Innovations in Evaluating Health Campaigns in Developing Countries

When conducting research in resource-poor settings, what research-method textbooks prescribe often varies substantially from what actually gets implemented on the ground. Randomization often breaks down, extraneous noise often pollutes the purity of experimental designs, and other challenges emerge in the field. The panel will highlight some of those challenges and engage the audience in discussions about possible solutions. Dr. Boulay will illustrate an analytic approach that combines propensity score matching and mediation analysis to provide a more comprehensive evaluation of SBCC activities. Dr. Firestone will discuss PSI\u27s experience using coarsened exact matching to strengthen evaluation of its behavior change communications programs. Case studies of how the methods have been applied will be discussed

Time-to-positivity in bloodstream infection is not a prognostic marker for mortality:analysis of a prospective multicentre randomized control trial

Objectives Time to positivity (TTP), calculated automatically in modern blood culture systems, is considered a proxy for microbial load and has been suggested as a potential prognostic marker in bloodstream infections. In this large, multicentre, prospectively collected cohort, our primary analysis aimed to quantify the relationship between the TTP of monomicrobial blood cultures and mortality. Methods Data from a multicentre randomized controlled trial (RAPIDO) in bloodstream infection were analysed. Bloodstream infections were classified into 13 groups/subgroups. The relationship between mortality and TTP was assessed by logistic regression, adjusted for site, organism, and clinical variables, and linear regression was applied to examine the association between clinical variables and TTP. Robustness was assessed by sensitivity analysis. Results In total 4468 participants were included in the RAPIDO. After exclusions, 3462 were analysed, with the most common organisms being coagulase-negative staphylococci (1072 patients) and Escherichia coli (861 patients); 785 patients (22.7%) died within 28 days. We found no relationship between TTP and mortality for any groups except for streptococci (odds ratio (OR) with each hour 0.98, 95%CI 0.96–1.00) and Candida (OR 1.03, 95%CI 1.00–1.05). There was large variability between organisms and sites in TTP. Fever (geometric mean ratio (GMR) 0.95, 95%CI 0.92–0.99), age (GMR per 10 years 1.01, 95%CI 1.00–1.02), and neutrophilia were associated with TTP (GMR 1.03, 95%CI 1.02–1.04). Conclusions Time to positivity is not associated with mortality, except in the case of Candida spp. (longer times associated with worse outcomes) and possibly streptococci (shorter times associated with worse outcomes). There was a large variation between median times across centres, limiting external validity

Analytical challenges in estimating the effect of exposures that are bounded by follow-up time: experiences from the Blood Stream Infection—Focus on Outcomes study

Abstract Objective To illustrate the challenges of estimating the effect of an exposure that is bounded by duration of follow-up on all-cause 28-day mortality, whilst simultaneously addressing missing data and time-varying covariates. Study design and methods BSI-FOO is a multicentre cohort study with the primary aim of quantifying the effect of modifiable risk factors, including time to initiation of therapy, on all-cause 28-day mortality in patients with bloodstream infection. The primary analysis involved two Cox proportional hazard models, first one for non-modifiable risk factors and second one for modifiable risk factors, with a risk score calculated from the first model included as a covariate in the second model. Modifiable risk factors considered in this study were recorded daily for a maximum of 28 days after infection. Follow-up was split at daily intervals from day 0 to 28 with values of daily collected data updated at each interval (i.e., one row per patient per day). Analytical challenges Estimating the effect of time to initiation of treatment on survival is analytically challenging since only those who survive to time t can wait until time t to start treatment, introducing immortal time bias. Time-varying covariates representing cumulative counts were used for variables bounded by survival time e.g. the cumulative count of days before first receipt of treatment. Multiple imputation using chained equations was used to impute missing data, using conditional imputation to avoid imputing non-applicable data e.g. ward data after discharge. Conclusion Using time-varying covariates represented by cumulative counts within a one row per day per patient framework can reduce the risk of bias in effect estimates. The approach followed uses established methodology and is easily implemented in standard statistical packages

Structure of an anti-blood group A Fv and improvement of its binding affinity without loss of specificity.

The specificity of antibody recognition of the ABO blood group trisaccharide antigens has been explored by crystal structure analysis and mutation methods. The crystal structure of the Fv corresponding to the anti-blood group A antibody AC1001 has been determined to 2.2-A resolution and reveals a binding pocket that is complementary to the blood group A-trisaccharide antigen. The effect of mutating specific residues lining this pocket on binding to the A and B blood group oligosaccharide antigens was investigated through a panel of single point mutations and through a phage library of mutations in complementarity determining region H3. Both approaches gave several mutants with improved affinity for antigen. Surface plasmon resonance indicated up to 8-fold enhancement in affinity for the A-pentasaccharide with no observable binding to the blood group B antigen. This is the first example of single point mutations in a carbohydrate-binding antibody resulting in significant increases in binding affinity without loss of specificity

EXPLORING THE ROLE OF OSPREYS IN EDUCATION

Recent research in childhood education has demonstrated that experiences in nature are important in shaping early environmental consciousness (Hinds and Sparks 2008, Hussar and Horvath 2011, Cheng and Monroe 2012) and ultimately the expression of pro-environmental attitudes and behaviors during adulthood (Wells and Lekies 2006, Chawla and Cushing 2007, Collado et al. 2013). Increasingly, those experiences happen via written and electronic media (e.g., textbooks, computer screens) or in very anthropogenic environments (e.g., in parks and zoos) and less through direct contact with nature, a concept Louv (2005) referred to as ‘‘nature deficit disorder.’’ Even in schools where environmental education is prioritized, the extent of access to outdoor classroom activities or experiential learning opportunities can limit the degree to which children can observe, explore, and directly experience the natural world (Hudson 2001, Louv 2005, Ernst 2009). Interestingly, the same information technologies that might serve to limit contact with nature also have the potential to enhance and encourage interest and concern for the natural world (Blewitt 2011, Pearson et al. 2011). We believe this is an important paradox that warrants much further exploration and evaluation within educational and scientific communities