Modeling relaxed policies for discontinuation of methicillin-resistant Staphylococcus aureus contact precautions

OBJECTIVE

To evaluate the economic costs of reducing the University of Virginia Hospital's present "3-negative" policy, which continues methicillin-resistant Staphylococcus aureus (MRSA) contact precautions until patients receive 3 consecutive negative test results, to either 2 or 1 negative.

DESIGN

Cost-effective analysis.

SETTINGS

The University of Virginia Hospital.

PATIENTS

The study included data from 41,216 patients from 2015 to 2019.

METHODS

We developed a model for MRSA transmission in the University of Virginia Hospital, accounting for both environmental contamination and interactions between patients and providers, which were derived from electronic health record (EHR) data. The model was fit to MRSA incidence over the study period under the current 3-negative clearance policy. A counterfactual simulation was used to estimate outcomes and costs for 2- and 1-negative policies compared with the current 3-negative policy.

RESULTS

Our findings suggest that 2-negative and 1-negative policies would have led to 6 (95% CI, -30 to 44; P < .001) and 17 (95% CI, -23 to 59; -10.1% to 25.8%; P < .001) more MRSA cases, respectively, at the hospital over the study period. Overall, the 1-negative policy has statistically significantly lower costs ($628,452; 95% CI, $513,592-$752,148) annually (P < .001) in US dollars, inflation-adjusted for 2023) than the 2-negative policy ($687,946; 95% CI, $562,522-$812,662) and 3-negative ($702,823; 95% CI, $577,277-$846,605).

CONCLUSIONS

A single negative MRSA nares PCR test may provide sufficient evidence to discontinue MRSA contact precautions, and it may be the most cost-effective option.

Evaluation of FluSight influenza forecasting in the 2021-22 and 2022-23 seasons with a new target laboratory-confirmed influenza hospitalizations

Accurate forecasts can enable more effective public health responses during seasonal influenza epidemics. Forecasting teams were asked to provide national and jurisdiction-specific probabilistic predictions of weekly confirmed influenza hospital admissions for one through four weeks ahead for the 2021-22 and 2022-23 influenza seasons. Across both seasons, 26 teams submitted forecasts, with the submitting teams varying between seasons. Forecast skill was evaluated using the Weighted Interval Score (WIS), relative WIS, and coverage. Six out of 23 models outperformed the baseline model across forecast weeks and locations in 2021-22 and 12 out of 18 models in 2022-23. Averaging across all forecast targets, the FluSight ensemble was the 2nd most accurate model measured by WIS in 2021-22 and the 5th most accurate in the 2022-23 season. Forecast skill and 95% coverage for the FluSight ensemble and most component models degraded over longer forecast horizons and during periods of rapid change. Current influenza forecasting efforts help inform situational awareness, but research is needed to address limitations, including decreased performance during periods of changing epidemic dynamics.

Using neural networks to calibrate agent based models enables improved regional evidence for vaccine strategy and policy

Distribution and administration strategy are critical to successful population immunization efforts. Agent-based modeling (ABM) can reflect the complexity of real-world populations and can experimentally evaluate vaccine strategy and policy. However, ABMs historically have been limited in their time-to-development, long runtime, and difficulty calibrating. Our team had several technical advances in the development of our GradABMs: a novel class of scalable, fast and differentiable simulations. GradABMs can simulate million-size populations in a few seconds on commodity hardware, integrate with deep neural networks and ingest heterogeneous sources. This allows for rapid and real-world sensitivity analyses. Our first epidemiological GradABM (EpiABMv1) enabled simulation interventions over real million-scale populations and was used in vaccine strategy and policy during the COVID-19 pandemic. Literature suggests decisions aided by evidence from these models saved thousands of lives. Our most recent model (EpiABMv2) extends EpiABMv1 to allow improved regional calibration using deep neural networks to incorporate local population data, and in some cases different policy recommendations versus our prior models. This is an important advance for our model to be more effective at vaccine strategy and policy decisions at the local public health level.

Using spectral characterization to identify healthcare-associated infection (HAI) patients for clinical contact precaution

Healthcare-associated infections (HAIs) are a major problem in hospital infection control. Although HAIs can be suppressed using contact precautions, such precautions are expensive, and we can only apply them to a small fraction of patients (i.e., a limited budget). In this work, we focus on two clinical problems arising from the limited budget: (a) choosing the best patients to be placed under precaution given a limited budget to minimize the spread (the isolation problem), and (b) choosing the best patients to release when limited budget requires some of the patients to be cleared from precaution (the clearance problem). A critical challenge in addressing them is that HAIs have multiple transmission pathways such that locations can also accumulate 'load' and spread the disease. One of the most common practices when placing patients under contact precautions is the regular clearance of pathogen loads. However, standard propagation models like independent cascade (IC)/susceptible-infectious-susceptible (SIS) cannot capture such mechanisms directly. Hence to account for this challenge, using non-linear system theory, we develop a novel spectral characterization of a recently proposed pathogen load based model, 2-MODE-SIS model, on people/location networks to capture spread dynamics of HAIs. We formulate the two clinical problems using this spectral characterization and develop effective and efficient algorithms for them. Our experiments show that our methods outperform several natural structural and clinical approaches on real-world hospital testbeds and pick meaningful solutions.

Empirical networks for localized COVID-19 interventions using WiFi infrastructure at university campuses

Infectious diseases, like COVID-19, pose serious challenges to university campuses, which typically adopt closure as a non-pharmaceutical intervention to control spread and ensure a gradual return to normalcy. Intervention policies, such as remote instruction (RI) where large classes are offered online, reduce potential contact but also have broad side-effects on campus by hampering the local economy, students' learning outcomes, and community wellbeing. In this paper, we demonstrate that university policymakers can mitigate these tradeoffs by leveraging anonymized data from their WiFi infrastructure to learn community mobility-a methodology we refer to as WiFi mobility models (WiMob). This approach enables policymakers to explore more granular policies like localized closures (LC). WiMob can construct contact networks that capture behavior in various spaces, highlighting new potential transmission pathways and temporal variation in contact behavior. Additionally, WiMob enables us to design LC policies that close super-spreader locations on campus. By simulating disease spread with contact networks from WiMob, we find that LC maintains the same reduction in cumulative infections as RI while showing greater reduction in peak infections and internal transmission. Moreover, LC reduces campus burden by closing fewer locations, forcing fewer students into completely online schedules, and requiring no additional isolation. WiMob can empower universities to conceive and assess a variety of closure policies to prevent future outbreaks.

Evaluation of individual and ensemble probabilistic forecasts of COVID-19 mortality in the United States

Short-term probabilistic forecasts of the trajectory of the COVID-19 pandemic in the United States have served as a visible and important communication channel between the scientific modeling community and both the general public and decision-makers. Forecasting models provide specific, quantitative, and evaluable predictions that inform short-term decisions such as healthcare staffing needs, school closures, and allocation of medical supplies. Starting in April 2020, the US COVID-19 Forecast Hub (https://covid19forecasthub.org/) collected, disseminated, and synthesized tens of millions of specific predictions from more than 90 different academic, industry, and independent research groups. A multimodel ensemble forecast that combined predictions from dozens of groups every week provided the most consistently accurate probabilistic forecasts of incident deaths due to COVID-19 at the state and national level from April 2020 through October 2021. The performance of 27 individual models that submitted complete forecasts of COVID-19 deaths consistently throughout this year showed high variability in forecast skill across time, geospatial units, and forecast horizons. Two-thirds of the models evaluated showed better accuracy than a naïve baseline model. Forecast accuracy degraded as models made predictions further into the future, with probabilistic error at a 20-wk horizon three to five times larger than when predicting at a 1-wk horizon. This project underscores the role that collaboration and active coordination between governmental public-health agencies, academic modeling teams, and industry partners can play in developing modern modeling capabilities to support local, state, and federal response to outbreaks.

Cut-n-Reveal

Recent hurricane events have caused unprecedented amounts of damage on critical infrastructure systems and have severely threatened our public safety and economic health. The most observable (and severe) impact of these hurricanes is the loss of electric power in many regions, which causes breakdowns in essential public services. Understanding power outages and how they evolve during a hurricane provides insights on how to reduce outages in the future, and how to improve the robustness of the underlying critical infrastructure systems. In this article, we propose a novel scalable segmentation with explanations framework to help experts understand such datasets. Our method, CnR (Cut-n-Reveal), first finds a segmentation of the outage sequences based on the temporal variations of the power outage failure process so as to capture major pattern changes. This temporal segmentation procedure is capable of accounting for both the spatial and temporal correlations of the underlying power outage process. We then propose a novel explanation optimization formulation to find an intuitive explanation of the segmentation such that the explanation highlights the culprit time series of the change in each segment. Through extensive experiments, we show that our method consistently outperforms competitors in multiple real datasets with ground truth. We further study real county-level power outage data from several recent hurricanes (Matthew, Harvey, Irma) and show that CnR recovers important, non-trivial, and actionable patterns for domain experts, whereas baselines typically do not give meaningful results.

Understanding the Relationship between Human Behavior and Susceptibility to Cyber Attacks

Despite growing speculation about the role of human behavior in cyber-security of machines, concrete data-driven analysis and evidence have been lacking. Using Symantec’s WINE platform, we conduct a detailed study of 1.6 million machines over an 8-month period in order to learn the relationship between user behavior and cyber attacks against their personal computers. We classify users into 4 categories (gamers, professionals, software developers, and others, plus a fifth category comprising everyone) and identify a total of 7 features that act as proxies for human behavior. For each of the 35 possible combinations (5 categories times 7 features), we studied the relationship between each of these seven features and one dependent variable, namely the number of attempted malware attacks detected by Symantec on the machine. Our results show that there is a strong relationship between several features and the number of attempted malware attacks. Had these hosts not been protected by Symantec’s anti-virus product or a similar product, they would likely have been infected. Surprisingly, our results show that software developers are more at risk of engaging in risky cyber-behavior than other categories.

Competing memes propagation on networks

If a false rumor propagates via Twitter, while the truth propagates between friends in Facebook, which one will prevail? This question captures the essence of the problem we address here. We study the intertwined propagation of two competing "memes" (or viruses, rumors, products etc.) in a composite network. A key novelty is the use of a composite network, which in its simplest model is defined as a single set of nodes with two distinct types of edges interconnecting them. Each meme spreads across the composite network in accordance to an SIS-like propagation model (a flu-like infection-recovery). To study the epidemic behavior of our system, we formulate it as a non-linear dynamic system (NLDS). We develop a metric for each meme that is based on the eigenvalue of an appropriately constructed matrix and argue that this metric plays a key role in determining the "winning" meme. First, we prove that our metric determines the tipping point at which both memes become extinct eventually. Second, we conjecture that the meme with the strongest metric will most likely prevail over the other, and we show evidence of that via simulations in both real and synthetic composite networks. Our work is among the first to study the interplay between two competing memes in composite networks.

Metal fractionation study on bed sediments of Hussainsagar Lake, Hyderabad, India

Hussainsagar Lake in the heart of Hyderabad City (India) receives toxic substances through five streams draining from a catchment area of 245 km(2). Of particular interest are heavy metals received from urban runoff as well as municipal sewage and industrial effluents. Heavy metals entering the lake get adsorbed onto the suspended sediments, which eventually settle down in the bottom of the lake. In this study, fractionation of metal ions has been studied on the bed sediments of Hussainsagar Lake in order to determine the ecotoxic potential of metal ions. Comparison of sediments with average shale values indicated anthropogenic enrichment with copper, nickel, lead, cadmium, and zinc. The risk assessment code as applied to the present study reveals that 10-17% of manganese, 10-18% of nickel, 14-24% of chromium, 10-19% of lead, 21-30% of cadmium, and 18-28% of zinc exist in exchangeable fraction and, therefore, comes under medium risk category and may enter into food chain. The association of these metals with the exchangeable fraction may cause deleterious effects to aquatic life. The present database will help in formulating guidelines for carrying out dredging operations under restoration programs in the Hussainsagar Lake.