Cost-effective control of chronic viral diseases: Finding the optimal level of screening and contact tracing

Chronic viral diseases such as human immunodeficiency virus (HIV) and hepatitis B virus (HBV) afflict millions of people worldwide. A key public health challenge in managing such diseases is identifying infected, asymptomatic individuals so that they can receive antiviral treatment. Such treatment can benefit both the treated individual (by improving quality and length of life) and the population as a whole (through reduced transmission). We develop a compartmental model of a chronic, treatable infectious disease and use it to evaluate the cost and effectiveness of different levels of screening and contact tracing. We show that: (1) the optimal strategy is to get infected individuals into treatment at the maximal rate until the incremental health benefits balance the incremental cost of controlling the disease; (2) as one reduces the disease prevalence by moving people into treatment (which decreases the chance that they will infect others), one should increase the level of contact tracing to compensate for the decreased effectiveness of screening; (3) as the disease becomes less prevalent, it is optimal to spend more per case identified; and (4) the relative mix of screening and contact tracing at any level of disease prevalence is such that the marginal efficiency of contact tracing (cost per infected person found) equals that of screening if possible (e.g., when capacity limitations are not binding). We also show how to determine the cost-effective equilibrium level of disease prevalence (among untreated individuals), and we develop an approximation of the path of the optimal prevalence over time. Using this, one can obtain a close approximation of the optimal solution without having to solve an optimal control problem. We apply our methods to an example of hepatitis B virus.     

Modeling the impact of random screening and contact tracing in reducing the spread of HIV

Mathematical models can help predict the effectiveness of control measures on the spread of HIV and other sexually transmitted diseases (STDs) by reducing the uncertainty in assessing the impact of intervention strategies such as random screening and contact tracing. Even though contact tracing is one of the most effective methods used for controlling treatable STDs, it is still a controversial strategy for controlling HIV because of cost and confidentiality issues. To help estimate the effectiveness of these control measures, we formulate two models with random screening and contact tracing based on the differential infectivity (DI) model and the staged-progression (SP) model. We derive formulas for the reproductive numbers and the endemic equilibria and compare the impact that random screening and contact tracing have in slowing the epidemic in the two models. In the DI model the infected population is divided into groups according to their infectiousness, and HIV is largely spread by a small, highly infectious, group of superspreaders. In this model contact tracing is an effective approach to identifying the superspreaders and has a large effect in slowing the epidemic. In the SP model every infected individual goes through a series of infection stages and the virus is primarily spread by individuals in an initial highly infectious stage or in the late stages of the disease. In this model random screening is more effective than for the DI model, and contact tracing is less effective. Thus the effectiveness of the intervention strategy strongly depends on the underlying etiology of the disease transmission.     

Contact tracing efficiency,transmission heterogeneity,and accelerating COVID-19 epidemics

Simultaneously controlling COVID-19 epidemics and limiting economic and societal impacts presents a difficult challenge, especially with limited public health budgets. Testing, contact tracing, and isolating/quarantining is a key strategy that has been used to reduce transmission of SARS-CoV-2, the virus that causes COVID-19 and other pathogens. However, manual contact tracing is a time-consuming process and as case numbers increase a smaller fraction of cases’ contacts can be traced, leading to additional virus spread. Delays between symptom onset and being tested (and receiving results), and a low fraction of symptomatic cases being tested and traced can also reduce the impact of contact tracing on transmission. We examined the relationship between increasing cases and delays and the pathogen reproductive number R_t, and the implications for infection dynamics using deterministic and stochastic compartmental models of SARS-CoV-2. We found that R_t increased sigmoidally with the number of cases due to decreasing contact tracing efficacy. This relationship results in accelerating epidemics because R_t initially increases, rather than declines, as infections increase. Shifting contact tracers from locations with high and low case burdens relative to capacity to locations with intermediate case burdens maximizes their impact in reducing R_t (but minimizing total infections may be more complicated). Contact tracing efficacy decreased sharply with increasing delays between symptom onset and tracing and with lower fraction of symptomatic infections being tested. Finally, testing and tracing reductions in R_t can sometimes greatly delay epidemics due to the highly heterogeneous transmission dynamics of SARS-CoV-2. These results demonstrate the importance of having an expandable or mobile team of contact tracers that can be used to control surges in cases. They also highlight the synergistic value of high capacity, easy access testing and rapid turn-around of testing results, and outreach efforts to encourage symptomatic cases to be tested immediately after symptom onset.     

Computational wear prediction of artificial knee joints based on a new wear law and formulation

Laboratory joint wear simulator testing has become the standard means for preclinical evaluation of wear resistance of artificial knee joints. Recent simulator designs have been advanced and become successful at reproducing the wear patterns observed in clinical retrievals. However, a single simulator test can be very expensive and take a long time to run. On the other hand computational wear modelling is an alternative attractive solution to these limitations. Computational models have been used extensively for wear prediction and optimisation of artificial knee designs. However, all these models have adopted the classical Archard's wear law, which was developed for metallic materials, and have selected wear factors arbitrarily. It is known that such an approach is not generally true for polymeric bearing materials and is difficult to implement due to the high dependence of the wear factor on the contact pressure. Therefore, these studies are generally not independent and lack general predictability. The objective of the present study was to develop a new computational wear model for the knee implants, based on the contact area and an independent experimentally determined non-dimensional wear coefficient. The effects of cross-shear and creep on wear predictions were also considered. The predicted wear volume was compared with the laboratory simulation measurements. The model was run under two different kinematic inputs and two different insert designs with curved and custom designed flat bearing surfaces. The new wear model was shown to be capable of predicting the difference of the wear volume and wear pattern between the two kinematic inputs and the two tibial insert designs. Conversely, the wear factor based approach did not predict such differences. The good agreement found between the computational and experimental results, on both the wear scar areas and volumetric wear rates, suggests that the computational wear modelling based on the new wear law and the experimentally calculated non-dimensional wear coefficient should be more reliable and therefore provide a more robust virtual modelling platform.     

Epidemic Contact Tracing via Communication Traces

Traditional contact tracing relies on knowledge of the interpersonal network of physical interactions, where contagious outbreaks propagate. However, due to privacy constraints and noisy data assimilation, this network is generally difficult to reconstruct accurately. Communication traces obtained by mobile phones are known to be good proxies for the physical interaction network, and they may provide a valuable tool for contact tracing. Motivated by this assumption, we propose a model for contact tracing, where an infection is spreading in the physical interpersonal network, which can never be fully recovered; and contact tracing is occurring in a communication network which acts as a proxy for the first. We apply this dual model to a dataset covering 72 students over a 9 month period, for which both the physical interactions as well as the mobile communication traces are known. Our results suggest that a wide range of contact tracing strategies may significantly reduce the final size of the epidemic, by mainly affecting its peak of incidence. However, we find that for low overlap between the face-to-face and communication interaction network, contact tracing is only efficient at the beginning of the outbreak, due to rapidly increasing costs as the epidemic evolves. Overall, contact tracing via mobile phone communication traces may be a viable option to arrest contagious outbreaks.     

Computational analysis of CFSE proliferation assay

CFSE based tracking of the lymphocyte proliferation using flow cytometry is a powerful experimental technique in immunology allowing for the tracing of labelled cell populations over time in terms of the number of divisions cells undergone. Interpretation and understanding of such population data can be greatly improved through the use of mathematical modelling. We apply a heterogenous linear compartmental model, described by a system of ordinary differential equations similar to those proposed by Kendall. This model allows division number-dependent rates of cell proliferation and death and describes the rate of changes in the numbers of cells having undergone j divisions. The experimental data set that we specifically analyze specifies the following characteristics of the kinetics of PHA-induced human T lymphocyte proliferation assay in vitroL (1) the total number of live cells, (2) the total number of dead but not disintegrated cells and (3) the number of cells divided j times. Following the maximum likelihood approach for data fitting, we estimate the model parameters which, in particular, present the CTL birth- and death rate “functions”. It is the first study of CFSE labelling data which convincingly shows that the lymphocyte proliferation and death both in vitro and in vivo are division number dependent. For the first time, the confidence in the estimated parameter values is analyzed by comparing three major methods: the technique based on the variance–covariance matrix, the profile-likelihood-based approach and the bootstrap technique. We compare results and performance of these methods with respect to their robustness and computational cost. We show that for evaluating mathematical models of differing complexity the information-theoretic approach, based upon indicators measuring the information loss for a particular model (Kullback–Leibler information), provides a consistent basis. We specifically discuss methodological and computational difficulties in parameter identification with CFSE data, e.g. the loss of confidence in the parameter estimates starting around the sixth division. Overall, our study suggests that the heterogeneity inherent in cell kinetics should be explicitly incorporated into the structure of mathematical models.      

Moment Approximation of Infection Dynamics in a Population of Moving Hosts

The modelling of contact processes between hosts is of key importance in epidemiology. Current studies have mainly focused on networks with stationary structures, although we know these structures to be dynamic with continuous appearance and disappearance of links over time. In the case of moving individuals, the contact network cannot be established. Individual-based models (IBMs) can simulate the individual behaviours involved in the contact process. However, with very large populations, they can be hard to simulate and study due to the computational costs. We use the moment approximation (MA) method to approximate a stochastic IBM with an aggregated deterministic model. We illustrate the method with an application in animal epidemiology: the spread of the highly pathogenic virus H5N1 of avian influenza in a poultry flock. The MA method is explained in a didactic way so that it can be reused and extended. We compare the simulation results of three models: 1. an IBM, 2. a MA, and 3. a mean-field (MF). The results show a close agreement between the MA model and the IBM. They highlight the importance for the models to capture the displacement behaviours and the contact processes in the study of disease spread. We also illustrate an original way of using different models of the same system to learn more about the system itself, and about the representation we build of it.     

On the Use of Bayesian Methods for Evaluating Compartmental Neural Models

Computational modeling is being used increasingly in neuroscience. In deriving such models, inference issues such as model selection, model complexity, and model comparison must be addressed constantly. In this article we present briefly the Bayesian approach to inference. Under a simple set of commonsense axioms, there exists essentially a unique way of reasoning under uncertainty by assigning a degree of confidence to any hypothesis or model, given the available data and prior information. Such degrees of confidence must obey all the rules governing probabilities and can be updated accordingly as more data becomes available. While the Bayesian methodology can be applied to any type of model, as an example we outline its use for an important, and increasingly standard, class of models in computational neuroscience—compartmental models of single neurons. Inference issues are particularly relevant for these models: their parameter spaces are typically very large, neurophysiological and neuroanatomical data are still sparse, and probabilistic aspects are often ignored. As a tutorial, we demonstrate the Bayesian approach on a class of one-compartment models with varying numbers of conductances. We then apply Bayesian methods on a compartmental model of a real neuron to determine the optimal amount of noise to add to the model to give it a level of spike time variability comparable to that found in the real cell.     

The identification of transport parameters from truncated physiological tracer curves

The primary data curves from the injection of tracers into the circulation are often obscured by the appearance of a recirculation hump. Previous techniques for parameter identification in the presence of such a complication have been extended from compartmental models to include circulatory models consisting of partial differential equations of the Taylor dispersion and Turner capacitance types. A comparative analysis of the efficiency of parameter identification by several computational strategies is presented.     

Comparison of deformable and elastic foundation finite element simulations for predicting knee replacement mechanics

Rigid body total knee replacement (TKR) models with tibiofemoral contact based on elastic foundation (EF) theory utilize simple contact pressure-surface overclosure relationships to estimate joint mechanics, and require significantly less computational time than corresponding deformable finite element (FE) methods. However, potential differences in predicted kinematics between these representations are currently not well understood, and it is unclear if the estimates of contact area and pressure are acceptable. Therefore, the objectives of the current study were to develop rigid EF and deformable FE models of tibiofemoral contact, and to compare predicted kinematics and contact mechanics from both representations during gait loading conditions with three different implant designs. Linear and nonlinear contact pressure-surface overclosure relationships based on polyethylene material properties were developed using EF theory. All other variables being equal, rigid body FE models accurately estimated kinematics predicted by fully deformable FE models and required only 2% of the analysis time. As expected, the linear EF contact model sufficiently approximated trends for peak contact pressures, but overestimated the deformable results by up to 30%. The nonlinear EF contact model more accurately reproduced trends and magnitudes of the deformable analysis, with maximum differences of approximately 15% at the peak pressures during the gait cycle. All contact area predictions agreed in trend and magnitude. Using rigid models, edge-loading conditions resulted in substantial overestimation of peak pressure. Optimal nonlinear EF contact relationships were developed for specific TKR designs for use in parametric or repetitive analyses where computational time is paramount. The explicit FE analysis method utilized here provides a unique approach in that both rigid and deformable analyses can be run from the same input file, thus enabling simple selection of the most appropriate representation for the analysis of interest.     

Testing Three Species Distribution Modelling Strategies to Define Fish Assemblage Reference Conditions for Stream Bioassessment and Related Applications

Species distribution models are widely used for stream bioassessment, estimating changes in habitat suitability and identifying conservation priorities. We tested the accuracy of three modelling strategies (single species ensemble, multi-species response and community classification models) to predict fish assemblages at reference stream segments in coastal subtropical Australia. We aimed to evaluate each modelling strategy for consistency of predictor variable selection; determine which strategy is most suitable for stream bioassessment using fish indicators; and appraise which strategies best match other stream management applications. Five models, one single species ensemble, two multi-species response and two community classification models, were calibrated using fish species presence-absence data from 103 reference sites. Models were evaluated for generality and transferability through space and time using four external reference site datasets. Elevation and catchment slope were consistently identified as key correlates of fish assemblage composition among models. The community classification models had high omission error rates and contributed fewer taxa to the ‘expected’ component of the taxonomic completeness (O/E₅₀) index than the other strategies. This potentially decreases the model sensitivity for site impact assessment. The ensemble model accurately and precisely modelled O/E₅₀ for the training data, but produced biased predictions for the external datasets. The multi-species response models afforded relatively high accuracy and precision coupled with low bias across external datasets and had lower taxa omission rates than the community classification models. They inherently included rare, but predictable species while excluding species that were poorly modelled among all strategies. We suggest that the multi-species response modelling strategy is most suited to bioassessment using freshwater fish assemblages in our study area. At the species level, the ensemble model exhibited high sensitivity without reductions in specificity, relative to the other models. We suggest that this strategy is well suited to other non-bioassessment stream management applications, e.g., identifying priority areas for species conservation.     

Differential susceptibility epidemic models

We formulate compartmental differential susceptibility (DS) susceptible-infective-removed (SIR) models by dividing the susceptible population into multiple subgroups according to the susceptibility of individuals in each group. We analyze the impact of disease-induced mortality in the situations where the number of contacts per individual is either constant or proportional to the total population. We derive an explicit formula for the reproductive number of infection for each model by investigating the local stability of the infection-free equilibrium. We further prove that the infection-free equilibrium of each model is globally asymptotically stable by qualitative analysis of the dynamics of the model system and by utilizing an appropriately chosen Liapunov function. We show that if the reproductive number is greater than one, then there exists a unique endemic equilibrium for all of the DS models studied in this paper. We prove that the endemic equilibrium is locally asymptotically stable for the models with no disease-induced mortality and the models with contact numbers proportional to the total population. We also provide sufficient conditions for the stability of the endemic equilibrium for other situations. We briefly discuss applications of the DS models to optimal vaccine strategies and the connections between the DS models and predator-prey models with multiple prey populations or host-parasitic interaction models with multiple hosts are also given.This research was partially supported by the Department of Energy under contracts W-7405-ENG-36 and the Applied Mathematical Sciences Program KC-07-01-01.     

Multi-Formalism Modelling and Simulation: Application to Cardiac Modelling

Cardiovascular modelling has been a major research subject for the last decade. Different cardiac models have been developed at a cellular level as well as at the whole organ level. Most of these models are defined by a comprehensive cellular modelling using continuous formalisms or by a tissue-level modelling often based on discrete formalisms. Nevertheless, both views still suffer from difficulties that reduce their clinical applications: the first approach requires heavy computational resources while the second one is not able to reproduce certain pathologies. This paper presents an original methodology trying to gather advantages from both approaches, by means of a hybrid model mixing discrete and continuous formalisms. This method has been applied to define a hybrid model of cardiac action potential propagation on a 2D grid of endocardial cells, combining cellular automata and a set of cells defined by the Beeler-Reuter model. For simulations under physiological and ischemic conditions, results show that the action potential propagation as well as electrogram reconstructions are consistent with clinical diagnosis. Finally, the advantage of the proposed approach is discussed within the frame of cardiac modelling and simulation.     

Guidelines for visualizing and annotating rule-based models

Rule-based modeling provides a means to represent cell signaling systems in a way that captures site-specific details of molecular interactions. For rule-based models to be more widely understood and (re)used, conventions for model visualization and annotation are needed. We have developed the concepts of an extended contact map and a model guide for illustrating and annotating rule-based models. An extended contact map represents the scope of a model by providing an illustration of each molecule, molecular component, direct physical interaction, post-translational modification, and enzyme-substrate relationship considered in a model. A map can also illustrate allosteric effects, structural relationships among molecular components, and compartmental locations of molecules. A model guide associates elements of a contact map with annotation and elements of an underlying model, which may be fully or partially specified. A guide can also serve to document the biological knowledge upon which a model is based. We provide examples of a map and guide for a published rule-based model that characterizes early events in IgE receptor (FcεRI) signaling. We also provide examples of how to visualize a variety of processes that are common in cell signaling systems but not considered in the example model, such as ubiquitination. An extended contact map and an associated guide can document knowledge of a cell signaling system in a form that is visual as well as executable. As a tool for model annotation, a map and guide can communicate the content of a model clearly and with precision, even for large models.     

Pooled testing of traced contacts under superspreading dynamics

Testing is recommended for all close contacts of confirmed COVID-19 patients. However, existing pooled testing methods are oblivious to the circumstances of contagion provided by contact tracing. Here, we build upon a well-known semi-adaptive pooled testing method, Dorfman’s method with imperfect tests, and derive a simple pooled testing method based on dynamic programming that is specifically designed to use information provided by contact tracing. Experiments using a variety of reproduction numbers and dispersion levels, including those estimated in the context of the COVID-19 pandemic, show that the pools found using our method result in a significantly lower number of tests than those found using Dorfman’s method. Our method provides the greatest competitive advantage when the number of contacts of an infected individual is small, or the distribution of secondary infections is highly overdispersed. Moreover, it maintains this competitive advantage under imperfect contact tracing and significant levels of dilution.     

Prediction of brain deformations and risk of traumatic brain injury due to closed-head impact: quantitative analysis of the effects of boundary conditions and brain tissue constitutive model

In this study, we investigate the effects of modelling choices for the brain–skull interface (layers of tissues between the brain and skull that determine boundary conditions for the brain) and the constitutive model of brain parenchyma on the brain responses under violent impact as predicted using computational biomechanics model. We used the head/brain model from Total HUman Model for Safety (THUMS)—extensively validated finite element model of the human body that has been applied in numerous injury biomechanics studies. The computations were conducted using a well-established nonlinear explicit dynamics finite element code LS-DYNA. We employed four approaches for modelling the brain–skull interface and four constitutive models for the brain tissue in the numerical simulations of the experiments on post-mortem human subjects exposed to violent impacts reported in the literature. The brain–skull interface models included direct representation of the brain meninges and cerebrospinal fluid, outer brain surface rigidly attached to the skull, frictionless sliding contact between the brain and skull, and a layer of spring-type cohesive elements between the brain and skull. We considered Ogden hyperviscoelastic, Mooney–Rivlin hyperviscoelastic, neo–Hookean hyperviscoelastic and linear viscoelastic constitutive models of the brain tissue. Our study indicates that the predicted deformations within the brain and related brain injury criteria are strongly affected by both the approach of modelling the brain–skull interface and the constitutive model of the brain parenchyma tissues. The results suggest that accurate prediction of deformations within the brain and risk of brain injury due to violent impact using computational biomechanics models may require representation of the meninges and subarachnoidal space with cerebrospinal fluid in the model and application of hyperviscoelastic (preferably Ogden-type) constitutive model for the brain tissue.     

Using dimension reduction to improve outbreak predictability of multistrain diseases

Multistrain diseases have multiple distinct coexisting serotypes (strains). For some diseases, such as dengue fever, the serotypes interact by antibody-dependent enhancement (ADE), in which infection with a single serotype is asymptomatic, but contact with a second serotype leads to higher viral load and greater infectivity. We present and analyze a dynamic compartmental model for multiple serotypes exhibiting ADE. Using center manifold techniques, we show how the dynamics rapidly collapses to a lower dimensional system. Using the constructed reduced model, we can explain previously observed synchrony between certain classes of primary and secondary infectives (Schwartz et al. in Phys Rev E 72:066201, 2005). Additionally, we show numerically that the center manifold equations apply even to noisy systems. Both deterministic and stochastic versions of the model enable prediction of asymptomatic individuals that are difficult to track during an epidemic. We also show how this technique may be applicable to other multistrain disease models, such as those with cross-immunity.     

Simulating tumor growth in confined heterogeneous environments

The holy grail of computational tumor modeling is to develop a simulation tool that can be utilized in the clinic to predict neoplastic progression and propose individualized optimal treatment strategies. In order to develop such a predictive model, one must account for many of the complex processes involved in tumor growth. One interaction that has not been incorporated into computational models of neoplastic progression is the impact that organ-imposed physical confinement and heterogeneity have on tumor growth. For this reason, we have taken a cellular automaton algorithm that was originally designed to simulate spherically symmetric tumor growth and generalized the algorithm to incorporate the effects of tissue shape and structure. We show that models that do not account for organ/tissue geometry and topology lead to false conclusions about tumor spread, shape and size. The impact that confinement has on tumor growth is more pronounced when a neoplasm is growing close to, versus far from, the confining boundary. Thus, any clinical simulation tool of cancer progression must not only consider the shape and structure of the organ in which a tumor is growing, but must also consider the location of the tumor within the organ if it is to accurately predict neoplastic growth dynamics.