Exploring Risk Perceptions of Emerging Infectious Diseases

This thesis is about risk perception of infectious diseases, with a special focus on the emerging infections SARS and avian influenza, and explores potential determinants of risk perception and the relation of risk perception with precautionary behaviours. In this first chapter I discuss the context of emerging diseases, the theoretical framework, relevant studies on risk perception and infectious diseases, and the research questions addressed in this thesis

The evolution of runaway stellar collision products

In the cores of young dense star clusters repeated stellar collisions involving the same object can occur, which has been suggested to lead to the formation of an intermediate-mass black hole. In order to verify this scenario we compute the detailed evolution of the merger remnant of three sequences. We follow the evolution until the onset of carbon burning and estimate the final remnant mass to determine the ultimate fate of a runaway merger sequence. We use a detailed stellar evolution code to follow the evolution of the collision product. At each collision, we mix the two colliding stars, taking account of mass loss during the collision. During the stellar evolution we apply mass loss rates from the literature, as appropriate for the evolutionary stage of the merger remnant. We compute models for high ($Z=0.02$) and low ($Z=0.001$) metallicity to quantify metallicity effects. We find that the merger remnant becomes a Wolf-Rayet star before the end of core hydrogen burning. Mass loss from stellar winds dominates over the mass increase due to repeated mergers for all three merger sequences that we consider. In none of our high metallicity models an intermediate-mass black hole is formed, instead our models have a mass of 10--14 \Msun{} at the onset of carbon burning. For low metallicity we expect the final remnant of the merger sequence to explode as a pair creation supernova. We find that our metal-rich models become inflated as a result of developing an extended low-density envelope. This may increase the probability of further collisions, but self-consistent $N$-body calculations with detailed evolution of runaway mergers are required to verify this.Comment: 10 pages, 6 figures, accepted for publication in A&A Updated with accepted versio

Nova Sco and coalescing low mass black hole binaries as LIGO sources

Double neutron star binaries, analogous to the well known Hulse--Taylor pulsar PSR 1913+16, are guaranteed-to-exist sources of high frequency gravitational radiation detectable by LIGO. There is considerable uncertainty in the estimated rate of coalescence of such systems, with conservative estimates of ~1 per million years per galaxy, and optimistic theoretical estimates one or more magnitude larger. Formation rates of low-mass black hole-neutron star binaries may be higher than those of NS-NS binaries, and may dominate the detectable LIGO signal rate. We estimate the enhanced coalescence rate for BH-BH binaries due to weak asymmetric kicks during the formation of low mass black holes like Nova Sco, and find they may contribute significantly to the LIGO signal rate, possibly dominating the phase I detectable signals if the range of BH masses for which there is significant kick is broad enough. For a standard Salpeter IMF, assuming mild natal kicks, we project that the R6 merger rate of BH-BH systems is ~0.5, smaller than that of NS-NS systems. However, the higher chirp mass of these systems produces a signal nearly four times greater, on average, with a commensurate increase in search volume. The BH-BH coalescence channel considered here also predicts that a substantial fraction of BH-BH systems should have at least one component with near-maximal spin (a/M ~ 1).The waveforms produced by the coalescence of such a system should produce a clear spin signature, so this hypothesis could be directly tested by LIGO.Comment: 16 pages, LaTeX/AASTeX, 5 figure

Skeletal muscle mass and sarcopenia can be determined with 1.5-T and 3-T neck MRI scans, in the event that no neck CT scan is performed

Objectives: Cross-sectional area (CSA) measurements of the neck musculature at the level of third cervical vertebra (C3) on CT scans are used to diagnose radiological sarcopenia, which is related to multiple adverse outcomes in head and neck cancer (HNC) patients. Alternatively, these assessments are performed with neck MRI, which has not been validated so far. For that, the objective was to evaluate whether skeletal muscle mass and sarcopenia can be assessed on neck MRI scans. Methods: HNC patients were included between November 2014 and November 2018 from a prospective data-biobank. CSAs of the neck musculature at the C3 level were measured on CT (n = 125) and MRI neck scans (n = 92 on 1.5-T, n = 33 on 3-T). Measurements were converted into skeletal muscle index (SMI), and sarcopenia was defined (SMI < 43.2 cm 2/m 2). Pearson correlation coefficients, Bland–Altman plots, McNemar test, Cohen’s kappa coefficients, and interclass correlation coefficients (ICCs) were estimated. Results: CT and MRI correlated highly on CSA and SMI (r = 0.958–0.998, p < 0.001). The Bland–Altman plots showed a nihil mean ΔSMI (− 0.13–0.44 cm 2/m 2). There was no significant difference between CT and MRI in diagnosing sarcopenia (McNemar, p = 0.5–1.0). Agreement on sarcopenia diagnosis was good with κ = 0.956–0.978 and κ = 0.870–0.933, for 1.5-T and 3-T respectively. Observer ICCs in MRI were excellent. In general, T2-weighted images had the best correlation and agreement with CT. Conclusions: Skeletal muscle mass and sarcopenia can interchangeably be assessed on CT and 1.5-T and 3-T MRI neck scans. This allows future clinical outcome assessment during treatment irrespective of used modality. Key Points: • Screening for low amount of skeletal muscle mass is usually measured on neck CT scans and is highly clinical relevant as it is related to multiple adverse outcomes in head and neck cancer patients. • We found that skeletal muscle mass and sarcopenia determined on CT and 1.5-T and 3-T MRI neck scans at the C3 level can be used interchangeably. • When CT imaging of the neck is missing for skeletal muscle mass analysis, patients can be assessed with 1.5-T or 3-T neck MRIs

Perceived Threat, Risk Perception, and Efficacy Beliefs Related to SARS and Other (Emerging) Infectious Diseases: Results of an International Survey

PURPOSE: To study the levels of perceived threat, perceived severity, perceived vulnerability, response efficacy, and self-efficacy for severe acute respiratory syndrome (SARS) and eight other diseases in five European and three Asian countries. METHOD: A computer-assisted phone survey was conducted among 3,436 respondents. The questionnaire focused on perceived threat, vulnerability, severity, response efficacy, and self-efficacy related to SARS and eight other diseases. RESULTS: Perceived threat of SARS in case of an outbreak in the country was higher than that of other diseases. Perceived vulnerability of SARS was at an intermediate level and perceived severity was high compared to other diseases. Perceived threat for SARS varied between countries in Europe and Asia with a higher perceived severity of SARS in Europe and a higher perceived vulnerability in Asia. Response efficacy and self-efficacy for SARS were higher in Asia compared to Europe. In multiple linear regression analyses, country was strongly associated with perceived threat. CONCLUSIONS: The relatively high perceived threat for SARS indicates that it is seen as a public health risk and offers a basis for communication in case of an outbreak. The strong association between perceived threat and country and different regional patterns require further researc

VLT/SINFONI time-resolved spectroscopy of the central, luminous, H-rich WN stars of R136

Using the Very Large Telescope's Spectrograph for INtegral Field Observation in the Near-Infrared (VLT/SINFONI), we have obtained repeated AO-assisted, NIR spectroscopy of the six central luminous, Wolf-Rayet (WR) stars in the core of the very young (~1 Myr), massive and dense cluster R136, in the Large Magellanic Cloud (LMC). We also de-archived available images that were obtained with the Hubble Space Telescope's Space Telescope Imaging Spectrograph (HST/STIS), and extracted high-quality, differential photometry of our target stars to check for any variability related to binary motion. Previous studies, relying on spatially unresolved, integrated, optical spectroscopy, had reported that one of these stars was likely to be a 4.377-day binary. Our study set out to identify the culprit and any other short-period system among our targets. However, none displays significant photometric variability, and only one star, BAT99-112 (R136c), located on the outer fringe of R136, displays a marginal variability in its radial velocities; we tentatively report an 8.2-day period. The binary status of BAT99-112 is supported by the fact that it is one of the brightest X-ray sources among all known WR stars in the LMC, consistent with it being a colliding-wind system. Follow-up observations have been proposed to confirm the orbital period of this potentially very massive system.Comment: 9 pages, 6 figures; accepted for publication in MNRA

The Galactic Population of Low- and Intermediate-Mass X-ray Binaries

(abridged) We present the first study that combines binary population synthesis in the Galactic disk and detailed evolutionary calculations of low- and intermediate-mass X-ray binaries (L/IMXBs). We show that the formation probability of IMXBs with initial donor masses of 1.5--4 Msun is typically >~5 times higher than that of standard LMXBs, and suggest that the majority of the observed systems may have descended from IMXBs. Distributions at the current epoch of the orbital periods, donor masses, and mass accretion rates have been computed, as have orbital-period distributions of BMPs. Several significant discrepancies between the theoretical and observed distributions are discussed. The orbital-period distribution of observed BMPs strongly favors cases where the envelope of the neutron-star progenitor is more easily ejected during the common-envelope phase. However, this leads to a >~100-fold overproduction of the theoretical number of luminous X-ray sources relative to the total observed number of LMXBs. X-ray irradiation of the donor star may result in a dramatic reduction in the X-ray active lifetime of L/IMXBs, thus possibly resolving the overproduction problem, as well as the long-standing BMP/LMXB birthrate problem.Comment: 12 pages, emulateapj, submitted to Ap

Bayesian analysis of weak gravitational lensing and Sunyaev-Zel'dovich data for six galaxy clusters

We present an analysis of observations made with the Arcminute Microkelvin Imager (AMI) and the Canada-France-Hawaii Telescope (CFHT) of six galaxy clusters in a redshift range of 0.16--0.41. The cluster gas is modelled using the Sunyaev--Zel'dovich (SZ) data provided by AMI, while the total mass is modelled using the lensing data from the CFHT. In this paper, we: i) find very good agreement between SZ measurements (assuming large-scale virialisation and a gas-fraction prior) and lensing measurements of the total cluster masses out to r_200; ii) perform the first multiple-component weak-lensing analysis of A115; iii) confirm the unusual separation between the gas and mass components in A1914; iv) jointly analyse the SZ and lensing data for the relaxed cluster A611, confirming our use of a simulation-derived mass-temperature relation for parameterizing measurements of the SZ effect.Comment: 22 pages, 12 figures, 12 tables, published by MNRA

Paradoxical risk perception and behaviours related to Avian Flu outbreak and education campaign, Laos

<p>Abstract</p> <p>Background</p> <p>In Laos, small backyard poultry systems predominate (90%). The first lethal human cases of highly pathogenic avian influenza (HPAI) occurred in 2007. Few studies have addressed the impact of outbreaks and education campaigns on a smallholder producer system. We evaluated awareness and behaviours related to educational campaigns and the 2007 HPAI outbreaks.</p> <p>Methods</p> <p>During a national 2-stage cross-sectional randomised survey we interviewed 1098 households using a pre-tested questionnaire in five provinces representative of the Southern to Northern strata of Laos. We used multivariate analysis (Stata, version 8; Stata Corporation, College Station, TX, USA) to analyse factors affecting recollection of HPAI educational messages, awareness of HPAI, and behaviour change.</p> <p>Results</p> <p>Of the 1098 participants, 303 (27.6%) received training on HPAI. The level of awareness was similar to that in 2006. The urban population considered risk to be decreased, yet unsafe behaviours persisted or increased. This contrasted with an increase in awareness and safe behaviour practices in rural areas.</p> <p>Reported behaviour changes in rural areas included higher rates of cessation of poultry consumption and dead poultry burial when compared to 2006. No participants reported poultry deaths to the authorities. Overall, 70% could recall an educational message but the content and accuracy differed widely depending on training exposure. Washing hands and other hygiene advice, messages given during the HPAI educational campaign, were not recalled. Trained persons were able to recall only one message while untrained participants recalled a broader range of messages. Factors associated with an awareness of a threat of AI in Laos were: having received HPAI training, literacy level, access to TV, recent information, living in rural areas.</p> <p>Conclusion</p> <p>We report a paradoxical relationship between unsafe behaviours and risk perception in urban areas, as well as exposure to HPAI training and message misinterpretation. Future educational campaigns need to be tailored to specific target populations and farming styles, for example, small holder farms as compared to commercial farms. Special attention must be given to varying risk perceptions and the risk of misinterpretation of key messages, economic hardship, and real life consequences of reporting.</p