Advanced Epidemiology Report: AKI, Sepsis, and NTD Analysis

This report delves into an advanced epidemiology analysis, focusing on the interplay between acute kidney injury (AKI), sepsis, and neural tube defects (NTD). The report begins with a statistical analysis of AKI and sepsis, examining prevalence rates across gender and age groups, and determining crude measures of association. It identifies and discusses confounding factors, specifically age and gender, and their impact on the incidence of these conditions. The report then explores selection bias and methods to minimize it, focusing on random sampling and representative patient selection. Furthermore, it evaluates the validity of blood tests, considering time constraints and inconsistencies. The report also examines differential and non-differential misclassification, providing examples and interpretations. The analysis extends to a comparative assessment of two research papers, discussing their methodologies, selection processes, and confounding minimization strategies. The report also analyzes the impact of folic acid supplementation on NTDs, discussing clinical implications, potential limitations, and the figure demonstrating the impact of NTD, as well as associated biases. Finally, the report concludes with a comparative analysis of the papers, emphasizing the strengths and weaknesses of each study, and providing a critical evaluation of their findings.

RUNNING HEAD: SID NUMBER 1
Advanced Epidemiology
Name
College

SID NUMBER 2
Question One
i.
Table 1: Sepsis and acute kidney injury by age and gender
Yes No Total
Female 39 45 84
Male 81 54 135
Total 120 99 219
ii.
Crude Measure of Association
A=Rate of the female who is exposed already = 39/39+45=0.46=46%
B=Rate of the male who is exposed already = 81/81+54=0.6=60%
Having said that the crude measure of association = A/B
46/60
=0.766667
=0.8
Interpretation
This means that female are 0.8 times likely to contract the disease than female in this setup,
compared to men. In general women are more prone to contract the two incidences of both acute
kidney injury which has more impact on Sepsis.
iii.
In this question age is a confounder because of the extrapolated relationship, it presents between
the incidences of the condition. Below is a table describing the confounding factor and the
impact it has on the individuals

SID NUMBER 3
Baseline AKI & Sepsis by age group
62+ years
Sepsis No Sepsis Total
AKI 62 33 99
No AKI 83 48 131
Total 145 85 230
Risk Ratio for age 62+
= (62/99)/ (83/131)
0.6263/0.63359
=0.99
Below 62 years
Sepsis No Sepsis Total
AKI 58 34 92
No AKI 100 51 151
Total 158 85 243
Risk Ratio for age< 62:
(58/92)/ (100/151)
0.6304/0.6623
=0.95
Conclusion

SID NUMBER 4
This means that those of age above 62 have a higher prevalence compared to the younger hence
age is a confounding factor here.
d. The baseline for AKI versus Sepsis by Gender
Below is a table describing the relationship that exists in these two aspects and a conclusion
thereof.
Sepsis No Sepsis Total
AKI 18 46 64
No AKI 39 5 44
Total 57 51 108
Risk ratio
= (18/64)/ (39/44)
=0.2813/0.8864
=0.32
Male
Sepsis No Sepsis Total
AKI 66 81 147
No AKI 164 54 218
Total 230 131 392
Risk factor = (66/147)/ (164/218)
=0.4490/0.7523
0.60

SID NUMBER 5
Conclusion
In this instance, gender is a confounding factor. It seems male to have a higher risk of developing
Sepsis with an increase of condition of AKI.
Question Two
a. The selection bias can be brought by the following factors: If the
researcher does not get a positive response from the patients. If the selection
group of the patients who do not consistently represent the population were
chosen to confirm the researcher's speculations
b. This manner of biases can be minimized by ensuring that:- The sample to be
selected is randomly picked from the population of the patients with acute kidney
failure Similar characteristics of the patients should be picked to ensure no
discrimination or advantage of the conclusion By encouraging and motiving the
patients selected would give a different impression to them and change the
outcome.
c. The values collected within the 24-hour period essential differ from those collected after
48 hours hence the measure of agreement lacks and therefore I may not recommend the
blood test. Shortage of time and inconsistencies are manifest in this particular aspect.
Because of these anomalies then It becomes in consisted to apply this blood test
principle.
d. This instance will cause non-differential miscalculation this is because in epidemiology,
when such an occasion happens; the results are similar in all points under consideration.
When all groups and samples have the same effect of the causative factors then it is
declared as a non –differential miscalculation

SID NUMBER 6
e. A- False; this is because miscalculation in non –differential miscalculation is
homogenous across all groups hence not depended on any variation. In this particular
instance, it refers to the differential measurement type of an error which may not
generally apply to all factors.
B- True; this actually in accordance with the principle of non-differential miscalculation
which states that the information that is different can be applied to all groups within the
sample.
Question Three
Part 1
a.
– Paper one is a cause to effect paper that outlines the conditions and their ultimate goals.
- Paper two is an analytical study paper
b.
In both of these papers; selection has been minimized in this way:- below is a
justification of how bias has been minimized. a) The selection of the patients randomly that was
to be assessed. b) A large sample was selected which probably was a representative of the whole
population. Through this; bias selection is reduced as random selection ensures that the
Probability of selected is not certain hence it reduces. Also, the large sample ensures that almost
the entire population is represented by their similar characteristics without any discrimination.
These two parameters to a great extent minimize the selection bias.
c.
In reference to the aspect of confounding minimization in stages of both paper 1 and paper 2 at
design and analysis stages. Randomization – in this aspect, the selection of the sample was
random meaning that there was no discrimination among those who were selected. This was
actually to minimize the confounding .through the two studies, only the relevant sample- in the

SID NUMBER 7
two studies was taken during selection something that has a great impact on confounding factors.
So in other words, through random identification of the samples and a homogenous aspect of it ,
the confounding factors have been regulated.
d.
Paper 1-the study demonstrated that when the patients were exposed in two different
environments for treatment; and a grace period of ninety days given, those who died in
Hydroxyethyl starch and those in saline were not so diverse, Lilla et al 2018. Little differences
were noted in each. In Hydroxyethyl starch environment the patients were reckoned to have a
higher rate of dying compared to those in the other environment.
e.
Paper 2- in this particular study there are fundamental concepts of necessity that comes
on board. It was realized that employment of hyper oncotic albumin would influence a higher
rate of mortality among those patients. The confounding factors stationed around the renal
functionality had a telling influence on the outcome as well. Hyper oncotic colloids both
artificial and natural had a telling influence on the death rates that were happening among the
patients that were chosen to represent the sample.
f.
No; The researchers employed different parameters as both study and outcome factors. The
study and analysis designs were diverse hence their perspectives could not be similar in any way.
g.
The papers from the author's perspectives are of high quality. This is because of the
reasons are given below. The content used in both papers presents the trustworthiness of the
authenticity. The conclusions seem to resonate consistently with other related published papers
elsewhere; the clear and required in text and referencing style demonstrates that the integrity of
the work is certain in both of them though there are all these strengths of quality. There are some
issues that the papers have. In both of them, there are some key conclusions that are still
debatable within the field of research which makes it crucial to explore more and more.

SID NUMBER 8
h.
If I am asked to pick the most outstanding paper among the two; I would pick paper 1paper in
preference. This is because the paper was published in 2012 as compared to the paper 2 which
was published in 2008. The first paper appears to have the most current content to evaluate. The
variance in terms of the periods means that there are more dependable facts in the paper 1 in
contrast to paper 2.
Question Four
a. It is necessary for women to be taught on this fundamental subject of life. Folic acid is
very important especially for the expectant women. Deficiency of this crucial element has
a telling influence on the health of the baby to be born, Strøm et al 2018. When a folic acid
supplement is taken by the mother during this crucial moment of her life, the spinal and
brain complications that often affect babies are stemmed. From this perspective of the
authors; it can be thus agreed on that the use of folic acid components reduces the Neural
Tube Defects. The supply of these supplements, builds some fundamental cells located in
the brain and the spinal area and strengthens them against any undue cause.
b. From a clinical angle of the results, there seems to be sympathy between the Folic acid
component and a decrease of Neural Tube Defects. This is scientific because the
component is the building block of the neurons and spine. Once there is a deficiency in
this, then clinically the child is diagnosed with a positive index in NTDs. It is clinically
proved that when folic acid is deficient in the system, the development of the brain
function is delayed and the spine cord growth is also impaired this is the reason why the
pregnant mothers are required to use more of this component.
c.
i. The cost of the supplement may lock out many women
ii. The unplanned pregnancies among women that may not be in a position to use the
components. These supplements are required to be taken sometimes before the
pregnancy develops so much for development of the sensitive parts that are prone to
the condition.

SID NUMBER 9
iii. Sometimes there may be little change in terms of the effect of the supplement.
d. i. By randomly picking women from various sectors and environments for the analysis
ii. By having large sample which can act as proof for the validity of the results. Large
sample of results ensures uniformity and a bigger scope of evaluation.
Part 2
a. The figure demonstrates various components of the impact that NTD has on the kids who
are born. The population presented has been selected on the specific bias; which limits
many women. It shows the rate of NTDS among women of various ages at particular
periods as provided. Older women are likely to have children who are NTDs positive
compared to the younger women.
b. The biases that some women who would not afford were left out
In case the women conceived without proper organization; the results were not involved in
the grand estimation of the population at large. It is also noted that this imbalance affected
the validity of the outcome since only the preferred members were engaged.

SID NUMBER 10
References
Lilla, N., Rinne, C., Weiland, J., Linsenmann, T., Ernestus, R. I., &Westermaier, T. (2018).
Early administration of hypertonic-hyperoncotic hydroxyethyl starch (HyperHES)
improves cerebral blood flow and outcome after experimental subarachnoid haemorrhage
in rats. World neurosurgery.
Strøm, M., Granström, C., Lyall, K., Ascherio, A., & Olsen, S. F. (2018). Folic acid
supplementation and intake of folate in pregnancy in relation to offspring risk of autism
spectrum disorder. Psychological medicine, 48(6), 1048-1054.