Requirements and design of the PROSPER protocol for implementation of information infrastructures supporting pandemic response: a Nominal Group study

Background

Advanced technical systems and analytic methods promise to provide policy makers with information to help them recognize the consequences of alternative courses of action during pandemics. Evaluations still show that response programs are insufficiently supported by information systems. This paper sets out to derive a protocol for implementation of integrated information infrastructures supporting regional and local pandemic response programs at the stage(s) when the outbreak no longer can be contained at its source.

Methods

Nominal group methods for reaching consensus on complex problems were used to transform requirements data obtained from international experts into an implementation protocol. The analysis was performed in a cyclical process in which the experts first individually provided input to working documents and then discussed them in conferences calls. Argument-based representation in design patterns was used to define the protocol at technical, system, and pandemic evidence levels.

Results

The Protocol for a Standardized information infrastructure for Pandemic and Emerging infectious disease Response (PROSPER) outlines the implementation of information infrastructure aligned with pandemic response programs. The protocol covers analyses of the community at risk, the response processes, and response impacts. For each of these, the protocol outlines the implementation of a supporting information infrastructure in hierarchical patterns ranging from technical components and system functions to pandemic evidence production.

Conclusions

The PROSPER protocol provides guidelines for implementation of an information infrastructure for pandemic response programs both in settings where sophisticated health information systems already are used and in developing communities where there is limited access to financial and technical resources. The protocol is based on a generic health service model and its functions are adjusted for community-level analyses of outbreak detection and progress, and response program effectiveness. Scientifically grounded reporting principles need to be established for interpretation of information derived from outbreak detection algorithms and predictive modeling.     

The photochemistry of some main chain liquid crystalline 4,4'-stilbene dicarboxylate polyesters.

Several aspects of the photochemistry and photophysics of four main chain liquid crystalline polyesters with a rigid trans-stilbene 4,4'-dicarboxylate mesogen as chromophore and flexible spacer groups are reported. The three polymers with the longest 'spacer' groups are liquid crystalline at room temperature, two have smectic phases. Chromophore aggregation has a dramatic effect on the photophysics and photochemistry of these polymers. Each of the polymers in poor solvents or as films has greatly perturbed UV-Vis absorption and fluorescence spectra due to aggregation of the stilbene chromophore. These effects are more pronounced upon annealing above the glass transition temperature, T(g), and in the mesophase. Film fluorescence is excitation wavelength dependent and is suppressed at elevated temperatures. The stilbene 'environment' in both films and solution is clearly heterogeneous and energy transfer processes relatively slow. The dominant photochemical reaction upon direct excitation above 300 nm is 2 + 2 photocycloaddition rendering polymer films insoluble. No significant trans-to-cis photoisomerization can be detected upon initial irradiation of the polymer films. There is evidence for the formation of aldehyde and carboxylate functionality upon irradiation in the presence of air. Loss of the aggregate UV-Vis absorption and fluorescence occurs during irradiation. Difference UV-Vis spectra of irradiated films suggest preferential initial consumption of dimeric aggregates. Loss of stilbene UV-Vis absorption upon irradiation above 300 nm can be partly photoreversed upon subsequent 254 nm irradiation. The rate of stilbene chromophore loss from films increased significantly above Tg and in the smectic phase above room temperature.     

The role of selection in the evolution of human mitochondrial genomes

High mutation rate in mammalian mitochondrial DNA generates a highly divergent pool of alleles even within species that have dispersed and expanded in size recently. Phylogenetic analysis of 277 human mitochondrial genomes revealed a significant (P < 0.01) excess of rRNA and nonsynonymous base substitutions among hotspots of recurrent mutation. Most hotspots involved transitions from guanine to adenine that, with thymine-to-cytosine transitions, illustrate the asymmetric bias in codon usage at synonymous sites on the heavy-strand DNA. The mitochondrion-encoded tRNAThr varied significantly more than any other tRNA gene. Threonine and valine codons were involved in 259 of the 414 amino acid replacements observed. The ratio of nonsynonymous changes from and to threonine and valine differed significantly (P = 0.003) between populations with neutral (22/58) and populations with significantly negative Tajima's D values (70/76), independent of their geographic location. In contrast to a recent suggestion that the excess of nonsilent mutations is characteristic of Arctic populations, implying their role in cold adaptation, we demonstrate that the surplus of nonsynonymous mutations is a general feature of the young branches of the phylogenetic tree, affecting also those that are found only in Africa. We introduce a new calibration method of the mutation rate of synonymous transitions to estimate the coalescent times of mtDNA haplogroups.     

Comparative study of semi-specific Aeromonas hydrophila and universal Pseudomonas fluorescens biosensors for BOD measurements in meat industry wastewaters

Aeromonas hydrophila P69.1 (A. hydrophila) was used to construct a semi-specific biosensor to estimate biochemical oxygen demand (BOD) in high fat and grease content wastewaters. A. hydrophila cells were grown in fat containing medium to induce necessary enzymes for transport and degradation of fatty substances. Universal biosensor based on non-specific Pseudomonas fluorescens P75 (P. fluorescens) was used to conduct comparison experiments. Biosensors were calibrated using OECD synthetic wastewater and steady-state method, subsequently several experiments with synthetic and industrial wastewaters were conducted. A linear range up to 45 mg l(-1) BOD(7) was gained using A. hydrophila biosensor, in comparison to 40 mg l(-1) BOD(7) obtained using P. fluorescens biosensors. The lower limit of detection was 5 mg l(-1) BOD(7). Service life of A. hydrophila and P. fluorescens biosensors were 110 and 115 days, respectively. The response time of the biosensors depended on the BOD(7) of measuring solution and was up to 20 min when analyzing different wastewaters. Both biosensors underestimated BOD in meat industry wastewater from 43% up to 71%, but more accurate results could be obtained with A. hydrophila biosensor. Semi-specific A. hydrophila biosensor was able to measure proportion of fat found in wastewater sample, while other refractory compounds remained undetectable to both biosensors.     

Age as a determinant for dissemination of seasonal and pandemic influenza: an open cohort study of influenza outbreaks in Östergötland County, Sweden

An understanding of the occurrence and comparative timing of influenza infections in different age groups is important for developing community response and disease control measures. This study uses data from a Scandinavian county (population 427.000) to investigate whether age was a determinant for being diagnosed with influenza 2005-2010 and to examine if age was associated with case timing during outbreaks. Aggregated demographic data were collected from Statistics Sweden, while influenza case data were collected from a county-wide electronic health record system. A logistic regression analysis was used to explore whether case risk was associated with age and outbreak. An analysis of variance was used to explore whether day for diagnosis was also associated to age and outbreak. The clinical case data were validated against case data from microbiological laboratories during one control year. The proportion of cases from the age groups 10-19 (p<0.001) and 20-29 years old (p<0.01) were found to be larger during the A pH1N1 outbreak in 2009 than during the seasonal outbreaks. An interaction between age and outbreak was observed (p<0.001) indicating a difference in age effects between circulating virus types; this interaction persisted for seasonal outbreaks only (p<0.001). The outbreaks also differed regarding when the age groups received their diagnosis (p<0.001). A post-hoc analysis showed a tendency for the young age groups, in particular the group 10-19 year olds, led outbreaks with influenza type A H1 circulating, while A H3N2 outbreaks displayed little variations in timing. The validation analysis showed a strong correlation (r = 0.625;p<0.001) between the recorded numbers of clinically and microbiologically defined influenza cases. Our findings demonstrate the complexity of age effects underlying the emergence of local influenza outbreaks. Disentangling these effects on the causal pathways will require an integrated information infrastructure for data collection and repeated studies of well-defined communities.     

Efficacy of different treatment regimes against setariosis (<Emphasis Type="Italic">Setaria tundra</Emphasis>, Nematoda: Filarioidea) and associated peritonitis in reindeer

Background  

When a severe peritonitis outbreak in semi-domesticated reindeer was noticed in 2003 in Finland, the concerned industry urged immediate preventive actions in order to avoid detrimental effects of S. tundra and further economical losses. A research programme was swiftly initiated to study S. tundra and its impact on the health and wellbeing of reindeer.     

Contributions of DOC from surface and groundflow into Lake Võrtsjärv (Estonia)

Hydrological changes have the greatest impact on shallow lakes where they alter the water volume and lake depth noticeably. Dissolved organic carbon (DOC), which is markedly affected by hydrological factors, has an important role in many biogeochemical processes. The DOC load supplied to Lake Võrtsjärv, the second largest lake in Estonia, was studied on the scale of the subcatchments discharging into the lake. Daily discharges and biweekly or monthly DOC concentrations were measured close to the river outlets over the years 1990–2002. The stream flow data were separated into groundflow and surface flow by applying local minimum and recursive digital filtering methods. Constituent load estimation software, LOADEST, was used to estimate DOC concentrations and load. LOADEST performed well for three of the four rivers. The total estimated DOC load to Võrtsjärv from all four main rivers varied from 1,320 to 4,934 t year^?1. The average annual load over the 13-year period was 3,265 t year^?1 or 1.18 g C m^?2 year^?1. Baseflow separation analysis indicated that the DOC load originating from groundflow contributed 79% and 69% of the total load according to the digital filter and local minimum methods, respectively. The results of our study demonstrate the utility of linking the rating-curve method and baseflow separation to assess the allochthonous DOC load to Võrtsjärv both currently and under changing climatic conditions.     

The effective mutation rate at Y chromosome short tandem repeats, with application to human population-divergence time

We estimate an effective mutation rate at an average Y chromosome short-tandem repeat locus as 6.9x10-4 per 25 years, with a standard deviation across loci of 5.7x10-4, using data on microsatellite variation within Y chromosome haplogroups defined by unique-event polymorphisms in populations with documented short-term histories, as well as comparative data on worldwide populations at both the Y chromosome and various autosomal loci. This value is used to estimate the times of the African Bantu expansion, the divergence of Polynesian populations (the Maoris, Cook Islanders, and Samoans), and the origin of Gypsy populations from Bulgaria.     

Most of the extant mtDNA boundaries in South and Southwest Asia were likely shaped during the initial settlement of Eurasia by anatomically modern humans

Background

Recent advances in the understanding of the maternal and paternal heritage of south and southwest Asian populations have highlighted their role in the colonization of Eurasia by anatomically modern humans. Further understanding requires a deeper insight into the topology of the branches of the Indian mtDNA phylogenetic tree, which should be contextualized within the phylogeography of the neighboring regional mtDNA variation. Accordingly, we have analyzed mtDNA control and coding region variation in 796 Indian (including both tribal and caste populations from different parts of India) and 436 Iranian mtDNAs. The results were integrated and analyzed together with published data from South, Southeast Asia and West Eurasia.

Results

Four new Indian-specific haplogroup M sub-clades were defined. These, in combination with two previously described haplogroups, encompass approximately one third of the haplogroup M mtDNAs in India. Their phylogeography and spread among different linguistic phyla and social strata was investigated in detail. Furthermore, the analysis of the Iranian mtDNA pool revealed patterns of limited reciprocal gene flow between Iran and the Indian sub-continent and allowed the identification of different assemblies of shared mtDNA sub-clades.

Conclusions

Since the initial peopling of South and West Asia by anatomically modern humans, when this region may well have provided the initial settlers who colonized much of the rest of Eurasia, the gene flow in and out of India of the maternally transmitted mtDNA has been surprisingly limited. Specifically, our analysis of the mtDNA haplogroups, which are shared between Indian and Iranian populations and exhibit coalescence ages corresponding to around the early Upper Paleolithic, indicates that they are present in India largely as Indian-specific sub-lineages. In contrast, other ancient Indian-specific variants of M and R are very rare outside the sub-continent.     

Traces of archaic mitochondrial lineages persist in Austronesian-speaking Formosan populations

Genetic affinities between aboriginal Taiwanese and populations from Oceania and Southeast Asia have previously been explored through analyses of mitochondrial DNA (mtDNA), Y chromosomal DNA, and human leukocyte antigen loci. Recent genetic studies have supported the “slow boat” and “entangled bank” models according to which the Polynesian migration can be seen as an expansion from Melanesia without any major direct genetic thread leading back to its initiation from Taiwan. We assessed mtDNA variation in 640 individuals from nine tribes of the central mountain ranges and east coast regions of Taiwan. In contrast to the Han populations, the tribes showed a low frequency of haplogroups D4 and G, and an absence of haplogroups A, C, Z, M9, and M10. Also, more than 85% of the maternal lineages were nested within haplogroups B4, B5a, F1a, F3b, E, and M7. Although indicating a common origin of the populations of insular Southeast Asia and Oceania, most mtDNA lineages in Taiwanese aboriginal populations are grouped separately from those found in China and the Taiwan general (Han) population, suggesting a prevalence in the Taiwanese aboriginal gene pool of its initial late Pleistocene settlers. Interestingly, from complete mtDNA sequencing information, most B4a lineages were associated with three coding region substitutions, defining a new subclade, B4a1a, that endorses the origin of Polynesian migration from Taiwan. Coalescence times of B4a1a were 13.2 ± 3.8 thousand years (or 9.3 ± 2.5 thousand years in Papuans and Polynesians). Considering the lack of a common specific Y chromosomal element shared by the Taiwanese aboriginals and Polynesians, the mtDNA evidence provided here is also consistent with the suggestion that the proto-Oceanic societies would have been mainly matrilocal.