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4 Case Studies of Triangulation Across Epidemiology Studies for Hazard Identification and Risk Assessment
Pages 18-24

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From page 18...
... studies that bolstered confidence in prior conclusions about associations between TRAP and specific health outcomes, Boogaard discussed the difficulty of evidence synthesis for environmental exposures and mixtures. Drawing from 350 observational studies, the review used a systematic approach to quantitatively summarize epidemiological results where possible using meta-analysis techniques.
From page 19...
... Finally, the review evaluated up- and downgrading factors independently following GRADE's Quality and Environmental Noise Guidelines for systematic reviews, because GRADE generally does permit upgrading after a body of evidence is downgraded. Roel Vermeulen of Utrecht University presented on triangulation of evidence concerning environmental exposures, including to diesel engine exhaust, power line proximity, benzene, and asbestos, and possible links to cancer.
From page 20...
... Ineligible studies were also mostly positive, and publication bias was considered to be unlikely because the radiation epidemiology field is a small field and most studies are known. This new body of epidemiological data from all available, eligible studies with dose-response estimates, directly supports excess cancer risks from low-dose ionizing radiation exposure.
From page 21...
... and whether a qualitative comparison is sufficient. She also urged her peers to publish quantitative bias assessments within original study publications.
From page 22...
... The Rich Life project5 serves as one example of this approach. Nearing publication, this project comprises a pragmatic cluster randomized trial that evaluates a collaborative stepped care intervention that involves a nurse care manager, community health worker, and special team to deliver individualized care to patients.
From page 23...
... Savitz added that evidence bases are complementary, not necessarily in their support of one another, but in their pertinence to the overall interpretation. Berrington de González agreed, noting that with a hierarchy of information, human data will usually outweigh animal experiments, even if they consistently point in the opposite direction, citing the ionizing radiation and radiobiology examples.
From page 24...
... Triangulation in Environmental Epidemiology for EPA Human Health Assessments approaches are established before data are evaluated, some of the potential pitfalls of triangulation may not be as concerning as other speakers posited. Summarizing the drawbacks voiced by speakers, committee moderator David Richardson stated, "I made a brief list of the dangers: anarchy, entropy, endless Sisyphean tasks, fear, and sleeplessness.


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