Fitting and validation of an agent-based model for COVID-19 case forecasting in workplaces and universities.

COVID-19 forecasting models have been critical in guiding decision-making on surveillance testing, social distancing, and vaccination requirements. Beyond influencing public health policies, an accurate COVID-19 forecasting model can impact community spread by enabling employers and university leaders to adapt worksite policies and practices to contain or mitigate outbreaks. While many such models have been developed for COVID-19 forecasting at the national, state, county, or city level, only a few models have been developed for workplaces and universities. Furthermore, COVID-19 forecasting models have rarely been validated against real COVID-19 case data. Here we present the systematic parameter fitting and validation of an agent-based compartment model for the forecasting of daily COVID-19 cases in single-site workplaces and universities with real-world data. Our approaches include manual fitting, where initial model parameters are chosen based on historical data, and automated fitting, where parameters are chosen based on candidate case trajectory simulations that result in best fit to prevalence estimation data. We use a 14-day fitting window and validate our approaches on 7- and 14-day testing windows with real COVID-19 case data from one employer. Our manual and automated fitting approaches accurately predicted COVID-19 case trends and outperformed the baseline model (no parameter fitting) across multiple scenarios, including a rising case trajectory (RMSLE values: 2.627 for baseline, 0.562 for manual fitting, 0.399 for automated fitting) and a decreasing case trajectory (RMSLE values: 1.155 for baseline, 0.537 for manual fitting, 0.778 for automated fitting). Our COVID-19 case forecasting model allows decision-makers at workplaces and universities to proactively respond to case trend forecasts, mitigate outbreaks, and promote safety.

A holistic approach for suppression of COVID-19 spread in workplaces and universities.

As society has moved past the initial phase of the COVID-19 crisis that relied on broad-spectrum shutdowns as a stopgap method, industries and institutions have faced the daunting question of how to return to a stabilized state of activities and more fully reopen the economy. A core problem is how to return people to their workplaces and educational institutions in a manner that is safe, ethical, grounded in science, and takes into account the unique factors and needs of each organization and community. In this paper, we introduce an epidemiological model (the "Community-Workplace" model) that accounts for SARS-CoV-2 transmission within the workplace, within the surrounding community, and between them. We use this multi-group deterministic compartmental model to consider various testing strategies that, together with symptom screening, exposure tracking, and nonpharmaceutical interventions (NPI) such as mask wearing and physical distancing, aim to reduce disease spread in the workplace. Our framework is designed to be adaptable to a variety of specific workplace environments to support planning efforts as reopenings continue. Using this model, we consider a number of case studies, including an office workplace, a factory floor, and a university campus. Analysis of these cases illustrates that continuous testing can help a workplace avoid an outbreak by reducing undetected infectiousness even in high-contact environments. We find that a university setting, where individuals spend more time on campus and have a higher contact load, requires more testing to remain safe, compared to a factory or office setting. Under the modeling assumptions, we find that maintaining a prevalence below 3% can be achieved in an office setting by testing its workforce every two weeks, whereas achieving this same goal for a university could require as much as fourfold more testing (i.e., testing the entire campus population twice a week). Our model also simulates the dynamics of reduced spread that result from the introduction of mitigation measures when test results reveal the early stages of a workplace outbreak. We use this to show that a vigilant university that has the ability to quickly react to outbreaks can be justified in implementing testing at the same rate as a lower-risk office workplace. Finally, we quantify the devastating impact that an outbreak in a small-town college could have on the surrounding community, which supports the notion that communities can be better protected by supporting their local places of business in preventing onsite spread of disease.

Toward a Mobile Platform for Real-world Digital Measurement of Depression: User-Centered Design, Data Quality, and Behavioral and Clinical Modeling.

BACKGROUND: Although effective mental health treatments exist, the ability to match individuals to optimal treatments is poor, and timely assessment of response is difficult. One reason for these challenges is the lack of objective measurement of psychiatric symptoms. Sensors and active tasks recorded by smartphones provide a low-burden, low-cost, and scalable way to capture real-world data from patients that could augment clinical decision-making and move the field of mental health closer to measurement-based care. OBJECTIVE: This study tests the feasibility of a fully remote study on individuals with self-reported depression using an Android-based smartphone app to collect subjective and objective measures associated with depression severity. The goals of this pilot study are to develop an engaging user interface for high task adherence through user-centered design; test the quality of collected data from passive sensors; start building clinically relevant behavioral measures (features) from passive sensors and active inputs; and preliminarily explore connections between these features and depression severity. METHODS: A total of 600 participants were asked to download the study app to join this fully remote, observational 12-week study. The app passively collected 20 sensor data streams (eg, ambient audio level, location, and inertial measurement units), and participants were asked to complete daily survey tasks, weekly voice diaries, and the clinically validated Patient Health Questionnaire (PHQ-9) self-survey. Pairwise correlations between derived behavioral features (eg, weekly minutes spent at home) and PHQ-9 were computed. Using these behavioral features, we also constructed an elastic net penalized multivariate logistic regression model predicting depressed versus nondepressed PHQ-9 scores (ie, dichotomized PHQ-9). RESULTS: A total of 415 individuals logged into the app. Over the course of the 12-week study, these participants completed 83.35% (4151/4980) of the PHQ-9s. Applying data sufficiency rules for minimally necessary daily and weekly data resulted in 3779 participant-weeks of data across 384 participants. Using a subset of 34 behavioral features, we found that 11 features showed a significant (P<.001 Benjamini-Hochberg adjusted) Spearman correlation with weekly PHQ-9, including voice diary-derived word sentiment and ambient audio levels. Restricting the data to those cases in which all 34 behavioral features were present, we had available 1013 participant-weeks from 186 participants. The logistic regression model predicting depression status resulted in a 10-fold cross-validated mean area under the curve of 0.656 (SD 0.079). CONCLUSIONS: This study finds a strong proof of concept for the use of a smartphone-based assessment of depression outcomes. Behavioral features derived from passive sensors and active tasks show promising correlations with a validated clinical measure of depression (PHQ-9). Future work is needed to increase scale that may permit the construction of more complex (eg, nonlinear) predictive models and better handle data missingness.

Coherence between motor unit discharges in response to shared neural inputs.

Coherence analysis is widely employed to study the correlation between discharge times of simultaneously active motor units. Despite the widespread application of the technique, it has not been fully established how the characteristics of the observed coherence are related to the properties of the shared motoneuron inputs. In addition, the exact relationship between coherence and traditional measures of motor unit synchronization remains unclear. The purpose of this study was to examine the influence of shared motoneuron inputs on coherence between motor unit discharge patterns using computer simulations. Although less sensitive to motor unit firing rates than traditional synchronization-based indices, coherence tended to decrease with increasing frequency of the common input and to increase slightly when the common input frequency was close to the motor unit firing rates. In addition, coherence tended to be highest between motor units with similar firing rates. A linear association was observed between synchronization and coherence in the 15-30 Hz range and between 'common drive' and coherence in the 0-5 Hz range. The results suggest that caution should be taken when interpreting differences in coherence observed between motor units with significantly different firing properties or when comparing data with coherence in different frequency ranges.

Time and frequency domain methods for quantifying common modulation of motor unit firing patterns.

BACKGROUND: In investigations of the human motor system, two approaches are generally employed toward the identification of common modulating drives from motor unit recordings. One is a frequency domain method and uses the coherence function to determine the degree of linear correlation between each frequency component of the signals. The other is a time domain method that has been developed to determine the strength of low frequency common modulations between motor unit spike trains, often referred to in the literature as 'common drive'. METHODS: The relationships between these methods are systematically explored using both mathematical and experimental procedures. A mathematical derivation is presented that shows the theoretical relationship between both time and frequency domain techniques. Multiple recordings from concurrent activities of pairs of motor units are studied and linear regressions are performed between time and frequency domain estimates (for different time domain window sizes) to assess their equivalence. RESULTS: Analytically, it may be demonstrated that under the theoretical condition of a narrowband point frequency, the two relations are equivalent. However practical situations deviate from this ideal condition. The correlation between the two techniques varies with time domain moving average window length and for window lengths of 200 ms, 400 ms and 800 ms, the r2 regression statistics (p < 0.05) are 0.56, 0.81 and 0.80 respectively. CONCLUSIONS: Although theoretically equivalent and experimentally well correlated there are a number of minor discrepancies between the two techniques that are explored. The time domain technique is preferred for short data segments and is better able to quantify the strength of a broad band drive into a single index. The frequency domain measures are more encompassing, providing a complete description of all oscillatory inputs and are better suited to quantifying narrow ranges of descending input into a single index. In general the physiological question at hand should dictate which technique is best suited.

Effective method for quantifying respiratory effective method for quantifying respiratory subsequent marker of anxiety.

Ambulatory respiratory data was gathered using inductive lethysmography technology with synchronous ECG(LifeShirte , VivoMetrics, Ventura, CA) during a study to evaluate the effect of an anxiolytic on heart rate variability and respiratory pattern as indicators of anxiety state. Positive control (PCR; post-marketing, broadly prescribed anxiolytic)and placebo (PBO) data was included in the analysis. Tidal volume waveforms were the result of a weighted sum of the abdominal and rib cage IP bands according to the qualitative diagnostic calibration method. A breath detection algorithm was run to identify the beginning and end of inhalation in these waveforms. Several types of respiratory artifact are common with ambulatory, non-controlled recordings and a consistent and reliable means is necessary to identify and manage such artifacts. An automated approach was adopted to define a reliable breathing index for each breath that labels that breath as contaminated by artifact or not. The root mean square of successive differences (RMSSD) were computed on the tidal inspiratory volumes and total breath times for each epoch, both for all breaths and for only those breaths that were labeled as reliable. The results indicate that when a priori automated artifact detection is included, there is a significant linear decrease in both the volume and time indices for the PCR, whilst no significant differences were noted in the PBO group. Analyzing the data without prior marking of reliable breaths showed no significant results for either group. This study demonstrates the validity of ambulatory respiratory measurements as a means to assess anxiety and establishes the need to first identify reliable breathing periods prior to the analysis of ambulatory respiratory data.