Impact of imperfect test sensitivity on determining risk factors : the case of bovine tuberculosis

Background Imperfect diagnostic testing reduces the power to detect significant predictors in classical cross-sectional studies. Assuming that the misclassification in diagnosis is random this can be dealt with by increasing the sample size of a study. However, the effects of imperfect tests in longitudinal data analyses are not as straightforward to anticipate, especially if the outcome of the test influences behaviour. The aim of this paper is to investigate the impact of imperfect test sensitivity on the determination of predictor variables in a longitudinal study. Methodology/Principal Findings To deal with imperfect test sensitivity affecting the response variable, we transformed the observed response variable into a set of possible temporal patterns of true disease status, whose prior probability was a function of the test sensitivity. We fitted a Bayesian discrete time survival model using an MCMC algorithm that treats the true response patterns as unknown parameters in the model. We applied our approach to epidemiological data of bovine tuberculosis outbreaks in England and investigated the effect of reduced test sensitivity in the determination of risk factors for the disease. We found that reduced test sensitivity led to changes to the collection of risk factors associated with the probability of an outbreak that were chosen in the ‘best’ model and to an increase in the uncertainty surrounding the parameter estimates for a model with a fixed set of risk factors that were associated with the response variable. Conclusions/Significance We propose a novel algorithm to fit discrete survival models for longitudinal data where values of the response variable are uncertain. When analysing longitudinal data, uncertainty surrounding the response variable will affect the significance of the predictors and should therefore be accounted for either at the design stage by increasing the sample size or at the post analysis stage by conducting appropriate sensitivity analyses

Adaptive strategies of African horse sickness virus to facilitate vector transmission

African horse sickness virus (AHSV) is an orbivirus that is usually transmitted between its equid hosts by adult Culicoides midges. In this article, we review the ways in which AHSV may have adapted to this mode of transmission. The AHSV particle can be modified by the pH or proteolytic enzymes of its immediate environment, altering its ability to infect different cell types. The degree of pathogenesis in the host and vector may also represent adaptations maximising the likelihood of successful vectorial transmission. However, speculation upon several adaptations for vectorial transmission is based upon research on related viruses such as bluetongue virus (BTV), and further direct studies of AHSV are required in order to improve our understanding of this important virus

The Spread of Bluetongue Virus Serotype 8 in Great Britain and Its Control by Vaccination

Bluetongue (BT) is a viral disease of ruminants transmitted by Culicoides biting midges and has the ability to spread rapidly over large distances. In the summer of 2006, BTV serotype 8 (BTV-8) emerged for the first time in northern Europe, resulting in over 2000 infected farms by the end of the year. The virus subsequently overwintered and has since spread across much of Europe, causing tens of thousands of livestock deaths. In August 2007, BTV-8 reached Great Britain (GB), threatening the large and valuable livestock industry. A voluntary vaccination scheme was launched in GB in May 2008 and, in contrast with elsewhere in Europe, there were no reported cases in GB during 2008.Here, we use carefully parameterised mathematical models to investigate the spread of BTV in GB and its control by vaccination. In the absence of vaccination, the model predicted severe outbreaks of BTV, particularly for warmer temperatures. Vaccination was predicted to reduce the severity of epidemics, with the greatest reduction achieved for high levels (95%) of vaccine uptake. However, even at this level of uptake the model predicted some spread of BTV. The sensitivity of the predictions to vaccination parameters (time to full protection in cattle, vaccine efficacy), the shape of the transmission kernel and temperature dependence in the transmission of BTV between farms was assessed.A combination of lower temperatures and high levels of vaccine uptake (>80%) in the previously-affected areas are likely to be the major contributing factors in the control achieved in England in 2008. However, low levels of vaccination against BTV-8 or the introduction of other serotypes could result in further, potentially severe outbreaks in future

A Modeling Framework to Describe the Transmission of Bluetongue Virus within and between Farms in Great Britain

Recently much attention has been given to developing national-scale micro-simulation models for livestock diseases that can be used to predict spread and assess the impact of control measures. The focus of these models has been on directly transmitted infections with little attention given to vector-borne diseases such as bluetongue, a viral disease of ruminants transmitted by Culicoides biting midges. Yet BT has emerged over the past decade as one of the most important diseases of livestock.We developed a stochastic, spatially-explicit, farm-level model to describe the spread of bluetongue virus (BTV) within and between farms. Transmission between farms was modeled by a generic kernel, which includes both animal and vector movements. Once a farm acquired infection, the within-farm dynamics were simulated based on the number of cattle and sheep kept on the farm and on local temperatures. Parameter estimates were derived from the published literature and using data from the outbreak of bluetongue in northern Europe in 2006. The model was validated using data on the spread of BTV in Great Britain during 2007. The sensitivity of model predictions to the shape of the transmission kernel was assessed.The model is able to replicate the dynamics of BTV in Great Britain. Although uncertainty remains over the precise shape of the transmission kernel and certain aspects of the vector, the modeling approach we develop constitutes an ideal framework in which to incorporate these aspects as more and better data become available. Moreover, the model provides a tool with which to examine scenarios for the spread and control of BTV in Great Britain

Subject specific and population average models for binary longitudinal data: a tutorial

Using data from the British Household Panel Survey, we illustrate how longitudinal repeated measures of binary outcomes are analysed using population average and subject specific logistic regression models. We show how the autocorrelation found in longitudinal data is accounted for by both approaches, and why, in contrast to linear models for continuous outcomes, the parameters of population average and subject specific models for binary outcomes are different. To illustrate these points, we fit different models to our data set using both approaches, and compare and contrast the results obtained. Finally, we use our example to provide some guidance on how to choose between the two approaches

Adaptación de la prueba Rossetti Infant - Toddler Language Scale para evaluar la comunicación y el juego en niños de 24 a 36 meses en instituciones educativas públicas y privadas de los distritos de Lince, Pueblo Libre, San Miguel, Magdalena y Jesús María

TesisLa presente investigación corresponde al proceso de adaptación de la prueba Rossetti Infant Toddler Language Scale que constituye un instrumento válido y confiable para la evaluación de las competencias lingüísticas y juego en niños pequeños, evaluando las áreas: de gesto, juego, lenguaje comprensivo y lenguaje expresivo. La información del trabajo proporciona datos basados en la adaptación de esta prueba a una muestra de 242 niños de ambos sexos entre 24 a 36 meses de edad. Cabe mencionar, que para la validez de la prueba se realizó la validez de contenido a través del criterio de jueces siendo los resultados procesados a través del estadístico de Aiken. Asimismo, se estudió la validez factorial mediante un análisis factorial exploratorio. Por otro lado, el análisis de la confiabilidad se obtuvo a través del Coeficiente Alfa de Cronbach. Finalmente se proporciona las puntuaciones medias y desviaciones típicas para las diferentes partes de la prueba, así como datos sobre los baremos de acuerdo a rangos percentiles para los infantes de Lima Metropolitana agrupados por edades. Palabras claves: Competencias lingüísticas, adaptación, lenguaje comprensivo, lenguaje expresivo, Rossetti

Factors associated with herd restriction and de-restriction with bovine tuberculosis in British cattle herds

The incidence of herd breakdown (HBD) with bovine tuberculosis (bTB) has continued to increase year on year since the 1980s in Great Britain. The management of bTB constitutes a major challenge for government and the cattle industry. Whilst various factors have been implicated with the risk of HBD with bTB, factors involved in recovery are less well described. In this paper, we used a multilevel multistate model to identify the factors affecting the probability of a herd being placed under restriction following a bTB outbreak and the factors involved in those restrictions being lifted. By modelling both transitions within the same model, we control for unobserved herd-specific characteristics, and investigate the frequency of change between the restricted and derestricted states. There were two patterns of herd breakdown: transient (characterised by fast cycling between restricted and derestricted states) and continuous (characterised by rare changes between the two states). The risk of a herd being placed under restriction was dominated by predictors related to cattle movements. The probability of derestriction increased with more regular testing. Some risks affected both transitions, namely log(e) mean size of neighbouring herds in the test-year, whether the herd bred its own replacements and the foot and mouth disease indicator of whether a bTB test was done between February 2002 and January 2003, possibly because the underlying true state of the herd, as infected or not, meant that these factors increased or reduced the risk of HBD. These results highlight that management of bTB is dependent on the true underlying herd status of bTB infection and that some confusion of the benefits or otherwise of some management practices, e.g. using home bred replacements can be explained by this underlying status

Best fit models obtained for each sensitivity value tested.

<p>The values are given as posterior mean estimate plus posterior standard deviation (sd). The different predictors are grouped according to the type of predictor. The predictors in italic indicate protective factors and the predictors in bold indicate non-significant differences for categorical predictors.</p