Guiding Health Care Policy through Applied Public Health Modeling and Simulation

The risk of a widespread epidemic is a primary public health concern with implications for healthcare providers and organizations. Modeling and simulation techniques have been successfully applied at the national level to set governmental polices and mitigation strategies through simulation-based predictions. Existing research in this field has been non-uniform in its coverage of local systems and region-specific findings. New collaborations between on the ground providers and modeling groups are required for successful simulation-based experimentation of region-specific health systems. These proposed collaborations are expected to contribute high-quality sub-population datasets to be used in experiments at the national level and allow for the reuse of existing disease models and simulation infrastructure in support of regional predictive experimentation

Resources for instructors of capstone courses in computing

Most computing programs now have some form of integrative or capstone course in which students undertake a significant project under supervision. There are many different models for such courses and conducting these courses is a complex task. This report is intended to assist instructors of capstone courses, particularly those new to the model of teaching and learning inherent in the capstone course.This paper discusses important issues that must be addressed when conducting capstone courses. These issues are addressed through a series of questions, with answers reflecting the way that different institutions have chosen to handle them, and commentary on the impact of these different choices. These questions include: Goals of the Course; Characteristics of Projects; Project Deliverables; Sponsors; Teams; Prerequisites and Preparation; Grading and Assessment; Administration and Supervision; and Reflection, Analysis and Review.Subsequently we present information about the companion Web site, intended as an active repository of best practice for instructors of capstone projects. The Web site will have examples of information about capstone courses and materials used by instructors. Readers are invited to contribute content to this site. The paper concludes with a bibliography of additional reference material and resources

Mining Mobile Datasets to Enable the Fine-Grained Stochastic Simulation of Ebola Diffusion

The emergence of Ebola in West Africa is of worldwide public health concern. Successful miti- gation of epidemics requires coordinated, well-planned intervention strategies that are specific to the pathogen, transmission modality, population, and available resources. Modeling and sim- ulation in the field of computational epidemiology provides predictions of expected outcomes that are used by public policy planners in setting response strategies. Developing up to date models of population structures, daily activities, and movement has proven challenging for developing countries due to limited governmental resources. Recent collaborations (in 2012 and 2014) with telecom providers have given public health researchers access to Big Data needed to build high-fidelity models. Researchers now have access to billions of anonymized, detailed call data records (CDR) of mobile devices for several West African countries. In addition to official census records, these CDR datasets provide insights into the actual population locations, densities, movement, travel patterns, and migration in hard to reach areas. These datasets allow for the construction of population, activity, and movement models. For the first time, these models provide computational support of health related decision making in these developing areas (via simulation-based studies). New models, datasets, and simulation software were produced to assist in mitigating the continuing outbreak of Ebola. Existing models of disease characteristics, propagation, and progression were updated for the current circulating strain of Ebola. The simulation process required the interactions of multi-scale models, including viral loads (at the cellular level), disease progression (at the individual person level), disease propagation (at the workplace and family level), societal changes in migration and travel movements (at the population level), and mitigating interventions (at the abstract governmental policy level). The predictive results from this system were validated against results from the CDC\u27s high-level predictions

X-Ray, UV, and radio timing observations of the radio galaxy 3C 120

We report the results of monitoring of the radio galaxy 3C 120 with the Neil Gehrels Swift Observatory, Very Long Baseline Array, and Metsähovi Radio Observatory. The UV-optical continuum spectrum and R-band polarization can be explained by a superposition of an inverted-spectrum source with a synchrotron component containing a disordered magnetic field. The UV-optical and X-ray light curves include dips and flares, while several superluminal knots appear in the parsec-scale jet. The recovery time of the second dip was longer at UV-optical wavelengths, in conflict with a model in which the inner accretion disk (AD) is disrupted during a dip and then refilled from outer to inner radii. We favor an alternative scenario in which occasional polar alignments of the magnetic field in the disk and corona cause the flux dips and formation of shocks in the jet. Similar to observations of Seyfert galaxies, intra-band time lags of flux variations are longer than predicted by the standard AD model. This suggests that scattering or some other reprocessing occurs. The 37 GHz light curve is well-correlated with the optical-UV variations, with a ∼20 day delay. A radio flare in the jet occurred in a superluminal knot 0.14 milliarcseconds downstream of the 43 GHz "core," which places the site of the preceding X-ray/UV/optical flare within the core 0.5–1.3 pc from the black hole. The inverted UV-optical flare spectrum can be explained by a nearly monoenergetic electron distribution with energy similar to the minimum energy inferred in the TeV γ-ray emitting regions of some BL Lacertae objects.The authors thank I. McHardy, R. Antonucci, and B. Punsly for informative discussions. This study was supported in part by NASA through Swift Guest Investigator grant NNX16AN69G, Fermi Guest Investigator grants NNX14AQ58G and 80NSSC17K0649, and by National Science Foundation grant AST-1615796. This publication makes use of data obtained at the Metsahovi Radio Observatory, operated by Aalto University in Finland. The VLBA is an instrument of the National Radio Astronomy Observatory. The National Radio Astronomy Observatory is a facility of the National Science Foundation operated under cooperative agreement by Associated Universities, Inc. This research has made use of the NASA/IPAC Extragalactic Database (NED), which is operated by the Jet Propulsion Laboratory, California Institute of Technology, under contract with the National Aeronautics and Space Administration. (NNX16AN69G - NASA; NNX14AQ58G - NASA; 80NSSC17K0649 - NASA; AST-1615796 - National Science Foundation; National Aeronautics and Space Administration)Accepted manuscrip

The course of the acute vertebral body fragility fracture: its effect on pain, disability and quality of life during 12 months

The vertebral body fracture is the most frequent bone fragility fracture. In spite of this there is considerable uncertainty about the frequency, extent and severity of the acute pain and even more about the duration of pain, the magnitude of disability and how much daily life is disturbed in the post-fracture period. The aim of the present study was to follow the course of pain, disability, ADL and QoL in patients during the year after an acute low energy vertebral body fracture. The study design was a longitudinal cohort study with prospective data collection. All the patients over 40 years admitted to the emergency unit because of back pain with a radiologically acute vertebral body fracture were eligible. A total of 107 patients were followed for a year. The pain, disability (von Korff pain and disability scores), ADL (Hannover ADL score), and QoL (EQ-5D) were measured after 3 weeks, 3, 6 and 12 months. Two-thirds of the patients were women, and were similar in average age, as the men around 75 years. A total of 65.4% of the fractures were due to a level fall or a minor trauma, whereas 34.6% had no recollection of trauma or a specific event as the cause of the fracture. A total of 76.6% of the fractured patients were immediately mobilized and allowed to return home while the remaining were hospitalized. The average pain intensity score after 3 weeks was 70.9 (SD 19.3), the disability score 68.9 (SD 23.6), the ADL score 37.7 (SD 22.1) and EQ-5D score of 0.37 (SD 0.37). The largest improvements, 10–15%, occurred between the initial visit and the 3 months follow-up and were quite similar for all the measures. From 3 months, all the outcome measures leveled out or tended to deteriorate resulting in a mean pain intensity score of 60.5, disability score of 53.9, ADL score of 47.6, and EQ-5D score 0.52 after 12 months. After a whole year the fractured patients’ condition was similar to the preoperative condition of patients with a herniated lumbar disc, central lumbar spinal stenosis or in patients 100% work disabled due to back or neck problems. Instead of the generally believed good prognosis for the greater majority of those fractured, the acute vertebral body fracture was the beginning of a long-lasting severe deterioration of their health

Effect of local anaesthesia and/or analgesia on pain responses induced by piglet castration

<p>Abstract</p> <p>Background</p> <p>Surgical castration in male piglets is painful and methods that reduce this pain are requested. This study evaluated the effect of local anaesthesia and analgesia on vocal, physiological and behavioural responses during and after castration. A second purpose was to evaluate if herdsmen can effectively administer anaesthesia.</p> <p>Methods</p> <p>Four male piglets in each of 141 litters in five herds were randomly assigned to one of four treatments: castration without local anaesthesia or analgesia (C, controls), analgesia (M, meloxicam), local anaesthesia (L, lidocaine), or both local anaesthesia and analgesia (LM). Lidocaine (L, LM) was injected at least three minutes before castration and meloxicam (M, LM) was injected after castration. During castration, vocalisation was measured and resistance movements judged. Behaviour observations were carried out on the castration day and the following day. The day after castration, castration wounds were ranked, ear and skin temperature was measured, and blood samples were collected for analysis of acute phase protein Serum Amyloid A concentration (SAA). Piglets were weighed on the castration day and at three weeks of age. Sickness treatments and mortality were recorded until three weeks of age.</p> <p>Results</p> <p>Piglets castrated with lidocaine produced calls with lower intensity (<it>p </it>< 0.001) and less resistance movements (<it>p </it>< 0.001) during castration. Piglets that were given meloxicam displayed less pain-related behaviour (huddled up, spasms, rump-scratching, stiffness and prostrated) on both the castration day (<it>p </it>= 0.06, n.s.) and the following day (<it>p </it>= 0.02). Controls had less swollen wounds compared to piglets assigned to treatments M, L and LM (<it>p </it>< 0.001). The proportion of piglets with high SAA concentration (over threshold values 200, 400 mg/l) was higher (<it>p </it>= 0.005; <it>p </it>= 0.05) for C + L compared to M + LM. Ear temperature was higher (<it>p </it>< 0.01) for controls compared to L and LM. There were no significant treatment effects for skin temperature, weight gain, sickness treatments or mortality.</p> <p>Conclusions</p> <p>The study concludes that lidocaine reduced pain during castration and that meloxicam reduced pain after castration. The study also concludes that the herdsmen were able to administer local anaesthesia effectively.</p

The utilization of appropriate osteoporosis medications improves following a multifaceted educational intervention: the Canadian quality circle project (CQC)

<p>Abstract</p> <p>Background</p> <p>Osteoporosis is a serious but treatable condition. However, appropriate therapy utilization of the disease remains suboptimal. Thus, the objective of the study was to change physicians' therapy administration behavior in accordance with the Osteoporosis Canada 2002 guidelines.</p> <p>Methods</p> <p>The Project was a two year cohort study that consisted of five Quality Circle (QC) phases that included: 1) Training & Baseline Data Collection, 2) First Educational Intervention & First Follow-Up Data Collection 3) First Strategy Implementation Session, 4) Final Educational Intervention & Final Follow-up Data Collection, and 5) Final Strategy Implementation Session. A total of 340 family physicians formed 34 QCs and participated in the study. Physicians evaluated a total of 8376, 7354 and 3673 randomly selected patient charts at baseline, follow-up #1 and the final follow-up, respectively. Patients were divided into three groups; the high-risk, low-risk, and low-risk without fracture groups. The generalized estimating equations technique was utilized to model the change over time of whether physicians</p> <p>Results</p> <p>The odds of appropriate therapy was 1.29 (95% CI: 1.13, 1.46), and 1.41 (95% CI: 1.20, 1.66) in the high risk group, 1.15 (95% CI: 0.97, 1.36), and 1.16 (95% CI: 0.93, 1.44) in the low risk group, and 1.20 (95% CI: 1.01, 1.43), and 1.23 (95% CI: 0.97, 1.55) in the low risk group without fractures at follow-up #1 and the final follow-up, respectively.</p> <p>Conclusion</p> <p>QCs methodology was successful in increasing physicians' appropriate use of osteoporosis medications in accordance with Osteoporosis Canada guidelines.</p

Structure and evolution of the gorilla and orangutan growth hormone loci

In primates, the unigenic growth hormone (GH) locus of prosimians, expressed primarily in the anterior pituitary, evolved by gene duplications, independently in New World Monkeys (NWM) and Old World Monkeys (OWMs)/apes, to give complex clusters of genes expressed in the pituitary and placenta. In human and chimpanzee, the GH locus comprises five genes, GH-N being expressed as pituitary GH, whereas GH-V (placental GH) and CSHs (chorionic somatomammotropins) are expressed (in human and probably chimpanzee) in the placenta; the CSHs comprise CSH-A, CSH-B and the aberrant CSH-L (possibly a pseudogene) in human, and CSH-A1, CSH-A2 and CSH-B in chimpanzee. Here the GH locus in two additional great apes, gorilla (Gorilla gorilla gorilla) and orangutan (Pongo abelii), is shown to contain six and four GH-like genes respectively. The gorilla locus possesses six potentially expressed genes, gGH-N, gGH-V and four gCSHs, whereas the orangutan locus has just three functional genes, oGH-N, oGH-V and oCSH-B, plus a pseudogene, oCSH-L. Analysis of regulatory sequences, including promoter, enhancer and P-elements, shows significant variation; in particular the proximal Pit-1 element of GH-V genes differs markedly from that of other genes in the cluster. Phylogenetic analysis shows that the initial gene duplication led to distinct GH-like and CSH-like genes, and that a second duplication provided separate GH-N and GH-V. However, evolution of the CSH-like genes remains unclear. Rapid adaptive evolution gave rise to the distinct CSHs, after the first duplication, and to GH-V after the second duplication. Analysis of transcriptomic databases derived from gorilla tissues establishes that the gGH-N, gGH-V and several gCSH genes are expressed, but the significance of the many CSH genes in gorilla remains unclear

The prognosis for pain, disability, activities of daily living and quality of life after an acute osteoporotic vertebral body fracture: its relation to fracture level, type of fracture and grade of fracture deformation

The level of the acute osteoporotic vertebral fracture, fracture type and grade of fracture deformation were determined in 107 consecutive patients and related to pain, disability, activities of daily living (ADL) and quality of life (QoL) after 3 weeks, 3, 6 and 12 months. Two-thirds of the fractured patients were women and with a similar average age, around 75 years, as the men. Fifty-eight of the acute fractures were located in the thoracic spine and 49 in the lumbar spine and predominantly at the Th12 and L1 levels. Sixty-nine percent of the fractures were wedge, 19% concave and 12% crush fractures. There were 22 mildly, 50 moderately and 35 severely deformed vertebrae. The grade of fracture deformation was not related to gender, age or fracture location. Severely deformed vertebrae predominantly (92%) occurred among the crush fracture type. One year after the fracture, irrespective of fracture level, fracture type or grade of fracture deformation, 4/5 still had pronounced pain and deteriorated QoL. Initial severe fracture deformation by far was the worst prognostic factor for severe lasting pain and disability, and deterioration of ADL and QoL. Factors like fracture level, lumbar fractures tended to improve steadily while thoracic deteriorated, type of fracture, the wedge and concave resulting in less pain and better QoL than the crush fracture type and gender influenced to a lesser extent the outcomes during the year after the acute fracture