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Respiratory Syncytial Virus (RSV) induced bronchiolitis is a common lung infection and a major cause of infant hospitalization and mortality. Unfortunately, there is no known cure for RSV but several vaccines are in various stages of clinical trials. Currently, immunoprophylaxis is a preventative measure consisting of a series of monthly shots that should be administered at the start, and throughout, peak RSV season. Thus, the successful implementation of immunoprophylaxis is contingent upon understanding when outbreak seasons will begin, peak, and end. In this research we estimate the seasonal epidemic curves of RSV induced bronchiolitis using a spatially varying change point model. Further, in a novel approach and using the fitted change point model, we develop a historical matching algorithm to generate real time predictions of seasonal curves for future years.
Assuntos
Bronquiolite , Infecções por Vírus Respiratório Sincicial , Teorema de Bayes , Bronquiolite/epidemiologia , Bronquiolite/etiologia , Hospitalização , Humanos , Lactente , Infecções por Vírus Respiratório Sincicial/complicações , Infecções por Vírus Respiratório Sincicial/epidemiologia , Infecções por Vírus Respiratório Sincicial/prevenção & controle , Estações do AnoRESUMO
Bronchiolitis (inflammation of the lower respiratory tract) in infants is primarily due to viral infection and is the single most common cause of infant hospitalization in the United States. To increase epidemiological understanding of bronchiolitis (and, subsequently, develop better prevention strategies), this research analyzes data on infant bronchiolitis cases from the U.S. Military Health System between the years 2003-2013 in Norfolk, Virginia, USA. For privacy reasons, child home addresses, birth dates, and diagnosis dates were randomized (jittered) creating spatio-temporal uncertainty in the geographic location and timing of bronchiolitis incidents. Using spatio-temporal point patterns, we created a modeling strategy that accounts for the jittering to estimate and quantify the uncertainty for the incidence proportion (IP) of bronchiolitis. Additionally, we regress the IP onto key covariates including pollution where we adequately account for uncertainty in the pollution levels (i.e., covariate uncertainty) using a land use regression model. Our analysis results indicate that the IP is positively associated with sulfur dioxide and population density. Further, we demonstrate how scientific conclusions may change if various sources of uncertainty (either spatio-temporal or covariate uncertainty) are not accounted for. Code submitted with this article was checked by an Associate Editor for Reproducibility and is available as an online supplement.
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RSV bronchiolitis (an acute lower respiratory tract viral infection in infants) is the most common cause of infant hospitalizations in the United States (US). The only preventive intervention currently available is monthly injections of immunoprophylaxis. However, this treatment is expensive and needs to be administered simultaneously with seasonal bronchiolitis cycles in order to be effective. To increase our understanding of bronchiolitis timing, this research focuses on identifying seasonal bronchiolitis cycles (start times, peaks, and declinations) throughout the continental US using data on infant bronchiolitis cases from the US Military Health System Data Repository. Because this data involved highly personal information, the bronchiolitis dates in the dataset were "jittered" in the sense that the recorded dates were randomized within a time window of the true date. Hence, we develop a statistical change point model that estimates spatially varying seasonal bronchiolitis cycles while accounting for the purposefully introduced jittering in the data. Additionally, by including temperature and humidity data as regressors, we identify a relationship between bronchiolitis seasonality and climate. We found that, in general, bronchiolitis seasons begin earlier and are longer in the southeastern states compared to the western states with peak times lasting approximately 1 month nationwide.
Assuntos
Bronquiolite/epidemiologia , Estações do Ano , Análise Espacial , Incerteza , Teorema de Bayes , Bases de Dados Factuais , Humanos , Modelos Estatísticos , Estados Unidos/epidemiologiaRESUMO
The Rapid Carbon Assessment (RaCA) project was conducted by the US Department of Agriculture's National Resources Conservation Service between 2010-2012 in order to provide contemporaneous measurements of soil organic carbon (SOC) across the US. Despite the broad extent of the RaCA data collection effort, direct observations of SOC are not available at the high spatial resolution needed for studying carbon storage in soil and its implications for important problems in climate science and agriculture. As a result, there is a need for predicting SOC at spatial locations not included as part of the RaCA project. In this paper, we compare spatial prediction of SOC using a subset of the RaCA data for a variety of statistical methods. We investigate the performance of methods with off-the-shelf software available (both stationary and nonstationary) as well as a novel nonstationary approach based on partitioning relevant spatially-varying covariate processes. Our new method addresses open questions regarding (1) how to partition the spatial domain for segmentation-based nonstationary methods, (2) incorporating partially observed covariates into a spatial model, and (3) accounting for uncertainty in the partitioning. In applying the various statistical methods we find that there are minimal differences in out-of-sample criteria for this particular data set, however, there are major differences in maps of uncertainty in SOC predictions. We argue that the spatially-varying measures of prediction uncertainty produced by our new approach are valuable to decision makers, as they can be used to better benchmark mechanistic models, identify target areas for soil restoration projects, and inform carbon sequestration projects.
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We provide a discussion of the article "Computationally Efficient Multivariate Spatio-Temporal Models for High-Dimensional Count-Valued Data" by Bradley, Holan, and Wikle. In our opinion, this work constitutes a major contribution to the field of spatio-temporal statistics and contains distribution theory that should be broadly applicable. In this note, we reflect on modeling decisions made by the authors. We include a small set of simulation results to illustrate the effect of one aspect of the proposed model.
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Infant bronchiolitis is primarily due to infection by respiratory syncytial virus (RSV), which is highly seasonal. The goal of the study is to understand how circulation of RSV is impacted by fluctuations in temperature and humidity in order to inform prevention efforts. Using data from the Military Health System (MHS) Data Repository (MDR), we calculated rates of infant bronchiolitis for the contiguous US from July 2004 to June 2013. Monthly temperature and relative humidity were extracted from the National Climate Data Center. Using a spatiotemporal generalized linear model for binomial data, we estimated bronchiolitis rates and the effects of temperature and relative humidity while allowing them to vary over location and time. Our results indicate a seasonal pattern that begins in the Southeast during November or December, then spreading in a Northwest direction. The relationships of temperature and humidity were spatially heterogeneous, and we find that climate can partially account for early onset or longer epidemic duration. Small changes in climate may be associated with larger fluctuations in epidemic duration.