Timely evaluation in international development

Impact and process evaluations are increasingly used in international development; however they are generally retrospective in outlook. A more timely approach to evaluation aims to identify necessary, feasible and effective changes during a programme or intervention’s lifetime. This paper aims to identify, categorise, describe and critically appraise methods to support more timely evaluation in international development. Potential methods were identified through scoping seminar, public symposium, targeted review of the literature, and the authors’ own experiences and opinions. Findings from the different data sources were reviewed collectively by the author group and triangulated to develop an analytical framework. We identified four purposes of timely evaluation for international development, and critiqued the use of approaches against four dimensions of timeliness and flexibility. Whilst we found significant interest in more timely approaches to evaluation in international development, there was a dearth of published empirical evidence upon which to base strong recommendations. There is significant potential for timely evaluation to improve international development outcomes. New approaches to mixing and adapting existing methods, together with new technologies offer increased potential. Research is needed to provide an empirical evidence base upon which to further develop the application, across sectors and contexts, of timely evaluation in international development

Adequacy of clinical information in X-ray referrals for traumatic ankle injury with reference to the Ottawa Ankle Rules-a retrospective clinical audit

Study Objective To assess the adequacy of clinical information with reference to the Ottawa Ankle Rules (OAR) in X-ray referrals for adults with traumatic ankle injury in the ED of a South Australian tertiary hospital and report upon referring trends between emergency department clinicians. Methods A retrospective clinical audit of adult ankle X-ray referrals in the emergency department was conducted. Eligible referrals were screened for their adherence to the OAR, patient details, clinical history and referrer. A logistic regression was used to determine the influence of these factors on the likelihood of being referred for X-rays despite not meeting the OAR criteria. Sensitivity, specificity, positive and negative likelihood ratios and their associated confidence intervals were calculated to assess the diagnostic accuracy of the OAR for those referred. Results Out of the 262 eligible referrals, 163 were deemed to have met the criteria for the OAR. Physiotherapists showed the highest OAR compliance of 77.3% and were the most accurate in their use of the rules, with a sensitivity of 0.86. Medical officers, registrars and interns were 2.5 times more likely to still refer a patient for X-ray if they did not meet the OAR criteria, compared to physiotherapists as the baseline. Patient age, duration of injury etc. were not significantly associated with likelihood of referral (even when they did not meet OAR criteria). The overall sensitivity, specificity, positive and negative likelihood ratios of the OAR were 0.59 (95% CI [0.47–0.71]), 0.37 (95% CI [0.30–0.44]), 0.93 (95% CI [0.76–1.16]) and 1.10 (95% CI [0.82–1.48]) respectively. Conclusion The results of this audit demonstrated poor sensitivity and moderate compliance by referrers with the rule. Reasonable evidence exists for the implementation of individual and/or institutional-based change strategies to improve clinician compliance and accuracy with use of the OAR

Literary stylistics, authorial intention and the scientific study of literature: a critical overview

A tendency by literary stylisticians to overlook the role of the author in the generation of literary meaning has been a significant source of tension between linguistic approaches to literariness and other practices in the discipline, such as text-editing and literary biography. Recently, however, efforts have been made to close this gap, with the branch of stylistics, cognitive poetics, claiming to have developed a new and empirical method of integrating an appreciation of authorial imagination and creativity into the study of readers' responses to the language of literary texts. We examine these claims critically, testing the grounds of assertions about scientific rigour in relation to demands about model testing and falsifiability associated with the scientific study of literature more generally. We then explore how some other methodologies, technologies and insights associated with this last branch of the discipline might be brought to bear on the topic of authorial intention, with the aim of determining whether, and in what ways, our understanding of an authorial intention, and its role in literary processing, might be furthered through empirical enquiry

Assessing the Dream-Lag Effect for REM and NREM Stage 2 Dreams

This study investigates evidence, from dream reports, for memory consolidation during sleep. It is well-known that events andmemories from waking life can be incorporated into dreams. These incorporations can be a literal replication of what occurredin waking life, or, more often, they can be partial or indirect. Two types of temporal relationship have been found tocharacterize the time of occurrence of a daytime event and the reappearance or incorporation of its features in a dream. Thesetemporal relationships are referred to as the day-residue or immediate incorporation effect, where there is the reappearance offeatures from events occurring on the immediately preceding day, and the dream-lag effect, where there is the reappearanceof features from events occurring 5–7 days prior to the dream. Previous work on the dream-lag effect has used spontaneoushome recalled dream reports, which can be from Rapid Eye Movement Sleep (REM) and from non-Rapid Eye Movement Sleep(NREM). This study addresses whether the dream-lag effect occurs only for REM sleep dreams, or for both REM and NREM stage2 (N2) dreams. 20 participants kept a daily diary for over a week before sleeping in the sleep laboratory for 2 nights. REM andN2 dreams collected in the laboratory were transcribed and each participant rated the level of correspondence between everydream report and every diary record. The dream-lag effect was found for REM but not N2 dreams. Further analysis indicatedthat this result was not due to N2 dream reports being shorter, in terms of number of words, than the REM dream reports.These results provide evidence for a 7-day sleep-dependent non-linear memory consolidation process that is specific to REMsleep, and accord with proposals for the importance of REM sleep to emotional memory consolidation

Curbing the hepatitis C virus epidemic in Pakistan: The impact of scaling up treatment and prevention for achieving elimination

Background: The World Health Organization (WHO) has developed a global health strategy to eliminate viral hepatitis. We project the treatment and prevention requirements to achieve the WHO HCV elimination target of reducing HCV incidence by 80% and HCV-related mortality by 65% by 2030 in Pakistan, which has the second largest HCV burden worldwide.Methods: We developed an HCV transmission model for Pakistan, and calibrated it to epidemiological data from a national survey (2007), surveys among people who inject drugs (PWID), and blood donor data. Current treatment coverage data came from expert opinion and published reports. The model projected the HCV burden, including incidence, prevalence and deaths through 2030, and estimated the impact of varying prevention and direct-acting antiviral (DAA) treatment interventions necessary for achieving the WHO HCV elimination targets.Results: With no further treatment (currently ∼150 000 treated annually) during 2016-30, chronic HCV prevalence will increase from 3.9% to 5.1%, estimated annual incident infections will increase from 700 000 to 1 100 000, and 1 400 000 HCV-associated deaths will occur. To reach the WHO HCV elimination targets by 2030, 880 000 annual DAA treatments are required if prevention is not scaled up and no treatment prioritization occurs. By targeting treatment toward persons with cirrhosis (80% treated annually) and PWIDs (double the treatment rate of non-PWIDs), the required annual treatment number decreases to 750 000. If prevention activities also halve transmission risk, this treatment number reduces to 525 000 annually.Conclusions: Substantial HCV prevention and treatment interventions are required to reach the WHO HCV elimination targets in Pakistan, without which Pakistan\u27s HCV burden will increase markedly

Reactivity of penicillin-binding proteins with peptidoglycan-mimetic beta-lactams: what's wrong with these enzymes?

Beta-lactams exert their antibiotic action through their inhibition of bacterial DD-peptidases (penicillin-binding proteins). Bacteria, in general, carry several such enzymes localized on the outside of their cell membrane to catalyze the final step in cell wall (peptidoglycan) synthesis. They have been classified into two major groups, one of high molecular weight, the other of low. Members of the former group act as transpeptidases in vivo, and their inhibition by beta-lactams leads to cessation of bacterial growth. The latter group consists of DD-carboxypeptidases, and their inhibition by beta-lactams is generally not fatal to bacteria. We have previously shown that representatives of the former group are ineffective at catalyzing the hydrolysis/aminolysis of peptidoglycan-mimetic peptides in vitro [Anderson et al. (2003) Biochem. J. 373, 949-955]. The theme of these experiments is expanded in the present paper where we describe the synthesis of a series of beta-lactams (penicillins and cephalosporins) containing peptidoglycan-mimetic side chains and the kinetics of their inhibition of a panel of penicillin-binding proteins spanning the major classes (Escherichia coli PBP 2 and PBP 5, Streptococcus pneumoniae PBP 1b, PBP 2x and PBP 3, the Actinomadura R39 DD-peptidase, and the Streptomyces R61 DD-peptidase). The results of these experiments mirror and expand the previous results with peptides. Neither peptides nor beta-lactams with appropriate peptidoglycan-mimetic side chains react with the solubilized constructs of membrane-bound penicillin binding proteins (the first five enzymes above) at rates exceeding those of generic analogues. Such peptides and beta-lactams do react at greatly enhanced rates with certain soluble low molecular weight enzymes (R61 and R39 DD-peptidases). The former result is unexpected and interesting. Why do the majority of penicillin-binding proteins not recognize elements of local peptidoglycan structure? Possible answers are discussed. That this question needs to be asked casts fascinating shadows on current studies of penicillin-binding proteins for new drug design