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Nutritional supplement treatment may be appropriate for major depression , bipolar disorder , schizophrenia , and obsessive compulsive disorder , the four most common mental disorders in developed countries. Supplements that have been studied most for mood elevation and stabilization include eicosapentaenoic acid and docosahexaenoic acid each of which are an omega-3 fatty acid contained in fish oil , but not in flaxseed oil , vitamin B 12 , folic acid , and inositol.

Cancer has become common in developing countries. According to a study by the International Agency for Research on Cancer , "In the developing world, cancers of the liver, stomach and esophagus were more common, often linked to consumption of carcinogenic preserved foods, such as smoked or salted food, and parasitic infections that attack organs. Developed countries "tended to have cancers linked to affluence or a 'Western lifestyle' — cancers of the colon, rectum, breast and prostate — that can be caused by obesity, lack of exercise, diet and age. The same report recommends eating mostly foods of plant origin and aiming to meet nutritional needs through diet alone, while limiting consumption of energy -dense foods, red meat , alcoholic drinks and salt and avoiding sugary drinks , processed meat and moldy cereals grains or pulses legumes.

Protein consumption leads to an increase in IGF-1 , which plays a role in cancer development. Several lines of evidence indicate lifestyle-induced hyperinsulinemia and reduced insulin function i. For example, hyperinsulinemia and insulin resistance are strongly linked to chronic inflammation, which in turn is strongly linked to a variety of adverse developments such as arterial microinjuries and clot formation i. Evidence indicates that diets possibly protective against metabolic syndrome include low saturated and trans fat intake and foods rich in dietary fiber , such as high consumption of fruits and vegetables and moderate intake of low-fat dairy products.

The challenges facing global nutrition are disease, child malnutrition, obesity, and vitamin deficiency. The most common non-infectious diseases worldwide, that contribute most to the global mortality rate, are cardiovascular diseases, various cancers, diabetes, and chronic respiratory problems, all of which are linked to poor nutrition.

Nutrition and diet are closely associated with the leading causes of death, including cardiovascular disease and cancer. Obesity and high sodium intake can contribute to ischemic heart disease, while consumption of fruits and vegetables can decrease the risk of developing cancer. Foodborne and infectious diseases can result in malnutrition, and malnutrition exacerbates infectious disease. Poor nutrition leaves children and adults more susceptible to contracting life-threatening diseases such as diarrheal infections and respiratory infections.

According to UNICEF, in , million children across the globe were underweight and one in four children, million, were stunted in growth. Childhood malnutrition is common and contributes to the global burden of disease. When humans are undernourished, they no longer maintain normal bodily functions, such as growth, resistance to infection, or have satisfactory performance in school or work.

Many children are born with the inherent disadvantage of low birth weight, often caused by intrauterine growth restriction and poor maternal nutrition, which results in worse growth, development, and health throughout the course of their lifetime. Data on global and regional food supply shows that consumption rose from in all regions. Diets became more diverse, with a decrease in consumption of cereals and roots and an increase in fruits, vegetables, and meat products.

Undernourishment, or hunger, according to the FAO, is dietary intake below the minimum daily energy requirement. The spike in food prices prevented many people from escaping poverty, because the poor spend a larger proportion of their income on food and farmers are net consumers of food. Malnutrition in industrialized nations is primarily due to excess calories and non-nutritious carbohydrates, which has contributed to the obesity epidemic affecting both developed and some developing nations.

Obesity is more prevalent amongst high income and higher middle income groups than lower divisions of income. Vitamins and minerals are essential to the proper functioning and maintenance of the human body. There are 20 trace elements and minerals that are essential in small quantities to body function and overall human health.

Iron deficiency is the most common inadequate nutrient worldwide, affecting approximately 2 billion people. Vitamin A plays an essential role in developing the immune system in children, therefore, it is considered an essential micronutrient that can greatly affect health. Estimates say that Moderate deficiencies are common in Europe and Africa, and over consumption is common in the Americas. This ultimately leads to poor school performance and impaired intellectual capabilities.

Improvement of breast feeding practices, like early initiation and exclusive breast feeding for the first two years of life, could save the lives of 1. This leaves children less likely to contract diarrheal diseases and respiratory infections. Besides the quality and frequency of breastfeeding, the nutritional status of mothers affects infant health. When mothers do not receive proper nutrition, it threatens the wellness and potential of their children. In the US, dietitians are registered RD or licensed LD with the Commission for Dietetic Registration and the American Dietetic Association, and are only able to use the title "dietitian," as described by the business and professions codes of each respective state, when they have met specific educational and experiential prerequisites and passed a national registration or licensure examination, respectively.

In California, registered dietitians must abide by the "Business and Professions Code of Section Archived from the original on Anyone may call themselves a nutritionist, including unqualified dietitians, as this term is unregulated. Some states, such as the State of Florida, have begun to include the title "nutritionist" in state licensure requirements. Dietary and physical activity guidelines from the USDA are presented in the concept of a plate of food which in superseded the MyPyramid food pyramid that had replaced the Four Food Groups.

Department of Health and Human Services provides a sample week-long menu which fulfills the nutritional recommendations of the government.

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These disparities are a direct product of social inequalities and social inequalities are rising throughout the industrialized world, particularly in Europe. South Asia has the highest percentage and number of underweight children under five in the world, at approximately 78 million children. The Eastern and Southern African nations have shown no improvement since in the rate of underweight children under five. Further nutrient indicators show that only 12 per cent of Cambodian babies are exclusively breastfed and only 14 per cent of households consume iodized salt.

This region has undergone the fastest progress in decreasing poor nutrition status of children in the world. Occurring throughout the world, lack of proper nutrition is both a consequence and cause of poverty. According to UNICEF, children in rural locations are more than twice as likely to be underweight as compared to children under five in urban areas.

That likelihood doubles to four times in Peru. In the United States, the incidence of low birthweight is on the rise among all populations, but particularly among minorities. Nutrition directly influences progress towards meeting the Millennium Goals of eradicating hunger and poverty through health and education. Policy and programming must target both individual behavioral changes and policy approaches to public health.

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While most nutrition interventions focus on delivery through the health-sector, non-health sector interventions targeting agriculture, water and sanitation, and education are important as well. For example, in , iodine deficiency was particularly prevalent, with one in five households, or 1. Emergencies and crises often exacerbate undernutrition, due to the aftermath of crises that include food insecurity, poor health resources, unhealthy environments, and poor healthcare practices.

Interventions aimed at pregnant women, infants, and children take a behavioral and program-based approach. Behavioral intervention objectives include promoting proper breast-feeding, the immediate initiation of breastfeeding, and its continuation through 2 years and beyond. However, because supplementation often occurs too late, these programs have had little effect.

For instance, several East Asian nations have enacted legislation to increase iodization of salt to increase household consumption. For example, in the Philippines , improved production and market availability of iodized salt increased household consumption. Nutrition is taught in schools in many countries. In England and Wales the Personal and Social Education and Food Technology curricula include nutrition, stressing the importance of a balanced diet and teaching how to read nutrition labels on packaging. In many schools a Nutrition class will fall within the Family and Consumer Science or Health departments.

In some American schools, students are required to take a certain number of FCS or Health related classes. Nutrition is offered at many schools, and if it is not a class of its own, nutrition is included in other FCS or Health classes such as: In many Nutrition classes, students learn about the food groups, the food pyramid, Daily Recommended Allowances, calories, vitamins, minerals, malnutrition, physical activity, healthy food choices and how to live a healthy life. The protein requirement for each individual differs, as do opinions about whether and to what extent physically active people require more protein.

The Recommended Dietary Allowances RDA , aimed at the general healthy adult population, provide for an intake of 0.

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The main fuel used by the body during exercise is carbohydrates, which is stored in muscle as glycogen — a form of sugar. Adequate nutrition is essential for the growth of children from infancy right through until adolescence. Some nutrients are specifically required for growth on top of nutrients required for normal body maintenance, in particular calcium and iron.

Malnutrition in general is higher among the elderly, but has different aspects in developed and undeveloped countries. Humans have evolved as omnivorous hunter-gatherers over the past , years. The diet of early modern humans varied significantly depending on location and climate. The diet in the tropics tended to depend more heavily on plant foods, while the diet at higher latitudes tended more towards animal products. Analyses of postcranial and cranial remains of humans and animals from the Neolithic, along with detailed bone-modification studies, have shown that cannibalism also occurred among prehistoric humans.

Agriculture developed about 10, years ago in multiple locations throughout the world, providing grains such as wheat , rice and maize and potatoes ; and originating staples such as bread and pasta dough [86] , and tortillas. Farming also provided milk and dairy products, and sharply increased the availability of meats and the diversity of vegetables. Around BC the Vedic texts made mention of scientific research on nutrition. The Bible's Book of Daniel recounts first recorded nutritional experiment.

Selected as court servants, they were to share in the king's fine foods and wine. But they objected, preferring vegetables pulses and water in accordance with their Jewish dietary restrictions. The king's chief steward reluctantly agreed to a trial. On comparison with the king's men, they appeared healthier, and were allowed to continue with their diet. The 16th-century scientist and artist Leonardo da Vinci — compared metabolism to a burning candle. James Lind , a physician in the British navy, performed the first attested scientific nutrition experiment, discovering that lime juice saved sailors who had been at sea for years from scurvy , a deadly and painful bleeding disorder.

The discovery was ignored [ by whom? Scientists would not identify the essential vitamin C within lime juice until the s. Around Antoine Lavoisier , the "Father of Nutrition and Chemistry", discovered the details of metabolism, demonstrating that the oxidation of food is the source of body heat. In George Fordyce recognized calcium as necessary for fowl survival.

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In the early 19th century, the elements carbon , nitrogen , hydrogen and oxygen were recognized [ by whom? In the s Claude Bernard discovered that body fat can be synthesized from carbohydrate and protein, showing that the energy in blood glucose can be stored as fat or as glycogen. Adding various types of vegetables and meats to the diets of Japanese sailors prevented the disease.

In Eugen Baumann observed iodine in thyroid glands. In , Christiaan Eijkman worked with natives of Java , who also suffered from beriberi. Eijkman observed that chickens fed the native diet of white rice developed the symptoms of beriberi, but remained healthy when fed unprocessed brown rice with the outer bran intact. Eijkman cured the natives by feeding them brown rice, demonstrating that food can cure disease. Over two decades later, nutritionists learned that the outer rice bran contains vitamin B. In the early 20th century Carl von Voit and Max Rubner independently measured caloric energy expenditure in different species of animals, applying principles of physics in nutrition.

In , Wilcock and Hopkins showed that the amino acid tryptophan was necessary for the survival of rats. A second group of rats to which he also fed an amount of milk containing vitamins. In Stephen M. Babcock and Edwin B. Hart conducted the single-grain experiment. This experiment ran through In Casimir Funk coined the term vitamin to label a vital factor in the diet: The vitamins were studied [ by whom?

In Elmer McCollum discovered the first vitamins, fat-soluble vitamin A and water-soluble vitamin B in ; later identified as a complex of several water-soluble vitamins and named vitamin C as the then-unknown substance preventing scurvy. Lafayette Mendel and Thomas Osborne — also performed pioneering work on vitamins A and B. In Sir Edward Mellanby incorrectly identified rickets as a vitamin A deficiency, because he could cure it in dogs with cod-liver oil. Also in , H.

Bishop discovered vitamin E as essential for rat pregnancy, and originally called it "food factor X" until In Hart discovered that iron absorption requires trace amounts of copper. In he synthesized it, and in won a Nobel Prize for his efforts. In the s William Cumming Rose identified essential amino acids , necessary protein components which the body cannot synthesize.

In Eric Underwood and Hedley Marston independently discovered the necessity of cobalt. In Eugene Floyd Dubois showed that work and school performance relate to caloric intake. In Erhard Fernholz discovered the chemical structure of vitamin E. It was synthesised by Paul Karrer — From rationing in the United Kingdom — during and after World War II — took place according to nutritional principles drawn up by Elsie Widdowson and others. In the U. Department of Agriculture introduced the Food Guide Pyramid.

In a Natural Justice study showed a relation between nutrition and violent behavior. In a study found that in addition to bad nutrition, adenovirus may cause obesity. From Wikipedia, the free encyclopedia. For nutrition science not specific to humans, see Nutrition. Overnutrition , Obesity , and Overweight. Underweight , Food security , and Epidemiology of malnutrition. Food portal Health and fitness portal. A Report Card on Nutrition No. Retrieved March 31, Vitamin and mineral requirements in human nutrition 2. Nutrient Intakes and Physical Measurements".

Australian Bureau of Statistics. Lehninger's Principles of Biochemistry 4th ed. New York, New York: European Journal of Clinical Nutrition.

PEER REVIEWED: Twelve Essentials of Science-based Policy

The American Journal of Clinical Nutrition. Journal of the American Dietetic Association. A systematic review with meta-analysis of observational studies" Full text. Critical Reviews in Food Science and Nutrition. Kathleen Mahan; Janice L. Raymond; Sylvia Escott-Stump Krausw's Food and the Nutrition Care Process 13th ed. An Outline of its Chemistry, Biochemistry, and Technology 5th ed. Principles of Bioinorganic Chemistry. Sultan Qaboos University Medical Journal.

Modern Nutrition in Health and Disease. Lippincott Williams and Wilkins. Archived from the original on 30 May Retrieved 8 October Acta Biol Med Ger. The World Bank Research Observer. The American College Health Association". Journal of American College Health. Journal of Public Economics. Chronicle of Higher Education. Following is an example of how such a model-user interface was created for public health practitioners.

During the first months of the severe acute respiratory syndrome SARS epidemic in , a mathematical model was developed to predict the spread of SARS The mathematical model can be thought of as a machine, with the engine of the machine comprising a series of four mathematical equations:. These equations are complex but do not have to be understood to be used, just as a person who drives a car does not have to understand how the engine works. The model-user interface is simple. The required information for using the previous SARS model to predict the number of SARS cases and deaths consists of only R 0, F, i, and d, and the result is a set of several line graphs showing the predicted and observed numbers of SARS cases and deaths.

The deviation of the observed numbers from the predicted numbers indicates the success of infection control measures For the general public, an effective yet simple and basic way to convey, or translate, complex information is by using health proverbs Sayings such as "an apple a day keeps the doctor away" 51 have helped convey important health messages through the years.

They were created by our ancestors, and we have the responsibility to create new science-based health proverbs for future generations. Public health practitioners can learn about knowledge translation techniques from weather forecasters 52 , who use symbols such as a sun partly covered by clouds and maps to explain the weather.

Symbols could be used to denote public health events, and the public could receive short- and long-term public health forecasts and public health alerts, complete with color-coded maps to illustrate public health problems in space and time. Timely dissemination of information requires an ongoing information distribution mechanism.

For example, health indicators relevant to the general public could be developed, with one per day being discussed on the evening news After the news and the weather forecasts, the reporter could discuss one of the indicators, such as air pollution during the previous 5 years and its predicted relationship to asthma in the next 3 years. The public would not be expected to watch the news without fail, but if the information dissemination occurred daily, the public's awareness and knowledge would increase with time In Canada, approximately , deaths result from chronic diseases each year.

A chronic disease clock was developed by the Public Health Agency of Canada to disseminate information in real time on its Web site The chronic disease clock is a digital clock with two categories: People can actually watch the number of deaths attributable to chronic disease increase every few minutes because one death occurs every 3 minutes in Canada. The clock keeps running 24 hours per day, days per year.

The general public is overwhelmed by health information. The end result is that they do nothing to improve their health because they do not know how to begin the process. The various types of available information need to be prioritized and disseminated in stages. Chapter 4 of The World Health Report is about major health risks. In industrialized countries, the leading risk factors for chronic diseases are tobacco use, high blood pressure, excessive alcohol consumption, high cholesterol, overweight, low fruit and vegetable intake, and physical inactivity. The four major chronic diseases in terms of resulting disability are cardiovascular disease, cancer, chronic respiratory diseases, and neuropsychiatric disorders The information in the chapter can be prioritized for modulated release 56 in three steps.

To promote health, the public is told to play it SAFE with the acronym SAFE representing smoking, alcohol, food, and exercise — refrain from smoking, drink alcohol in moderation, eat a balanced diet, and increase physical activity. If they do not play it SAFE, they have to call a COP to assess the situation with COP representing cholesterol, obesity, and pressure — go for annual medical examinations to assess blood cholesterol levels, weight, and blood pressure.

If they do not play it SAFE and call a COP, they have to expect HARM with HARM representing heart disease, abnormal growth, respiratory disease, and mental disorders — in the form of chronic conditions such as heart disease, cancer, lung disease, and mental disorders. They would then have to seek treatment. Scientific findings must be published in accessible formats.

For example, information posted on a Web site may be considered accessible; however, some people do not have access to the Internet. Even people who do have Internet access may have difficulty retrieving a specific piece of information. For example, a Google search of the Internet using the key words health information resulted in 13,, Web sites Various unique information dissemination tools have been invented. For example, executives at Xerox's Palo Alto Research Center Palo Alto, Calif can monitor the company's overall share price by watching an office fountain.

The water flow is controlled through an Ethernet connection to a computer that has the latest stock data. Flow strengthens when the price increases New ways to actively market information and make it accessible to various populations are needed. A group of experts at an occupational health workshop for Latin Americans suggested unique ideas such as writing folk songs for the radio on the health effects of pesticides and organizing concerts with themes related to healthy living The Brazilian Ministry of Health distributes a free package of two decks of playing cards, and one health message is written on each card, for a total of health messages.

Messages include tips such as "Take a walk with your dog for 30 minutes to burn up to calories" and "Increase your fruit and vegetable consumption to five times a day. To be understood by different audiences, a message must be conveyed in relevant terms. For example, Canadian policymakers readily understand the economic and health impact of smoking on society.

This message may not be relevant to members of the general public who are not interested in policy and economics but are passionate about sports. Instead of telling them about how much society will save if they quit smoking, you could tell them how many important sports events, such as Stanley Cup hockey playoffs, World Cup international soccer games, or Super Bowl football playoffs, they would miss in their lifetime if they continued smoking For younger audiences, a relevant message such as "smoking makes you ugly" could be an innovative way to convey smoking-related information Teenage smokers who do not care about the long-term health effects of tobacco smoking may be able relate to the more immediate effects on appearance, such as smoking-induced facial wrinkles 61 , 62 and baldness It is important to raise awareness of how scientific evidence can be used to make health policy decisions.

The key is to create an atmosphere in which knowledge users are interested in and seeking out scientific knowledge rather than being inundated with unwanted information. Knowledge users can be motivated in many ways, and education plays an important role. Presenting facts is not enough. For example, after returning home from a doctor's office, a colleague's teenage son told her that his doctor told him he was obese. The boy then said that he really did not need to worry about the problem because obesity was so common.

The boy had the facts but was not motivated to do anything about them. Educating people by teaching them about the severity and consequences of a health problem helps motivate them to act. For example, obese people need to know that they have a higher risk of developing chronic diseases such as diabetes and heart disease.

Knowing the number of people who became blind or had limbs amputated because of diabetes would be a better way to drive home the ramifications of diabetes than simply stating the number of people who had diabetes. Policymakers and the general public must be convinced that using science for making health decisions will be beneficial and have a noticeable impact on their health — in other words, that it will have a rewarding outcome. For example, mathematical prediction models could help policymakers evaluate how various policies will affect a particular situation. To help show the general public how scientific evidence can be used to make health decisions and improve their health, computer software could be used to calculate the probability of disease risks or overall health outcomes based on input related to personal lifestyle choices, demographics, diet, and smoking For example, a year-old man in excellent health may find out that he is expected to live 75 years.

The computer program could be used to show him that if he were to start smoking, he would only be expected to live 67 years The 8-year difference may be rewarding enough for him to decide not to start smoking. The science-based policy framework of knowledge generation, knowledge exchange, and knowledge uptake has similarities to Boyer's research Boyer studied the concept of scholarship and distinguished four kinds of scholarly pursuits: Many parallels exist between Boyer's work and the framework described in this article: Boyer's discovery category parallels the framework's knowledge generation area, his integration category parallels the knowledge exchange area, and his application category parallels the knowledge uptake area.

Overall, education is important in all three areas of the framework. Corresponding to the 12 essentials are 12 recommendations for the future Table 2. It is hoped that these recommendations will stimulate additional research and provide evidence for the necessity of a strong evidence base in public health policy. Views presented in this article are those of the author and cannot be attributed to the Public Health Agency of Canada, the University of Ottawa, or the University of Toronto.

The opinions expressed by authors contributing to this journal do not necessarily reflect the opinions of the U. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.


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Suggested citation for this article: Twelve essentials of science-based policy. Prev Chronic Dis [serial online] Oct [date cited]. National Center for Biotechnology Information , U. Journal List Prev Chronic Dis v. This article has been cited by other articles in PMC. Abstract This article presents a systematic framework of 12 essentials, or basic elements, of science-based policy.

Introduction The relationship between science and policy is an important topic in evidence-based public health policy and practice 1. Open in a separate window. Knowledge Generation Credible design Ideally, evidence for policy decisions should be generated from scientific research based on high-quality study designs. Accurate data Bias is defined as the "deviation of results or inferences from the truth, or processes leading to such deviation" An example of framing bias follows: Which operation would you prefer?

Sound analysis Failure to control for confounding effects is a common problem in data analysis. Comprehensive synthesis Scientific papers are being published constantly. Knowledge Exchange Relevant content Information should not be disseminated all at once and should not be provided to everyone. Appropriate translation As scientists make new discoveries, more sophisticated methods and theories are developed. The mathematical model can be thought of as a machine, with the engine of the machine comprising a series of four mathematical equations: Timely dissemination Timely dissemination of information requires an ongoing information distribution mechanism.

Modulated release The general public is overwhelmed by health information. Knowledge Uptake Accessible information Scientific findings must be published in accessible formats. Readable message To be understood by different audiences, a message must be conveyed in relevant terms.


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Motivated user It is important to raise awareness of how scientific evidence can be used to make health policy decisions. Rewarding outcome Policymakers and the general public must be convinced that using science for making health decisions will be beneficial and have a noticeable impact on their health — in other words, that it will have a rewarding outcome. Conclusion The science-based policy framework of knowledge generation, knowledge exchange, and knowledge uptake has similarities to Boyer's research Area Essential Recommendation Knowledge generation Credible design Use high-quality study designs and apply a systematic approach in research to prevent the false-positive research cycle.

Accurate data Apply existing methods and develop new methods for reducing bias and increasing data accuracy obtained from scientific research. Sound analysis Apply sound analysis methods to produce high-quality results from scientific research. Comprehensive synthesis Use existing tools and develop new tools for summarizing scientific findings. Knowledge exchange Relevant content Apply existing methods and develop new methods to extract relevant content from existing information. Appropriate translation Develop new techniques for information translation, and simplify the science—user interface.

Timely dissemination Develop innovative ways to disseminate information in a timely way. Modulated release Create new methods for organizing the release of prioritized information. Knowledge uptake Accessible information Invent new ways to market health information and make it more accessible. Readable message Produce information in a readable, understandable format that is relevant to the audience. Motivated user Educate and motivate policymakers so that they actively seek out scientific evidence to make decisions.

Rewarding outcome Develop new ways to effectively show how using science to make decisions is beneficial. Acknowledgments Views presented in this article are those of the author and cannot be attributed to the Public Health Agency of Canada, the University of Ottawa, or the University of Toronto. Footnotes The opinions expressed by authors contributing to this journal do not necessarily reflect the opinions of the U. Contributor Information Bernard C. Evidence based health promotion: J Epidemiol Community Health. The unbearable lightness of healthcare policy making: Haynes B, Haines A.

Barriers and bridges to evidence based clinical practice ; Centre for Global eHealth Innovation. The Global eHealth Innovation Network. Knowledge acquisition, dissemination and application. Enhancing the uptake of research knowledge in health policy. Canadian Health Services Research Foundation. Canadian Health Services Research Foundation; Institute for Work and Health. Knowledge transfer and exchange. Institute for Work and Health; National Center for the Dissemination of Disability Research.

NIDRR's long range plan — knowledge dissemination and utilization. National Center for the Dissemination of Disability Research; Canadian Institutes of Health Research. Canadian Institutes of Health Research; [cited Mar 3]. Getting the right knowledge to the right people at the right time: Health Canada; [cited Aug 6]. Epidemiologic design options for health risk studies on dental amalgam.

Can J Community Dentistry ; World Health Organization; Geneva, Switzerland: Concepts of modern risk assessment and management. J Am College Dentists ; Centre for Evidence Based Medicine. Levels of evidence and grades of recommendation, May. Centre for Evidence Based Medicine; [cited Oct 22]. Health insight — take charge of health information. Harvard University; [cited Oct 20].

Perspectives on epidemiologic surveillance in the 21st century. Chron Dis Canada ; Mobile phone — brain tumor risk in the limelight again: Microwave News; [cited Oct 20]. Armitage P, Colton T, editors. Western Kentucky University; [cited Oct 20]. A dictionary of epidemiology. Reducing variability in treatment decision making: Medical Educ ; 32 1: Cell type identification in leukemia: