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Experimental vs. control group explained.
Home » Experimental vs. Control Group Explained
Group Comparison Analysis plays a pivotal role in experimental research. By examining the differences between experimental and control groups, researchers can draw meaningful conclusions about specific interventions. This process helps in determining whether observed effects are indeed attributable to the treatment or merely due to chance.
In any experiment, understanding how participants respond to different conditions is crucial. Group Comparison Analysis allows scientists to tease apart these responses, yielding insights that can inform various fields. Ultimately, this analytical approach not only enhances the validity of research findings but also supports the development of effective strategies based on empirical evidence.
In research, understanding the distinction between experimental groups is essential for accurate findings. An experimental group consists of participants exposed to a variable being tested, while a control group serves as the baseline for comparison. This design enhances the reliability of results by isolating the effects of the independent variable. To conduct a thorough group comparison analysis, researchers need to ensure that both groups are similar in characteristics, minimizing biases.
The selection of participants plays a crucial role in the integrity of the study. Random assignment helps to ensure that individuals in both groups do not display pre-existing differences. This allows researchers to draw valid conclusions regarding the impact of the experimental treatment. Analyzing data from both groups provides insights into whether the intervention produces the expected changes. Effective comparison between these groups is foundational for advancing scientific knowledge. Understanding these basics will guide you through interpreting research outcomes with confidence.
Understanding the experimental and control groups is essential in any Group Comparison Analysis. The experimental group receives the treatment or intervention, while the control group serves as a baseline for comparison. This structure is pivotal in determining the effectiveness of a given treatment and minimizes bias, ensuring the results are reliable.
The purpose of utilizing these groups lies in establishing a clear cause-and-effect relationship. By comparing outcomes from both groups, researchers can identify any significant differences attributable to the treatment. This comparison not only enhances the validity of findings but also influences data-driven decisions in various fields, including healthcare and marketing. Ultimately, the insight gained from this method fosters informed strategies that can lead to improved outcomes, whether in product development or user experience.
Designing an experimental group involves carefully planning each aspect to ensure valid results through group comparison analysis. This analysis is crucial for distinguishing the effects of a treatment or intervention from the natural variability found in any population. To effectively design your experimental group, you need to determine the characteristics that will make it comparable to the control group.
A proper comparison requires selection criteria such as age, gender, and baseline characteristics. This helps ensure that differences in outcomes arise solely from the intervention rather than from pre-existing variances. Next, consider randomization; randomly assigning participants reduces bias and enhances the study's reliability. Lastly, maintaining consistency in treatment delivery is essential. This ensures that everyone in the experimental group receives the same intervention, thus allowing for an accurate analysis of effects. By following these principles, your group comparison analysis can yield insightful and actionable outcomes.
Control groups play a vital role in research by providing a benchmark to which experimental groups can be compared. Through group comparison analysis, researchers can discern the effects of an intervention by measuring outcomes against the control group that does not receive the treatment. This approach ensures that any observed changes in the experimental group can be more confidently attributed to the treatment rather than other external factors.
Moreover, control groups help minimize bias and variability in research outcomes. By allowing researchers to assess how participants behave under standard conditions, it becomes easier to isolate the impact of the experimental variable. Understanding these dynamics improves the reliability of results, making findings more valid and generalizable. Therefore, incorporating control groups in studies is essential for achieving accurate and trustworthy conclusions that can inform future practices or theories.
Control groups are essential in group comparison analysis, serving as benchmarks for experimental outcomes. These groups consist of participants who do not receive the treatment or intervention under investigation, allowing researchers to isolate the impact of specific variables. By comparing the results from the experimental group against the control group, researchers can determine the effectiveness of the intervention in a more precise manner.
The purpose of control groups is to minimize biases and ensure valid conclusions. They help in identifying whether observed changes in the experimental group are genuinely caused by the treatment or merely due to external factors. Additionally, control groups enable replication of studies, which is vital for affirming findings and fostering scientific credibility. In summary, control groups are indispensable tools in group comparison analysis, providing clarity and enhancing the reliability of research outcomes.
Control groups are essential in various fields, enabling researchers to validate their findings by providing a baseline for comparison. For instance, in a clinical trial assessing a new medication, one group receives the drug while a control group receives a placebo. This setup allows for a clearer understanding of the drug's effectiveness versus no treatment at all.
In market research, control groups allow analysts to examine consumer behavior under different conditions. A common example is testing two marketing strategies: one group receives traditional ads, while the control group is exposed to digital campaigns. Group comparison analysis reveals which method resonates better with the audience, helping to refine marketing approaches and optimize future campaigns. Through these examples, it's evident that control groups are invaluable in ensuring scientific rigor and making informed decisions across various domains.
Group Comparison Analysis serves as a critical tool for researchers, allowing them to discern the differences between experimental and control groups. By methodically comparing these groups, researchers can assess the effectiveness of interventions or treatments. This type of analysis provides vital insights, facilitating a deeper understanding of how variables impact outcomes.
Furthermore, the importance of this analysis extends beyond mere statistical significance. It fosters evidence-based decision-making, ensuring that findings are reliable and applicable in real-world settings. Ultimately, understanding the dynamics between different groups equips researchers with the knowledge to make informed conclusions, driving advancements in various fields of study.
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HDS sediment is a type of solid waste produced when the high-concentration mud method (HDS) is adopted to treat acid wastewater from copper mines. It can rationally utilize sediment resources by using phytoremediation, which plays a role in the ecological restoration of mines.
To reveal the effect of different phytoremediation on the heavy metal, enrichment capacity and microbial diversity of the HDS sediments of copper mines, in this experiment, the HDS sediments of a copper mine without phytoremediation were selected as the control group, while the sediments of black locust ( Robinia pseudoacacia ), slash pine ( Pinus elliottii Engelmann ) and Chinese white poplar ( Populus tomentosa Carr. ) were used as test groups to analyze the physical and chemical properties, heavy metal pollution and bioaccumulation capacity of HDS sediments under three phytoremediation.
The results show that different phytoremediation can reduce the sediment's conductivity and adjust the sediment’s pH value to the range suitable for plant growth. The BCF Shoot and BTF values of Chinese white poplar to Cd and Zn and slash pine to Pb were both greater than 1.
As discovered from the bioconcentration coefficient and biotransport coefficient results, Chinese white poplar is a Cd-enriched and Zn-enriched plant, while slash pine is a Pb-enriched plant.
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This work was funded by the National Natural Science Foundation of China (Grants 51664016, 51664017), the Key R&D projects in Jiangxi Province (20212BBG73013), and Jiangxi Copper Company Limited Chengmenshan Copper Technology Projects (CTYJ2022006, CMS-23SCJS-07JS-01F).
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Zhuyu Zhao & Chuanliang Yan
School of Energy and Mechanical Engineering, Jiangxi University of Science and Technology, Nanchang, 330013, China
Zhuyu Zhao, Ruoyan Cai & Jinchun Xue
Zhejiang Shangfeng High-Tech Specialized Wind Industrial Co, LTD, Shaoxing, 311231, China
Key Laboratory of Environmental Geotechnical and Engineering Hazard Control of Jiangxi Province, Ganzhou, 341000, China
Jinchun Xue
State Key Laboratory of Deep Oil and Gas, China University of Petroleum (East China), Qingdao, 266580, China
Emergency Management Administration of Haojiang District, Shantou, 515071, China
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Zhuyu Zhao and Ruoyan Cai performed the data analyses and wrote the manuscript; Jinchun Xue contributed to the conception of the study; Li Tan and Chuanliang Yan helped perform the analysis with constructive discussions.
Correspondence to Jinchun Xue .
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Zhao, Z., Cai, R., Xue, J. et al. Experimental study on different phytoremediation of heavy metal pollution in HDS sediment of copper mines. Plant Soil (2024). https://doi.org/10.1007/s11104-024-06886-2
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Colibacillosis in broiler chickens is associated with economic loss and localized or systemic infection. Usually, the last resort is antibacterial therapy. Insight into the disease pathogenesis, host responses and plausible immunomodulatory effects of the antibacterials is important in choosing antibacterial agent and optimization of the treatment. Selected responses of broiler chickens experimentally infected with Escherichia coli ( E. coli) and also those treated with florfenicol are evaluated in this study. Chickens ( n = 70, 5 weeks old) were randomly assigned to four groups. The control groups included normal control (NC) and intratracheal infection control (ITC) (received sterile bacterial medium). The experimental groups consisted of intratracheal infection (IT) that received bacterial suspension and intratracheal infection with florfenicol administration (ITF) group.
Florfenicol reversed the decreased albumin/globulin ratio to the level of control groups ( p > 0.05). Serum interleukin 10 (IL-10) and interferon‐gamma (IFN-γ) concentrations decreased in IT birds as compared to NC group. Florfenicol decreased the serum interleukin 6 (IL-6) concentration as compared to IT group. Milder signs of inflammation, septicemia, and left shift were observed in the leukogram of the ITF group. Florfenicol decreased the severity of histopathological lesions in lungs and liver. Depletion of lymphoid tissue was detected in spleen, thymus and bursa of IT group but was absent in ITF birds. The number of colony forming units of E. coli in liver samples of ITF group was only slightly lower than IT birds.
Experimental E. coli infection of chickens by intratracheal route is associated with remarkable inflammatory responses as shown by changes in biochemical and hematological parameters. Histopathological lesions in lymphoid organs (especially in the spleen) were also prominent. Florfenicol has positive immunomodulatory effects and improves many of the lesions before the full manifestation of its antibacterial effects. These effects of florfenicol should be considered in pharmacotherapy decision-making process.
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Colibacillosis which is caused by avian pathogenic Escherichia coli (APEC) is commonly diagnosed in broiler chicken flocks already afflicted with viral diseases or other stressors. The bacteria can also be considered as a primary pathogen. The disease is associated with appreciable economic loss and adversely affects the birds’ welfare. Unfortunately, efficient vaccines are not currently available and usually the last resort is antibacterial therapy of infected flocks [ 18 , 11 ].
Gaining insight into the host responses against colibacillosis and antibacterial therapy is important in tailoring control and treatment strategies. Controlled experimental studies with APEC as the primary pathogen are mainly used for evaluation of immune responses in chickens with colibacillosis. According to these experiments, the host defense against colibacillosis comprises a strong early innate immune response followed by humoral and cell-mediated adaptive responses. Many different factors related to bacteria, host and even sampling are shown to be associated with changes in host responses to APEC bacteria. Moreover; discrepancies are observed between results from ex vivo and in vivo studies [ 1 ].
Florfenicol is a broad spectrum antibacterial agent and a derivative of chloramphenicol with the advantage of applicability in food producing animals. The drug has an indication for use in broiler flocks with colibacillosis according to label instructions and shows good therapeutic effects. Florfenicol also shows immunomodulatory and anti-inflammatory properties in veterinary species [ 22 ]. In normal chickens, florfenicol has shown inconsistent immunomodulatory effects. Khalifeh et al., [ 12 ], reported that florfenicol administration to layers suppresses Newcastle disease (ND) antibody production measured by both HI and ELISA. In a study by Han et al., [ 7 ] administration of florfenicol to 1-day-old broilers for 5 consecutive days resulted in increased antibody titer against ND vaccine. The latter researchers found no change in total white blood cell (WBC) count and WBC subsets as well as serum interferon‐gamma (IFN-γ) and interleukin 4 (IL-4) in the treated broilers at the age of 21 and 42 days. Serum interleukin 2 (IL-2) content was decreased while peripheral lymphocyte transformation rate was increased in 42-day-old treated birds as compared to control group in this study. More recently, [ 16 ], reported immunotoxic effects of florfenicol administered for 6 consecutive days to 3-day-old chickens with regards to assessment of serum ND antibody titer, cytokine levels and histological features of bursa of Fabricius [ 16 ].
Available reports on the effects of florfenicol on immune responses of broilers with colibacillosis are scarce. In a study by [ 8 ], relatively high dosages (30 mg/kg or 60 mg/kg) of florfenicol were administered to broilers experimentally infected with E. coli O78 by intratracheal route. These authors found that 60 mg/kg florfenicol increases hemagglutination inhibition (HI) and enzyme-linked immunosorbent assay (ELISA) antibody titers against ND vaccination. Moreover, gene expression of interferon-inducible genes in the spleen tissue of birds increased by both dosages. In histopathological examination of bone marrow, moderate atrophy of hematopoietic lineage and increased fat cells in both florfenicol-treated groups were observed while no specific change in spleen was reported. Unfortunately, in the above mentioned study, most of the assays were performed very lately and after confirmation of E. coli clearance of the body. Therefore, the authors could not precisely relate the observed effects to immunomodulatory properties of florfenicol and deduced that the antibacterial effects of florfenicol may be involved in at least some of the observed effects.
In the present study, we evaluated selected immune responses of broilers experimentally infected with E.coli and also those treated with routine clinical dosages of florfenicol at early days after infection by considering cytokine levels, hematological changes and histopathological examination of the immune organs (spleen, thymus and bursa of Fabricius).
Bacteria and experimental infection.
The bacterium which was used in the study was an APEC from O2 serotype originally isolated from broiler chickens. The bacteria were provided by Razi Vaccine and Serum Research Institute, Iran. According to the result of disk diffusion testing, the bacteria were not resistant to florfenicol. A bacterial suspension was made in tryptic soy broth (TSB) medium and bacterial dose for administration to broilers was chosen based on our previous study [ 19 ]. Birds were infected with 1 mL of the bacterial suspension at the concentration of 7.1 × 10 8 CFU/mL by intratracheal route as described by Kromann et al., [ 13 ].
Seventy, 1-day-old Cobb chicks from both sexes were included in the study. Chickens were purchased from a commercial local hatchery for this specific study. Birds were reared in similar conditions according to Cobb Broiler Management Guide. No vaccination or drug administration was performed during the rearing period. Biosecurity practices were followed to prevent infectious diseases. At the age of 5 weeks, birds were randomly assigned to four groups including two control groups ( n = 15 each) and two experimental groups ( n = 20 each). Birds in each group were allocated into 5 replicates. The control groups included normal control (NC) group which was comprised of normal birds with no specific treatment, and intratracheal infection control (ITC) group where birds received 1 mL of sterile TSB medium by intratracheal route. The experimental groups included intratracheal infection (IT) group that received 1 mL of the bacterial suspension inoculated by intratracheal route, and intratracheal infection with florfenicol administration (ITF) group that in addition to being infected was treated with florfenicol (Fluorfen®, 10% solution; Rooyan Darou Pharmaceutical Co., Tehran, Iran) at a dosage of 1 mL/L of drinking water (20 mg/kg per day) according to label instructions. Administration of florfenicol was started after overt manifestation of clinical signs (roughly 12 h. post inoculation) and lasted for 3 consecutive days.
At the end of antibacterial treatment period, 10 birds from each group were randomly selected for blood sampling from wing vein. About 4 mL blood was collected from each bird in plain and citrate sodium coated vacutainer tubes (2 mL each). Five birds from each group were euthanatized by cervical dislocation after concussion. Under aseptic conditions, right lobe of the liver was removed and transferred to sterile containers for total bacterial count. Moreover, samples of liver, lung, spleen, thymus and bursa of Fabricius of these birds were collected in 10% neutral buffered formalin for histopathological examination.
All procedures used in this study were conducted in accordance with European Union commission legislation on the protection of animals used for scientific purposes [ 6 ] and were approved by an institutional ethical review committee (code number: 1GCB3M163773).
For serum collection, blood samples in plain tubes were centrifuged for 5 min at 2500 rpm. Harvested sera were kept at -20 °C until use.
Serum total protein was determined by photometric test according to biuret method. Determination of albumin level was performed by using bromocresol green spectrophotometric method. Both kits were provided by Pars Azmun Co., Tehran, Iran. All methods were performed according to kit protocols. The total globulin fraction was determined by subtracting the albumin from the total protein.
Chicken specific ELISA kits were used for the assay of IFN-γ, interleukin 6 (IL-6) and IL-10 in sera. All kits were provided by ZellBio GmbH, Ulm, Germany. All kits were based on one-step biotin double antibody sandwich ELISA method with intra assay and inter assay coefficients of variation (CVs) of < 10% and < 12%, respectively. All assays were performed according to manufacturer’s instructions.
Total WBC count and thrombocyte count were determined by manual technique. To determine the differential leukocyte counts (heterophil, lymphocyte, monocyte, and immature white blood cells), a drop of blood was thinly spread over a glass slide, air-dried, and stained with the Giemsa staining technique. One hundred cells are then counted and classified. Then absolute number of WBC subsets was calculated by using their percentage and total WBC count [ 21 , 24 ].
After fixation, samples were routinely processed and embedded in paraffin. Five μm-thick sections from paraffin blocks were made and stained with hematoxylin and eosin for examination under light microscope [ 3 ]. Different histopathological lesions were determined in each tissue (Nakamura et al., [ 17 ] and Usman et al. [ 23 ] with modifications). Lesions in all tissues were semi quantitatively scored from 0–3. The scoring system was as follows: 0: no lesion, 1: mild, 2: moderate and 3: severe lesion.
Liver samples were immediately used for bacterial count. Samples were weighed and then were placed in boiling normal saline for 4 s for surface sterilization. Then samples were transferred to sterile bags and sterile normal saline was added to each bag at 9:1 w/w ratio. After mechanical homogenization, serial dilutions (10 –2 to 10 –6 ) were made in sterile micro tubes. Ten µL of each dilution was transferred to MacConkey agar plates and incubated for 18–24 h at 37 °C. Plates containing less than 250 colonies were used for colony count and total bacterial CFU count/g tissue was calculated (Adzitey and Yildiz [ 2 ] with modifications).
Shapiro-Wilks’s normality test was performed on all data sets. Based on the results, data were analyzed by one-way ANOVA followed by Tukey’s multiple comparison test or Kruskal–Wallis test followed by Dunn's multiple comparisons test where appropriate. P < 0.05 was considered as the level of significance for statistical analysis.
It should be noted that data related to clinical signs, mortality, gross pathology, pathogenesis, etc. are reported in our previously published paper [ 19 ].
Birds in IT group showed significantly increased serum levels of total protein and total globulin as compared to control birds in NC group ( p < 0.01 and p < 0.0001, respectively). Although a slight decrease was observed in serum albumin levels of IT group in comparison with control groups, the change was not significant ( p > 0.05). Florfenicol administration to birds in ITF group was associated with a significant decrease in serum total protein and globulin concentrations as compared to untreated birds in IT group ( p < 0.01 and p < 0.0001, respectively). No significant difference was observed in these parameters among ITF and control groups ( p > 0.05). The albumin/globulin (A/G) ratio was significantly decreased in IT group as compared to control groups ( p < 0.05 for both comparisons). Birds in ITF group showed statistically the same A/G ratio as compared to control groups and IT birds ( p > 0.05) (Fig. 1 ).
Serum levels (mean and SD) of total protein, albumin, globulin and A/G ratio in different groups. NC: normal control, normal birds with no specific treatment, ITC: intratracheal infection control, birds received sterile medium by intratracheal route; IT: Intratracheal infection group, birds received bacterial suspension inoculated by intratracheal route and ITF: intratracheal infection with florfenicol administration group, in addition to being infected, birds were treated with florfenicol. Values in columns without a common letter are significantly different at p < 0.05
Induction of colibacillosis in birds of IT group was associated with significantly lower serum concentrations of IL-10 and IFN-γ as compared to normal birds of NC group ( p < 0.01 for both comparisons). IL-6 levels remained statistically similar between these two groups ( p > 0.05). Administration of florfenicol to birds with colibacillosis (ITF group) resulted in appreciable decrease in serum concentration of IL-6 as compared to birds in IT group ( p < 0.05). Antibiotic therapy of birds in ITF group had no significant effect on serum IL-10 or IFN-γ as compared to IT birds ( p > 0.05) (Fig. 2 ).
Serum levels (mean and SD) of cytokines in different groups. NC: normal control, normal birds with no specific treatment, ITC: intratracheal infection control, birds received sterile medium by intratracheal route; IT: Intratracheal infection group, birds received bacterial suspension inoculated by intratracheal route and ITF: intratracheal infection with florfenicol administration group, in addition to being infected, birds were treated with florfenicol. MS: missed samples. Values in columns without a common letter are significantly different at p < 0.05
Birds in IT group showed a significant increase in number of WBCs as compared to control groups ( p < 0.0001 for both comparisons). Birds in ITF group had significantly lower number of WBCs as compared to IT group ( p < 0.05), however this parameter value was statistically higher in ITF birds than NC or ITC groups ( p < 0.01 for both comparisons).
Although the percentage of heterophils was statistically the same among groups, birds in IT and ITF groups showed significantly higher number of heterophils as compared to birds in NC group ( p < 0.0001 and p < 0.001, respectively). Florfenicol administration resulted in an appreciable decrease in heterophils count as compared to IT group ( p < 0.05).
Lymphocytes counts in birds of IT and ITF groups were significantly higher than NC birds ( p < 0.001 and p < 0.05, respectively). Birds in IT and ITF groups showed statistically the same counts of lymphocytes ( p > 0.05). The percentage of lymphocytes in IT and ITF groups was lower than NC birds ( p < 0.001 and p < 0.05, respectively). The values of this parameter were not significantly different between IT and ITF groups ( p > 0.05).
Regarding monocytes, birds in IT and ITF groups showed significantly higher numbers of these cells as compared to NC birds ( p < 0.0001 and p < 0.01, respectively). Birds in ITF group had lower number of monocytes in comparison with birds in IT group ( p < 0.001). Percentage of monocytes in IT and ITF groups was also higher than NC birds ( p < 0.0001 and p < 0.01). Birds in ITF group showed lower percentage of monocytes as compared to IT birds ( p < 0.05).
Birds in IT group had significantly higher counts and percentage of immature white blood cells as compared to NC group ( p < 0.0001 for both comparisons). Number and percentage of these cells in ITF group were statistically the same as NC birds ( p > 0.05) and significantly lower than IT group ( p < 0.0001 for both comparisons).
Number of thrombocytes was statistically the same among all groups ( p > 0.05).
Data related to blood cells are summarized in Table 1 .
Blood cells in NC and ITC groups showed completely normal appearances. In IT group, signs of severe acute inflammation and septicemia were present. Toxic heterophils with vacuolated cytoplasm were abundantly observed. Severe left shift with presence of toxic myelocytes, metamyelocytes and band heterophils was detected in blood smears. Polychromatophilic erythrocytes were detected relatively more in IT group than ITF birds. The severity of changes was generally lower in ITF group as shown by the presence of some band heterophils and heterophils that only showed mildly vacuolated cytoplasms. Red blood cells were normal. Figure 3 represents some of these changes in IT and ITF groups.
Representative photomicrographs of birds in intratracheal infection group (IT) (A and B) and intratracheal infection with florfenicol administration group (ITF) (C and D). Short thin arrow: Toxic heterophil with vacuolated cytoplasm; Long thin arrow: Toxic metamyelocyte, vacuoles and dark toxic granules are present in cytoplasm; Star: Polychromatophilic erythrocyte; Thick arrow: Toxic myelocyte, vacuoles and dark toxic granules are present in cytoplasm; Curved arrow: heterophil with mildly vacuolated cytoplasm; #: Normal monocytes. Giemsa staining, Magnification: 1000X
Lungs and livers of birds in NC and ITC groups did not show any lesions and looked normal in histopathological examination. Infiltration of inflammatory cells, presence of necrotic foci, accumulation of eosinophilic substances in parabronchi and intravascular fibrin thrombi were the most profound lesions that were observed in lungs of birds in IT group. Hemorrhage was not detected in lungs of these birds. Except congestion, the severity of lesions was lower in birds of ITF group as compared to IT group although the only parameter that showed significantly lower scores was the accumulation of eosinophilic substances in parabronchi ( p < 0.05).
Fatty changes, intravascular fibrin thrombi, perihepatitis, accumulation of heterophils around portal areas and congestion were detected in livers of birds in IT group. The only parameter that showed significantly lower scores in ITF group compared to IT birds was accumulation of heterophils around portal areas ( p < 0.05) (Table 2 ).
Selected lesions in lungs and livers of birds are shown in Fig. 4 .
Representative photomicrographs of liver ( A ) and lung ( B ) of birds experimentally infected with E. coli by intratracheal route (IT group). Long arrow: perihepatitis; #: Lymphatic cells accumulation; Star: accumulation of eosinophilic substances in parabronchi; Short arrow: Intravascular thrombus, hematoxylin and eosin staining
Spleen, bursa of Fabricius and thymus of birds in NC and ITC groups were normal without any considerable lesions. Among the three immune organs that were histopathologically examined, spleen was the most affected organ of birds in IT group where almost all of the assayed parameters showed a median score of 3 (the highest severity score). Congestion, hemorrhage, intravascular fibrin thrombi, heterophil accumulation foci, depletion of lymphoid cells in white pulp and focal areas of necrosis were profoundly detected in the spleens of IT birds. The scores of all these parameters were statistically lower in ITF birds as compared to IT group ( p < 0.05) and were reversed to normal values of NC group ( p > 0.05). Moreover, birds in ITF group showed hyperplasia in white pulp which was not observed in any other groups.
Congestion, intravascular fibrin thrombi, heterophil accumulation, depletion of lymphoid tissues and edema were detected in thymi of birds in IT group. Thymi of birds in ITF group showed normal structural features without detectable lesions in histopathological examination.
Depletion of lymphoid cells, cyst formation, interfollicular edema and distended lymphatic vessels were observed in bursa of Fabricius of birds in IT group. Except for interfollicular edema, the bursas of birds in ITF group looked almost normal in histopathological evaluation.
Figure 5 shows selected lesions in lymphoid organs of birds in IT group.
Representative photomicrographs of spleen ( A ), thymus ( B ) and bursa of Fabricius ( C ) of birds experimentally infected with E. coli by intratracheal route (IT group). Long arrow: Focal necrosis; #: Lymphatic cells depletion; *: inter follicular edema, hematoxylin and eosin staining
Table 3 summarizes the scores of histopathological findings in different groups.
As shown in Fig. 6 , no E. coli growth was observed in liver samples collected from control groups (NC and ITC). Incubation of liver samples from both infected groups (IT and ITF) resulted in E. coli bacterial growth. The number of colony forming units (CFUs) of E. coli in liver samples of ITF group was only slightly lower than IT birds ( p > 0.05).
E. coli count (mean and SD) in liver samples of birds in different groups. NC: normal control, normal birds with no specific treatment, ITC: intratracheal infection control, birds received sterile medium by intratracheal route; IT: Intratracheal infection group, birds received bacterial suspension inoculated by intratracheal route and ITF: intratracheal infection with florfenicol administration group, in addition to being infected, birds were treated with florfenicol. Values in columns without a common letter are significantly different at p < 0.05
This study is focused on certain aspects of responses of chickens experimentally infected with APEC via intra tracheal route with or without florfenicol treatment.
In acute or chronic inflammatory conditions, total protein may increase due to elevated globulin fraction. In these situations, albumin concentrations often decrease. The combined effect of these changes is a decrease in the A/G ratio [ 15 ]. Consistently, in the present study, hyperproteinemia and decreased A/G ratio was observed in birds of IT group which was due to increased serum globulins. Hyperglobulinemia in chickens with colibacillosis has been reported by other investigators [ 20 , 5 ]. As previously stated, in the present study birds in ITF group showed statistically similar levels of serum globulin and A/G ratio compared to control groups which can be related to a suppressed inflammatory condition following florfenicol administration to these birds.
In 2024, Usman et al., observed that serum concentration of IL-6 significantly increases in chickens that were inoculated via intra nasal route by O78:K80 E. coli three days post inoculation. In a study by Elnagar et al., [ 4 ]; broiler chickens which were orally infected with E. coli O78, O26, O55, or O44 showed increased mRNA expression of IL-6 in ileal tissue two days post infection. Conversely, in our study serum level of IL-6 was not significantly changed in IT birds. It is worth to mention that in the study performed by Elnagar et al., the level of increase in mRNA expression of IL-6 cytokine was different between the E. coli strains. Therefore, the reason for the observed discrepancy, might be the difference in E. coli strain used as well as time of sampling, inoculation route and type of the sample.
We observed that ITF birds show significantly lower levels of IL-6 as compared to IT group. The suppressive effects of florfenicol on IL-6 serum levels has also been previously reported in mice challenged with LPS [ 27 ]. These researchers also showed that florfenicol inhibits the translocation of LPS-induced nuclear factor-κB (NF-κB) from cytoplasm into the nucleus in RAW 264.7 macrophages. Therefore, they suggested that the effects of florfenicol on early cytokine responses can be due to blocking of NF-κB pathway.
Interleukin 6 is a multifunctional cytokine in chickens with major roles in immune responses including activating B and T lymphocytes and encouraging macrophage production [ 25 ]. As an important cytokine in innate immune responses, IL-6 alerts the immune system about the presence of the pathogen. However, improper over production of this molecule may also be damaging [ 4 ]. On the other hand, suppressed production of this cytokine may help to the spread of infection as shown for Salmonella gallinarum [ 10 ] . Therefore, the suppressive effect of florfenicol on this cytokine level in chickens with colibacillosis should be considered conservatively.
It is well stablished that IL-10 is an inducible feedback regulator of immune response in chickens and acts as an anti-inflammatory cytokine [ 26 ]. It is reported that IL-10 mRNA expression decreases in ileal tissue of chickens with colibacillosis [ 4 ]. Consistently, in the present study, we observed decreased serum levels of IL-10 in birds of IT group. These birds also showed decreased serum levels of IFN-γ. It has been shown that administration of IFN-γ to chickens with colibacillosis enhances immune responses against the disease although it does not mitigate the development of air sac lesions [ 9 ]. Therefore the decreased serum level of IFN-γ may negatively affect the immune responses of chickens with colibacillosis.
In a study by Zhang et al., [ 27 ], florfenicol prolonged IL-10 expression in serum of mice challenged with LPS while had no effect on IL-10 production by LPS-induced RAW 264.7 cells in vitro. Administration of florfenicol to SPF chicks at the age of 3 days for six consecutive days has been associated with decreased serum levels of IFN-γ compared to control group in the early stages of drug withdrawal [ 16 ]. In contrast, in the present study, florfenicol administration had no effect on the levels of IL-10 or IFN-γ in chickens with colibacillosis. The differences in the nature and conditions of the mentioned studies might have a role in the discrepancy observed in the results.
In the present study, florfenicol improved the hematological profile of birds with colibacillosis as shown by milder signs of inflammation, toxemia and left shift presented by WBCs. Leukocytosis and monocytosis were also ameliorated by florfenicol administration. Moreover, florfenicol decreased the severity of some of the lesions observed in lung (accumulation of eosinophilic substances in parabronchi) and liver (congestion and heterophil accumulation in portal area). Although it was not addressed in the present study, these effects of florfenicol at cellular level may improve organ function and subsequently expedite the recovery and escalate health status of the bird. Regarding the lymphoid organs, administration of florfenicol resulted in remarkable decrease of lesion severity especially with regard to the spleen which was the most affected lymphoid organ in IT birds. Depletion of lymphoid tissue was observed in spleens, thymus and bursa of Fabricius of birds in IT group. Lymphocytic depletion of bursa and thymus of chickens infected with E. coli has been previously reported by Nakamura et al., [ 17 ]. Interestingly, florfenicol administration protected these organs against lymphoid tissue depletion and even resulted in mild hyperplasia of white pulp in the spleen of chickens in ITF group. Consistently, in a study by Lis et al. [ 14 ], florfenicol increased percentage and absolute number of T lymphocytes in mesenteric lymph nodes of mice.
An important question is that whether the observed effects of florfenicol in this study are related to its antibacterial effect (reversal of lesions and changes after bacterial clearance) and/or its plausible immunomodulatory effects? As it was confirmed by the results related to bacterial count performed on liver samples, birds in both infected groups were still afflicted with systemic colibacillosis. Interestingly, although the bacteria were sensitive to florfenicol (based on sensitivity test), administration of this drug was not associated with a drastic decrease in bacterial load at the time of sampling. This can be related to the fact that florfenicol administration in this study was continued for relatively short period (3 days) before sampling and a very high load of bacteria was used for inoculation as it is a routine procedure in studies that use experimental models of colibacillosis. Therefore, there is a high chance that the observed beneficial effects are related to the immunomodulatory effects of the drug, although we cannot completely rule out the possibility that antibacterial effects of the drug could be still involved since we could not count bacteria in all afflicted organs.
In conclusion, experimental E. coli infection of chickens by intratracheal route results in remarkable inflammatory responses associated with changes in serum cytokine levels (IL-10 and IFN-γ) as well as in biochemical (decreased A/G ratio) and hematological (severe left shit with presence of toxic myelocytes, leukocytosis and monocytosis) parameters. Histopathological lesions in lymphoid organs (especially in spleen) were also prominent in these birds. Florfenicol administration ameliorated inflammatory responses and improved many of the lesions when it has not yet dominated the bacteria. These anti-inflammatory and beneficial effects of florfenicol should be considered in pharmacotherapy decision-making process and might help clinicians select a more effective antimicrobial agent among options to which bacteria may be susceptible. Of course, effects of florfenicol (suppressive or stimulant) on other response parameters that have a role in host defense mechanisms and the outcome of chickens with colibacillosis need to be clarified in future studies.
The data that support the findings of this study are not openly available due to reasons of sensitivity and are available from the corresponding author upon reasonable request.
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This work was supported by the Shiraz University under Grant number 1GCB3M163773.
Authors and affiliations.
Avian Diseases Research Center, Department of Clinical Sciences, School of Veterinary Medicine, Shiraz University, Shiraz, Iran
Zahra Ghahramani & Najmeh Mosleh
Division of Pharmacology and Toxicology, Department of Basic Sciences, School of Veterinary Medicine, Shiraz University, P.O. Box 71441-69155, Shiraz, Iran
Tahoora Shomali
Department of Clinical Sciences, School of Veterinary Medicine, Shiraz University, Shiraz, Iran
Saeed Nazifi
Department of Pathobiology, School of Veterinary Medicine, Shiraz University, Shiraz, Iran
Azizollah Khodakaram-Tafti
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T. Sh and N. Mosleh conceptualization, data analysis, supervision, T. Sh prepared the draft, Z. Gh, S. Nazifi and A. Kh. T data acquisition and methodology, all authors have read and approved the manuscript.
Correspondence to Tahoora Shomali .
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It is uncertain what could be the best training methods for infection prevention and control when an infectious disease threat is active or imminent in especially vulnerable or resource-scarce settings.
A scoping review was undertaken to find and summarise relevant information about training modalities, replicability and effectiveness of IPC training programmes for clinical staff as reported in multiple study designs. Eligible settings were conflict-affected or in countries classified as low-income or lower-middle income (World Bank 2022 classifications). Search terms for LILACS and Scopus were developed with input of an expert working group. Initially found articles were dual-screened independently, data were extracted especially about infection threat, training outcomes, needs assessment and teaching modalities. Backwards and forwards citation searches were done to find additional studies. Narrative summary describes outcomes and aspects of the training programmes. A customised quality assessment tool was developed to describe whether each study could be informative for developing specific future training programmes in relevant vulnerable settings, based on six questions about replicability and eight questions about other biases.
Included studies numbered 29, almost all ( n = 27) were pre-post design, two were trials. Information within the included studies to enable replicability was low (average score 3.7/6). Nearly all studies reported significant improvement in outcomes suggesting that the predominant study design (pre-post) is inadequate to assess improvement with low bias, that any and all such training is beneficial, or that publication bias prevented reporting of less successful interventions and thus a informative overview.
It seems likely that many possible training formats and methods can lead to improved worker knowledge, skills and / or practice in infection prevention and control. Definitive evidence in favour of any specific training format or method is hard to demonstrate due to incomplete descriptions, lack of documentation about unsuccessful training, and few least-biased study designs (experimental trials). Our results suggest that there is a significant opportunity to design experiments that could give insights in favour of or against specific training methods. “Sleeping” protocols for randomised controlled trials could be developed and then applied quickly when relevant future events arise, with evaluation for outcomes such as knowledge, practices, skills, confidence, and awareness.
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A survey of health and care workers in low or lower middle countries in 2017–18 suggested that infection prevention and control (IPC) training while in post was unusual in many countries (reported in 54% of respondent countries [ 1 ]). Moreover, such training may only happen when there is already a defined infectious threat present or likely to arrive imminently. A highly responsive strategy in developing and delivering IPC training means opportunity to customise training formats and methods for local workforce contexts and curricula with regard to very specific pathogens and transmission pathways. However, the context of needing to deliver training urgently with little advance notice of specific pathogen or local context means that such training may be designed and delivered hurriedly, and with minimal setting-specific needs assessment and little evaluation for effectiveness.
As part of past pandemic recovery and future pandemic preparedness, it is useful to collate evidence about which IPC training methods have been applied in specific settings or contexts. Evidence would be especially useful that could be used to inform ongoing development of best training delivery guidelines in settings that may be described as fragile, conflict-affected or otherwise vulnerable (FCV). Best quality evidence may be defined with regard to completeness of reporting (if the training methods are replicable) as well as evidence of effectiveness (desired outcomes). We searched on Google Scholar and Prospero in August 2023 for completed or registered systematic or scoping reviews addressing the topic of emergency IPC training in vulnerable settings. The most similar and comprehensive existing systematic review (Nayahangan et al. 2021; [ 2 ]) described medical and/or nursing training (delivered for any clinical training purpose, not just IPC) delivered during viral epidemics (only). The search date for the Nayahangan et al. review was April 2020, more than 3 years before our own study commenced. Systematic literature reviews may be considered ‘out of date’ by two years after their most recent search date [ 3 ]. Nayahangan et al. included clinical settings in any country and was not confined to training delivered in emergency or urgent contexts (readiness or response phases [ 4 , 5 ]). Nayahangan et. al . performed quality assessment using the Educational Interventions Checklist [ 6 ] which focuses on replicability and mapping of reported teaching methods in the primary research, but only indirectly addresses effectiveness. Nayahangan et. al . concluded that previous studies had used a variety of training methods and settings but few training methods had been related to specific patient or other epidemic outcomes. Another somewhat similar previous systematic review was Barrera-Cancedda et al. [ 7 ] which described and assessed IPC training strategies in sub-Saharan Africa for nurses. Most of the strategies they found and described were during “business as usual” conditions, rather than readiness or response phases of an outbreak or epidemic presenting imminent threat. Their quality assessment tools were for assessing bias in effectiveness rather than replicability. Their focus was narrowly on nurses in a specific geographic region. Their conclusions arose from considering evidence that went far beyond staff training methods. Barrera-Cancedda et al. concluded that creating good future guidelines for evidence-based practice required that additional primary research to be undertaken from an implementation science-specific perspective.
A challenge in emergency IPC training manifest during the Covid-19 pandemic is inherent to other emerging diseases: early in an outbreak situation there is often uncertainty about the best IPC practices. The actual best practices may vary according to predominant disease transmission pathway(s) that are not yet well-understood. There is merit in considering evidence according to what disease(s) are being prepared for.
This study aimed to provide an updated evidence summary about IPC training formats and apparent effectiveness in a scoping review design. We collected and summarised evidence about IPC training formats and methods as delivered in FCV settings when there was an active infectious disease present (response phase) or the infection arrival was fairly imminent (expected within 6 months, readiness phase) [ 4 , 5 ]. We undertook a scoping review of IPC training programmes reported in peer reviewed scientific literature to summarise which training formats or methods had been described in FCV settings, and to describe how often such training was associated with success in these settings. Key effectiveness outcomes were: knowledge, skills, compliance, case counts or case mortality while training delivery was summarised according to key features such as format, duration and delivery mode.
PROSPERO registration number is CRD42023472400. We originally planned to undertake a systematic review but later realised that answering our research question was better suited to a scoping review format, where evidence is summarised narratively with respect to creating a comprehensive overview of evidence rather than obtaining evidence to be evaluated for effectiveness. There were two other notable deviations from protocol: we did not use the Covidence platform and we decided to develop and apply a customised quality assessment (QA) checklist instead of originally listed QA instruments. This article is one of several outputs arising from the same protocol.
Training programmes had to take place in FCV settings or for staff about to be deployed to FCV settings. Fragile or vulnerable settings were defined as being in countries that were designated as low income or lower-middle income by the (World Bank 2022 classification; [ 8 ]). Conflicted-affected settings were determined using reader judgement for individual studies, and had to feature concurrent with the training and care delivery, high threat of armed violence or civil unrest. Participants had to be health care professionals (HCPs), social care staff, student or trainee HCPs or trainee social care staff working in an FCV setting. If in doubt about whether the participants qualified, we deferred to World Health Organisation occupational definitions [ 9 ]. Voluntary carers such as family members or community hygiene champions as targets were excluded. Eligible interventions could be described as training or education related to any aspect of IPC outcomes.
The training programme could be any training or education that was delivered in a response phase (when there was a concurrently present infectious disease threat) or in the readiness phase [ 5 ], when there was high risk that the infectious threat would become present in the clinical environment within six months, such as soon after Covid-19 was declared to be a public health threat of international concern in January 2020.
Comparators were either the same cohort measured at baseline or a contemporaneous cohort in same setting who did not receive IPC training.
Changes in individual knowledge, skills, adherence (compliance or practice), case counts or mortality related to infection were primary effectiveness outcomes. These were chosen because preliminary searches suggested they were commonly reported outcomes in the likely literature. Most of these were immediate benefits that could result as soon as training was completed. We also included case incidence and infection-related mortality as primary outcomes because we knew from preliminary literature searches that these were often the only specific outcomes reported after IPC training. Secondary outcomes (data only collected from articles with at least one primary outcome) were attitudes, acceptability of the training, self-efficacy, confidence, trust in IPC, awareness, index-of-suspicion, ratings for value or relevance of the training, objectives of the training, lessons learned about training needs or recommendations about training needs to be addressed in similar subsequent training programmes.
Outcomes could be objectively- or self-assessed. We wanted to extract outcomes that could be most comparable between studies (not adjusted for heterogenous covariates) and that were objectively assessed rather than self-reported, if possible. Hence, objectively assessed outcomes were extracted and are reported if both objectively- and self-assessed outcomes were available, else self-reported outcomes were extracted and are reported. We extracted and report unadjusted outcomes where available, but adjusted results after post-processing (such as using regression models) were extracted if no unadjusted results were reported.
Specific aspects of how training was delivered were key to understanding the potential that each training programme might have to achieve replicable results elsewhere. We used an iterative process with an expert working group giving advice to develop a list of training features such as setting, duration, target participants and programme design (see list below). These categorisations are not presented as definitive but rather they were pragmatically determined attributes for what information could be gathered in the eligible studies and that directly inform how replicable each education programme was, and how generalisable its results might be in other settings/with other target participants. We extracted information from the studies to categorise the training that they described according to the below features. Multiple answers were possible for many of these features. “Unclear” or “Mixture” were possible answers, too.
Where (location) : Off-site without real patients; in house but not while caring for patients; on the job training (during patient care).
Length of the training session(s): such as 1 h on one day, or 6 sessions over 8 weeks, etc.
When (timing with respect to possible threat) : Pre-deployment to clinical environment; in post or as continuing professional development.
Mode (of delivery) : 3 options which were: face to face; blended (a mix of face to face and online) or hybrid (face to face with opportunity for some participants to join in remotely); only digital: e.g. digital resources uploaded to an USB stick or online via an online platform, either synchronous or asynchronous.
Broad occupational category receiving the training : Clinical frontline staff; trainers who were expected to directly train others; programme overseers or senior managers.
Specific occupations receiving the training : Nurses, doctors/physicians, others.
Learning group size : Individual or group.
Format : Workshops; courses; seminars/webinars; mentoring/shadowing; e-learning; e-resources, other.
Methods : Didactic instruction/lectures/audio-visual presentations; demonstrations/modelling; discussion/debate; case studies or scenarios; role play or clinical practice simulations; assessment or exams with formative assessment; hands-on practice / experience; games; field trips or site visits; virtual reality or immersive learning; repeated training; shadowing; other.
We included scientific studies with concurrent comparison groups (CCT or RCT) where post-training outcomes were reported for both arms and pre-post studies where both baseline and post-training measurements of a primary effectiveness outcome were reported. Clinical cases, case reports, cross-sectional studies, letters to the editor, editorials, commentaries, perspectives, technical notes, and review summaries were excluded unless they reported baseline and post-training eligible effectiveness outcomes. Studies must have been published in 2000 or later. Infectious biological entities could be bacteria, viruses, protozoa or funghi, but not complex multicellular organisms (like mites or lice).
Studies could be published in any language that members of the team could read or translate to coherent English using Google Translate. Training in infection prevention and control had to be applicable to a clinical or social care environment for humans. Non-residential care settings (such as daily childcare facilities) were excluded. Studies about controlling infection risks from or to animals or risk reduction in non-clinical environments (such as removing mosquito breeding sites) were excluded.
We wanted to focus on IPC training that related to individual action and could result in immediate benefits and in clinical not community environments. For this reason, we excluded interventions or outcomes that related to: forms of patient care (e.g., anti-viral treatment) that might hasten end of infectious period; vaccination programmes; surveillance; availability of personal protective equipment (PPE) or other resources that reflect institutional will and opportunity as much as any individual action; testing strategies or protocols or actions to speed up test results or screening patients for infection. Also excluded were training programmes in environmental management outside of the clinical/care environment with exception for waste management generated within clinic and managed on site which might include some outdoor/away from clinic/care location handling and disposal decisions.
Eligible studies had to report at least one of our primary outcomes so that we could summarise the evidence base about which training methods linked to evidence of effectiveness. To focus on the response and readiness phase of emergencies, we excluded studies where the primary outcome was only measured > 12 months after training started (i.e., quality improvement reports).
MEDLINE, Scopus, LILACS were searched on 9 October 2023 with the search phrase (Scopus syntax):
(“infection-control”[Title/Abstract] or “transmission”[Title/Abstract] or.
“prevent-infectio*”[Title/Abstract]).
(“emergency”[Title/Abstract] or “epidemic”[Title/Abstract] or “outbreak”[Title/Abstract]).
(“training”[Title/Abstract] or “educat*”[Title/Abstract] or “teach*”[Title/Abstract]).
Included studies in a recent and highly relevant systematic review [ 2 ] were also screened. Initially included studies from those search strategy steps were then subjected to forward and backward citation searches to look for additional primary studies.
After deduplication, two authors independently screened all studies found by the search strategy, recording decisions on MS Excel spreadsheets. All studies selected by at least one author had full text review for final decision about inclusion.
We assess quality indicatively and with regard to usefulness of the studies to inform development of future IPC training programmes in relevant settings. The focus was on two broad domains that informed A) how replicable the training programme was, as described; B) how biased its results were likely to be. Our protocol planned to apply the Cochrane Risk of Bias 1.0 for trials (ROB.1) and Newcastle Ottawa Scale (NOS) tools to undertake quality assessment for pre-post study designs. However, we realised that neither of these tools captured whether the original research had reported sufficient details to make the original training programme replicable. Another problem is that the judgements arising from the RoB.1 and NOS would not be strictly comparable, given the different assessment criteria. Other existing quality checklists that we are aware of that were suitable for each of trials, cohorts or pre-post study designs had the shortcomings of only capturing replicability or bias in apparent effectiveness (not both), and tending to be suitable for only one study design. Some checklists (eg The Cochrane Risk of Bias 2.0 tool [ 10 ] or Mixed Methods Appraisal Tool [ 11 ]) require more resources to operationalise than we had or that was required for a scoping review. Instead, we devised and applied an indicative quality checklist that comprised 14 simple questions with possible answers that were “yes, no or uncertain” using specific predefined criteria for deciding each answer. Our checklist is available as File S 1 . These questions were modified from suggested questions in the USA National Institutes of Health assessment checklist for pre-post designs [ 12 ]. Applying a single quality assessment tool across multiple study designs had the further advantage of facilitating comparability with regard to identifying relative informativeness for future effectiveness evaluation and training programme design. The answers were scored as 1 point per yes answer, so maximum score (for least biased and most replicable studies) would be 14. We interpret the overall quality assessment results as follows: ≥ 11/14 = most informative, 8–10 = somewhat informative, ≤ 7/14 least informative. The quality assessment results are reported quantitatively and narratively. Subdomains for replicability and other bias (generalisability) scores are reported separately.
These data were extracted: author of the study, year of publication, study country, study design, sample size in comparator arms, relevant infectious diseases (that author identified), primary outcomes, secondary outcomes. With regard to training delivered, we also extracted information about any needs assessment that was undertaken, training objectives and any statements about lessons learned or what should be addressed in future design of such programmes or in research. One author extracted data which was confirmed by a second author. Results are reported quantitatively (counts of studies with any particular training aspect) and narratively for needs assessment, objectives and lessons learned.
To interpret likely usefulness, we prioritise higher scores (for informativeness), but also consider study design, with trials presumed to have less biased results with regard to effectiveness outcomes. We address potential differences that were monitored or observed between knowledge, skills or practices with respect to the training attributes. For instance, were outcomes assessed immediately after training (within 1 day) as opposed to (ideally) observed and assessed independently at least three weeks later, which would suggest knowledge, skills and/or practice retention. We also highlight when training applicable to conflict-affected settings was delivered in that same conflicted-affected setting or prior to entry to the setting (such as for military personnel deployed overseas).
Figure 1 shows the study selection process. 29 studies were included. Extracted data for each study are in File S 2 . Almost all ( n = 27) were pre-post design; 2 were experimental studies [ 13 , 14 ]. Table 1 lists summary information about the included studies. Seven reports described training delivered in single low-income countries, 19 studies described training in single lower middle income countries. Two articles described IPC training for staff in context of conflict-affected settings, either in the USA prior to military deployment [ 15 ] or in the affected setting during a period of civil unrest (in Haiti in 2010; [ 16 ]). Two studies [ 17 , 18 ] described training using a common core curriculum in multiple African countries (mix of low and lower middle income). The most represented countries were India (4 studies) and Nigeria (6 studies). Nine studies were about Ebola disease, 14 related to controlling Covid-19. Other studies addressed cholera ( n = 2), antimicrobial resistant organisms ( n = 3) and tuberculosis ( n = 1). Clinical environments were most commonly described as hospitals ( n = 9) while twelve studies described programmes for staff working in multiple types of health care facilities. 21 studies were undertaken in response phase, two in readiness phase and six in mixed readiness/response phases. Nurses were the most commonly specified type of health care worker (mentioned in 24 studies). In Table 1 , higher scores for knowledge, attitudes, practices or skills were the better clinical outcomes unless otherwise stated. Some additional outcome information for LN Patel, S Kozikott, R Ilboudo, M Kamateeka, M Lamorde, M Subah, F Tsiouris, A Vorndran, CT Lee and C of Practice [ 18 ] and N Zafar, Z Jamal and M Mujeeb Khan [ 19 ] are in the original studies but could not be concisely repeated in Table 1 . Most articles reported statistically significant (at p < 0.05) improvements in outcomes after training. A notable exception is OO Odusanya, A Adeniran, OQ Bakare, BA Odugbemi, OA Enikuomehin, OO Jeje and AC Emechebe [ 20 ] who attributed a lack of improvement after training to very good baseline knowledge, attitudes and practices.
Selection procedure for eligible studies
Outcomes were assessed immediately after training ended in 14 studies; assessment point was unclear in two studies. Other outcome assessments ( n = 13 studies) took place between 1 week and 6 months after training finished (especially with respect to case counts or mortality). Because almost all studies reported outcome benefits, studies with delayed assessment cannot be said to have achieved greater benefits.
Needs assessment was described in most studies ( n = 27). For instance, C Carlos, R Capistrano, CF Tobora, MR delos Reyes, S Lupisan, A Corpuz, C Aumentado, LL Suy, J Hall and J Donald [ 32 ] stated that “Although briefings for health care workers (HCWs) in Ebola treatment centres have been published, we were unable to locate a course designed to prepare clinicians for imported Ebola virus disease in developing country settings.” HM Soeters, L Koivogui, L de Beer, CY Johnson, D Diaby, A Ouedraogo, F Touré, FO Bangoura, MA Chang and N Chea [ 38 ] cited widespread evidence that there was a high transmission rate to health care workers within Ebola Treatment centres to justify the need for IPC training in these settings. S Ahmed, PK Bardhan, A Iqbal, RN Mazumder, AI Khan, MS Islam, AK Siddique and A Cravioto [ 41 ], A Das, R Garg, ES Kumar, D Singh, B Ojha, HL Kharchandy, BK Pathak, P Srikrishnan, R Singh and I Joshua [ 21 ] and MO Oji, M Haile, A Baller, N Trembley, N Mahmoud, A Gasasira, V Ladele, C Cooper, FN Kateh and T Nyenswah [ 35 ] describe that expert observers identified deficiencies in existing IPC practices and developed training based on those observations. Independent observations of training needs were formalised as a cross-sectional survey of dental student IPC knowledge in A Etebarian, S Khoramian Tusi, Z Momeni and K Hejazi [ 22 ], and by applying a validated IPC checklist in L Kabego, M Kourouma, K Ousman, A Baller, J-P Milambo, J Kombe, B Houndjo, FE Boni, C Musafiri and S Molembo [ 34 ].
All studies stated specific training objectives and gave at least some information about the specific topics and curriculum. Objectives statements mentioned improvement ( n = 10 studies), knowledge ( n = 7), safety ( n = 6), attitudes ( n = 3), increasing capacity or skills ( n = 6), and development ( n = 1). Examples of other objectives statements were to “teach the basics” [ 41 ] or “to cover the practical essentials” [ 16 ]. Training content and delivery were often highly adapted for local delivery [ 23 , 24 , 25 , 28 , 29 , 32 , 33 , 36 , 38 , 41 ]. Training materials were entirely or mostly derived from published guidance in some studies [ 16 , 19 , 34 , 35 , 37 ]. F Tsiouris, K Hartsough, M Poimboeuf, C Raether, M Farahani, T Ferreira, C Kamanzi, J Maria, M Nshimirimana and J Mwanza [ 17 ] and LN Patel, S Kozikott, R Ilboudo, M Kamateeka, M Lamorde, M Subah, F Tsiouris, A Vorndran, CT Lee and C of Practice [ 18 ] both report that training delivery methods were highly adapted and variable, but developed using the same core course content about Covid-19 in 11 or 22 African countries. Other studies were unclear about how much of their programme was original and how much relied on previously published guidance and recommendations [ 13 , 15 , 20 , 21 , 24 , 26 , 27 , 30 , 31 , 39 , 40 ].
Counts of training locations were: ten off-site; seven on-site but not during patient care; nine were a mix of learning locations; three had unclear locations relative to clinical facility location. Among the 21 studies that described the specific cumulative duration of training sessions, median training duration was 24 h (typically delivered over 3 consecutive days), ranging from about 15 min to 8 full days. Most studies ( n = 21) described training where it was clear that many or most participants were in post, 3 studies clearly described training being provided prior to deployment, another 5 training programmes had mixed or unclear timing with regard to deployment. Twelve studies described training that was delivered only in person, 9 studies described purely digital delivery, 7 were blended delivery and 1 programme was unclear whether the training was delivered digitally or in person. In terms of IPC roles, all studies included at least some frontline workers. In addition, six studies were explicitly designed to train people who would educate others about IPC, seven studies reported including facility managers or supervisors among the trainees. 23 studies mentioned nurses specifically among the trainees, 17 studies specifically mentioned doctors or physicians. Other professionals mentioned were cleaners, porters, paramedics, midwives, anaesthesiologists, hygienists, housekeeping staff, lab technicians, medical technologists and pharmacists. Almost half ( n = 14) of studies were group education; purely individual learning was specified in just one study and others ( n = 14) were unclear or could be either individual or group learning.
Often training formats or teaching methods were described unclearly. With regard to formats that were described clearly, counts were workshop ( n = 10), course (22), seminar or webinar (1), mentoring or shadowing (4), e-learning (13) and inclusion of e-resources (14). Counts of studies using specific teaching methods that were described clearly were didactic (23), demonstrations (17), discussion or debate (8), case-studies or scenarios (6), role play or simulations (9), formative assessment (3), hands-on practice (12), site visits (2), repeat or refresher training (5), shadowing (3). Additional teaching methods described specifically were poster reminders, monitoring (active and passive as well as observation), re-enforcement (updating procedure documents, re-assessing, more training), brainstorming, small group work and other visual aids. Many articles described multiple formats or teaching methods that were used as part of the same training programme, hence these categorisations sum up to more than the total count of included studies.
Most studies ( n = 25) provided some commentary that could be interpreted as “lessons learned” about training methods and delivery. That success of such programmes depends as much on improving mindset or attitude about IPC as teaching other skills or habits was mentioned by at least 6 studies [ 13 , 14 , 20 , 22 , 32 , 39 ]. The merits of capacity building were explicitly reiterated in concluding commentary in seven studies [ 21 , 26 , 29 , 30 , 31 , 35 ]. Other aspects repeatedly endorsed (at least three times) in concluding comments in the included studies were the value of IPC champions or leaders [ 21 , 34 , 35 ] the value of training relevant to specific job role [ 14 , 18 , 22 , 31 ]; advantages of digital not in-person learning [ 13 , 14 , 19 , 20 , 23 ]; value of refresher sessions [ 13 , 14 , 17 , 21 , 30 , 35 ] and merits of evaluation beyond the immediate end of the training programme to make sure that benefits were sustained [ 21 , 29 , 38 , 39 ]. Regarding lessons learned, Thomas et al. 2022 [ 29 ] and Otu et al. 2021 [ 24 ] (both Nigerian studies) gave specific details about challenges and benefits of mobile phone digital training delivery, for instance reliance on assumed e-literacy, uncertainty about consistent access to Internet or access to devices with suitable versions of the Android operating system. Four studies [ 14 , 25 , 29 , 38 ] listed benefits when training was delivered in participant’s native language(s).
Quality assessment scores are shown in Table 2 . Recall that the customised quality assessment evaluation addressed two broad domains: replicability and other biases (other potential for generalisability), with results interpreted as usefulness of the study to inform future design of similar IPC training programmes. The quality assessment found that replicability potential was not high overall, with an average score of 3.7/6. There was insufficient easily available information (score was < 4 of 6 replicability domains in QA checklist) to undertake the same intervention again for 11 studies, while replicability was relatively high (≥ 5/6) for 9 studies. The generalisability domain in the quality assessment checklist addressed other factors that may have biased the apparent effectiveness outcomes of each training programme . 22 studies scored < 5/8 for generalisability (suggesting they were likely to be at high risk of bias with regard to outcomes reported). Only one study was assessed to be of overall relatively higher quality (quality checklist score ≥ 11/14) and can be considered especially (“most”) useful for informing design of such IPC training in future. Shreshtha et al. [ 28 ] had a pre-post design and is especially thorough in describing training in intubation and triage protocols in Nepal to prevent Covid-19 transmission. The two controlled trials included in our review [ 13 , 14 ] both scored below 11 (10/14) in the quality assessment because they had unclear information about how many participants were assessed and did not provide specific training or assessment materials. There was minimal or no difference in most outcome improvements between arms in one of the trials (Jafree et al. 2022; [ 14 ]), but statistically significant greater improvement in outcomes, especially knowledge, in the active intervention arm, in the other trial. (Sharma et al. 2021; [ 13 ]). This number of experimental trials was small ( n = 2) and they described fairly different format training programmes for different diseases.
The evidence available is difficult to interpret because of incomplete reporting and lack of specific descriptions. Training delivery was often vaguely described, or even explicitly described as highly diverse while relatively few pathogens were addressed. Only two moderate size ( n = about 200 in each) experimental trials were found which is insufficient for making broad conclusions about effectiveness. It seems likely that many possible training methods can successfully improve HCW knowledge, skills, attitude, practices, etc. We note that there is unlikely to be definitive evidence in favour of or against specific training methods due to lack of thorough description of training methods in addition to lack of robust study designs (very few clinical trials). Lack of specificity about which aspects of training were least or most beneficial may hinder successful development of future training programmes. Lack of controlled trials and generally poor description of any training programmes that existed prior to implementation of the programmes described in pre-post studies means that we can’t discern if training was effective because of how it was delivered or because relevant training had never been given previously. It seems clear that there is huge opportunity for design of well-run controlled trials in IPC training delivery. A controlled trial could be designed and tested with a pre-specified curriculum for a common and recurring type of pathogen (e.g., influenza-like illness or for a specific common anti-microbial resistant organism), but with 2 or more delivery formats pre-approved with institutional review bodies, and thus ready to be implemented when a relevant crisis arose. Suitable outcomes to include in the trial design would measure aspects of knowledge, practices, skills, confidence and awareness. Complexity-informed evaluation strategies [ 42 ] are likely to be desirable in fragile, conflict-affected or vulnerable settings, too. (Nayahangan et al. 2021; [ 2 ]) recommended that medical training be more standardised during viral epidemics. We did not find evidence to show that universally formatted IPC training programmes are optimal in FCV settings. We have, however, provided information that can be used to begin to assess effectiveness of training programmes that are either universally formatted or more highly locally adapted.
Only two of our studies described training that was applied in conflict-affected settings; one of these [ 15 ] described training that was also delivered prior to worker arrival in the conflict-affected setting. We judge that these two studies are too few and too heterogenous to pool, so we cannot draw broad conclusions about training delivery and benefits in a conflict-affected area context or in a high resource setting prior to deployment.
Other researchers have systematically described many key issues that affect effectiveness of IPC training in low resource or conflict-affected settings. For instance, Qureshi et al. 2022 [ 43 ] undertook a scoping review of national guidelines for occupational IPC training. They audited how up to date such guidelines were. They identified key deficiencies, especially in LMIC countries with regard to the most recent best recommended practices in evaluation and adult learning principles. A global situational analysis undertaken in 2017–2018 [ 1 ] concluded that although nearly all countries audited had relevant national training guidelines in IPC, there was far less training of HCWs taking place, less surveillance and lower staffing levels in lower-middle and lower-income countries (World Bank classifications) than in upper-middle and high income countries.
Data and analyses have been undertaken to specifically describe challenges and potential strategies to meet those challenges, when undertaking IPC in conflict affected settings [ 44 ] or low and middle income countries dealing with a specific disease [e.g., tuberculosis; 45 ]. These studies are fundamentally qualitative in design and narrative, so while they provide insight, they do not lead to confident conclusions about which if any training methods are most likely to be successful. There is a dearth of experimental evidence in lower-middle and lower income countries. The Covid-19 pandemic especially focused interest on IPC guidelines for respiratory infection prevention. A review by Silva et al. 2021 [ 46 ] of randomised controlled trials that tried to improve adherence to IPC guidelines on preventing respiratory infections in healthcare workplaces included 14 interventions, only one of which was not in a high income setting [in Iran; 47 ], and all were in arguably undertaken in preparation phase (not response or readiness).
Although we included incidence and mortality as primary outcomes, these outcomes are often not immediate benefits from good IPC training and thus are problematic indicators of IPC success. Case incidence is highly dependent on local community prevalence of relevant pathogen(s), while mortality rates often reflect quality of medical care available in addition to population awareness and subsequent timing of presentation. Our search strategy was not tested using eligible exemplar studies, nor did it include controlled vocabulary which might have found additional eligible studies. We did not rigorously determine risk of bias in each of the few trials available. We did not explicitly look for evidence of publication bias [ 48 ] in this evidence group, but we suspect that the near total absence of any information about failed interventions biases what we can say with confidence about truly successful training formats and methods.
A key limitation when we graded the studies for likely usefulness is that we did not attempt to contact primary study authors to obtain more information or specific training materials. Additional materials are likely to be available from most of the primary study authors and would boost their study replicability and apparent biases. However, such contact could also be a very demanding and not necessarily productive exercise. A broader review than ours could have collected all evidence about any training modalities when delivered in eligible contexts (readiness or response phase in FCV settings), regardless of whether effectiveness outcomes were reported. A review with similar such objectives was published in 2019 [ 7 ], which inventoried implementation strategies for IPC promotion in nurses in Sub-Saharan Africa.
We decline to adopt a broad inventorying approach because the information obtained would still lack evidence of effectiveness. We found some studies [e.g., 49 ] which provided a thorough description of training delivery, but without evaluation of our outcomes and therefore ineligible for inclusion in our review. A broader review than ours would have included grey literature and qualitative studies. Qualitative studies especially provide information about effective communication and leadership, acceptability of training delivery methods, incentives, accountability strategies, satisfaction ratings and barriers to learning [ 50 ]. While those are highly relevant outcomes to effective training in IPC, they were removed from the core outcome that is likely to matter most in achieving good IPC, which is consistency of desired practices.
Our conclusions are limited because of the mediocre quality of evidence available. Although existing evidence in favour of or against any specific training approach is far from definitive, there is much opportunity to design future studies which explicitly and robustly test specific training formats and strategies.
The datasets used and/or analysed during the current study are available from the corresponding author upon reasonable request.
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We thank members of the WHO Expert Working Group for comments and guidance.
This work was primarily funded by a grant from the World Health Organization (WHO) based on a grant from the United States Centers for Disease Control and Prevention (US CDC). JB and ICS were also supported by the UK NHIR Health Protection Research Unit (NIHR HPRU) in Emergency Preparedness and Response at King’s College London in partnership with the UK Health Security Agency (UKHSA) in collaboration with the University of East Anglia. EH is affiliated with the UK Public Health Rapid Support Team, funded by UK Aid from the Department of Health and Social Care and is jointly run by UK Health Security Agency and the London School of Hygiene & Tropical Medicine. The views expressed are those of the author(s) and not necessarily those of the WHO, NHS, NIHR, UEA, UK Department of Health, UKHSA or US CDC.
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Analysis plan: JB, CCH, JW, VW, HOM. Comments on draft manuscript: All. Conception: EH, JB, VW, HOM. Data acquisition and extraction: JB, ICS, JW. Data curation: JB. Data summary: JB. Funding: JB, CCH, VW, HOM. Interpretation: JB, CCH, VW, HOM. Research governance: JB. Screening: JB, ICS, CCH. Searches: JB, ICS. Writing first draft, assembling revisions: JB.
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Brainard, J., Swindells, I.C., Wild, J. et al. Emergency infection prevention and control training in fragile, conflict-affected or vulnerable settings: a scoping review. BMC Health Serv Res 24 , 937 (2024). https://doi.org/10.1186/s12913-024-11408-y
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Zhongsheng Zhai, Xiatian Yu, Zhen Zeng, Yi Zhang, Qinghua Lv, Da Liu, and Jun Tu
Zhongsheng Zhai, 1 Xiatian Yu, 1 Zhen Zeng, 1 Yi Zhang, 1 Qinghua Lv, 2, * Da Liu, 1 and Jun Tu 1
1 Hubei Key Laboratory of Modern Manufacturing Quantity Engineering, School of Mechanical Engineering, Hubei University of Technology, Wuhan, Hubei 430068, China
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To realize three-dimensional microscopic imaging with high time resolution and high space resolution at the same time, a multi-plane imaging method with constant axial multi-plane imaging quality is proposed. The optical theory to ensure that different axial sections have consistent lateral resolution has been analyzed. In the system, it is proposed to superimpose a spatial light modulator with programmable ability and wavefront control function on the focal plane of the image square of the front group of the infinite tube length microscope objective and load a digital multiplexing lens with multi-focus and multi-diffraction angle to form a new combined imaging system. The system can clearly image any axial section or multiple target planes within a certain imaging range without compensating the imaging aberration of the axial section, so that each axial section has the same imaging quality. With the help of the USAF 1951 resolution chart, it is verified that different axial object planes have consistent lateral resolution up to 57.0 lp/mm. For samples with different thicknesses, multi-plane layer-by-layer imaging and multi-plane simultaneous imaging experiments were performed using single-focus lens, multi-focus Fresnel lens, and digital multiplexing lens phase grayscale images, respectively. Experimental results show that this scheme can achieve some degree of simultaneous multiplanar imaging with an axial spacing of up to 0.2 mm, which is potentially useful in research areas where samples should not be moved or where relative motion is not desirable.
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Equations (24).
Gisele Bennett, Editor-in-Chief
Field error.
IMAGES
COMMENTS
In a controlled experiment, scientists compare a control group, and an experimental group is identical in all respects except for one difference - experimental manipulation.. Differences. Unlike the experimental group, the control group is not exposed to the independent variable under investigation. So, it provides a baseline against which any changes in the experimental group can be compared.
The control group and experimental group are compared against each other in an experiment. The only difference between the two groups is that the independent variable is changed in the experimental group. The independent variable is "controlled", or held constant, in the control group. A single experiment may include multiple experimental ...
A true experiment (a.k.a. a controlled experiment) always includes at least one control group that doesn't receive the experimental treatment.. However, some experiments use a within-subjects design to test treatments without a control group. In these designs, you usually compare one group's outcomes before and after a treatment (instead of comparing outcomes between different groups).
In this lesson, discover what is an experimental group, compare the difference between an experimental group and a control group, and examine two examples of experimental groups. Updated: 11/21/2023
There are two groups in the experiment, and they are identical except that one receives a treatment (water) while the other does not. The group that receives the treatment in an experiment (here, the watered pot) is called the experimental group, while the group that does not receive the treatment (here, the dry pot) is called the control group.The control group provides a baseline that lets ...
An experimental group in a scientific experiment is the group on which the experimental procedure is performed. The independent variable is changed for the group and the response or change in the dependent variable is recorded. In contrast, the group that does not receive the treatment or in which the independent variable is held constant is ...
In this experiment, the group of participants listening to no music while working out is the control group. They serve as a baseline with which to compare the performance of the other two groups. The other two groups in the experiment are the experimental groups. They each receive some level of the independent variable, which in this case is ...
In an experiment, the control is a standard or baseline group not exposed to the experimental treatment or manipulation.It serves as a comparison group to the experimental group, which does receive the treatment or manipulation. The control group helps to account for other variables that might influence the outcome, allowing researchers to attribute differences in results more confidently to ...
Three types of experimental designs are commonly used: 1. Independent Measures. Independent measures design, also known as between-groups, is an experimental design where different participants are used in each condition of the independent variable. This means that each condition of the experiment includes a different group of participants.
Published on April 19, 2021 by Pritha Bhandari . Revised on June 22, 2023. In experiments, researchers manipulate independent variables to test their effects on dependent variables. In a controlled experiment, all variables other than the independent variable are controlled or held constant so they don't influence the dependent variable.
A true experiment (aka a controlled experiment) always includes at least one control group that doesn't receive the experimental treatment.. However, some experiments use a within-subjects design to test treatments without a control group. In these designs, you usually compare one group's outcomes before and after a treatment (instead of comparing outcomes between different groups).
A control group is not the same thing as a control variable. A control variable or controlled variable is any factor that is held constant during an experiment. Examples of common control variables include temperature, duration, and sample size. The control variables are the same for both the control and experimental groups.
Positive control groups: In this case, researchers already know that a treatment is effective but want to learn more about the impact of variations of the treatment.In this case, the control group receives the treatment that is known to work, while the experimental group receives the variation so that researchers can learn more about how it performs and compares to the control.
A control group is typically thought of as the baseline in an experiment. In an experiment, clinical trial, or other sort of controlled study, there are at least two groups whose results are compared against each other. The experimental group receives some sort of treatment, and their results are compared against those of the control group ...
A true experiment (a.k.a. a controlled experiment) always includes at least one control group that doesn't receive the experimental treatment. However, some experiments use a within-subjects design to test treatments without a control group. In these designs, you usually compare one group's outcomes before and after a treatment (instead of ...
Experimental Group Definition. In a comparative experiment, the experimental group (aka the treatment group) is the group being tested for a reaction to a change in the variable. There may be experimental groups in a study, each testing a different level or amount of the variable. The other type of group, the control group, can show the effects ...
The experimental groups and the control group were raised under the same environment. After a period of time, various activity indexes of the experimental groups and the controlled group were evaluated. If there were differences, it was considered that drug addiction had different effects. If there were differences between the two experimental ...
control group, the standard to which comparisons are made in an experiment. Many experiments are designed to include a control group and one or more experimental groups; in fact, some scholars reserve the term experiment for study designs that include a control group. Ideally, the control group and the experimental groups are identical in every ...
Conclusion. Experimental treatment studies function in the way that they involve different groups, one of which serves as a control group to provide a baseline for the estimation of the treatment effect. The treatment therefore defines the group as independent variable, which is manipulated and therefore makes the investigation an experiment.
Definition. A study design that randomly assigns participants into an experimental group or a control group. As the study is conducted, the only expected difference between the control and experimental groups in a randomized controlled trial (RCT) is the outcome variable being studied.
In controlled experiments, researchers use random assignment (i.e. participants are randomly assigned to be in the experimental group or the control group) in order to minimize potential confounding variables in the study. For example, imagine a study of a new drug in which all of the female participants were assigned to the experimental group and all of the male participants were assigned to ...
A randomized control trial (RCT) is a type of study design that involves randomly assigning participants to either an experimental group or a control group to measure the effectiveness of an intervention or treatment. Randomized Controlled Trials (RCTs) are considered the "gold standard" in medical and health research due to their rigorous ...
A true experiment (aka a controlled experiment) always includes at least one control group that doesn't receive the experimental treatment. However, some experiments use a within-subjects design to test treatments without a control group. In these designs, you usually compare one group's outcomes before and after a treatment (instead of ...
By comparing the results from the experimental group against the control group, researchers can determine the effectiveness of the intervention in a more precise manner. The purpose of control groups is to minimize biases and ensure valid conclusions. They help in identifying whether observed changes in the experimental group are genuinely ...
The conductivity of the control group, the black locust group, the slash pine group and the Chinese white poplar was 213 mS s −1, 241 mS s −1, 226 mS s −1, and 235 mS s −1, respectively, when there was an increase of 13.1%, 6.1%, and 10.3% accordingly, compared with the control group.
Experimental E. coli infection of chickens by intratracheal route is associated with remarkable inflammatory responses as shown by changes in biochemical and hematological parameters. ... at the age of 3 days for six consecutive days has been associated with decreased serum levels of IFN-γ compared to control group in the early stages of drug ...
Figure 1 shows the study selection process. 29 studies were included. Extracted data for each study are in File S2.Almost all (n = 27) were pre-post design; 2 were experimental studies [13, 14].Table 1 lists summary information about the included studies. Seven reports described training delivered in single low-income countries, 19 studies described training in single lower middle income ...
To realize three-dimensional microscopic imaging with high time resolution and high space resolution at the same time, a multi-plane imaging method with constant axial multi-plane imaging quality is proposed. The optical theory to ensure that different axial sections have consistent lateral resolution has been analyzed. In the system, it is proposed to superimpose a spatial light modulator ...