Case definition Notified case • Admitted pneumonia or influenza or any cases R/O avian influenza with history of – contact to the sick or death poultry within 7 days before onset or – living in the village where there was abnormal death of poultry within 14 days before onset or – Contact to other pneumonia patients Suspect: • Notified case with severe pneumonia, or pneumonia with positive laboratory test for Influenza A Confirmed: • Patient who has laboratory confirmation of H5N1
An Investigation of Influenza A Outbreak in Boarding Schools, Yunnan Province, China, 2005
Method - Laboratory Investigation • Throat swabs were collected from children within the first 3 days of illness onset • Specimens were analyzed in the laboratory of Yunnan CDC • Influenza virus was isolated on Madin Darby canine Kidney (MDCK) cells
A Large Outbreak of Brucellosis among Farm Workers, Western Thailand - 2005 Theerayudh Sukmee 1 , Bumrungsana K. 1 , O’Reilly M. 1 , D. Ari M. 4 , Rangsin R. 5 , Leelayoova S. 5 , Chanachai K. 1 , Choomkasean P. 2 , Wattanasri S. 2 , Siriarayaporn P. 2 1. Field Epidemiology Training Program - Thailand, Bureau of Epidemiology 2. Bureau of Epidemiology, Department of Disease Control, Ministry of Public health. 3. Thailand MOPH – US CDC collaboration (TUC) 4. Meningitis and Special Pathogens Branch, US CDC 5. Phramongkutklao College of Medicine, Thailand.
Statistical analyses • Two-sided T tests used for univariate analysis. • Risk factors with p ≤ 0.20 were included in multivariate analysis. • Logistic-regression model developed by forward and change of estimate criteria.
Results What results slides do: • Show descriptive statistics on ill and non-ill persons studied • State laboratory results • Show results for primary analysis • Show results for secondary analysis • Can include observations from environmental survey
Results Slides Components: • Table of characteristics of ill and non-ill persons • Epi curve • Attack rates • Site map, where appropriate • Univariate analysis results • Multivariate analysis results • P values or CIs for measures of association • Other
Results Slides Components: • Viral/bacterial isolation yield • Serology, PCR, rapid test, IFA or other results • Dendogram • Nucleotide sequences • Other • Photos of environment
Results Slides Relative weight in 15 minute talk: 2-5 slides *Be selective; often, not all results can be included in a 15 minute talk
Case-control study of risk factors for Vibrio cholerae infection in a refugee camp, Thailand, 2005 Chawanee Sintuvongsanon Hanshaoworakul W., Areechokchai D. Pongkankham W., Suchatsunton C. Sukmee T., Sodprakod C. Iamsirithaworn S., Siriarayaporn P. FETP-Thailand Bureau of Epidemiology Department of Disease Control Ministry of Public Health
Attack rate of cholera cases C3 by section per 1000 population 3.7 6.9 C1A C4 C2 1.6 5.3 Attack rate by zone C5 B1 3.8 A 8.9 A = 3.6/1000 pop C1B 14.0 B B = 4.6/1000 pop 4.2 B3 B2 C C = 6.5/1000 pop 5.0 4.8 B4 5.6 5.8 B5 A1 7.1 A2 A3 0.9 2.7 A4 A5 11
Human Influenza A/H5N1 Cases Investigation in Urban Settings, China, 2006 Huai Yang M.D. International FETP-Thailand Office for Disease Control and Emergency Response, Chinese CDC E-mail: huaiyang12@gmail.com
Entry Entry Slaughter Store Sell Entry
Limitations Slides What limitations slides do: • Reassure your audience that you have a realistic understanding of your work’s ability to address hypotheses • Present honestly and openly potential weaknesses in your work
Limitations Slides • Bias and Confounding • Limited epi data • Did not get all data expected from cases • Poor response rate • Other • Limited laboratory results • Testing not available • Specimens not adequate • Analytic assumptions that may be invalid • Comparison groups not comparable • Assumptions about disease rarity
Limitations Slides Relative weight in 15 minute talk: 1 slide Up to 4 items *Honest presentation of limitations increases the audience’s confidence in your results/analysis
Retrospective Cohort Study of a Large Foodborne Botulism Outbreak in Thailand March, 2006 Kusak Bumrungsena 1 , M. O’Reilly 1 , C. Jiraphongsa 1 , A. Wannachak 1 , P. Doung-ngern 1 , W. Pongkankham 1 , T. Sukmee 1 , L. Sangsuk 2 , P. Siriarayapon 1 1 FETP – Thailand 2 NIH , Department of Medical Sciences
Limitations • In some early cases inadequate amount of serum collected or serum collected after administration of antitoxin. • We could not collect other suspected foods. • In emergency situation, clinical records may have been incomplete. Also, we relied on proxies for data in severe cases.
Conclusion What conclusion slides do: • Summarize key findings • Focus audience’s attention on important (sometimes unstated) material presented so far • Provides a segue to discussion
Conclusion Slides Components: • Statement of etiology, if not obvious • Statement of risk factor(s) • Statement of what is not a risk factor • Can include any key point in your presentation
Conclusion Slides Relative weight in 15 minute talk: 0-1 slides *Try to avoid simply restating your results
Retrospective Cohort Study of a Large Foodborne Botulism Outbreak in Thailand March, 2006 Kusak Bumrungsena 1 , M. O’Reilly 1 , C. Jiraphongsa 1 , A. Wannachak 1 , P. Doung-ngern 1 , W. Pongkankham 1 , T. Sukmee 1 , L. Sangsuk 2 , P. Siriarayapon 1 1 FETP – Thailand 2 NIH , Department of Medical Sciences
Conclusions • This was the largest foodborne botulism type A outbreak ever reported • High morbidity: - 56% attack rate among bamboo eaters - 43 (1/3 of admitted cases) intubated • No mortality
A Large Outbreak of Brucellosis among Farm Workers, Western Thailand - 2005 Theerayudh Sukmee 1 , Bumrungsana K. 1 , O’Reilly M. 1 , D. Ari M. 4 , Rangsin R. 5 , Leelayoova S. 5 , Chanachai K. 1 , Choomkasean P. 2 , Wattanasri S. 2 , Siriarayaporn P. 2 1. Field Epidemiology Training Program - Thailand, Bureau of Epidemiology 2. Bureau of Epidemiology, Department of Disease Control, Ministry of Public health. 3. Thailand MOPH – US CDC collaboration (TUC) 4. Meningitis and Special Pathogens Branch, US CDC 5. Phramongkutklao College of Medicine, Thailand.
Conclusions 1. This brucellosis outbreak was caused by occupational contact and inadequate self-protection. 2. High risk groups: • Animal husbandry assistants • Non-Thai workers 3. Obtaining goat blood practices increased risk of getting the disease.
Discussion What discussion slides do: • Provides a space for thoughtful discussion of a question that is addressed in the presentation, or one that arises from it • Answers the question “So what?” about your work • Describes possible directions of future work
Discussion Slides Components: • Paragraphs or key words signifying a coherent paragraph of thought about your work and the health problem it addresses • Highlights unanswered questions or next intellectual steps
Discussion Slides Relative weight in 15 minute talk: 1-3 slides *These are the most important (and fun) slides in your presentation; don’t leave this work to the last minute
Retrospective Cohort Study of a Large Foodborne Botulism Outbreak in Thailand March, 2006 Kusak Bumrungsena 1 , M. O’Reilly 1 , C. Jiraphongsa 1 , A. Wannachak 1 , P. Doung-ngern 1 , W. Pongkankham 1 , T. Sukmee 1 , L. Sangsuk 2 , P. Siriarayapon 1 1 FETP – Thailand 2 NIH , Department of Medical Sciences
No Mortality ! • Early diagnosis and rapid detection of additional cases may have prevented some cases from developing respiratory failure outside of the hospital setting. • Efficient use of good public health system infrastructure (referrals of 25 intubated patients to 10 different hospitals) • First botulism outbreak that utilized antitoxin in Thailand
Case-control study of risk factors for Vibrio cholerae infection in a refugee camp, Thailand, 2005 Chawanee Sintuvongsanon Hanshaoworakul W., Areechokchai D. Pongkankham W., Suchatsunton C. Sukmee T., Sodprakod C. Iamsirithaworn S., Siriarayaporn P. FETP-Thailand Bureau of Epidemiology Department of Disease Control Ministry of Public Health
Discussion • Overcrowding of houses in the camp made distance between latrines and wells shorter than recommended distance (30 m) • Shallow well water used for cooking, washing vegetables and so on, can contaminate food at many stages of preparation • Karen eating culture for some foods: cook at breakfast time; eat again at lunch without reheating (e.g. sticky rice, fish paste) - allows cholera to multiply 21
Recommendations What recommendation slides do: • Suggest practical next steps in prevention/control of the disease of interest • Point out ways to correct methodologic flaws • Provide a common sense approach to resolving a problem • Recommend initiating a new program – such as surveillance
Recommendation Slides Relative weight in 15 minute talk: 0-2 slides *Try not to reflexively recommend further study of the problem; make the recommendations practical; state if they have already been carried out
Recommendation Slides Some people advocate for public health actions slides instead of recommendations slides
Case-control study of risk factors for Vibrio cholerae infection in a refugee camp, Thailand, 2005 Chawanee Sintuvongsanon Hanshaoworakul W., Areechokchai D. Pongkankham W., Suchatsunton C. Sukmee T., Sodprakod C. Iamsirithaworn S., Siriarayaporn P. FETP-Thailand Bureau of Epidemiology Department of Disease Control Ministry of Public Health
Recommendations • Routine RSC in watery diarrhea cases should be performed when there is an ongoing cholera outbreak in nearby areas • If an adequate safe water is not available during the outbreak, well water should be treated with chlorine before use • Increase collaboration between NGO working in the camp and Thai public health officials for early investigation and control 23
Practicing your presentation • Budget time • How and what to practice • Where to practice • Anticipating questions • “Answer” slides
How and what to practice • Basic contents • Out loud 5 times • Keep timing until within limits (or close) • Transitions • Most important aspect of slide presentation; makes your talk coherent • Questions • Whenever audience is available, ask them to ask questions • Practice answering likely questions
Where to practice • Practice at least once at the podium/stage where you will present • Observe how your slides project • Pay attention to any special control knobs, microphone requirements, etc.
Anticipating questions “Answer” slides • Write out the 7-10 most likely questions and practice answering them out loud • Have the questioner pretend to be a person likely to ask a question • If you have time, prepare 3-5 slides that provide support for the answer of a specific question
Titles • Use of generic titles throughout a presentation should be discouraged • Especially uninteresting is a sequence of Methods 1, Methods 2, etc. • Use the title to convey more information, or get the audience excited
Text Density • If your English is very good/excellent, use a few key words for each point • If your English is OK, use more words for each point • If your English is not good, use full sentences and have your script mirror your text
Text Density • English excellent: a few key words • English OK: more words • English not good: use full sentences
Text Density • If your facility with spoken English is at a very good or excellent level, consider using only a few key words for each point • If your facility with English is at a moderate level, try to use more words and more complex grammar for each point • If your facility with English is poor, it would be best to use full sentences, complex grammar and full punctuation
Scripts • Write a script for every slide in a formal presentation • You can deviate from it if you are comfortable during your presentation • Writing the script forces you to construct more coherent, grammatically correct speech • Some people never use a script
Script and Text Interplay • Try to make your spoken and written words work together • Reading the text is boring! • If you list p values, consider saying CIs • If you list raw counts, consider saying percent • Dependent on English ability and text density
Guiding principles for tables, charts and graphs in slide presentations • Simplicity • Clarity • Integrity • Grace (not always obtainable)
Simplicity • Maximize ink used on data • Minimize ink used on everything else • Plain is better than fancy for slide presentations. • Avoid distractions: grid lines, 3-D, extraneous labels, fancy symbols
Children Aged ≤ 14 Years Injured in or Around Motor Vehicles, July 2000 – June 2001 Age - Nonfatal injuries Type of incident – Nonfatal injuries Other 10-14 15.1% 25.5% 0-3 30.7% Struck by MV Fell out of MV 39.6% 16.7% Run over or 4-9 backed over by MV 43.8% 28.6% Age - Fatal injuries Type of incident – Fatal injuries 10-14 3.8% Other 4-9 16.7% Left in MV 14.1% in hot weather MV put in motion 34.6% by child 12.8% Trunk Entrapment 9.0% 0-3 Backed over by MV 82.1% 26.9%
Clarity: The Ten-Ten Rule • Any graphic used in a scientific presentation should be clear enough that a ten year-old can understand the point(s) of the graphic after viewing the slide (and hearing you speak) for 10 seconds.
Dengue Fever Cases in Poipet Districts A , B and C: 2002-2006 90 80 70 Reported Cas 60 50 Dist A 40 Dist B 30 Dist C 20 10 0 2002 2003 2004-2005 2006 Years
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