Optimizing strategies for population-based chlamydia infection screening among young women: an age-structured system dynamics approach

BACKGROUND: Chlamydia infection (CT) is one of the most commonly reported sexually transmitted diseases. It is often referred to as a "silent" disease with the majority of infected people having no symptoms. Without early detection, it can progress to serious reproductive and other health problems. Economical identification of asymptomatically infected is a key public health challenge. Increasing evidence suggests that CT infection risk varies over the range of adolescence. Hence, age-dependent screening strategies with more frequent testing for certain age groups of higher risk may be cost-saving in controlling the disease. METHODS: We study the optimization of age-dependent screening strategies for population-based chlamydia infection screening among young women. We develop an age-structured compartment model for CT natural progress, screening, and treatment. We apply parameter optimization on the resultant PDE-based system dynamical models with the objective of minimizing the total care spending, including screening and treatment costs during the program period and anticipated costs of treating the sequelae afterwards). For ease of practical implementation, we also search for the best screening initiation age for strategies with a constant screening frequency. RESULTS: The optimal age-dependent strategies identified outperform the current CDC recommendations both in terms of total care spending and disease prevalence at the termination of the program. For example, the age-dependent strategy that allows monthly screening rate changes can save about 5% of the total spending. Our results suggest early initiation of CT screening is likely beneficial to the cost saving and prevalence reduction. Finally, our results imply that the strategy design may not be sensitive to accurate quantification of the age-specific CT infection risk if screening initiation age and screening rate are the only decisions to make. CONCLUSIONS: Our research demonstrates the potential economic benefit of age-dependent screening strategy design for population-based screening programs. It also showcases the applicability of age-structured system dynamical modeling to infectious disease control with increasing evidence on the age differences in infection risk. The research can be further improved with consideration of the difference between first-time infection and reinfection, as well as population heterogeneity in sexual partnership

Optimizing strategies for population-based chlamydia infection screening among young women: An age-structured system dynamics approach Infectious Disease epidemiology

Background Chlamydia infection (CT) is one of the most commonly reported sexually transmitted diseases. It is often referred to as a “silent” disease with the majority of infected people having no symptoms. Without early detection, it can progress to serious reproductive and other health problems. Economical identification of asymptomatically infected is a key public health challenge. Increasing evidence suggests that CT infection risk varies over the range of adolescence. Hence, age-dependent screening strategies with more frequent testing for certain age groups of higher risk may be cost-saving in controlling the disease. Methods We study the optimization of age-dependent screening strategies for population-based chlamydia infection screening among young women. We develop an age-structured compartment model for CT natural progress, screening, and treatment. We apply parameter optimization on the resultant PDE-based system dynamical models with the objective of minimizing the total care spending, including screening and treatment costs during the program period and anticipated costs of treating the sequelae afterwards). For ease of practical implementation, we also search for the best screening initiation age for strategies with a constant screening frequency. Results The optimal age-dependent strategies identified outperform the current CDC recommendations both in terms of total care spending and disease prevalence at the termination of the program. For example, the age-dependent strategy that allows monthly screening rate changes can save about 5 % of the total spending. Our results suggest early initiation of CT screening is likely beneficial to the cost saving and prevalence reduction. Finally, our results imply that the strategy design may not be sensitive to accurate quantification of the age-specific CT infection risk if screening initiation age and screening rate are the only decisions to make. Conclusions Our research demonstrates the potential economic benefit of age-dependent screening strategy design for population-based screening programs. It also showcases the applicability of age-structured system dynamical modeling to infectious disease control with increasing evidence on the age differences in infection risk. The research can be further improved with consideration of the difference between first-time infection and reinfection, as well as population heterogeneity in sexual partnership

Estimating Age-Dependent Per-Encounter Chlamydia Trachomatis Acquisition Risk Via a Markov-Based State-Transition Model.

Background Chlamydial infection is a common bacterial sexually transmitted infection worldwide, caused byC. trachomatis. The screening for C. trachomatis has been proven to be successful. However, such success is not fully realized through tailoring the recommended screening strategies for different age groups. This is partly due to the knowledge gap in understanding how the infection is correlated with age. In this paper, we estimate age-dependent risks of acquiring C. trachomatisby adolescent women via unprotected heterosexual acts. Methods We develop a time-varying Markov state-transition model and compute the incidences of chlamydial infection at discrete age points by simulating the state-transition model with candidate per-encounter acquisition risks and sampled numbers of unit-time unprotected coital events at different age points. We solve an optimization problem to identify the age-dependent estimates that offer the closest matches to the observed infection incidences. We also investigate the impact of antimicrobial treatment effectiveness on the parameter estimates and the differences between the acquisition risks for the first-time infections and repeated infections. Results Our case study supports the beliefs that age is an inverse predictor of C. trachomatistransmission and that protective immunity developed after initial infection is only partial. Conclusions Our modeling method offers a flexible and expandable platform for investigating STI transmission

Stabilizing Microwave Frequency of a Photonic Oscillator

A scheme for stabilizing the frequency of a microwave signal is proposed that exploits the operational characteristics of a coupled optoelectronic oscillator (COEO) and related optoelectronic equipment. An essential element in the scheme is a fiber mode-locked laser (MLL), the optical frequency of which is locked to an atomic transition. In this scheme, the optical frequency stability of the mode-locked laser is transferred to that of the microwave in the same device. Relative to prior schemes for using wideband optical frequency comb to stabilize microwave signals, this scheme is simpler and lends itself more readily to implementation in relatively compact, rugged equipment. The anticipated development of small, low-power, lightweight, highly stable microwave oscillators based on this scheme would afford great benefits in communication, navigation, metrology, and fundamental sciences. COEOs of various designs, at various stages of development, in some cases called by different names, have been described in a number of prior NASA Tech Briefs articles. A COEO is an optoelectronic apparatus that generates both short (picosecond) optical pulses and a steady microwave signal having an ultrahigh degree of spectral purity. The term "coupled optoelectronic" in the full name of such an apparatus signifies that its optical and electronic oscillations are coupled to each other in a single device. The present frequency-stabilization scheme is best described indirectly by describing the laboratory apparatus used to demonstrate it. The apparatus (see figure) includes a COEO that generates a comb-like optical spectrum, the various frequency components of which interfere, producing short optical pulses. This spectrum is centered at a nominal wavelength of 1,560 nm. The spectrum separation of this comb is about 10 GHz, as determined primarily by the length of an optical loop and the bandpass filter in the microwave feedback loop. The optical loop serves as microwave resonator having a very high value of the resonance quality factor (Q). The optical frequency of MLL is then stabilized by locking it to an atomic transition as described below. The COEO contains a tunable 1-nm band-pass optical filter and a piezoelectric-transducer (PZT) drum over which a stretch of fiber is wound. The 1-nm-wide pass band of the filter provides coarse tuning to overlap the frequency comb with the atomic transition frequency. Controlled stretching of the fiber by means of the PZT drum can be used in conjunction with temperature control for locking the laser frequency. To reference to an atomic resonance at 780 nm in this demonstration setup, the optical output of the COEO at 1,560 nm is fed through an erbium-doped-fiber amplifier (EDFA) to a frequency doubler in the form of a periodically poled lithium niobate (PPLN) crystal. The frequency-doubled output is combined with the output of a separate frequency-stabilized diode laser at a photodetector. As described thus far, the two 780-nm laser subsystems are nominally independent of each other and can, therefore, operate at different frequencies. Hence, at the photodetector, the two laser beams interfere, so that the output of the photodetector includes a beat note (a component at the difference between the two laser frequencies)

Measuring a Fiber-Optic Delay Line Using a Mode-Locked Laser

The figure schematically depicts a laboratory setup for determining the optical length of a fiber-optic delay line at a precision greater than that obtainable by use of optical time-domain reflectometry or of mechanical measurement of length during the delay-line-winding process. In this setup, the delay line becomes part of the resonant optical cavity that governs the frequency of oscillation of a mode-locked laser. The length can then be determined from frequency-domain measurements, as described below. The laboratory setup is basically an all-fiber ring laser in which the delay line constitutes part of the ring. Another part of the ring - the laser gain medium - is an erbium-doped fiber amplifier pumped by a diode laser at a wavelength of 980 nm. The loop also includes an optical isolator, two polarization controllers, and a polarizing beam splitter. The optical isolator enforces unidirectional lasing. The polarization beam splitter allows light in only one polarization mode to pass through the ring; light in the orthogonal polarization mode is rejected from the ring and utilized as a diagnostic output, which is fed to an optical spectrum analyzer and a photodetector. The photodetector output is fed to a radio-frequency spectrum analyzer and an oscilloscope. The fiber ring laser can generate continuous-wave radiation in non-mode-locked operation or ultrashort optical pulses in mode-locked operation. The mode-locked operation exhibited by this ring is said to be passive in the sense that no electro-optical modulator or other active optical component is used to achieve it. Passive mode locking is achieved by exploiting optical nonlinearity of passive components in such a manner as to obtain ultra-short optical pulses. In this setup, the particular nonlinear optical property exploited to achieve passive mode locking is nonlinear polarization rotation. This or any ring laser can support oscillation in multiple modes as long as sufficient gain is present to overcome losses in the ring. When mode locking is achieved, oscillation occurs in all the modes having the same phase and same polarization. The frequency interval between modes, often denoted the free spectral range (FSR), is given by c/nL, where c is the speed of light in vacuum, n is the effective index of refraction of the fiber, and L is the total length of optical path around the ring. Therefore, the length of the fiber-optic delay line, as part of the length around the ring, can be calculated from the FSRs measured with and without the delay line incorporated into the ring. For this purpose, the FSR measurements are made by use of the optical and radio-frequency spectrum analyzers. In experimentation on a 10-km-long fiber-optic delay line, it was found that this setup made it possible to measure the length to within a fractional error of about 3 10(exp -6), corresponding to a length error of 3 cm. In contrast, measurements by optical time-domain reflectometry and mechanical measurement were found to be much less precise: For optical time-domain reflectometry, the fractional error was found no less than 10(exp -4) (corresponding to a length error of 1 m) and for mechanical measurement, the fractional error was found to be about 10(exp -2) (corresponding to a length error of 100 m)

Asymmetric nanoparticle may go “active” at room temperature

Using molecular dynamics simulations, we show that an asymmetrically shaped nanoparticle in dilute solution possesses a spontaneously curved trajectory within a finite time interval, instead of the generally expected random walk. This unexpected dynamic behavior has a similarity to that of active matters, such as swimming bacteria, cells, or even fish, but is of a different physical origin. The key to the curved trajectory lies in the non-zero resultant force originated from the imbalance of the collision forces acted by surrounding solvent molecules on the asymmetrically shaped nanoparticle during its orientation regulation. Theoretical formulae based on microscopic observations have been derived to describe this non-zero force and the resulting motion of the asymmetrically shaped nanoparticle