Short-course antiretroviral therapy in primary HIV infection

Background Short-course antiretroviral therapy (ART) in primary human immunodeficiency virus (HIV) infection may delay disease progression but has not been adequately evaluated. Methods We randomly assigned adults with primary HIV infection to ART for 48 weeks, ART for 12 weeks, or no ART (standard of care), with treatment initiated within 6 months after seroconversion. The primary end point was a CD4+ count of less than 350 cells per cubic millimeter or long-term ART initiation. Results A total of 366 participants (60% men) underwent randomization to 48-week ART (123 participants), 12-week ART (120), or standard care (123), with an average followup of 4.2 years. The primary end point was reached in 50% of the 48-week ART group, as compared with 61% in each of the 12-week ART and standard-care groups. The average hazard ratio was 0.63 (95% confidence interval [CI], 0.45 to 0.90; P = 0.01) for 48-week ART as compared with standard care and was 0.93 (95% CI, 0.67 to 1.29; P = 0.67) for 12-week ART as compared with standard care. The proportion of participants who had a CD4+ count of less than 350 cells per cubic millimeter was 28% in the 48-week ART group, 40% in the 12-week group, and 40% in the standard-care group. Corresponding values for long-term ART initiation were 22%, 21%, and 22%. The median time to the primary end point was 65 weeks (95% CI, 17 to 114) longer with 48-week ART than with standard care. Post hoc analysis identified a trend toward a greater interval between ART initiation and the primary end point the closer that ART was initiated to estimated seroconversion (P = 0.09), and 48-week ART conferred a reduction in the HIV RNA level of 0.44 log10 copies per milliliter (95% CI, 0.25 to 0.64) 36 weeks after the completion of short-course therapy. There were no significant between-group differences in the incidence of the acquired immunodeficiency syndrome, death, or serious adverse events. Conclusions A 48-week course of ART in patients with primary HIV infection delayed disease progression, although not significantly longer than the duration of the treatment. There was no evidence of adverse effects of ART interruption on the clinical outcome. (Funded by the Wellcome Trust; SPARTAC Controlled-Trials.com number, ISRCTN76742797, and EudraCT number, 2004-000446-20.

Replicability, Robustness, and Reproducibility in Psychological Science

Replication—an important, uncommon, and misunderstood practice—is gaining appreciation in psychology. Achieving replicability is important for making research progress. If findings are not replicable, then prediction and theory development are stifled. If findings are replicable, then interrogation of their meaning and validity can advance knowledge. Assessing replicability can be productive for generating and testing hypotheses by actively confronting current understandings to identify weaknesses and spur innovation. For psychology, the 2010s might be characterized as a decade of active confrontation. Systematic and multi-site replication projects assessed current understandings and observed surprising failures to replicate many published findings. Replication efforts highlighted sociocultural challenges such as disincentives to conduct replications and a tendency to frame replication as a personal attack rather than a healthy scientific practice, and they raised awareness that replication contributes to self-correction. Nevertheless, innovation in doing and understanding replication and its cousins, reproducibility and robustness, has positioned psychology to improve research practices and accelerate progress

Better together: reliable application of the post-9/11 and post-Iraq US intelligence tradecraft standards requires collective analysis

Background: The events of 9/11 and the October 2002 National Intelligence Estimate on Iraq's Continuing Programs for Weapons of Mass Destruction precipitated fundamental changes within the US Intelligence Community. As part of the reform, analytic tradecraft standards were revised and codified into a policy document – Intelligence Community Directive (ICD) 203 – and an analytic ombudsman was appointed in the newly created Office for the Director of National Intelligence to ensure compliance across the intelligence community. In this paper we investigate the untested assumption that the ICD203 criteria can facilitate reliable evaluations of analytic products. Method: Fifteen independent raters used a rubric based on the ICD203 criteria to assess the quality of reasoning of 64 analytical reports generated in response to hypothetical intelligence problems. We calculated the intra-class correlation coefficients for single and group-aggregated assessments. Results: Despite general training and rater calibration, the reliability of individual assessments was poor. However, aggregate ratings showed good to excellent reliability. Conclusions: Given that real problems will be more difficult and complex than our hypothetical case studies, we advise that groups of at least three raters are required to obtain reliable quality control procedures for intelligence products. Our study sets limits on assessment reliability and provides a basis for further evaluation of the predictive validity of intelligence reports generated in compliance with the tradecraft standards

Systematizing Confidence in Open Research and Evidence (SCORE)

Assessing the credibility of research claims is a central, continuous, and laborious part of the scientific process. Credibility assessment strategies range from expert judgment to aggregating existing evidence to systematic replication efforts. Such assessments can require substantial time and effort. Research progress could be accelerated if there were rapid, scalable, accurate credibility indicators to guide attention and resource allocation for further assessment. The SCORE program is creating and validating algorithms to provide confidence scores for research claims at scale. To investigate the viability of scalable tools, teams are creating: a database of claims from papers in the social and behavioral sciences; expert and machine generated estimates of credibility; and, evidence of reproducibility, robustness, and replicability to validate the estimates. Beyond the primary research objective, the data and artifacts generated from this program will be openly shared and provide an unprecedented opportunity to examine research credibility and evidence

Predicting reliability through structured expert elicitation with the repliCATS (Collaborative Assessments for Trustworthy Science) process

As replications of individual studies are resource intensive, techniques for predicting the replicability are required. We introduce the repliCATS (Collaborative Assessments for Trustworthy Science) process, a new method for eliciting expert predictions about the replicability of research. This process is a structured expert elicitation approach based on a modified Delphi technique applied to the evaluation of research claims in social and behavioural sciences. The utility of processes to predict replicability is their capacity to test scientific claims without the costs of full replication. Experimental data supports the validity of this process, with a validation study producing a classification accuracy of 84% and an Area Under the Curve of 0.94, meeting or exceeding the accuracy of other techniques used to predict replicability. The repliCATS process provides other benefits. It is highly scalable, able to be deployed for both rapid assessment of small numbers of claims, and assessment of high volumes of claims over an extended period through an online elicitation platform, having been used to assess 3000 research claims over an 18 month period. It is available to be implemented in a range of ways and we describe one such implementation. An important advantage of the repliCATS process is that it collects qualitative data that has the potential to provide insight in understanding the limits of generalizability of scientific claims. The primary limitation of the repliCATS process is its reliance on human-derived predictions with consequent costs in terms of participant fatigue although careful design can minimise these costs. The repliCATS process has potential applications in alternative peer review and in the allocation of effort for replication studies

COVID-19 in children and adolescents in Europe: a multinational, multicentre cohort study

Background To date, few data on paediatric COVID-19 have been published, and most reports originate from China. This study aimed to capture key data on children and adolescents with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection across Europe to inform physicians and health-care service planning during the ongoing pandemic. Methods This multicentre cohort study involved 82 participating health-care institutions across 25 European countries, using a well established research network—the Paediatric Tuberculosis Network European Trials Group (ptbnet)—that mainly comprises paediatric infectious diseases specialists and paediatric pulmonologists. We included all individuals aged 18 years or younger with confirmed SARS-CoV-2 infection, detected at any anatomical site by RT-PCR, between April 1 and April 24, 2020, during the initial peak of the European COVID-19 pandemic. We explored factors associated with need for intensive care unit (ICU) admission and initiation of drug treatment for COVID-19 using univariable analysis, and applied multivariable logistic regression with backwards stepwise analysis to further explore those factors significantly associated with ICU admission. Findings 582 individuals with PCR-confirmed SARS-CoV-2 infection were included, with a median age of 5·0 years (IQR 0·5–12·0) and a sex ratio of 1·15 males per female. 145 (25%) had pre-existing medical conditions. 363 (62%) individuals were admitted to hospital. 48 (8%) individuals required ICU admission, 25 (4%) mechanical ventilation (median duration 7 days, IQR 2–11, range 1–34), 19 (3%) inotropic support, and one (<1%) extracorporeal membrane oxygenation. Significant risk factors for requiring ICU admission in multivariable analyses were being younger than 1 month (odds ratio 5·06, 95% CI 1·72–14·87; p=0·0035), male sex (2·12, 1·06–4·21; p=0·033), pre-existing medical conditions (3·27, 1·67–6·42; p=0·0015), and presence of lower respiratory tract infection signs or symptoms at presentation (10·46, 5·16–21·23; p<0·0001). The most frequently used drug with antiviral activity was hydroxychloroquine (40 [7%] patients), followed by remdesivir (17 [3%] patients), lopinavir–ritonavir (six [1%] patients), and oseltamivir (three [1%] patients). Immunomodulatory medication used included corticosteroids (22 [4%] patients), intravenous immunoglobulin (seven [1%] patients), tocilizumab (four [1%] patients), anakinra (three [1%] patients), and siltuximab (one [<1%] patient). Four children died (case-fatality rate 0·69%, 95% CI 0·20–1·82); at study end, the remaining 578 were alive and only 25 (4%) were still symptomatic or requiring respiratory support. Interpretation COVID-19 is generally a mild disease in children, including infants. However, a small proportion develop severe disease requiring ICU admission and prolonged ventilation, although fatal outcome is overall rare. The data also reflect the current uncertainties regarding specific treatment options, highlighting that additional data on antiviral and immunomodulatory drugs are urgently needed. Funding ptbnet is supported by Deutsche Gesellschaft für Internationale Zusammenarbeit

Genomic investigations of unexplained acute hepatitis in children

Since its first identification in Scotland, over 1,000 cases of unexplained paediatric hepatitis in children have been reported worldwide, including 278 cases in the UK1. Here we report an investigation of 38 cases, 66 age-matched immunocompetent controls and 21 immunocompromised comparator participants, using a combination of genomic, transcriptomic, proteomic and immunohistochemical methods. We detected high levels of adeno-associated virus 2 (AAV2) DNA in the liver, blood, plasma or stool from 27 of 28 cases. We found low levels of adenovirus (HAdV) and human herpesvirus 6B (HHV-6B) in 23 of 31 and 16 of 23, respectively, of the cases tested. By contrast, AAV2 was infrequently detected and at low titre in the blood or the liver from control children with HAdV, even when profoundly immunosuppressed. AAV2, HAdV and HHV-6 phylogeny excluded the emergence of novel strains in cases. Histological analyses of explanted livers showed enrichment for T cells and B lineage cells. Proteomic comparison of liver tissue from cases and healthy controls identified increased expression of HLA class 2, immunoglobulin variable regions and complement proteins. HAdV and AAV2 proteins were not detected in the livers. Instead, we identified AAV2 DNA complexes reflecting both HAdV-mediated and HHV-6B-mediated replication. We hypothesize that high levels of abnormal AAV2 replication products aided by HAdV and, in severe cases, HHV-6B may have triggered immune-mediated hepatic disease in genetically and immunologically predisposed children

Five lessons to guide more effective biodiversity conservation message framing

Communication and advocacy approaches that influence attitudes and behaviors are key to addressing conservation problems, and the way an issue is framed can affect how people view, judge, and respond to an issue. Responses to conservation interventions can also be influenced by subtle wording changes in statements that may appeal to different values, activate social norms, influence a person's affect or mood, or trigger certain biases, each of which can differently influence the resulting engagement, attitudes, and behavior. We contend that by strategically considering how conservation communications are framed, they can be made more effective with little or no additional cost. Key framing considerations include, emphasizing things that matter to the audience, evoking helpful social norms, reducing psychological distance, leveraging useful biases, and, where practicable, testing messages. These lessons will help communicators think strategically about how to frame messages for greater effect

We have a steak in it: Eliciting interventions to reduce beef consumption and its impact on biodiversity

Beef production is a major driver of biodiversity loss and greenhouse gas emissions globally, and multiple studies recommend reducing beef production and consumption. Although there have been significant efforts from the biodiversity conservation sector toward reducing beef-production impacts, there has been comparatively much less engagement in reducing beef consumption. As a first step to address this gap and identify leverage points, we conducted a policy Delphi expert elicitation. We asked 16 multidisciplinary experts from research and practitioner backgrounds to propose interventions for reducing beef consumption in the United States. Experts generated and critiqued 20 interventions, creating a qualitative dataset that was thematically analyzed to allow the interventions to be prioritized. Effective, feasible interventions included changing perceived social norms, targeting food providers, and increasing the availability and quality of beef alternatives. This work introduces a conservation research agenda for reducing beef consumption and explores a structured process for prioritizing behavioral interventions