The Unknown Ecology of an Environmental Pathogen: Buruli ulcer Disease in West Africa

http://www.gis.ku.edu/gisday/2013/Platinum Sponsors KU Institute for Policy & Social Research Gold Sponsors Bartlett & West KU Department of Geography KU Libraries State of Kansas Data Access and Support Center (DASC) Silver Sponsors Kansas Biological Survey KU Center for Global & International Studies KU Environmental Studies Program Bronze Sponsors Global Information Systems KU Center for Remote Sensing of Ice Sheets (CReSIS) TREKK Design Group, LL

Modeling Approaches to Investigating Distributions, Abundances, and Connectivity of Mosquito Vector Species

Vector-borne and zoonotic diseases comprise a serious public health concern globally. Over the past 30 years, an increase in newly-emerging vector-borne pathogens, coupled with the broader dispersal of known pathogens, has resulted in substantial challenges for public health intervention and prevention programs. This burden highlights the need for continued improvement of modeling approaches and prediction methods to help identify areas vulnerable to infection, thereby contributing toward more efficient distributions of limited public health resources. The field of disease ecology emphasizes interactions between disease system components and the natural environment, recognizing that humans are not always the catalyst for pathogen dispersal and distributions. While incorporating environmental factors in assessing potential pathogen risk is a logical first step, complexities in this approach exist because pathogens are nested within the broader community ecology of host, vector, and reservoir species, and often, not all of these elements are known. Although this element poses challenges to understanding limiting factors of specific environmental pathogens, the multitude of components within individual disease systems offer several avenues from which to study patterns, providing insight into risk. Mosquito vectors are one such component. This knowledge, coupled with advances in geospatial technologies, provides excellent opportunities to model environmental factors contributing to potential pathogen distributions and to help predict disease risk in humans. Here, I present three ecological modeling approaches to quantify and predict suitable environments, abundances, and connectivity for three mosquito vector species important to human and domestic livestock health. The first chapter delivers a global model of suitable environments for Aedes aegypti and Ae. albopictus under present and future climate change calibrated on presence-only data. The second chapter outlines a new approach to predicting Ae. mcintoshi abundances in Kenya and western Somalia at an 8-day temporal resolution during October to January from 2002 – 2015. The third chapter demonstrates the potential to investigate Ae. mcintoshi population genetic structure and associations between environmental variables across eastern Kenya using gene sequence data. Each of these chapters address individual research questions using a disease ecology approach, while contributing more broadly to knowledge of mosquito vector ecologies and the potential for human disease risk

Typhoon frequency and intensity across the Western Pacific Ocean north of the Equator, 1951 – 2014

Disturbance has been a repeated theme in ecology in recent decades, yet incorporating its frequency and pattern at broad spatial scales into ecological analyses has been difficult – rather, most environmental datasets used in broad-extent analyses represent average conditions. We present a detailed dataset summarizing the frequency (i.e., number of typhoons) and intensity (average and maximum windspeeds) of typhoons across the Western Pacific north of the Equator, based on data characterizing tracks for 1673 typhoons from the Japan Meteorological Center. The data presented are aggregated and resampled to 0.2° (~22 km at the Equator) spatial resolution; temporal coverage extends 1951 – 2014. We also present data specifically for prior to 1980 and after 1999, to respond to questions related to climate change, although no major changes were evident between the time periods

Potential distribution of a new Bacillus species causing anthrax in African rainforests

This presentation was given as part of the GIS Day@KU symposium on November 14, 2018. For more information about GIS Day@KU activities, please see http://gis.ku.edu/gisday/2018/PLATINUM SPONSORS: KU Department of Geography and Atmospheric Science KU Institute for Policy & Social Research GOLD SPONSORS: KU Libraries State of Kansas Data Access & Support Center (DASC) SILVER SPONSORS: Bartlett & West Kansas Applied Remote Sensing Program KU Center for Global and International Studies BRONZE SPONSORS: Boundles

Nurse led interventions to improve control of blood pressure in people with hypertension: systematic review and meta-analysis

Objective To review trials of nurse led interventions for hypertension in primary care to clarify the evidence base, establish whether nurse prescribing is an important intervention, and identify areas requiring further study

Muscle Activated 3D Printed Prosthetic Arm

Due to the rapid growth of children and the cost of myoelectric technology, children are not given the same opportunities to use myoelectric prosthetics as adults. The Muscle Activated Prosthesis (MAP) team seeks to reconcile this by creating an affordable, trans-radial, myoelectric prosthesis that utilizes the flexibility of 3D printing technology for a fourteen-year-old congenital amputee named Lily. The MAP team has completed the design and prototype of a myoelectric prosthesis with a material cost of approximately $1,000 as opposed to the$10,000-$20,000 cost of clinically accepted myoelectric prosthetic upper limbs. The 3D printed prosthetic arm prototype incorporates electromyography (EMG) electrodes, a motor and tendon system, an open-source prosthetic hand design, a custom printed circuit board (PCB), and lithium-ion battery power. The opening and closing of the prosthetic hand is controlled by the myoelectric signals from the user’s forearm contractions which can be tested by the team using our adaptive prosthetic attachment. All these components result in an affordable prosthetic that has the potential for customization and adaptation to different sized limbs. Funding for this work provided by The Collaboratory for Strategic Partnerships and Applied Research.https://mosaic.messiah.edu/engr2022/1009/thumbnail.jp

Relative effectiveness of insulin pump treatment over multiple daily injections and structured education during flexible intensive insulin treatment for type 1 diabetes: cluster randomised trial (REPOSE).

Objective To compare the effectiveness of insulin pumps with multiple daily injections for adults with type 1 diabetes, with both groups receiving equivalent training in flexible insulin treatment.Design Pragmatic, multicentre, open label, parallel group, cluster randomised controlled trial (Relative Effectiveness of Pumps Over MDI and Structured Education (REPOSE) trial).Setting Eight secondary care centres in England and Scotland.Participants Adults with type 1 diabetes who were willing to undertake intensive insulin treatment, with no preference for pumps or multiple daily injections. Participants were allocated a place on established group training courses that taught flexible intensive insulin treatment ("dose adjustment for normal eating," DAFNE). The course groups (the clusters) were then randomly allocated in pairs to either pump or multiple daily injections.Interventions Participants attended training in flexible insulin treatment (using insulin analogues) structured around the use of pump or injections, followed for two years.Main outcome measures The primary outcomes were a change in glycated haemoglobin (HbA1c) values (%) at two years in participants with baseline HbA1c value of ≥7.5% (58 mmol/mol), and the proportion of participants achieving an HbA1c value of <7.5%. Secondary outcomes included body weight, insulin dose, and episodes of moderate and severe hypoglycaemia. Ancillary outcomes included quality of life and treatment satisfaction.Results 317 participants (46 courses) were randomised (156 pump and 161 injections). 267 attended courses and 260 were included in the intention to treat analysis, of which 235 (119 pump and 116 injection) had baseline HbA1c values of ≥7.5%. Glycaemic control and rates of severe hypoglycaemia improved in both groups. The mean change in HbA1c at two years was -0.85% with pump treatment and -0.42% with multiple daily injections. Adjusting for course, centre, age, sex, and accounting for missing values, the difference was -0.24% (-2.7 mmol/mol) in favour of pump users (95% confidence interval -0.53 to 0.05, P=0.10). Most psychosocial measures showed no difference, but pump users showed greater improvement in treatment satisfaction and some quality of life domains (dietary freedom and daily hassle) at 12 and 24 months.Conclusions Both groups showed clinically relevant and long lasting decreases in HbA1c, rates of severe hypoglycaemia, and improved psychological measures, although few participants achieved glucose levels currently recommended by national and international guidelines. Adding pump treatment to structured training in flexible intensive insulin treatment did not substantially enhance educational benefits on glycaemic control, hypoglycaemia, or psychosocial outcomes in adults with type 1 diabetes. These results do not support a policy of providing insulin pumps to adults with poor glycaemic control until the effects of training on participants' level of engagement in intensive self management have been determined.Trial registration Current Controlled Trials ISRCTN61215213.This research was funded by the UK Health Technology Assessment Programme (project No 08/107/01) and will be published in full in Health Technology Assessment. See the HTA programme website for further project information. (http://www.nets.nihr.ac.uk/). This report presents independent research commissioned by the National Institute for Health Research (NIHR). We also acknowledge financial support from the Research and Development Programmes of the Department of Health for England and the Scottish Health and Social Care Directorates who supported the costs of consumables, and of Medtronic UK, which provided the insulin pumps for the trial. These funders had no involvement in the design of the protocol; the collection, analysis, and interpretation of the data; the writing of this paper; or the decision to submit this article for publication. The views and opinions expressed herein are those of the authors and do not necessarily reflect those of the HTA, NIHR, NHS, the Department of Health, or Medtronic UK

Predicting Abundances of Aedes mcintoshi, a primary Rift Valley fever virus mosquito vector

Rift Valley fever virus (RVFV) is a mosquito-borne zoonotic arbovirus with important livestock and human health, and economic consequences across Africa and the Arabian Peninsula. Climate and vegetation monitoring guide RVFV forecasting models and early warning systems; however, these approaches make monthly predictions and a need exists to predict primary vector abundances at finer temporal scales. In Kenya, an important primary RVFV vector is the mosquito Aedes mcintoshi. We used a zero-inflated negative binomial regression and multimodel averaging approach with georeferenced Ae. mcintoshi mosquito counts and remotely sensed climate and topographic variables to predict where and when abundances would be high in Kenya and western Somalia. The data supported a positive effect on abundance of minimum wetness index values within 500 m of a sampling site, cumulative precipitation values 0 to 14 days prior to sampling, and elevated land surface temperature values ~3 weeks prior to sampling. The probability of structural zero counts of mosquitoes increased as percentage clay in the soil decreased. Weekly retrospective predictions for unsampled locations across the study area between 1 September and 25 January from 2002 to 2016 predicted high abundances prior to RVFV outbreaks in multiple foci during the 2006–2007 epizootic, except for two districts in Kenya. Additionally, model predictions supported the possibility of high Ae. mcintoshi abundances in Somalia, independent of Kenya. Model-predicted abundances were low during the 2015–2016 period when documented outbreaks did not occur, although several surveillance systems issued warnings. Model predictions prior to the 2018 RVFV outbreak indicated elevated abundances in Wajir County, Kenya, along the border with Somalia, but RVFV activity occurred west of the focus of predicted high Ae. mcintoshi abundances

Potential distributions of Bacillus anthracis and Bacillus cereus biovar anthracis causing anthrax in Africa

Background Bacillus cereus biovar anthracis (Bcbva) is an emergent bacterium closely related to Bacillus anthracis, the etiological agent of anthrax. The latter has a worldwide distribution and usually causes infectious disease in mammals associated with savanna ecosystems. Bcbva was identified in humid tropical forests of Côte d’Ivoire in 2001. Here, we characterize the potential geographic distributions of Bcbva in West Africa and B. anthracis in sub-Saharan Africa using an ecological niche modeling approach. Methodology/Principal findings Georeferenced occurrence data for B. anthracis and Bcbva were obtained from public data repositories and the scientific literature. Combinations of temperature, humidity, vegetation greenness, and soils values served as environmental variables in model calibrations. To predict the potential distribution of suitable environments for each pathogen across the study region, parameter values derived from the median of 10 replicates of the best-performing model for each pathogen were used. We found suitable environments predicted for B. anthracis across areas of confirmed and suspected anthrax activity in sub-Saharan Africa, including an east-west corridor from Ethiopia to Sierra Leone in the Sahel region and multiple areas in eastern, central, and southern Africa. The study area for Bcbva was restricted to West and Central Africa to reflect areas that have likely been accessible to Bcbva by dispersal. Model predicted values indicated potential suitable environments within humid forested environments. Background similarity tests in geographic space indicated statistical support to reject the null hypothesis of similarity when comparing environments associated with B. anthracis to those of Bcbva and when comparing humidity values and soils values individually. We failed to reject the null hypothesis of similarity when comparing environments associated with Bcbva to those of B. anthracis, suggesting that additional investigation is needed to provide a more robust characterization of the Bcbva niche. Conclusions/Significance This study represents the first time that the environmental and geographic distribution of Bcbva has been mapped. We document likely differences in ecological niche—and consequently in geographic distribution—between Bcbva and typical B. anthracis, and areas of possible co-occurrence between the two. We provide information crucial to guiding and improving monitoring efforts focused on these pathogens