Quantification of the resilience of primary care networks by stress testing the health care system.

There are practically no quantitative tools for understanding how much stress a health care system can absorb before it loses its ability to provide care. We propose to measure the resilience of health care systems with respect to changes in the density of primary care providers. We develop a computational model on a 1-to-1 scale for a countrywide primary care sector based on patient-sharing networks. Nodes represent all primary care providers in a country; links indicate patient flows between them. The removal of providers could cause a cascade of patient displacements, as patients have to find alternative providers. The model is calibrated with nationwide data from Austria that includes almost all primary care contacts over 2 y. We assign 2 properties to every provider: the "CareRank" measures the average number of displacements caused by a provider's removal (systemic risk) as well as the fraction of patients a provider can absorb when others default (systemic benefit). Below a critical number of providers, large-scale cascades of patient displacements occur, and no more providers can be found in a given region. We quantify regional resilience as the maximum fraction of providers that can be removed before cascading events prevent coverage for all patients within a district. We find considerable regional heterogeneity in the critical transition point from resilient to nonresilient behavior. We demonstrate that health care resilience cannot be quantified by physician density alone but must take into account how networked systems respond and restructure in response to shocks. The approach can identify systemically relevant providers.

Unraveling cradle-to-grave disease trajectories from multilayer comorbidity networks.

We aim to comprehensively identify typical life-spanning trajectories and critical events that impact patients' hospital utilization and mortality. We use a unique dataset containing 44 million records of almost all inpatient stays from 2003 to 2014 in Austria to investigate disease trajectories. We develop a new, multilayer disease network approach to quantitatively analyze how cooccurrences of two or more diagnoses form and evolve over the life course of patients. Nodes represent diagnoses in age groups of ten years; each age group makes up a layer of the comorbidity multilayer network. Inter-layer links encode a significant correlation between diagnoses (p < 0.001, relative risk > 1.5), while intra-layers links encode correlations between diagnoses across different age groups. We use an unsupervised clustering algorithm for detecting typical disease trajectories as overlapping clusters in the multilayer comorbidity network. We identify critical events in a patient's career as points where initially overlapping trajectories start to diverge towards different states. We identified 1260 distinct disease trajectories (618 for females, 642 for males) that on average contain 9 (IQR 2-6) different diagnoses that cover over up to 70 years (mean 23 years). We found 70 pairs of diverging trajectories that share some diagnoses at younger ages but develop into markedly different groups of diagnoses at older ages. The disease trajectory framework can help us to identify critical events as specific combinations of risk factors that put patients at high risk for different diagnoses decades later. Our findings enable a data-driven integration of personalized life-course perspectives into clinical decision-making.

Visual Exploration of Financial Data with Incremental Domain Knowledge.

Modelling the dynamics of a growing financial environment is a complex task that requires domain knowledge, expertise and access to heterogeneous information types. Such information can stem from several sources at different scales, complicating the task of forming a holistic impression of the financial landscape, especially in terms of the economical relationships between firms. Bringing this scattered information into a common context is, therefore, an essential step in the process of obtaining meaningful insights about the state of an economy. In this paper, we present Sabrina 2.0, a Visual Analytics (VA) approach for exploring financial data across different scales, from individual firms up to nation-wide aggregate data. Our solution is coupled with a pipeline for the generation of firm-to-firm financial transaction networks, fusing information about individual firms with sector-to-sector transaction data and domain knowledge on macroscopic aspects of the economy. Each network can be created to have multiple instances to compare different scenarios. We collaborated with experts from finance and economy during the development of our VA solution, and evaluated our approach with seven domain experts across industry and academia through a qualitative insight-based evaluation. The analysis shows how Sabrina 2.0 enables the generation of insights, and how the incorporation of transaction models assists users in their exploration of a national economy.

Systematic population-wide ecological analysis of regional variability in disease prevalence.

The prevalence of diseases often varies substantially from region to region. Besides basic demographic properties, the factors that drive the variability of each prevalence are to a large extent unknown. Here we show how regional prevalence variations in 115 different diseases relate to demographic, socio-economic, environmental factors and migratory background, as well as access to different types of health services such as primary, specialized and hospital healthcare. We have collected regional data for these risk factors at different levels of resolution; from large regions of care (Versorgungsregion) down to a 250 by 250 m square grid. Using multivariate regression analysis, we quantify the explanatory power of each independent variable in relation to the regional variation of the disease prevalence. We find that for certain diseases, such as acute heart conditions, diseases of the inner ear, mental and behavioral disorders due to substance abuse, up to 80% of the variance can be explained with these risk factors. For other diagnostic blocks, such as blood related diseases, injuries and poisoning however, the explanatory power is close to zero. We find that the time needed to travel from the inhabited center to the relevant hospital ward often contributes significantly to the disease risk, in particular for diabetes mellitus. Our results show that variations in disease burden across different regions can for many diseases be related to variations in demographic and socio-economic factors. Furthermore, our results highlight the relative importance of access to health care facilities in the treatment of chronic diseases like diabetes.

SARS-ANI: a global open access dataset of reported SARS-CoV-2 events in animals.

The zoonotic origin of SARS-CoV-2, the etiological agent of COVID-19, is not yet fully resolved. Although natural infections in animals are reported in a wide range of species, large knowledge and data gaps remain regarding SARS-CoV-2 in animal hosts. We used two major health databases to extract unstructured data and generated a global dataset of SARS-CoV-2 events in animals. The dataset presents harmonized host names, integrates relevant epidemiological and clinical data on each event, and is readily usable for analytical purposes. We also share the code for technical and visual validation of the data and created a user-friendly dashboard for data exploration. Data on SARS-CoV-2 occurrence in animals is critical to adapting monitoring strategies, preventing the formation of animal reservoirs, and tailoring future human and animal vaccination programs. The FAIRness and analytical flexibility of the data will support research efforts on SARS-CoV-2 at the human-animal-environment interface. We intend to update this dataset weekly for at least one year and, through collaborations, to develop it further and expand its use.

Assessing the impact of SARS-CoV-2 prevention measures in Austrian schools using agent-based simulations and cluster tracing data.

We aim to identify those measures that effectively control the spread of SARS-CoV-2 in Austrian schools. Using cluster tracing data we calibrate an agent-based epidemiological model and consider situations where the B1.617.2 (delta) virus strain is dominant and parts of the population are vaccinated to quantify the impact of non-pharmaceutical interventions (NPIs) such as room ventilation, reduction of class size, wearing of masks during lessons, vaccinations, and school entry testing by SARS-CoV2-antigen tests. In the data we find that 40% of all clusters involved no more than two cases, and 3% of the clusters only had more than 20 cases. The model shows that combinations of NPIs together with vaccinations are necessary to allow for a controlled opening of schools under sustained community transmission of the SARS-CoV-2 delta variant. For plausible vaccination rates, primary (secondary) schools require a combination of at least two (three) of the above NPIs.

Stress-testing the resilience of the Austrian healthcare system using agent-based simulation.

Patients do not access physicians at random but rather via naturally emerging networks of patient flows between them. As mass quarantines, absences due to sickness, or other shocks thin out these networks, the system might be pushed to a tipping point where it loses its ability to deliver care. Here, we propose a data-driven framework to quantify regional resilience to such shocks via an agent-based model. For each region and medical specialty we construct patient-sharing networks and stress-test these by removing physicians. This allows us to measure regional resilience indicators describing how many physicians can be removed before patients will not be treated anymore. Our model could therefore enable health authorities to rapidly identify bottlenecks in access to care. Here, we show that regions and medical specialties differ substantially in their resilience and that these systemic differences can be related to indicators for individual physicians by quantifying their risk and benefit to the system.

Agent-based simulations for protecting nursing homes with prevention and vaccination strategies.

Due to its high lethality among older people, the safety of nursing homes has been of central importance during the COVID-19 pandemic. With test procedures and vaccines becoming available at scale, nursing homes might relax prohibitory measures while controlling the spread of infections. By control we mean that each index case infects less than one other person on average. Here, we develop an agent-based epidemiological model for the spread of SARS-CoV-2 calibrated to Austrian nursing homes to identify optimal prevention strategies. We find that the effectiveness of mitigation testing depends critically on test turnover time (time until test result), the detection threshold of tests and mitigation testing frequencies. Under realistic conditions and in absence of vaccinations, we find that mitigation testing of employees only might be sufficient to control outbreaks if tests have low turnover times and detection thresholds. If vaccines that are 60% effective against high viral load and transmission are available, control is achieved if 80% or more of the residents are vaccinated, even without mitigation testing and if residents are allowed to have visitors. Since these results strongly depend on vaccine efficacy against infection, retention of testing infrastructures, regular testing and sequencing of virus genomes is advised to enable early identification of new variants of concern.

Decompression of Multimorbidity Along the Disease Trajectories of Diabetes Mellitus Patients.

Multimorbidity, the presence of two or more diseases in a patient, is maybe the greatest health challenge for the aging populations of many high-income countries. One of the main drivers of multimorbidity is diabetes mellitus (DM) due to its large number of risk factors and complications. Yet, we currently have very limited understanding of how to quantify multimorbidity beyond a simple counting of diseases and thereby inform prevention and intervention strategies tailored to the needs of elderly DM patients. Here, we conceptualize multimorbidity as typical temporal progression patterns of multiple diseases, so-called trajectories, and develop a framework to perform a matched and sex-specific comparison between DM and non-diabetic patients. We find that these disease trajectories can be organized into a multi-level hierarchy in which DM patients progress from relatively healthy states with low mortality to high-mortality states characterized by cardiovascular diseases, chronic lower respiratory diseases, renal failure, and different combinations thereof. The same disease trajectories can be observed in non-diabetic patients, however, we find that DM patients typically progress at much higher rates along their trajectories. Comparing male and female DM patients, we find a general tendency that females progress faster toward high multimorbidity states than males, in particular along trajectories that involve obesity. Males, on the other hand, appear to progress faster in trajectories that combine heart diseases with cerebrovascular diseases. Our results show that prevention and efficient management of DM are key to achieve a compression of morbidity into higher patient ages. Multidisciplinary efforts involving clinicians as well as experts in machine learning and data visualization are needed to better understand the identified disease trajectories and thereby contribute to solving the current multimorbidity crisis in healthcare.

A structured open dataset of government interventions in response to COVID-19.

In response to the COVID-19 pandemic, governments have implemented a wide range of non-pharmaceutical interventions (NPIs). Monitoring and documenting government strategies during the COVID-19 crisis is crucial to understand the progression of the epidemic. Following a content analysis strategy of existing public information sources, we developed a specific hierarchical coding scheme for NPIs. We generated a comprehensive structured dataset of government interventions and their respective timelines of implementation. To improve transparency and motivate collaborative validation process, information sources are shared via an open library. We also provide codes that enable users to visualise the dataset. Standardization and structure of the dataset facilitate inter-country comparison and the assessment of the impacts of different NPI categories on the epidemic parameters, population health indicators, the economy, and human rights, among others. This dataset provides an in-depth insight of the government strategies and can be a valuable tool for developing relevant preparedness plans for pandemic. We intend to further develop and update this dataset until the end of December 2020.

Visualization Multi-Pipeline for Communicating Biology.

We propose a system to facilitate biology communication by developing a pipeline to support the instructional visualization of heterogeneous biological data on heterogeneous user-devices. Discoveries and concepts in biology are typically summarized with illustrations assembled manually from the interpretation and application of heterogenous data. The creation of such illustrations is time consuming, which makes it incompatible with frequent updates to the measured data as new discoveries are made. Illustrations are typically non-interactive, and when an illustration is updated, it still has to reach the user. Our system is designed to overcome these three obstacles. It supports the integration of heterogeneous datasets, reflecting the knowledge that is gained from different data sources in biology. After pre-processing the datasets, the system transforms them into visual representations as inspired by scientific illustrations. As opposed to traditional scientific illustration these representations are generated in real-time - they are interactive. The code generating the visualizations can be embedded in various software environments. To demonstrate this, we implemented both a desktop application and a remote-rendering server in which the pipeline is embedded. The remote-rendering server supports multi-threaded rendering and it is able to handle multiple users simultaneously. This scalability to different hardware environments, including multi-GPU setups, makes our system useful for efficient public dissemination of biological discoveries.

Multiscale Visualization and Scale-Adaptive Modification of DNA Nanostructures.

We present an approach to represent DNA nanostructures in varying forms of semantic abstraction, describe ways to smoothly transition between them, and thus create a continuous multiscale visualization and interaction space for applications in DNA nanotechnology. This new way of observing, interacting with, and creating DNA nanostructures enables domain experts to approach their work in any of the semantic abstraction levels, supporting both low-level manipulations and high-level visualization and modifications. Our approach allows them to deal with the increasingly complex DNA objects that they are designing, to improve their features, and to add novel functions in a way that no existing single-scale approach offers today. For this purpose we collaborated with DNA nanotechnology experts to design a set of ten semantic scales. These scales take the DNA's chemical and structural behavior into account and depict it from atoms to the targeted architecture with increasing levels of abstraction. To create coherence between the discrete scales, we seamlessly transition between them in a well-defined manner. We use special encodings to allow experts to estimate the nanoscale object's stability. We also add scale-adaptive interactions that facilitate the intuitive modification of complex structures at multiple scales. We demonstrate the applicability of our approach on an experimental use case. Moreover, feedback from our collaborating domain experts confirmed an increased time efficiency and certainty for analysis and modification tasks on complex DNA structures. Our method thus offers exciting new opportunities with promising applications in medicine and biotechnology.

Vis-A-Ware: Integrating Spatial and Non-Spatial Visualization for Visibility-Aware Urban Planning.

3D visibility analysis plays a key role in urban planning for assessing the visual impact of proposed buildings on the cityscape. A call for proposals typically yields around 30 candidate buildings that need to be evaluated with respect to selected viewpoints. Current visibility analysis methods are very time-consuming and limited to a small number of viewpoints. Further, analysts neither have measures to evaluate candidates quantitatively, nor to compare them efficiently. The primary contribution of this work is the design study of Vis-A-Ware, a visualization system to qualitatively and quantitatively evaluate, rank, and compare visibility data of candidate buildings with respect to a large number of viewpoints. Vis-A-Ware features a 3D spatial view of an urban scene and non-spatial views of data derived from visibility evaluations, which are tightly integrated by linked interaction. To enable a quantitative evaluation we developed four metrics in accordance with experts from urban planning. We illustrate the applicability of Vis-A-Ware on the basis of a use case scenario and present results from informal feedback sessions with domain experts from urban planning and development. This feedback suggests that Vis-A-Ware is a valuable tool for visibility analysis allowing analysts to answer complex questions more efficiently and objectively.

LiteVis: Integrated Visualization for Simulation-Based Decision Support in Lighting Design.

State-of-the-art lighting design is based on physically accurate lighting simulations of scenes such as offices. The simulation results support lighting designers in the creation of lighting configurations, which must meet contradicting customer objectives regarding quality and price while conforming to industry standards. However, current tools for lighting design impede rapid feedback cycles. On the one side, they decouple analysis and simulation specification. On the other side, they lack capabilities for a detailed comparison of multiple configurations. The primary contribution of this paper is a design study of LiteVis, a system for efficient decision support in lighting design. LiteVis tightly integrates global illumination-based lighting simulation, a spatial representation of the scene, and non-spatial visualizations of parameters and result indicators. This enables an efficient iterative cycle of simulation parametrization and analysis. Specifically, a novel visualization supports decision making by ranking simulated lighting configurations with regard to a weight-based prioritization of objectives that considers both spatial and non-spatial characteristics. In the spatial domain, novel concepts support a detailed comparison of illumination scenarios. We demonstrate LiteVis using a real-world use case and report qualitative feedback of lighting designers. This feedback indicates that LiteVis successfully supports lighting designers to achieve key tasks more efficiently and with greater certainty.

Visual analytics and rendering for tunnel crack analysis: A methodological approach for integrating geometric and attribute data.

The visual analysis of surface cracks plays an essential role in tunnel maintenance when assessing the condition of a tunnel. To identify patterns of cracks, which endanger the structural integrity of its concrete surface, analysts need an integrated solution for visual analysis of geometric and multivariate data to decide if issuing a repair project is necessary. The primary contribution of this work is a design study, supporting tunnel crack analysis by tightly integrating geometric and attribute views to allow users a holistic visual analysis of geometric representations and multivariate attributes. Our secondary contribution is Visual Analytics and Rendering, a methodological approach which addresses challenges and recurring design questions in integrated systems. We evaluated the tunnel crack analysis solution in informal feedback sessions with experts from tunnel maintenance and surveying. We substantiated the derived methodology by providing guidelines and linking it to examples from the literature.