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  • Statistical methods for adaptive clinical trials in tropical diseases

    Oxford University Clinical Research Unit Vietnam PhD Programme 2014-15

    Project 1

    Title

    Statistical methods for adaptive clinical trials in tropical diseases

    Project overview

    Randomized clinical trials (RCTs) are the gold standard for testing medical interventions. Conventional RCTs randomly assign a pre-defined number of patients to one of two or more treatment arms (including a control arm) and evaluate a patient-relevant outcome during follow-up. At the end of the trial, when all patients have been randomized and evaluated, the outcomes are compared between the treatment groups based on statistical estimation and hypothesis testing.

    Adaptive randomized trials are RCTs that allow for (pre-planned) adaptations while the trial is ongoing. Potential adaptations include dropping of study arms, changes in sample size or inclusion/exclusion criteria (to target the “right” population), early stopping for efficacy or futility, and changes in randomization ratios. Adaptive trials can be considerably more efficient in answering relevant research questions compared to conventional RCTs but are also more complicated to design and frequently require extensive trial simulations.

    The purpose of this project is to develop statistical methodology as well as concept protocols for adaptive RCTs in infectious and tropical diseases. The PhD project will evaluate in detail methodological challenges and potential designs in several disease areas including typhoid, malaria, and tuberculous meningitis (TBM). Methodological challenges include the handling of multi-arm studies with efficient dropping of inefficacious arms, investigations regarding the value of adaptive randomization in diseases with changing resistance patterns, and the identification and efficient use of early markers of outcome in diseases where the primary endpoint requires substantial follow-up (e.g. 9-month mortality in TBM).

    Training opportunities

    General OUCRU PhD training programme

    Extensive specialized training within the OUCRU biostatistics group

    Possibility for overseas training (dependent on additional approval)

    Location

    OUCRU HCMC

    Supervisors

    Dr Marcel Wolbers

    Skills required in the candidate

    MSc in biostatistics, statistics or mathematics

    Strong interest and, ideally, experience in medical applications

    PhD-Application-Form

  • HFMD in Vietnam: A Study of Epidemiology and Health Economics

    Oxford University Clinical Research Unit Vietnam PhD Programme 2014-15

    Project 2

    Title: HFMD in Vietnam: A Study of Epidemiology and Health Economics

    Project overview

    Hand Foot and Mouth Disease (HFMD) is a common infectious disease that is mostly caused by the species Enterovirus A (including Coxsackie virus A 2-8, 10, 12, 14, 16 and enterovirus 71, 76 and 89-92). HFMD is typically a benign self-limited illness among children under 5 years old. Outbreaks of mild HFMD occur worldwide and are often associated with day-care centres, kindergartens, and elementary schools. However since 1997, EV71 has emerged as a frequent cause of severe and sometimes fatal HFMD in Asia-Pacific region.

    In Vietnam, HFMD became a notifiable illness in 2008 and is associated with an increasing number of cases and fatalities with over 200,000 cases and 207 deaths in 2011-12.

    Currently, there is no specific antiviral treatment available EV71, whilst phase III trials of 3 different inactivated EV71 vaccines from China have recently been completed, but have not been implemented. Synthesizing epidemiology data therefore remains essential to controlling this emerging infection, whereas understanding the economic burden of the disease is important as it may influence prevention and clinical management strategy, and outbreak response.

    In collaboration with 3 referral hospitals: the Hospital for Tropical Diseases, Children Hospital 1 and Children Hospital 2, and Centre of Preventive Medicine in Ho Chi Minh City, as well as with external collaborators in Australia, Singapore and the US, the Emerging Infections group is running an in-depth research program on HFMD, encompassing clinical, virology, immunology and epidemiology.

    This PhD research aims:

    1. To investigate the spatiotemporal dynamics of HFMD and its associated climatic variables in southern Vietnam, in particular HCMC – an urban setting with high population density. This will involve the collection and analysis of existing data from 3 hospitals in Ho Chi Minh City
    2. To determine the contribution of EV71 patients and their household members to the spread of the disease in community. Specifically, the aim is to identify the detection rate of EV71 among household members of EV71 patients and the contagious period of the patients and their household members who have EV71 detected in either throat or rectal swab
    3. To determine the economic burden of HFMD

    Training opportunities

    Epidemiology

    Mathematical modelling, basic health economics

    Virology: PCR, sequencing and virus isolation

    Location

    OUCRU-VN, Ho Chi Minh City

    Time spending abroad may be required as project develops

    Supervisors

    Le Van Tan, PhD

    Rogier van Doorn, MD, PhD

    Skills required in the candidate

    MD (preferably with paediatric specialisation)/MSc in relevant field

    PhD-Application-Form

  • OPEN DAY on 24th April 2015

    Are you interested in doing research in biomedical science?

    Would you like an opportunities to do research on tropical infectious diseases for a BSc, MSc or PhD program?

    Please attend the OUCRU Open Day to find out more information

    The OPEN DAY event is held at Oxford University Clinical Research Viet Nam (OUCRU) which located in the grounds of the Hospital for Tropical Disease HCMC. OUCRU is an internationally funded research organization conducting clinical and laboratory based research on tropical infectious diseases. This date provides prospective Vietnamese students with an opportunity to meet our current students, to see a demonstration of their project work, to visit the laboratories and to attend a short induction talk about OUCRU and its training opportunities.

    Date: Wednesday 24th April 2015

    Time: 9:00 – 11:30 am.

    At: the meeting room 301 (third floor)

    OUCRU

    Hospital for Tropical Diseases

    764 Vo Van Kiet, Ward 1, District 5, HCMC

    If possible, please register in advance with the OUCRU Training Coordinator: Ms Le Thi Kim Yen, email Yenltk@oucru.org

  • Antibiotic-resistant typhoid likely to spread despite drug control programmes

    Source: http://www.wellcome.ac.uk/News/Media-office/Press-releases/2013/Press-releases/WTP054930.htm

    Restricting the use of antibiotics is unlikely to stop the spread of drug resistance in typhoid fever, according to a study funded by the Wellcome Trust and published in the journal ‘eLife’.The findings reveal that antibiotic-resistant strains of Salmonella Typhi bacteria can outcompete drug-sensitive strains when grown in the laboratory, even in the absence of antibiotics.

    Typhoid fever is transmitted by consuming food or drink that is contaminated with Salmonella Typhi bacteria, and the disease is linked to poor sanitation and limited access to clean drinking water. The disease can be treated, but there is widespread drug resistance to common antibiotics and resistance to the recommended, more specialised antibiotic therapy for typhoid fever is increasing.

    Researchers at the Oxford University Clinical Research Unit, Wellcome Trust Vietnam Research Programme, created 12 laboratory strains of Salmonella Typhi bacteria with one or more genetic mutations that confer resistance to the recommended antibiotic therapy for typhoid fever, fluoroquinolone. Typically, developing antibiotic resistance comes at a cost for bacteria, and when the drug is absent they are usually weaker and less able to compete for food and resources than strains that are not resistant.

    Dr Maciej Boni, a Sir Henry Dale Fellow funded jointly by the Wellcome Trust and the Royal Society at the Oxford University Clinical Research Unit in Vietnam, who co-led the study, said: “When we grew different strains of Salmonella Typhi in the lab, we found that half of the antibiotic-resistant strains had a growth advantage over their parent strain, even in the absence of antibiotic, enabling them to predominate in the population.”

    Dr Stephen Baker, also a Sir Henry Dale Fellow in the Oxford University Clinical Research Unit, said: “Currently, the control of typhoid across Asia and Africa relies on treatment with fluoroquinolones, but resistance is rising. Withdrawing or restricting the use of this class of antibiotics is one approach to try and combat the spread of resistance. However, the results of this study suggest that we need to think beyond this, as antibiotic resistance will likely continue to rise even if these strategies are implemented.”

    Dr Jimmy Whitworth, Head of International Activities at the Wellcome Trust, said: “These important findings from researchers in Vietnam are very worrying. If confirmed, one of our main strategies for controlling drug resistance in typhoid will be ineffective. We will need to concentrate on developing more effective and affordable vaccines and improving water supplies and sanitation, a Herculean task for low- and middle-income countries.”

    There are an estimated 21 million cases of typhoid fever around the world each year. If left untreated, it’s estimated that up to one in five people with the disease will die; of those who survive, some will have permanent physical or mental disabilities. According to a World Health Organization report, 90 per cent of the world’s typhoid deaths occur in Asia and the disease persists mainly in children under five years.

    Typhoid infects the gut and bloodstream, causing fever that can reach temperatures of 40°C and constipation or diarrhoea. The disease can be associated with other characteristics, including rose-coloured spots on the chest, confusion and perforation of the gut.

  • Foreign Bodies, Common Ground at Wellcome Collection

    Wellcome Collection’s winter exhibition, Foreign Bodies, Common Ground, opens today, offering a unique exploration of global health.

    The exhibition brings together artworks including painting, photography, sculpture, film and performance, made during residencies at medical research centres funded by the Wellcome Trust in Kenya, Malawi, South Africa, Thailand, Vietnam and the UK.

    The contributing artists were given a simple and wide-ranging brief: to find out about research being undertaken and produce work responding to their investigations. The result is a series of varied, moving and humorous works, recording journeys taken within the complex realm that lies between scientific processes and local communities, often on the frontlines of communicable diseases.

    Although the tools and objectives of scientific research may be broadly agreed, the social relevance of vital work is often shaped by cultural contexts, and it is here – among ambiguities, frictions and negotiated understandings – that the keen and curious eyes of artists can bring fresh perspectives. Foreign Bodies, Common Ground outlines the intricate web of relationships upon which the future health of communities depends.

    Collaborative exchanges on data collection and use, the spread of disease and ideas, the motivations of participants and researchers, and the role of trust give rise to art animated by the search for connections between mind-sets and datasets.

    Lna Bis drawings, photography, video and installation explore zoonosis, the transfer of disease from animals to humans. Her work is visceral, tracing the relationship between the consumption of animals and the conditions of their breeding, killing and packaging in Vietnam. Working with the teams at the Oxford University Clinical Research Unit in Ho Chi Minh City, her work celebrates the messiness of the research she encounters and the sensitivities involved in gathering data.

    Katie Patersons work takes a longer view. Her time in the laboratories at the Wellcome Trust Sanger Institute in Cambridge inspired her enquiry into genomic archaeology and the result, Fossil Necklace, is nothing less than a biological history of the planet. Each of the works 170 beads is carved from a fossil representing a major event in the evolution of life.

    Elson Kambalus residency explored the different understandings of medicine and research in Malawi. Fascinated by the cultural complexities that divide and unite research teams at the Malawi-Liverpool-Wellcome Trust Clinical Research Programme and the communities they work within, Kambalu interviewed clinicians and traditional herbalists, chiefs and study participants, community workers and pharmacologists, and health economists and musicians.

    B-Floor Theatre are Thailands vanguard physical theatre company. Their performance Survival Games unpacked the challenges facing immunologists at the Wellcome Trust-Mahidol University-Oxford Tropical Medicine Research Programme, from malaria research on the Thai-Myanmar border (where nine languages are spoken) to the worlds highest rate of melioidosis. The exhibition features footage and a photographic montage of the B-Floors research and performance.

    Miriam Syowia Kyambi and James Muriukis work gets to the heart of the ethical dilemmas and negotiations that arise in encounters between different belief systems and cultural values in Kenya. In residency at the KEMRI-Wellcome Trust Research Programme in Kilifi, the artists developed the Pata Picha Photo Studio, a mobile set with props. The studio will be operating within Foreign Bodies, Common Ground, alongside portraits taken in Kilifi and artworks developed throughout the residency.

    Photographs from the workshops at the Africa Centre for Health and Population Studies in KwaZulu-Natal, South Africa, put a human face to data collection. Systematic demographic surveys are a cornerstone of the Africa Centres work to understand the HIV epidemic, and the nine photographs on display acknowledge the contribution of the Mtubatuba community to this work. Following workshops with artist Zwelethu Mthethwa, the young photographers whose work is displayed were given cameras and a task of exploring impilo engcono, or good health.

    Danielle Olsen, exhibition curator, says: Foreign Bodies, Common Ground is the result of six very different journeys united by a generous and collaborative exchange of ideas. Placing artists within scientific research institutions is one small way of bridging discourses and practices, creating opportunities for self-reflection.

    The exhibition asks questions about what we understand by global health and the wonderfully rich body of artworks on display offers moving and often unexpected insights into scientific processes and the community relationships upon which those processes depend.

    The artists residencies ran for up to six months during 2012 and 2013 and were followed by exhibitions and performances in each country. More details of the process can be found on the Wellcome Collection website.

  • Art Meets Science

    On 11th October 2012 OUCRU-HCMC hosted a unique evening of contemporary art and science. The programme opened with a short video art screening of three films by international artists Jeremy Deller; Phillipe Warnell (with Jean-Luc Nancy); Helen Pynor and Peta Clancy. This was followed by presentations by celebrated visual artist Maria Fernanda Cardoso (Colombia/Australia) and research scientist Dr Tran Nguyen Bich Chau (Vietnam) who shared their ongoing work and research to reveal how the fields of art and science can be interwoven. An informal discussion and audience Q&A was held.

    This event was co-organized by OUCRU and San Art, as part of Lena Bui’s artist-in-residency at OUCRU.

  • Art Meets Science

    On 11th October 2012 OUCRU-HCMC hosted a unique evening of contemporary art and science. The programme opened with a short video art screening of three films by international artists Jeremy Deller; Phillipe Warnell (with Jean-Luc Nancy); Helen Pynor and Peta Clancy. This was followed by presentations by celebrated visual artist Maria Fernanda Cardoso (Colombia/Australia) and research scientist Dr Tran Nguyen Bich Chau (Vietnam) who shared their ongoing work and research to reveal how the fields of art and science can be interwoven. An informal discussion and audience Q&A was held.

    This event was co-organized by OUCRU and San Art, as part of Lena Bui’s artist-in-residency at OUCRU.

  • Art in Global Health

    ‘Art in Global Health’ was a Wellcome Trust initiative to set up artist residencies in the Wellcome Trust-funded research centres as a way of teasing out some of the more personal, philosophical, cultural and political dimensions of health research.

    Lena Bui, an artist based in Ho Chi Minh City, did her residency with OUCRU-HCMC in 2012. While in residence, Lena explored zoonosis research and the relationship between animals and people. She visited rural farming areas where researchers are investigating the human-animal interface of ‘high risk cohorts’ – people with high levels of occupational exposure to animals (farmers, animal traders, abattoir and market workers). She also travelled further afield, visiting small villages with long histories of economies based on harvesting bird feathers. The outcomes of her residency included an exhibition at Ho Chi Minh City Fine Arts Museum in partnership with San Art in November 2012.

    Our other Art-based projects:

    Art Meets Science

  • Art in Global Health

    ‘Art in Global Health’ was a Wellcome Trust initiative to set up artist residencies in the Wellcome Trust-funded research centres as a way of teasing out some of the more personal, philosophical, cultural and political dimensions of health research.

    Lena Bui, an artist based in Ho Chi Minh City, did her residency with OUCRU-HCMC in 2012. While in residence, Lena explored zoonosis research and the relationship between animals and people. She visited rural farming areas where researchers are investigating the human-animal interface of ‘high risk cohorts’ – people with high levels of occupational exposure to animals (farmers, animal traders, abattoir and market workers). She also travelled further afield, visiting small villages with long histories of economies based on harvesting bird feathers. The outcomes of her residency included an exhibition at Ho Chi Minh City Fine Arts Museum in partnership with San Art in November 2012.

     

    Our other Art-based projects:

    Art Meets Science

     

  • Health in the Backyard

    In rural Viet Nam the relationships between farmers and their animals are close, with pigs and poultry often kept in vicinity of the houses. The recent history of serious zoonotic outbreaks of novel pathogens such as SARS, H5N1 and Nipah virus has raised awareness of the health risk of such close contact with animals.

    Health in the Backyard is an interactive media project using digital story telling methods to explore the attitudes and perceptions of risk of communities involved in animal husbandry. The Health in the Backyard project supports the activities of the OUCRU research project on zoonotic diseases (Vietnam Initiative on Zoonotic Infections or VIZIONS) by engaging with rural communities involved in animal farming practices, and to improve communication between stakeholders and scientists. Through this project we have partnered with Dong Thap Department for Animal Health and worked with small hold farmers, slaughterhouse workers and people involved with the rats for meat trade.

    Working with Fact and Fiction Films (FFF), community members were taught how to use simple digital cameras which they took home. Each created and narrated a short photo story of situations and events that pose a risk to the health of themselves, their families and their animals.

    The finished films were screened for group review sessions, allowing individuals to discuss and share concerns and good practice. The group identified key areas of interest which informed the curriculum of 2 one-day training workshops for provincial animal health officers and local farmers (about 65 participants in each workshop). Topics covered included:

    • Vaccine schedule for pigs and poultry
    • Transmission of diseases between humans and animals
    • Good practices in farming (biogas, hygiene, home produced feed etc)
    • Pig and poultry diseases
    • Environmental issues in farming


    Speakers came from OUCRU; University of Agriculture and Forestry; Institute of Environment and Resources HCMC; Dong Thap Community College and the Department of Animal Health Dong Thap province.

    The films and views shared through the Health in the Backyard project are informing scientists and health workers of perceptions and practices of the people they work with, which scientific research doesn’t reveal. It is also informing the writing of non-technical educational material on veterinary diseases and zoonotic health risks to be distributed as part of the Public Engagement section of VIZIONS project.