tothe syndrome lege to have elo fom axposie to sla, wn lft due otha broad age rt ymplomswocompaceod by that term and the relative lack of iach that ‘hited inlay Cel Infence is posible ony if one assumes thatthe ontol ar Topresnttiveof te eame candidate popelaton fr which he casendolloped slab, Kupper & Morgenston, 182: 6) {Crssequeny the section of epproprate cases and contol is ruil to the valiaiy ofthe stud. ‘Method nd tal forthe elections appropriate cases an controls hve Bota dissed extensively in he erste and wil oly be some: ‘oe hore, Carr ae often slated fom paloma seoking modal ae for the condition dat slag lnestigatd. is peer to Include as caves {dviduals eho hve bean recently disgnosed wih the bess rther than {viduals who ave had the disses Yor en extarid pore of time. tn ‘nde to dust between exposure fst oooued for dee one! tnd exposure that accured at Oke sures of aes nclude disease og ‘tes, drug survelanee pans, tchoole, snd places of employment (Klee), Thompaon, vans 808) ‘Controle set be “ropes ofthe same bas experience” a the ass (Miatingn, 1988). "be consol srs i need to provide aa ‘alo of the exposure rate that sould he espocad to occur in the ca 5 ther sere Ro section buween ‘he stay’ ese and exporure” (Sehlasslnan 182 76) Hie important to ecogsie that eonls are hes ‘ete contluotay elie to ene cai invidl wha i inlly “lac 8 contol and who tater dowlope th dese) sader stacy ‘hereby becoming «eas, abald be counted we blk cash and a conch [Labi Cal 18), Contolsare gus clea fem probity amples ff the population fim which he ence sob: fom palentseciving medical {aro a the sae fois athe case, bu oy conditions unclatod tothe ‘bes agnor rem neighbor ends, sibling cr coworar of ease (ole, Thempsn,& Bven, 168. Dead cools may sob aed in sto les wore the remarchr ihe to compare individuals who died fom ont ‘cause with inviuas who did fom othe causes Lash Sly 1894) ‘Case-conuu studios ae raluable bacase they permit the etlution of 1 zouge of exposes that me bo related tothe dastse under investigation They are geonally les expeoiv to conduct than ecko ets a pat Tecate aver people te beaded fore sty. Howrve stay be dfBeut 1 determine individual’ exponue status Gata, 1986) (Corot ude, Une ee ctr saline conte studies xposre and date satus ee eecred the ana past ie | in eress-srhonal studies. This approsen reruns eerie limitation, (0 that it may be dill to deerine ince theyre bath measured atthe sane tine. Adon, ute caeeseciooal sade Inchige provlen cusce of desse, L. nue eases af lendy-enting cane, highar proportion leases wil bare Jad tho diss fara longer ptiod of tne. This maybe problematic i poo ‘lo who die oucly or resver quick from the disuse afer on heparan aration those who hve he disease over ong pid tine “To, individuals wha sess oreo ay be ean hn ted as nodisased Kalan, Thorpe, bres 150) | -BelogceStaais. nth study design previously dscusse, he nd: ‘ial was th urs of obseratin, Ecologia design, however tle ¢ soup of prope. such as cour tact dat, at the wnt of servation Rothman, 1s An example of wa eologial ty would bean examine. on of orl evar rates agains the use of cheng tbuec noah ate rag suis are ttn conducted to observe geographic diferenes ite fates of spose dioas or to observe the cletonship bees change ‘the average exoosuelvol and changes in th ate of spect esse ia pestis por ation. They av usaf in generating logic hypothe a for evaluat he efecvenesofpopttion intervention. Beouss daar ‘srllable onl athe group lee, howrvet,infereaoe fom the elo alyssa inciiduale within he groupe ot nv serose poupeey bo seriously vad (Mongenstn, 1083). Th tatu int city {o aus and measure exranous facto on an nds evel tht ay be ‘ote othe disease and the xporure under examination, Measures iy eee of tion In he ot of edly ‘quits an eahation af the study designe tse, ncuding the scope 08 wong fag, The patna cosa mares reoulng from te studs, Bpiemlalgy tla spre of css fe. pond ttn ppulin, Cle near Fines 15 na intone ater wile 2° Se pty one Pine os : > tenlousder nl gure 16 Hoth C end D are ated by the se r Seed tr andy Cit Figwe 17 oth Cand D a afta by ant lmesied rak ior U, Uae by Cle nota Oo ‘sul Fig £9 kor bh ad D.C ‘ost confounds. ae can be uscd in coho, caseconta, and crosssectonal suis, This toch ‘gue equ thst level ofthe confounding vaibles Ye defia and the Tigonretisese asociton aimated win each Level. Sraticaton is ‘Sppreprnt if (0) thee fa eufcient numberof Seal ach Level SERta) the cate of conva able ts sppropeate; and (he definition sf lovee for sah ofthe conbundingvarabls ts appropiate (Ksibeum, upper & Morgenstern, 1962. Aa exarpl, stoking cou ew confound: {ng vsiabe ina study amin the relationship between besos exposure fn cova hang dssses. Congonhas would wart tt iy the analysleby love of making eg. Hleine vals of smokin Mathematica! modsing involve the os of anaes tha relate expo sre, outcome, and extraneous variables. These analyses asi 1 be ml UUvariete beomse they include mulplefetne in the mods. to cob Sites the ilmse of diseoe outcome or eat i ota te dependent ‘arable wl eter the exporue satus of duces oucoms ay be the Uopondent vaible in easeconzel studs, Mathematical madoling bes ‘any advantages, (eing ose of uso with small mambas the stilt © ‘radic \ndvidoal risk end the sity tore he taclque with contin ‘Sr varisbles and wth multe exposure vrais. Mathematical modeling may also ental evra disadvantages All nod ‘ets requre tht cartsn assnptons be made about he data part the ap ‘ation ofthe model. The selon ofthe model ogres an evaluation ofthese ihderlying sssunidone fhe ecumptins donot hol, acter modeling technique mut be used. Mathematieal modeling may also present ial {nthe interpretation ofthe sls (lelnbaum, Koppert Meret 1882 Sompling ond Sample Size. Many epidemiologic studies wilze data fom aren exiting dats sources, often cllced ona rating bas, such fs data um varios ote rpitas or orp diacargorecotds. This ‘ype of datas known ae scondary date rcil tat hee data sours ‘ene accurate a poatblo, eg tet minimal mielasfeston es Most epidemialogi ties, hoveovr rly on polmary data collected oom the egal spore, rach te tials with patna elseabe ot ‘rposure of ttre Ths fen require the enfction ofthe indvidule ‘who wil partite, the developmint of qasstonnares, aus Un condect flares. In moet ease, asamp of sec indvidnals mast be usd, ‘ther than aa ene popuan,Rellanoe one sarple of he population Tlpe to eos sty cot and to come extent my increas hs acculace ofthe mearuremeats ince more ie can thn be focusod on fever perp. ‘When assembling «supe popeltion, he sampling nit will Japend fon the paticlar study. Most eken, tho uot wail be an invieal or » FRouehold although it ay lee be »eghbathood cae. schocl, re: sity A Hsing ofthe araplicg une constuse te sampling ae Sumpling Techniques The manner by wich sampling conuced catical. Appropise sapling techlgues wil eden ftom aa, which delat ete Carne, ® em reduce the pcision of the epidemiologic measurements that are shiained (ethan, 1986). Probably sampling i one muted of redcing, random ener. Pratt enmpingrlr to empling by which “ech sam pling vst bss & foown. nenaero probability of big includod tn the Sample Kel: Teampson, w Evans, 198). Thar re Yarous techniques ‘lable (Sr zsohllty sampling. including simple madam sampling. ‘ystemat: sasolng. sted sampling, cluster sampling. and multstags ‘npn: OMe ling technique, sh a snowball smpling, te sai efor ee -ts-on here probaly ssmpling ent possible ‘WILE sms Jom sampling. each samplag wit tha aligile pop ulation 3541 gue chance of being included in the ead. In order oe08 duct a: ag, tne invertor must ose complet epg tame. 1s. evesobe whe spotty ible to bein te tad. Sampling fan occu isc witout replacement. With replscoment samplh Selected sampling wits suchas the individuals selced for participation Is "he studs re sturmed to the pol frm which the sumpla i being taka, Nos pinion dies lyon sapling wits replacimen wich ‘side mere preci etmates. With syseraate sampling, sampling unit ae slecte from rgulr spaced posticas fom the eampling fame, euch a: every tenth pationt ‘mtd o a inpatnt fly Systmai sampling relalvely easy to Splemést end date sl rouie a pri Knawlde of the apling fe. ‘Stated sang requires that the population be divided nt pred twemine: sta Wi each tat the camping uate sbreprtclar har Seles sacs ar vex The sty patpnte ae thn slated by thing fandom samgic Bas within each sat. Satie sampling ie particles ‘fal to ease tt ell subgroups of itarst aw rprested in ho ay Populaicn Scuied sampling may seo yield nae precie etnstes of the popsstos marae snc the overall variance rte onthe ith saturn variavs (ele. Thompson, @ Evan, 1086. ‘Disproporssnateeasfeaton refers to the depropatonst sampling at such = spel elghborhvod, which conan high concentztions of th povulat-s of tres For insane, fan investor wre nested ~ frstudag thy fo: of ealtre on nttonl ina, be or she might over Sample cerais rugs to env that te aufeat aber of such individuls isthe study to be able to enlyze the dat. The teclqe resis is aneg-lslction probable for membor ofthe diferente, these reqrg welgbting edjustnens a the analisof the data (Kalen, "luise ei involio te scion of cuss fom th pepulstion bear des made on each indivdval wibin cluster, As 20 trample. one sey wish ta identity erin neghtortoods (cuss) an ‘han Sure Aca within thes selected peghahsods, ‘uhcttage sing ilar to ctr sanpig i at el gue tho ide et priory sampling ule, such a eighorhood. Unlle shister' =p. kowever multe sampling alin sample of secondary its with each primary wnt rther than a sample fa of the secondary ite Asan exp, tulistage sampling would rogie the sapling ct ‘uselds win tn elected eighbriaod, sche aery eta hows > the selected neighbrboods rather than rellanes onal of the hooeebols titi ech seloted neighborhood alton, 1983). Location sampling refs t the election of ptipants hrovgh rar ‘mont a loetione and tines hon numbers of the tagt populton re Spied tebe high Loans coul fsude fo fotans, bs. grocers Sor botiton or chuches,dependigupoo the polaticn ob st bled This ye of sample generally consider n anreience ple ‘inelspace sampling ts condcte a speci Tratins sod mer shaolin fon a epee crs hr aghast on dy sampling rae contig of tines combinations i on Suellen pl fd vested bon ie sled ‘Sivpling unis. Ts matbed of sampling produce « pobabily sample of ‘saber than individ (Kalo, 199) ‘Snowall sampling razed cn te promise that nebes of pati 1a, kev, poptlation Know each or India are ecified within {he argted are population. These Iniduals are ashe to deny other individ within te same age rou. This totniqucan bo red a= trata the supleCanowall emplingy oy aleratvly, to comarca Bling fine forthe rare pops, tom which hn sample then seco For eample if sm investor Wished to examine th prevelnc of needle ‘hasing tbaviows among injection drug weer, snowball sampling woud permit invegeor 0 sily eights patcipnts by rlng on pre ‘isly dented elge paricipants This coulé be more fio th attempting to Went edvidats though hospitals or eine, Sal ‘Stpling i «ronpretahilty sampling pochdue:Saowbeling for fame ‘onatrtion dons teu fom thi weakness, bt eas th posi: ‘hat socily iced nonbers of th ae population wl be ising fy {he Game alton, 1093, Sample Sie and Power. The epidaiologia sconces nt only withthe appropeltancs ofthe sampling method sed, but aso with tre Thee of te timpl,Invssing these ofthe sample ey recs rand ‘cow ad create precio, ‘ower eloulations a often ution o detent requis same sien “Powe bas teen deeds "the probebily of detecing sat Cally sipltcan]« posted level fete” (Rataan, 1980, nee leant power, on meet apeciy the (atti sig\ioacs, or sips ‘eva the mage ofthe fies tat oe wishes to dee such ano rato of the supe ssf the exposed group in eort or ros wtonl Study oF the sample sia the diseased yroup nace contol stay at {heratioof be ste ofthe comparison group tthe sia the exposed group Inv cor renoueaectioal sy ot he san othe dsssed group in ‘evconto sy (ele, Teompeon,& Evans 1988) ~ * diy te Cnn An aerate approach tasting the edoqcy of the stp ize to collet rue sing oe ef tbe sled sample sae forme te Thea ose reqs tht th lero poly de el of ea Gl slgnicance (abe sorte chance of missing el eflec ta eer ‘ho mapntads of half tobe detected he prevalence ofthe exposure tn the notaisesado the dlewe rato simon he unexposed: a ther th ‘ofthe exposed tothe wexpoed etal fhe caves ete contol {Rothman 108) Reliance co hac lomo ha bon eaaed becnge ‘nay cet te sion of oundaty wan an adequate nd inadeeate "plete nent fac the variable spied fo teas te ap Siu recon st etber stay oe by sog on exter (Rothian, ‘00, Mutanasis fers Il quantitative matod of combining th resi of snopsnder tudes (nly daw on pled roti) ad Suthexsngsummsrie and cochsone wich ny bed to east herp fictrenean, pl new andl te” (Olin, 198519) ‘tunel efoto ot nly the sett conaton fee ude Sat aleo tothe whe proces of slant appeal, enol and {nlorprtion..” (Ciera, 199: 81). Beeaee metranalyele pers the seregtion of scl en, may be wil in necting eee that ave ‘een somevhe difeat fo canve de oe al ssp sn of adi Sal suis eur aprons tana have Bn sot oe sm Incdadg the we of quay sore er ho aeprogtion of edie of ‘th good n= poor quay snd overaanoe on pve (Osn 3985) ‘Addons ns. (he vl of awnsoayaedepande oa com es sxmpling of al the suds performed on a priclr topic” Fslson, 190: a theres of metaelyei may beled de to erie ome 2 samp ia sleson bin ormieieton (Elen, 3982) ‘sablabnent ef nav or lee igh Inlsin and exclusion exter can impet hn: on he ale sto metres. Causation ia a 1146 pean recogni ta a nk cheer heat xen ‘ct we ite pr rmedeyarwing oe asuns enfant ae get ae ‘As daonstte below, in tho lgal nates, prompt action msy bo nee asoary een wien lack pce, of oon extensive ledge Sources of Low Lawn Ssquealy claslid into wo domains, the public and the private Publics encompates aw that ie conerned wih goverment or ts lations with individuals an businesses, Public law i capcored with the deinition,rgdlton, abd enforerent of lights whore a ety of ie {overament ea panty tothe action. Public law derives from constitutions, ‘Ratton and regan end eas that ae boon promulgated by 2 an strtioe entity, such aa federal agency Por insabes the routs of ie ood and Dri Administration veil oepeat to informed consent would be ‘lta a pli Private law rf i that regulates the rltons betwee and amen individuals and individual nd busiesees. The includes scons oat to contest to propa ators and torts The primary aouress of piste Inse includ statutes and ial decision iw alan clsifid nto criminal ond vi ey. Cena a deal ‘with crimes Even tough a xz may have bron comnts» per on, fr stance, bans person i obked the eine ssid to evo born ‘Sgnint tho sat nd ii the stl a odor gveranant depending pen ‘he nate of the rine andthe ase of th carga ht ha th ph to pros ‘ute the scouted ined ox any Chol nw i hat la a afore 1 nominal public and private aw, "Fou sou oflaw canbe thought ofa being in an ovate pyramidal shape. At the very iso of this inverted pyramid the constitution Evorything above the consti must he consistant wth to principles fnuncited in the ensituin, Above the conetlon sr the sts: AE Sos move up the ivered pyramid ox find the regulations and tho pe opts that have been derive from cseshear'by the court. At ect lv, {he ection and pelnsptoe must be consstent wih hog ofthe revi levels. Although i would sem thatthe eyetem ir roltsly ‘neat ‘because th constitution, which forms the basi for everthing eli: att pola of iti actualy quit sable bese svoyting les ae ‘omsin in balance with the eonetion. j ‘The Constitation “Th federal onittutlon hes bon cll the “spre The Consttion actly represents & ant of power am the state tothe foderal government bests ll powershot specially aalegted eth fo} ‘ral government se renant tothe terms ofthe Caneutos reared he ate “The Cotton allocates pow mong thes tranches of government. ‘Th lage ranch i enrged with the responsibilty and dogo the author ako laws (ttutes Th exzeutivo rach of he government it eapenible for thn eaforsment ofthe awe while the fuel razah "esponsibie fr te interpretation of thse lve, “Thereare26 amendment to he main body ofthe Conitution. The es 10 ofthe smendments ae kna‘m a the Bil of Rights. Thaso encompass ‘any of te ighte with wh pee maybe mest al, och eo aam ‘of spooch and eedom ofmliglon. Wis importa to remember, though, tat Fld ate Gesoom = ‘hase sgt as dlincatod arin the fed constitution nd a uch apply ‘othe federal tat, goverment. The oueenth Ateneo, hawenes, rovdes specially that no slate may deprive any petiam af bert rope witos the due press of lave Teo Aan lo provides hat ho ate may deo egal prosctin to ay person wii te jusdicion, “Most of he righs hat are enumeratad athe Bl of Right ave bor found by tho Supreme Cour to constitute de paca, so that ultately. thers rahe leo upp the stato awl ste the feel government ich ofthe £0 states alg has ite otmcontitution The sat emai ‘Sons eanot sao petsons fer rghts han are guarantod tthe by the {deal cnstan towene ey my pat pcan po forby the feta conttatens . oe Statutes States ae feral lela promngiod by Cone, cbsétng of {he Hous of Representatives en the Swans. ol, th sso Ishtars ls criti two hoses. eons fe premulgation of sates For eampl, Canges pared teas which ge he Pol and Bg nso nd the Deut of Ph an hen Secs {ees suerte regulations, Judges ee esponsefor th Inrpe tation ft aus wha thr ack of clay or whe tei an Aicrbotween rious stator peotsians Adninistrouve Low ‘Adnairziv ae th ow th mde byt egies ich conse per fy cae ch of pen Soto Inv Cretan er gl cd pay Demons Ecler efector dat at heres Sscluebod snd rug stn hon tse fas ‘othe Depron an eer Ste sea tarncrs maltese droped snd ema tough oe ‘Semeh pocadueswhany be poplars bled ne eau Rarer stich sla pe tebe, Plone and eps Sng wishes renting ey ay ees Comment on repsnd lio, cmt pales athe cant and Inpprnig bat spy dees “opamp 8 sn oe flowed o selec Admin deel ne al Shapira he frig i oss ot oust Decisions Asindicste jade] decisions mustbs cositent with stair idtho CConstttion. The cours hee to the doctine Keown se slate dc r moaning hat hey must lock a pst neo with simian acts nd gal ses {Dmolve the eases tnt appa efor them. In genaal, they are bound by {ection of ll higher cute within the are jusdicton. This wil become ‘dearer flowing t diacussion of tho structure of the legal aysen. For {Eetineas all federal and sate coast ar bound by the decisions of the Supreme Cour ofthe United Soin All federal iste courts are bod by {he detsons of th edral Cou of Appeal for the ciralin which he fe Sat ditt cous is but hey a8 not Sosa by the docsone af Court of ‘Appeal fora eiflent Geol, For instance, Clifrma sits In the Nin eva. The eda ert cout fr te soutbor suit of Califor ts found by the decision ofthe Mth Cvcat Cast of Appel, bt isnot ound Uy the decison ofthe Fil Clzcu, which covers the gogaph ‘tog encnmpersng such sates as Texas and Lausiana. jue decone alo follow the doc of re judi, This means that once cae had been decided and al ofthe canoes for appeal have trem utiliza. ts panty bringing the ese mey not ring it agln ‘The Structure ofthe Lego! System ‘The state and fade cour systems can bo thought of as pyramids At tho ary bse ofthe pyratld seth lowest courts AL the mitlevel of the pyramid the our of st appeal and, the pinnacle of the pyran, ts Ro supree cout ofthe tater ofthe federal court som. Dillerent sates, however name these various lovee diferent For insane, tho sprems ‘cout in California ir Known ste Supreme Court but in Masoetsets ‘f Inow asthe Maeachuses Supreme Judicial Cour, and in New York it fs calod he Cour of Appeal The sate cot eyte the lowest Jovel court af often died ito those tat have limited Jariditon and hore tht have general jurditon ‘The with linited jrledicion oft est cases Involving lees serious ‘tienes and ll leit tht donot tale age sams of money. Gots ff gene jviediction mony bes easesnvelving monly sus ve p< ‘fied amount orimote serious mnre: Court of neal jtsdicin ar often ‘ivided into special cust vel the volun of cases andthe aad for pr Called exper. Examples of euch spesialid courte Inlude juvenile out, family enue and aly cout “The mitre cours, ar appellate cout, ave the power to"heat ‘ppale om the deislons of th lower court This Le known a appellate [itedeion, es contested with original jurado, which is the power Neara ae tite inception The appellate cote ray hse cng jrsdc- thom with tespoct o# Imad range of cue. The te spe cv ny ‘near sppenls fom the sppelate sur Sees The lowest Uren tls pyar in the federal stom coos of the federal ditt couts, Theos cours fea cee involving climes that aise ‘ander federal atte, such a making alse atoments on a feerel apie al ideal ete Cte » ving» ction of anther at (vest of etzenship ease ifthe amount in dept rater nna specified imum. Stat courts may seo est (eos in which actin of ones sulngecize of noha ste Tie ‘ekinowrn a eunear st uneeion. Not eeguealy the party bo did not fete origin! aval may ask to have te cave removed to federal out) Tefal eit ours ny also Bear eves rng andar the odes com ‘tution vad over aiing nde orl statutes. “Appine tro cdeltone ae district sure are made othe federal. Coit of ppl ing aredicton over the crc la which the dit oar sit There ae 1 Coats of Appa. Twelve of tase ae for named ee fale, ob eo cas! aatag nthe istritof Columbia, ant he 12th is fr ‘he Fert Circ ble has sein moe cli hat ae exclusively ‘yin the doroin ef aw, potent and eedamsk lav. ‘The Supross Cran hears appeals fom the Courts of Appeal. However inmost stetony, tars no atomic right to appesl tthe Supreme Cote Rats, he Supreme Gort choase th case that wll ae. Regie ‘ohare an apeal bee made trough wri of extra, which is pet lag ta dea appeal Apt ce te aici yet, som agencio may hae the power | weave ease ncminirately For inetancn the Office of Research Ltepty ‘br the suberty te nvetigte and edjudoneellgetions of centiie mie- ‘conduct Appeals pocrd te th Department Appts Board and from hers, to.cour fons: Givil Procedure ‘levis commenced through the ing of compli by spay a She leit The complain goer, tate the mature of he ee, ‘ho facet supr de sim, andthe sunt in contover. Te defendant wb send sith cap ft complaint psn ih 3 mmone. Tn ‘inosine nth ent mt he a ome fesion within a spcted prod of i or plat wl wn the iecatyaane “te defendant wil then anwer he cman and wil ani deny psd igzorne toch llogaton th complnt Th Sefndan ya Eos ceutert gan the plo sue hid pay The doendat tay gow tate cous lo the aati aco, liming ht a “St asm joo oon te aoe ht he pain ied to site usaf con Following he aon ofthe eve and the newer the defendant, ‘tac il be geod dacovey, daring wich sch pasty to the action Sil have the opportu to eter additional feo pone ese {ooo expert witnsss Oat the tr side may sd to Sent se ses a he opposing pats care Discovery aay Include depot Unis, wate inteptrog, he podason of dosunets, aegis fora ‘neal sonal enmontion aod somes So adsons. howe tat aco most tlovant tothe ah researc context sxe deposon, waiten inveroguories eequest for he production of document abd eqs or ‘eimiesions “The il elf conse of mamerous stages 4. the opening statement of he pati, The opening statement ofthe defend, the preston of dict evidence by the plat, wit cross ‘aination of each wear by the defendant, rede! by the nia recone the defends, 4, the presentation of bot evidence by tho defo, with cot fexuinaon by Be pit eet by he defendant andro Spee pa 5. postu af bul evince y the pan, &, presentation of vebutal evidence bythe etndant 4. pln segment te er. 8 lelendants argent othe fry, pais Cont argument ote fy. 10 osrctons rt he udge tothe fry. and jury delibetion and verde Proving Causation in Negligence Actions ‘The euficlency of data wficient to establish a cael astoeation| ‘beeen anaction, jury, exposure and consequence wil ary depen ng pen the elevast lg context, Fo instance, what i deemed ficiont io te contest of famvlating regulation fo cootal the use of «| pesticide tt ie belioved tae carcinogenic may be git diferent than the ‘Brine anor gonntity ofthe information or data that he uy ads neces ‘Sry to ea that a pats pte Mess ecled om exposure o 2 defendants produc such as 4 sharaceutcal Tis dscssion focuses the tse of epdemiolopa data to eaablich causation inthe context of ‘Wation. The we of piduaialogial data to establish causation inthe com ‘Gato foraulaag agency gliosis aieeed in chape In oder to eeablieh cusation In the context of 2 cv last the plat mart eis thatthe defendant owed s duty tothe pli, {ht ty ws rch, dst the Breach tht dat ested tm harm tothe paint ease in fet), tht see Wass noni baton the defendant’ co ‘luc andthe plaisir (proximate case, ood hat the pln ‘ooking éngue,Lagal Joico dif rit esos to whathar = duty ‘wed to pininis who tay nok be foresexile, In some funedcoas, ia duty ed to anybody, is ove to everbody. In eh urisictions, ‘day demo eed thas i are safes Even wher, however the lal ay be foreseeable, thor may nthe a duty owed depending upen the closenars ofthe connesion baton the dlendaatscondct and te Peoblshing a Brsach of a Duty In ods to ecich thatthe defendant breached» duty of care the sili must poe poof of what actly happened and mus deny Fale tha the desadant iced nrensonbly ender Ibe trcumslences “eroining whsher th conduct ls uneasoabl, the cout may lok t ho bales batwer: tha rss and the benelts of hs dafsdants conduct ‘Terk ofrs te sry ofthe harm hat aight sur as arsul of tbe sna ced and Ue rabbit Ua that bas wil occur In eal ‘he Bene. «cout may consider auch things a the exten and ‘Sallbityof sf trative method, the cata hoe alternative mel ‘Cs, and the sore. lus attached fo te defendant's cond The defn {uate conduct wis cenaiderad untesonsle fe resonable pets athe fendants post = wou have poosivod in advance ht the risks of he sade outweighs ta benalte Establishing Cause in Fact ‘Thee a seve diferent rls, or andar to serine where onde the dient ws snp fo te inser elered by te isn. Diferen "secon lw dra le. Aare cry a lita a defendant ny depend onthe ution nck Cem sna ode law Alden en th sae fac "The but fr ale asia tht pl wuld hot are eon sed ut orate defendant Tle cada rently the sal eqlaes ofbe detrinte mode of eaaton in epdemilogy. trend uss eusoton aha of sna Ini or neta,

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