Forecasting Influenza Outbreaks in Boroughs and Neighborhoods of New York City

The ideal spatial scale, or granularity, at which infectious disease incidence should be monitored and forecast has been little explored. By identifying the optimal granularity for a given disease and host population, and matching surveillance and prediction efforts to this scale, response to emergent and recurrent outbreaks can be improved. Here we explore how granularity and representation of spatial structure affect influenza forecast accuracy within New York City. We develop network models at the borough and neighborhood levels, and use them in conjunction with surveillance data and a data assimilation method to forecast influenza activity. These forecasts are compared to an alternate system that predicts influenza for each borough or neighborhood in isolation. At the borough scale, influenza epidemics are highly synchronous despite substantial differences in intensity, and inclusion of network connectivity among boroughs generally improves forecast accuracy. At the neighborhood scale, we observe much greater spatial heterogeneity among influenza outbreaks including substantial differences in local outbreak timing and structure; however, inclusion of the network model structure generally degrades forecast accuracy. One notable exception is that local outbreak onset, particularly when signal is modest, is better predicted with the network model. These findings suggest that observation and forecast at sub-municipal scales within New York City provides richer, more discriminant information on influenza incidence, particularly at the neighborhood scale where greater heterogeneity exists, and that the spatial spread of influenza among localities can be forecast

Presynchronizing PGF2α and GnRH injections before timed artificial insemination CO-Synch + CIDR program

Fixed-time artificial insemination is an effective management tool that reduces the labor associated with more conventional artificial insemination programs requiring detection of estrus. The 7-day CO-Synch + controlled internal drug release (CIDR) insert protocol has been shown to effectively initiate estrus and ovulation in cycling and non-cycling suckled beef cows, producing pregnancy rates at or greater than 50% in beef cows. The gonadotropin-releasing hormone (GnRH) injection that begins the CO-Synch + CIDR program initiates ovulation in a large proportion of cows, particularly anestrous cows. The CIDR, which releases progesterone intravaginally, prevents short estrous cycles that usually follow the first postpartum ovulation in beef cows. Our hypothesis was that inducing estrus with a prostaglandin injection followed 3 days later with a GnRH injection, 7 days before applying the 7-day CO-Synch + CIDR protocol, might increase the percentage of cycling cows that would exhibit synchronous follicular waves after the onset of the CO-Synch + CIDR protocol. We also hypothesized that the additional GnRH injection would increase the percentage of anestrous cows that would ovulate, thereby increasing pregnancy outcomes

Propagule Pressure and Stream Characteristics Influence Introgression: Cutthroat and Rainbow Trout in British Columbia

Hybridization and introgression between introduced and native salmonids threaten the continued persistence of many inland cutthroat trout species. Environmental models have been developed to predict the spread of introgression, but few studies have assessed the role of propagule pressure. We used an extensive set of fish stocking records and geographic information system (GIS) data to produce a spatially explicit index of potential propagule pressure exerted by introduced rainbow trout in the Upper Kootenay River, British Columbia, Canada. We then used logistic regression and the information-theoretic approach to test the ability of a set of environmental and spatial variables to predict the level of introgression between native westslope cutthroat trout and introduced rainbow trout. Introgression was assessed using between four and seven co-dominant, diagnostic nuclear markers at 45 sites in 31 different streams. The best model for predicting introgression included our GIS propagule pressure index and an environmental variable that accounted for the biogeoclimatic zone of the site (r2¼0.62). This model was 1.4 times more likely to explain introgression than the next-best model, which consisted of only the propagule pressure index variable. We created a composite model based on the model-averaged results of the seven top models that included environmental, spatial, and propagule pressure variables. The propagule pressure index had the highest importance weight (0.995) of all variables tested and was negatively related to sites with no introgression. This study used an index of propagule pressure and demonstrated that propagule pressure had the greatest influence on the level of introgression between a native and introduced trout in a human-induced hybrid zone

Microwave Brightness Temperatures of Tilted Convective Systems

Aircraft and ground-based radar data from the Tropical Ocean and Global Atmosphere Coupled-Ocean Atmosphere Response Experiment (TOGA COARE) show that convective systems are not always vertical. Instead, many are tilted from vertical. Satellite passive microwave radiometers observe the atmosphere at a viewing angle. For example, the Special Sensor Microwave/Imager (SSM/I) on Defense Meteorological Satellite Program (DMSP) satellites and the Tropical Rainfall Measurement Mission (TRMM) Microwave Imager (TMI) on the TRMM satellite have an incident angle of about 50deg. Thus, the brightness temperature measured from one direction of tilt may be different than that viewed from the opposite direction due to the different optical depth. This paper presents the investigation of passive microwave brightness temperatures of tilted convective systems. To account for the effect of tilt, a 3-D backward Monte Carlo radiative transfer model has been applied to a simple tilted cloud model and a dynamically evolving cloud model to derive the brightness temperature. The radiative transfer results indicate that brightness temperature varies when the viewing angle changes because of the different optical depth. The tilt increases the displacements between high 19 GHz brightness temperature (Tb(sub 19)) due to liquid emission from lower level of cloud and the low 85 GHz brightness temperature (Tb(sub 85)) due to ice scattering from upper level of cloud. As the resolution degrades, the difference of brightness temperature due to the change of viewing angle decreases dramatically. The dislocation between Tb(sub 19) and Tb(sub 85), however, remains prominent

Relationship of national institutes of health stroke scale to 30-day mortality in medicare beneficiaries with acute ischemic stroke.

BackgroundThe National Institutes of Health Stroke Scale (NIHSS), a well-validated tool for assessing initial stroke severity, has previously been shown to be associated with mortality in acute ischemic stroke. However, the relationship, optimal categorization, and risk discrimination with the NIHSS for predicting 30-day mortality among Medicare beneficiaries with acute ischemic stroke has not been well studied.Methods and resultsWe analyzed data from 33102 fee-for-service Medicare beneficiaries treated at 404 Get With The Guidelines-Stroke hospitals between April 2003 and December 2006 with NIHSS documented. The 30-day mortality rate by NIHSS as a continuous variable and by risk-tree determined or prespecified categories were analyzed, with discrimination of risk quantified by the c-statistic. In this cohort, mean age was 79.0 years and 58% were female. The median NIHSS score was 5 (25th to 75th percentile 2 to 12). There were 4496 deaths in the first 30 days (13.6%). There was a strong graded relation between increasing NIHSS score and higher 30-day mortality. The 30-day mortality rates for acute ischemic stroke by NIHSS categories were as follows: 0 to 7, 4.2%; 8 to 13, 13.9%; 14 to 21, 31.6%; 22 to 42, 53.5%. A model with NIHSS alone provided excellent discrimination whether included as a continuous variable (c-statistic 0.82 [0.81 to 0.83]), 4 categories (c-statistic 0.80 [0.79 to 0.80]), or 3 categories (c-statistic 0.79 [0.78 to 0.79]).ConclusionsThe NIHSS provides substantial prognostic information regarding 30-day mortality risk in Medicare beneficiaries with acute ischemic stroke. This index of stroke severity is a very strong discriminator of mortality risk, even in the absence of other clinical information, whether used as a continuous or categorical risk determinant. (J Am Heart Assoc. 2012;1:42-50.)

Patterns, predictors, variations, and temporal trends in emergency medical service hospital prenotification for acute ischemic stroke.

BACKGROUND#ENTITYSTARTX02014;: Emergency medical services (EMS) hospital prenotification of an incoming stroke patient is guideline recommended as a means of increasing the timeliness with which stroke patients are evaluated and treated. Still, data are limited with regard to national use of, variations in, and temporal trends in EMS prenotification and associated predictors of its use. METHODS AND RESULTS#ENTITYSTARTX02014;: We examined 371 988 patients with acute ischemic stroke who were transported by EMS and enrolled in 1585 hospitals participating in Get With The Guidelines-Stroke from April 1, 2003, through March 31, 2011. Prenotification occurred in 249 197 EMS-transported patients (67.0%) and varied widely by hospital (range, 0% to 100%). Substantial variations by geographic regions and by state, ranging from 19.7% in Washington, DC, to 93.4% in Montana, also were noted. Patient factors associated with lower use of prenotification included older age, diabetes mellitus, and peripheral vascular disease. Prenotification was less likely for black patients than for white patients (adjusted odds ratio 0.94, 95% confidence interval 0.92-0.97, P<0.0001). Hospital factors associated with greater EMS prenotification use were absence of academic affiliation, higher annual volume of tissue plasminogen activator administration, and geographic location outside the Northeast. Temporal improvements in prenotification rates showed a modest general increase, from 58.0% in 2003 to 67.3% in 2011 (P temporal trend <0.0001). CONCLUSIONS#ENTITYSTARTX02014;: EMS hospital prenotification is guideline recommended, yet among patients transported to Get With The Guidelines-Stroke hospitals it is not provided for 1 in 3 EMS-arriving patients with acute ischemic stroke and varies substantially by hospital, state, and region. These results support the need for enhanced implementation of stroke systems of care. (J Am Heart Assoc. 2012;1:e002345 doi: 10.1161/JAHA.112.002345.)