125 research outputs found
How to Fairly Allocate Scarce Medical Resources: Justice Trade-Offs between an Individual and a Population Perspective
ISSN:0300-5771ISSN:1464-368
Measuring distance through dense weighted networks: The case of hospital-associated pathogens
Hospital networks, formed by patients visiting multiple hospitals, affect the spread of hospital-associated infections, resulting in differences in risks for hospitals depending on their network position. These networks are increasingly used to inform strategies to prevent and control the spread of hospital-associated pathogens. However, many studies only consider patients that are received directly from the initial hospital, without considering the effect of indirect trajectories through the network. We determine the optimal way to measure the distance between hospitals within the network, by reconstructing the English hospital network based on shared patients in 2014–2015, and simulating the spread of a hospital-associated pathogen between hospitals, taking into consideration that each intermediate hospital conveys a delay in the further spread of the pathogen. While the risk of transferring a hospital-associated pathogen between directly neighbouring hospitals is a direct reflection of the number of shared patients, the distance between two hospitals far-away in the network is determined largely by the number of intermediate hospitals in the network. Because the network is dense, most long distance transmission chains in fact involve only few intermediate steps, spreading along the many weak links. The dense connectivity of hospital networks, together with a strong regional structure, causes hospital-associated pathogens to spread from the initial outbreak in a two-step process: first, the directly surrounding hospitals are affected through the strong connections, second all other hospitals receive introductions through the multitude of weaker links. Although the strong connections matter for local spread, weak links in the network can offer ideal routes for hospital-associated pathogens to travel further faster. This hold important implications for infection prevention and control efforts: if a local outbreak is not controlled in time, colonised patients will appear in other regions, irrespective of the distance to the initial outbreak, making import screening ever more difficult
Effects of Contact Network Models on Stochastic Epidemic Simulations
The importance of modeling the spread of epidemics through a population has
led to the development of mathematical models for infectious disease
propagation. A number of empirical studies have collected and analyzed data on
contacts between individuals using a variety of sensors. Typically one uses
such data to fit a probabilistic model of network contacts over which a disease
may propagate. In this paper, we investigate the effects of different contact
network models with varying levels of complexity on the outcomes of simulated
epidemics using a stochastic Susceptible-Infectious-Recovered (SIR) model. We
evaluate these network models on six datasets of contacts between people in a
variety of settings. Our results demonstrate that the choice of network model
can have a significant effect on how closely the outcomes of an epidemic
simulation on a simulated network match the outcomes on the actual network
constructed from the sensor data. In particular, preserving degrees of nodes
appears to be much more important than preserving cluster structure for
accurate epidemic simulations.Comment: To appear at International Conference on Social Informatics (SocInfo)
201
Collecting close-contact social mixing data with contact diaries: reporting errors and biases
The analysis of contact networks plays a major role to understanding the dynamics of disease spread. Empirical contact data is often collected using contact diaries. Such studies rely on self-reported perceptions of contacts, and arrangements for validation are usually not made. Our study was based on a complete network study design that allowed for the analysis of reporting accuracy in contact diary studies. We collected contact data of the employees of three research groups over a period of 1 work week. We found that more than one third of all reported contacts were only reported by one out of the two involved contact partners. Non-reporting is most frequent in cases of short, non-intense contact. We estimated that the probability of forgetting a contact of â©˝5 min duration is greater than 50%. Furthermore, the number of forgotten contacts appears to be proportional to the total number of contact
Intensive care unit (ICU)-acquired bacteraemia and ICU mortality and discharge:Addressing time-varying confounding using appropriate methodology
Background: Studies often ignore time-varying confounding or may use inappropriate methodology to adjust for time-varying confounding.
Aim: To estimate the effect of intensive care unit (ICU)-acquired bacteraemia on ICU mortality and discharge using appropriate methodology.
Methods: Marginal structural models with inverse probability weighting were used to estimate the ICU mortality and discharge associated with ICU-acquired bacteraemia among patients who stayed more than two days at the general ICU of a London teaching hospital and remained bacteraemia-free during those first two days. For comparison, the same associations were evaluated with (i) a conventional Cox model, adjusting only for baseline confounders and (ii) a Cox model adjusting for baseline and time-varying confounders.
Findings: Using the marginal structural model with inverse probability weighting, bacteraemia was associated with an increase in ICU mortality (cause-specific hazard ratio (CSHR): 1.29; 95% confidence interval (CI): 1.02-1.63)and a decrease in discharge (CSHR: 0.52; 95% CI: 0.45-0.60). By 60 days, among patients still in the ICU after two days and without prior bacteraemia, 8.0% of ICU deaths could be prevented by preventing all ICU-acquired bacteraemia cases. The conventional Cox model adjusting for time-varying confounders gave substantially different results [for ICU mortality, CSHR: 1.08 (95% CI: 0.88-1.32); for discharge, CSHR: 0.68 (95% CI: 0.60-0.77)].
Conclusion: In this study, even after adjusting for the timing of acquiring bacteraemia and time-varying confounding using inverse probability weighting for marginal structura
Comparison of contact patterns relevant for transmission of respiratory pathogens in Thailand and the Netherlands using respondent-driven sampling
Understanding infection dynamics of respiratory diseases requires the identification and quantification of behavioural, social and environmental factors that permit the transmission of these infections between humans. Little empirical information is available about contact patterns within real-world social networks, let alone on differences in these contact networks between populations that differ considerably on a socio-cultural level. Here we compared contact network data that were collected in the Netherlands and Thailand using a similar online respondent-driven method. By asking participants to recruit contact persons we studied network links relevant for the transmission of respiratory infections. We studied correlations between recruiter and recruited contacts to investigate mixing patterns in the observed social network components. In both countries, mixing patterns were assortative by demographic variables and random by total numbers of contacts. However, in Thailand participants reported overall more contacts which resulted in higher effective contact rates. Our findings provide new insights on numbers of contacts and mixing patterns in two different populations. These data could be used to improve parameterisation of mathematical models used to design control strategies. Although the spread of infections through populations depends on more factors, found similarities suggest that spread may be similar in the Netherlands and Thailand
Simulation of an SEIR infectious disease model on the dynamic contact network of conference attendees
The spread of infectious diseases crucially depends on the pattern of
contacts among individuals. Knowledge of these patterns is thus essential to
inform models and computational efforts. Few empirical studies are however
available that provide estimates of the number and duration of contacts among
social groups. Moreover, their space and time resolution are limited, so that
data is not explicit at the person-to-person level, and the dynamical aspect of
the contacts is disregarded. Here, we want to assess the role of data-driven
dynamic contact patterns among individuals, and in particular of their temporal
aspects, in shaping the spread of a simulated epidemic in the population.
We consider high resolution data of face-to-face interactions between the
attendees of a conference, obtained from the deployment of an infrastructure
based on Radio Frequency Identification (RFID) devices that assess mutual
face-to-face proximity. The spread of epidemics along these interactions is
simulated through an SEIR model, using both the dynamical network of contacts
defined by the collected data, and two aggregated versions of such network, in
order to assess the role of the data temporal aspects.
We show that, on the timescales considered, an aggregated network taking into
account the daily duration of contacts is a good approximation to the full
resolution network, whereas a homogeneous representation which retains only the
topology of the contact network fails in reproducing the size of the epidemic.
These results have important implications in understanding the level of
detail needed to correctly inform computational models for the study and
management of real epidemics
The importance of including dynamic social networks when modeling epidemics of airborne infections: does increasing complexity increase accuracy?
Mathematical models are useful tools for understanding and predicting epidemics. A recent innovative modeling study by Stehle and colleagues addressed the issue of how complex models need to be to ensure accuracy. The authors collected data on face-to-face contacts during a two-day conference. They then constructed a series of dynamic social contact networks, each of which was used to model an epidemic generated by a fast-spreading airborne pathogen. Intriguingly, Stehle and colleagues found that increasing model complexity did not always increase accuracy. Specifically, the most detailed contact network and a simplified version of this network generated very similar results. These results are extremely interesting and require further exploration to determine their generalizability
Does appropriate empiric antibiotic therapy modify intensive care unit-acquired Enterobacteriaceae bacteraemia mortality and discharge?
BACKGROUND: Conflicting results have been found regarding outcomes of intensive care unit (ICU)-acquired Enterobacteriaceae bacteraemia and the potentially modifying effect of appropriate empiric antibiotic therapy. AIM: To evaluate these associations while adjusting for potential time-varying confounding using methods from the causal inference literature. METHODS: Patients who stayed more than two days in two general ICUs in England between 2002 and 2006 were included in this cohort study. Marginal structural models with inverse probability weighting were used to estimate the mortality and discharge associated with Enterobacteriaceae bacteraemia and the impact of appropriate empiric antibiotic therapy on these outcomes. FINDINGS: Among 3411 ICU admissions, 195 (5.7%) ICU-acquired Enterobacteriaceae bacteraemia cases occurred. Enterobacteriaceae bacteraemia was associated with an increased daily risk of ICU death [cause-specific hazard ratio (HR): 1.48; 95% confidence interval (CI):Â 1.10-1.99] and a reduced daily risk of ICU discharge (HR: 0.66; 95% CI: 0.54-0.80). Appropriate empiric antibiotic therapy did not significantly modify ICU mortality (HR: 1.08; 95% CI: 0.59-1.97) or discharge (HR: 0.91; 95% CI: 0.63-1.32). CONCLUSION: ICU-acquired Enterobacteriaceae bacteraemia was associated with an increased daily risk of ICU mortality. Furthermore, the daily discharge rate was also lower after acquiring infection, even when adjusting for time-varying confounding using appropriate methodology. No evidence was found for a beneficial modifying effect of appropriate empiric antibiotic therapy on ICU mortality and discharge
Robust modeling of human contact networks across different scales and proximity-sensing techniques
The problem of mapping human close-range proximity networks has been tackled
using a variety of technical approaches. Wearable electronic devices, in
particular, have proven to be particularly successful in a variety of settings
relevant for research in social science, complex networks and infectious
diseases dynamics. Each device and technology used for proximity sensing (e.g.,
RFIDs, Bluetooth, low-power radio or infrared communication, etc.) comes with
specific biases on the close-range relations it records. Hence it is important
to assess which statistical features of the empirical proximity networks are
robust across different measurement techniques, and which modeling frameworks
generalize well across empirical data. Here we compare time-resolved proximity
networks recorded in different experimental settings and show that some
important statistical features are robust across all settings considered. The
observed universality calls for a simplified modeling approach. We show that
one such simple model is indeed able to reproduce the main statistical
distributions characterizing the empirical temporal networks
- …