Fluent Essays

Read the Oswego Outbreak Investigation, located in the Topic Materials.Part 1Complete the following:Using the line listing in the Excel Oswego Line Listing Workbook, calculate the attack rate ratios for each food item using the table in the Excel Oswego Attack Rate Table. Create a separate 2x2 table for the food item you think is responsible for the outbreak and interpret the attack rate ratio for this food item. Refer to the Creating a 2x2 Contingency Table resource for guidance.Using the line listing in Excel Oswego Line Listing Workbook, construct an epidemic curve by the time of onset of illness. What does this curve tell you regarding the average incubation period, source, and transmission? Using the incubation range and clinical symptoms, identify potential infectious agents that could be responsible for the outbreak (refer to the Topic Material, Compendium of Acute Foodborne and Waterborne Diseases). Discuss your rationale.Part 2In a 500-750 word paper, evaluate the situation and present your findings. Including the following:Does this case meet the definition of an outbreak? Why or why not?Identify the steps required to investigate an outbreak. How did these steps help in investigating the Oswego event? Include the relevant information needed for each step to be successful.Discuss the possible routes of transmission for the expected agent.Based on this information, what control measures would you recommend? State whether they are primary, secondary, or tertiary prevention strategies. week2rubric.xlsx oswegoattackratetable.xlsx oswegolinelistingworkbook.xlsx creating2x2contingencytable.docx oswegooutbreakinvestigation.docx Unformatted Attachment Preview Course Code PUB-540 Class Code PUB-540-O500 Criteria Criteria Percentage 100.0\% Calculation of Attack Rate Ratios for Food Items 10.0\% Construction of Epidemic Curve by Time of Onset of Illness 10.0\% Identify Incubation Range Identification of Infectious Agent 10.0\% Evaluation of Situation (Analysis of outbreak, steps to investigate outbreak 15.0\% Possible Routes of Transmission 10.0\% Recommendations (Control measures recommended; primary, secondary or tertiary prevention strategies) 15.0\% Thesis Development and Purpose 7.0\% Argument Logic and Construction 8.0\% Mechanics of Writing (includes spelling, punctuation, grammar, language use) 5.0\% Paper Format (use of appropriate style for the major and assignment) 5.0\% Documentation of Sources (citations, footnotes, references, bibliography, etc., as appropriate to assignment and style) 5.0\% Total Weightage 100\% Assignment Title Oswego Outbreak Case Study Unsatisfactory (0.00\%) Calculation of attack rate ratios for food items is not performed; or, the calculation is not performed or presented according to assignment guidelines. Epidemic curve by time of onset of illness is not constructed; or, it is not presented according to assignment guidelines. Identification of an agent is not discussed. Analysis of the case history as an outbreak and the steps to investigating an outbreak is not presented; or, the analysis and presentation are incomplete. Possible routes of transmission of the expected agent are not presented. Control measures and prevention strategies are not recommended. Paper lacks any discernible overall purpose or organizing claim. Statement of purpose is not justified by the conclusion. The conclusion does not support the claim made. Argument is incoherent and uses noncredible sources. Surface errors are pervasive enough that they impede communication of meaning. Inappropriate word choice or sentence construction is used. Template is not used appropriately or documentation format is rarely followed correctly. Sources are not documented. Total Points 120.0 Less than Satisfactory (74.00\%) N/A N/A Identification of an agent is present but does not include any rationale. Analysis of the case history as an outbreak and the steps to investigating an outbreak is summarized. The summary contains significant inaccuracies. Possible routes of transmission of the expected agent are summarized. The summary contains inaccuracies or is incomplete. An incomplete recommendation for control measures and prevention strategies is presented. Thesis is insufficiently developed or vague. Purpose is not clear. Sufficient justification of claims is lacking. Argument lacks consistent unity. There are obvious flaws in the logic. Some sources have questionable credibility. Frequent and repetitive mechanical errors distract the reader. Inconsistencies in language choice (register) or word choice are present. Sentence structure is correct but not varied. Appropriate template is used, but some elements are missing or mistaken. A lack of control with formatting is apparent. Documentation of sources is inconsistent or incorrect, as appropriate to assignment and style, with numerous formatting errors. Satisfactory (79.00\%) Calculation of attack rate ratios for food items is performed accurately and according to assignment guidelines. However, the data used are inaccurate, yielding an inaccurate attack rate ratio, or the wrong formula is utilized to calculate the ratio. Epidemic curve by time of onset of illness is presented according to assignment guidelines. However, the data used, or the manner in which the curve is displayed is inaccurate. Identification of an agent is present including some rationale, but the agent or discussion is incorrect. Analysis of case history as an outbreak and the steps to investigating an outbreak is discussed. The discussion presents a general evaluation the situation. There are minor inaccuracies. More evidence is needed for support. Possible routes of transmission of the expected agent are generally presented. There are minor inaccuracies. More evidence is needed for support. A general recommendation for control measures and prevention strategies is presented. The recommendation contains inaccuracies or requires more detail and evidence to support claims. Thesis is apparent and appropriate to purpose. Argument is orderly, but may have a few inconsistencies. The argument presents minimal justification of claims. Argument logically, but not thoroughly, supports the purpose. Sources used are credible. Introduction and conclusion bracket the thesis. Some mechanical errors or typos are present, but they are not overly distracting to the reader. Correct and varied sentence structure and audience-appropriate language are employed. Appropriate template is used. Formatting is correct, although some minor errors may be present. Sources are documented, as appropriate to assignment and style, although some formatting errors may be present. Good (87.00\%) N/A N/A Identification of more than one possible agents is present, and rationale is appropriate. Use of the epidemic curve and incubation range are evident. Discussion is sufficient and appropriate based on the agents identified. Analysis of the case history as an outbreak and the steps to investigating an outbreak is discussed. The discussion presents an evaluation of the situation. Some evidence or detail is needed for clarity. Possible routes of transmission of the expected agent are presented. Some evidence or detail is needed for clarity. A recommendation for control measures and prevention strategies is presented. The recommendation requires some detail for clarity. Evidence provided adequately supports claims. Thesis is clear and forecasts the development of the paper. Thesis is descriptive and reflective of the arguments and appropriate to the purpose. Argument shows logical progressions. Techniques of argumentation are evident. There is a smooth progression of claims from introduction to conclusion. Most sources are authoritative. Prose is largely free of mechanical errors, although a few may be present. The writer uses a variety of effective sentence structures and figures of speech. Appropriate template is fully used. There are virtually no errors in formatting style. Sources are documented, as appropriate to assignment and style, and format is mostly correct. Excellent (100.00\%) Calculation of attack rate ratios for food items is presented according to assignment guidelines and the results are accurate. Epidemic curve by time of onset of illness is constructed and accurate. Identification of several agents is present and supported by strong rationale. Use of the epidemic curve and incubation range are evident. Discussion is comprehensive and correctly explains the rationale for selecting the appropriate agent. Analysis of the case history as an outbreak and the steps to investigating the outbreak is thoroughly discussed. The discussion presents a detailed evaluation of the situation. Sufficient evidence and detail are provided to support the evaluation of the situation. Possible routes of transmission of the expected agent are clearly presented. Sufficient evidence and detail is provided to support claims. A detailed recommendation for control measures and prevention strategies is presented. The recommendation provides strong evidence that supports claims. The recommendations demonstrate insight into addressing critical thinking. Comments Thesis is comprehensive and contains the essence of the paper. Thesis statement makes the purpose of the paper clear. Clear and convincing argument that presents a persuasive claim in a distinctive and compelling manner. All sources are authoritative. Writer is clearly in command of standard, written, academic English. All format elements are correct. Sources are completely and correctly documented, as appropriate to assignment and style, and format is free of error. Points Earned Number of persons who ate specified Ill Baked ham Spinach Mashed potatoes cabbage Jello Rolls Brown bread Milk Coffee Water Cakes Van ice cream Cho ice cream Fruit salad Not Ill Total Percent Ill (Attack Rate) Number of persons who did not eat Ill Not Ill Total Percent Ill (Attack Rate) Attack Rate Ratio 2:00 19-Apr 19-Apr 18-Apr 10:30 0:30 22:15 18-Apr 19-Apr 18-Apr 22:00 1:00 23:00 18-Apr 21:45 18-Apr 19-Apr 21:45 1:00 18-Apr 23:00 18-Apr 19-Apr 19-Apr 21:00 1:00 1:00 18-Apr 21:15 18-Apr 19-Apr 23:30 1:00 Coffee 19-Apr Milk 22:30 22:30 2:00 1:00 23:00 Brown bread 18-Apr 18-Apr 19-Apr 19-Apr 18-Apr Rolls 0:30 0:30 0:30 Jello 19-Apr 19-Apr 19-Apr Cabbage N Y Y Y N Y Y Y Y Y N N N Y N Y Y Y N Y Y Y N Y N Y Y N Y N Y Y Y N N Y N Y Y Mashed potatoes M F M F F F M F F F M F F M M F F M M F F M M M F F F M F M M M F M F F M F F Ill Time of Onset Spinach SEX Date of Onset Baked ham ID AGE 1 11 2 52 3 65 4 59 5 13 6 63 7 70 8 40 9 15 10 33 11 65 12 38 13 62 14 10 15 25 16 32 17 62 18 36 19 11 20 33 21 13 22 7 23 64 24 3 25 65 26 59 27 15 28 62 29 37 30 17 31 35 32 15 33 50 34 40 35 35 36 35 37 36 38 57 39 16 Time of Meal unk 20:00 18:30 18:30 unk 19:30 19:30 19:30 22:00 19:00 unk unk unk 19:30 unk unk unk unk unk unk 22:00 unk unk unk unk unk 22:00 unk unk 22:00 unk 22:00 22:00 unk unk unk unk unk 22:00 N Y Y Y N Y Y N N Y Y Y Y N Y Y N Y Y Y N Y N N Y N N Y Y N Y N N Y Y Y Y Y N N Y Y Y N Y Y N N Y Y Y Y N Y Y N Y Y Y N Y N Y Y Y N Y Y N Y N N Y Y Y N Y N N Y Y N N N Y N N Y Y Y N N Y N N N ? Y N Y N Y Y Y N N Y N Y N N N Y Y Y N N N N Y N N Y N N N N N N Y N Y N N Y Y Y N Y N N Y Y N Y N N N N N N N Y Y Y N N N N N N Y Y N N N Y N Y N Y N N N N Y N Y N N Y N N N Y N Y N N N N N N Y N N Y N N N N Y N N Y Y Y Y N Y Y N Y Y Y N Y N Y N Y N Y Y N Y N N Y Y Y Y Y N N N N N N N Y N N Y N N Y N Y N N Y N N N Y N N Y Y N Y Y N Y N N Y Y Y Y Y N N N N N N N N N N N N N N N Y N N N N N N N N N N N N N N N N N N N N N N N N N Y Y Y N N Y N N N N Y N N Y Y N N N Y N N N N Y N N Y Y N Y N N Y Y Y Y Y N 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 68 54 77 72 58 20 17 62 20 52 9 50 8 35 48 25 11 74 12 44 53 37 24 69 7 17 8 11 17 36 21 60 18 14 52 45 M F M F M M M F F F F M M F F M F M F F F M F F M F F F M F F M F F M F unk unk unk unk unk 22:00 unk unk 19:00 unk unk unk 11:00 unk unk unk unk unk 22:00 19:30 19:30 unk unk unk unk 22:00 unk 19:30 19:30 unk unk 19:30 19:30 22:00 unk unk Y N Y Y Y N N Y Y Y N N Y N Y Y N Y Y Y Y N N N N Y Y N N N Y Y Y N Y Y 18-Apr 21:30 19-Apr 19-Apr 18-Apr 2:30 2:00 9:30 19-Apr 19-Apr 18-Apr 0:30 1:00 22:30 18-Apr 15:00 19-Apr 18-Apr 0:00 23:00 18-Apr 19-Apr 19-Apr 18-Apr 22:30 1:00 2:30 23:30 19-Apr 19-Apr 1:00 0:30 19-Apr 19-Apr 19-Apr 0:30 1:00 0:00 19-Apr 18-Apr 2:15 23:00 Y Y N Y Y N Y Y N Y N Y N N Y Y N Y N Y Y N Y N Y N Y Y Y N Y N Y N Y Y N Y N Y Y N Y Y N Y N Y N N Y N N Y N Y Y N Y Y Y N N Y Y N N N Y N N Y Y Y N N Y N Y N N Y N Y N N Y Y N Y N Y Y N Y Y Y N Y Y Y N N N Y N Y Y Y N N Y N N N N N Y N Y N N Y N N Y N N Y N N N Y N Y Y Y N Y N Y N N Y N N N Y N N N N N N N Y N N Y N N Y N N Y N N Y Y N Y N N N Y N Y N Y Y N Y N N N N Y Y N Y N Y N N Y Y N Y N Y N N Y N Y N N Y Y N N N N N Y Y Y N N Y Y N N N N N N Y N N Y Y N Y N N Y N N Y N N N N N N N N N N Y Y N N N N Y N N N N N N Y N N Y N N N N N N N N N N N N N N N N N N N N N Y Y N Y Y N N N N Y N Y N N Y N N Y N N Y N Y N N N N Y Y N N N N N Y Y Water Cakes Van ice cream Cho ice cream Fruit salad N N N N N Y Y N N Y N N Y N Y N N N Y Y N Y N Y N Y N Y N N N N N Y Y N N N N N N N Y N N N N Y N N N N N Y Y N N N Y Y Y N Y Y Y Y Y Y Y Y Y N Y N N N Y Y N Y Y Y N Y Y Y N Y Y Y N Y Y Y Y Y N Y Y Y Y Y Y Y Y N Y Y Y Y Y N N Y N Y N Y N Y Y Y N N Y Y Y N Y N Y N Y N N Y Y N Y N N Y N Y Y N Y N N N Y Y N Y Y Y N N N N N N N N N N N Y N N N N N N N N N N N N N N N N N N Y N N Y N N N N N N N N N N N Y Y N N N Y N N N Y N N N Y Y N N Y Y N N Y N N N N Y N Y N N Y N Y N Y N N N N Y Y N N Y Y N Y Y Y Y N N Y Y Y Y N Y N N Y Y Y Y Y Y N Y Y Y Y Y Y Y Y N N Y Y Y Y N Y Y N Y N N N N Y Y N Y N Y Y Y Y Y Y N Y N Y ? Y Y N N Y Y Y Y Y Y Y Y N Y Y Y Y N Y Y Y Y Y N Y Y N Y N Y N N N Y N Y N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N Y Creating a 2x2 Contingency Table Creating a 2x2 contingency table is very useful in calculating a variety of public health measurements, including sensitivity and specificity, negative and positive predictive value, risk ratios, attack rate ratios, and odds ratios. A 2x2 table is actually a 3x3 table when you include the rows and columns for the totals. If you are setting up a table to measure the sensitivity and specificity of a test or its negative and positive predictive values, you should put the test results on the y-axis (rows) and the actual presence of disease on the x-axis (columns). Disease No Disease Total Test (+) (a) (b) a+b Test (-) (c) (d) c+d Total a+c b+d a+b+c+d The highlighted section is where you will enter the data for each corresponding cell. You can set up the table switching the rows and columns but you will generally see them set up in this format with test results on the y-axis and disease on the x-axis. Setting up a table to measure the association of a risk factor or exposure is similar, with the outcome or disease on the x-axis and the presence of the risk factor or exposure on the y-axis. Disease No Disease Total Exposure (+) (a) (b) a+b Exposure (-) (c) (d) c+d Total a+c b+d a+b+c+d Note: You can set up the table differently but you will need to be cognizant of which numbers you are putting in your numerator and denominator for the measure you are calculating. For example: Exposure (+) Exposure (-) Total No Disease (b) (d) b+d Disease (a) (c) a+c Total a+b b+c a+b+c+d © 2019. Grand Canyon University. All Rights Reserved. Oswego Outbreak Investigation NOTE: The following resource was prepared for class use by replicating portions of the Centers for Disease Control and Preventions (CDC), Oswego - An Outbreak of Gastrointestinal Illness Following a Church Supper: Student Guide (CDC, n.d.), except for the Questions section, with the understanding that the CDC document is in the public domain and available for educational use. Background: On April 19, 1940, the local health officer in the village of Lycoming, Oswego County, New York, reported the occurrence of an outbreak of acute gastrointestinal illness to the District Health Officer in Syracuse. Dr. A. M. Rubin, epidemiologist-in-training, was assigned to conduct an investigation. When Dr. Rubin arrived in the field, he learned from the health officer that all persons known to be ill had attended a church supper held on the previous evening, April 18. Family members who did not attend the church supper did not become ill. Accordingly, Dr. Rubin focused the investigation on the supper. He completed interviews with 75 of the 80 persons known to have attended, collecting information about the occurrence and time of onset of symptoms, and foods consumed. Of the 75 persons interviewed, 46 persons reported gastrointestinal illness. Clinical Description: The onset of illness in all cases was acute, characterized chiefly by nausea, vomiting, diarrhea, and abdominal pain. None of the ill persons reported having an elevated temperature; all recovered within 24 to 30 hours. Approximately 20\% of the ill persons visited physicians. No fecal specimens were obtained for bacteriologic examination. Description of the Supper: The supper was held in the basement of the village church. Foods were contributed by numerous members of the congregation. The supper began at 6:00 p.m. and continued until 11:00 p.m. Food was spread out on a table and consumed over a period of several hours. Data regarding onset of illness and food eaten or water drunk by each of the 75 persons interviewed [are provided in the Excel Oswego Line Listing Workbook (CDC, n.d.)]. The approximate time of eating supper was collected for only about half the persons who had gastrointestinal illness. Conclusion: The following is quoted verbatim from the report prepared by Dr. Rubin: The ice cream was prepared by the Petrie sisters as follows: On the afternoon of April 17 raw milk from the Petrie farm at Lycoming was brought to boil over a water bath, sugar and eggs were then added and a little flour to add body to the mix. The chocolate and vanilla ice cream were prepared separately. Hersheys chocolate was necessarily added to the chocolate mix. At 6 p.m. the two mixes were taken in covered containers to the church basement and allowed to stand overnight. They were presumably not touched by anyone during this period. 1 On the morning of April 18, Mr. Coe added five ounces of vanilla and two cans of condensed milk to the vanilla mix, and three ounces of vanilla and one can of condensed milk to the chocolate mix. Then the vanilla ice cream was transferred to a freezing can and placed in an electrical freezer for 20 minutes, after which the vanilla ice cream was removed from the freezer can and packed into another can which had been previously washed with boiling water. Then the chocolate mix was put into the freezer can which had been rinsed out with tap water and allowed to freeze for 20 minutes. At the conclusion of this both cans were covered and placed in large wooden receptacles which were packed with ice. As noted, the chocolate ice cream remained in the one freezer can. All handlers of the ice cream were examined. No external lesions or upper respiratory infections were noted. Nose and throat cultures were taken from two individuals who prepared the ice cream. Bacteriological examinations were made by the Division of Laboratories and Research, Albany, on both ice creams. Their report is as follows: Large numbers of Staphylococcus aureus and albus were found in the specimen of vanilla ice cream. Only a few staphylococci were demonstrated in the chocolate ice cream. Report of the nose and throat cultures of the Petries who prepared the ice cream read as follows: Staphylococcus aureus and hemolytic streptococci were isolated from nose culture and Staphylococcus albus from throat culture of Grace Petrie. Staphylococcus albus was isolated from the nose culture of Marian Petrie. The hemolytic streptococci were not of the type usually associated with infections in man. Discussion as to Source: The source of bacterial contamination of the vanilla ice cream is not clear. Whatever the method of the introduction of the staphylococci, it appears reasonable to assume it must have occurred between the evening of April 17 and the morning of April 18. No reason for contamination peculiar to the vanilla ice cream is known. In dispensing the ice creams, the same scooper was used. It is therefore not unlikely to assume that some contamination to the chocolate ice cream occurred in this way. This would appear to be the most plausible explanation for the illness in the three individuals who did not eat the vanilla ice cream. Control Measures: On May 19, all remaining ice cream was condemned. All other food at the church supper had been consumed. Conclusions: An attack of gastroenteritis occurred following a church supper at Lycoming. The cause of the outbreak was contaminated vanilla ice cream. The method of contamination of ice cream is not clearly understood. Whether the positive Staphylococcus nose and throat cultures occurring in the Petrie family had anything to do with the contamination is a matter of conjecture. Note: Patient #52 was a child who while watching the freezing procedure was given a dish of vanilla ice cream at 11:00 a.m. on April 18. Addendum: Certain laboratory techniques not available at the time of this investigation might prove v ... Purchase answer to see full attachment