Volvulus of a wandering spleen in a pediatric patient.

Wandering spleen is a rare condition in children that is often caused by the loss or weakening of the splenic ligaments. Its clinical presentation is variable; 64% of children with wandering spleen have splenic torsion as a complication. A 13-year-old boy who had been showing abdominal pain in the hypogastric region accompanied by vomit and an enormous tumefaction in the suprapubic region came to our observation. Considering the ovoid morphology at ultrasound exam, the echostructure and the marked reduction of parenchymal vascularization, suspicion for torsion of an ectopic spleen arose. Ultrasound evaluation has a primary role in the diagnosis of a suspected wandering spleen and, to avoid potentially life-threatening complications, immediate surgery is often times required.

Epidemicity indices and reproduction numbers from infectious disease data in connected human populations.

We focus on distinctive data-driven measures of the fate of ongoing epidemics. The relevance of our pursuit is suggested by recent results proving that the short-term temporal evolution of infection spread is described by an epidemicity index related to the maximum instantaneous growth rate of new infections, echoing concepts and tools developed to study the reactivity of ecosystems. Suitable epidemicity indices can showcase the dynamics of infections, together with commonly employed effective reproduction numbers, especially when the latter assume values less than 1. In particular, epidemicity evaluates the short-term reactivity to perturbations of a disease-free equilibrium. Here, we show that sufficient epidemicity thresholds to prevent transient epidemic outbreaks in a spatially connected setting can be estimated by generalizing existing analogues derived when spatial effects are neglected. We specifically account for the discrete nature, in both space and time, of surveillance data of the type typically employed to estimate effective reproduction numbers that formed the bulk of the communication of the state of the COVID-19 pandemic and its controls. After analyzing the effects of spatial heterogeneity on the considered prognostic indicators, we perform a short- and long-term analysis on the COVID-19 pandemic in Italy, showing that endemic conditions were maintained throughout the duration of our simulation despite stringent control measures. Our method provides a portfolio of prognostic indices that are essential to pinpoint the ongoing pandemic in both a qualitative and quantitative manner, as our results demonstrate. We base our conclusions on extended investigations of the effects of spatial fragmentation of communities of different sizes owing to connectivity by human mobility and contact scenarios, within real geographic contexts and synthetic setups designed to test our framework.

Emergent encoding of dispersal network topologies in spatial metapopulation models.

We address a generalization of the concept of metapopulation capacity for trees and networks acting as the template for ecological interactions. The original measure had been derived from an insightful phenomenological model and is based on the leading eigenvalue of a suitable landscape matrix. It yields a versatile predictor of metapopulation persistence through a threshold value of the eigenvalue determined by ecological features of the focal species. Here, we present an analytical solution to a fundamental microscopic model that incorporates key ingredients of metapopulation dynamics and explicitly distinguishes between individuals comprising the "settled population" and "explorers" seeking colonization. Our approach accounts for general network characteristics (in particular graph-driven directional dispersal which is known to significantly constrain many ecological estimates) and yields a generalized version of the original model, to which it reduces for particular cases. Through examples, including real landscapes used as the template, we compare the predictions from our approach with those of the standard model. Results suggest that in several cases of practical interest, differences are significant. We also examine, with both models, how changes in habitat fragmentation, including removal, addition, or alteration in size, affect metapopulation persistence. The current approach demonstrates a high level of flexibility, enabling the incorporation of diverse "microscopic" elements and their impact on the resulting biodiversity landscape pattern.

Spatially explicit effective reproduction numbers from incidence and mobility data.

Current methods for near real-time estimation of effective reproduction numbers from surveillance data overlook mobility fluxes of infectors and susceptible individuals within a spatially connected network (the metapopulation). Exchanges of infections among different communities may thus be misrepresented unless explicitly measured and accounted for in the renewal equations. Here, we first derive the equations that include spatially explicit effective reproduction numbers, ℛk(t), in an arbitrary community k. These equations embed a suitable connection matrix blending mobility among connected communities and mobility-related containment measures. Then, we propose a tool to estimate, in a Bayesian framework involving particle filtering, the values of ℛk(t) maximizing a suitable likelihood function reproducing observed patterns of infections in space and time. We validate our tools against synthetic data and apply them to real COVID-19 epidemiological records in a severely affected and carefully monitored Italian region. Differences arising between connected and disconnected reproduction numbers (the latter being calculated with existing methods, to which our formulation reduces by setting mobility to zero) suggest that current standards may be improved in their estimation of disease transmission over time.

Optimal control of the spatial allocation of COVID-19 vaccines: Italy as a case study.

While campaigns of vaccination against SARS-CoV-2 are underway across the world, communities face the challenge of a fair and effective distribution of a limited supply of doses. Current vaccine allocation strategies are based on criteria such as age or risk. In the light of strong spatial heterogeneities in disease history and transmission, we explore spatial allocation strategies as a complement to existing approaches. Given the practical constraints and complex epidemiological dynamics, designing effective vaccination strategies at a country scale is an intricate task. We propose a novel optimal control framework to derive the best possible vaccine allocation for given disease transmission projections and constraints on vaccine supply and distribution logistics. As a proof-of-concept, we couple our framework with an existing spatially explicit compartmental COVID-19 model tailored to the Italian geographic and epidemiological context. We optimize the vaccine allocation on scenarios of unfolding disease transmission across the 107 provinces of Italy, from January to April 2021. For each scenario, the optimal solution significantly outperforms alternative strategies that prioritize provinces based on incidence, population distribution, or prevalence of susceptibles. Our results suggest that the complex interplay between the mobility network and the spatial heterogeneities implies highly non-trivial prioritization strategies for effective vaccination campaigns. Our work demonstrates the potential of optimal control for complex and heterogeneous epidemiological landscapes at country, and possibly global, scales.

Ecohydrology 2.0.

This paper aims at a definition of the domain of ecohydrology, a relatively new discipline borne out of an intrusion-as advertised by this Topical Collection of the Rendiconti Lincei-of hydrology and geomorphology into ecology (or vice-versa, depending on the reader's background). The study of hydrologic controls on the biota proves, in our view, significantly broader than envisioned by its original focus that was centered on the critical zone where much of the action of soil, climate and vegetation interactions takes place. In this review of related topics and contributions, we propose a reasoned broadening of perspective, in particular by firmly centering ecohydrology on the fluvial catchment as its fundamental control volume. A substantial unity of materials and methods suggests that our advocacy may be considered legitimate.

Epidemicity of cholera spread and the fate of infection control measures.

The fate of ongoing infectious disease outbreaks is predicted through reproduction numbers, defining the long-term establishment of the infection, and epidemicity indices, tackling the reactivity of the infectious pool to new contagions. Prognostic metrics of unfolding outbreaks are of particular importance when designing adaptive emergency interventions facing real-time assimilation of epidemiological evidence. Our aim here is twofold. First, we propose a novel form of the epidemicity index for the characterization of cholera epidemics in spatial models of disease spread. Second, we examine in hindsight the survey of infections, treatments and containment measures carried out for the now extinct 2010-2019 Haiti cholera outbreak, to suggest that magnitude and timing of non-pharmaceutical and vaccination interventions imply epidemiological responses recapped by the evolution of epidemicity indices. Achieving negative epidemicity greatly accelerates fading of infections and thus proves a worthwhile target of containment measures. We also show that, in our model, effective reproduction numbers and epidemicity indices are explicitly related. Therefore, providing an upper bound to the effective reproduction number (significantly lower than the unit threshold) warrants negative epidemicity and, in turn, a rapidly fading outbreak preventing coalescence of sparse local sub-threshold flare-ups.

Effects of visual training on motor performance in young tennis players using FitLight trainer.

BACKGROUND: Tennis is an open-skill sport in which the athletes have a short period of time to elaborate all the information coming from the surrounding environment and produce a motor answer based on them. The aim of this study was divided in two hypotheses: 1) to assess if belonging to a certain category, athlete, or non-athlete, older or younger, can affect the development of reaction time on children; and 2) if a protocol based on visual training (VT) of 6 weeks could improve the motor performance on the field in young tennis players using FitLight Trainer (Medical Graphics, Milan, Italy). METHODS: In this evidence a group of young children (N.=40) have been tested on light board through reaction test then some young tennis players (N.=15, age: 7-12 years old) were taken as reference for the second hypothesis. They were divided in two groups: 7 of them were in the group Under-10 (U10) while 8 in a second group (U12). They performed a VT protocol once a week for at least 40 minutes for 6 weeks. They were tested at baseline (T0) and follow-up (T6) to evaluate the reaction time, time in specific lateral shift and precision about forehand and backhand. RESULTS: The development of reaction time of the athletes is principally caused by their growth (P<0.05). Principal components analysis (PCA) showed significant improvements in the Under-10 category in all the tests while in the Under-12 category not every individual showed a significant result in terms of performance. CONCLUSIONS: The developing of reaction time and coordination eye-hand is mainly due to the growth of young athletes. Also, performing a 6-week VT using FitLight Trainer is possible improve the reaction time and the motor performance on the field especially in young tennis players under 10 years old.

Seeing the forest for the trees through metabolic scaling.

We demonstrate that when power scaling occurs for an individual tree and in a forest, there is great resulting simplicity notwithstanding the underlying complexity characterizing the system over many size scales. Our scaling framework unifies seemingly distinct trends in a forest and provides a simple yet promising approach to quantitatively understand a bewilderingly complex many-body system with imperfectly known interactions. We show that the effective dimension, D tree , of a tree is close to 3, whereas a mature forest has D forest approaching 1. We discuss the energy equivalence rule and show that the metabolic rate-mass relationship is a power law with an exponent D/(D + 1) in both cases leading to a Kleiber's exponent of 3/4 for a tree and 1/2 for a forest. Our work has implications for understanding carbon sequestration and for climate science.

Characterizing human mobility patterns in rural settings of sub-Saharan Africa.

Human mobility is a core component of human behavior and its quantification is critical for understanding its impact on infectious disease transmission, traffic forecasting, access to resources and care, intervention strategies, and migratory flows. When mobility data are limited, spatial interaction models have been widely used to estimate human travel, but have not been extensively validated in low- and middle-income settings. Geographic, sociodemographic, and infrastructure differences may impact the ability for models to capture these patterns, particularly in rural settings. Here, we analyzed mobility patterns inferred from mobile phone data in four Sub-Saharan African countries to investigate the ability for variants on gravity and radiation models to estimate travel. Adjusting the gravity model such that parameters were fit to different trip types, including travel between more or less populated areas and/or different regions, improved model fit in all four countries. This suggests that alternative models may be more useful in these settings and better able to capture the range of mobility patterns observed.

Scaling of joint mass and metabolism fluctuations in in silico cell-laden spheroids.

Variations and fluctuations are characteristic features of biological systems and are also manifested in cell cultures. Here, we describe a computational pipeline for identifying the range of three-dimensional (3D) cell-aggregate sizes in which nonisometric scaling emerges in the presence of joint mass and metabolic rate fluctuations. The 3D cell-laden spheroids with size and single-cell metabolic rates described by probability density functions were randomly generated in silico. The distributions of the resulting metabolic rates of the spheroids were computed by modeling oxygen diffusion and reaction. Then, a method for estimating scaling exponents of correlated variables through statistically significant data collapse of joint probability distributions was developed. The method was used to identify a physiologically relevant range of spheroid sizes, where both nonisometric scaling and a minimum oxygen concentration (0.04 mol⋅m-3) is maintained. The in silico pipeline described enables the prediction of the number of experiments needed for an acceptable collapse and, thus, a consistent estimate of scaling parameters. Using the pipeline, we also show that scaling exponents may be significantly different in the presence of joint mass and metabolic-rate variations typically found in cells. Our study highlights the importance of incorporating fluctuations and variability in size and metabolic rates when estimating scaling exponents. It also suggests the need for taking into account their covariations for better understanding and interpreting experimental observations both in vitro and in vivo and brings insights for the design of more predictive and physiologically relevant in vitro models.

The Widened Pipe Model of plant hydraulic evolution.

Shaping global water and carbon cycles, plants lift water from roots to leaves through xylem conduits. The importance of xylem water conduction makes it crucial to understand how natural selection deploys conduit diameters within and across plants. Wider conduits transport more water but are likely more vulnerable to conduction-blocking gas embolisms and cost more for a plant to build, a tension necessarily shaping xylem conduit diameters along plant stems. We build on this expectation to present the Widened Pipe Model (WPM) of plant hydraulic evolution, testing it against a global dataset. The WPM predicts that xylem conduits should be narrowest at the stem tips, widening quickly before plateauing toward the stem base. This universal profile emerges from Pareto modeling of a trade-off between just two competing vectors of natural selection: one favoring rapid widening of conduits tip to base, minimizing hydraulic resistance, and another favoring slow widening of conduits, minimizing carbon cost and embolism risk. Our data spanning terrestrial plant orders, life forms, habitats, and sizes conform closely to WPM predictions. The WPM highlights carbon economy as a powerful vector of natural selection shaping plant function. It further implies that factors that cause resistance in plant conductive systems, such as conduit pit membrane resistance, should scale in exact harmony with tip-to-base conduit widening. Furthermore, the WPM implies that alterations in the environments of individual plants should lead to changes in plant height, for example, shedding terminal branches and resprouting at lower height under drier climates, thus achieving narrower and potentially more embolism-resistant conduits.

The epidemicity index of recurrent SARS-CoV-2 infections.

Several indices can predict the long-term fate of emerging infectious diseases and the effect of their containment measures, including a variety of reproduction numbers (e.g. [Formula: see text]). Other indices evaluate the potential for transient increases of epidemics eventually doomed to disappearance, based on generalized reactivity analysis. They identify conditions for perturbations to a stable disease-free equilibrium ([Formula: see text]) to grow, possibly causing significant damage. Here, we introduce the epidemicity index e0, a threshold-type indicator: if e0 > 0, initial foci may cause infection peaks even if [Formula: see text]. Therefore, effective containment measures should achieve a negative epidemicity index. We use spatially explicit models to rank containment measures for projected evolutions of the ongoing pandemic in Italy. There, we show that, while the effective reproduction number was below one for a sizable timespan, epidemicity remained positive, allowing recurrent infection flare-ups well before the major epidemic rebounding observed in the fall.

Range of reproduction number estimates for COVID-19 spread.

To monitor local and global COVID-19 outbreaks, and to plan containment measures, accessible and comprehensible decision-making tools need to be based on the growth rates of new confirmed infections, hospitalization or case fatality rates. Growth rates of new cases form the empirical basis for estimates of a variety of reproduction numbers, dimensionless numbers whose value, when larger than unity, describes surging infections and generally worsening epidemiological conditions. Typically, these determinations rely on noisy or incomplete data gained over limited periods of time, and on many parameters to estimate. This paper examines how estimates from data and models of time-evolving reproduction numbers of national COVID-19 infection spread change by using different techniques and assumptions. Given the importance acquired by reproduction numbers as diagnostic tools, assessing their range of possible variations obtainable from the same epidemiological data is relevant. We compute control reproduction numbers from Swiss and Italian COVID-19 time series adopting both data convolution (renewal equation) and a SEIR-type model. Within these two paradigms we run a comparative analysis of the possible inferences obtained through approximations of the distributions typically used to describe serial intervals, generation, latency and incubation times, and the delays between onset of symptoms and notification. Our results suggest that estimates of reproduction numbers under these different assumptions may show significant temporal differences, while the actual variability range of computed values is rather small.

True scale-free networks hidden by finite size effects.

We analyze about 200 naturally occurring networks with distinct dynamical origins to formally test whether the commonly assumed hypothesis of an underlying scale-free structure is generally viable. This has recently been questioned on the basis of statistical testing of the validity of power law distributions of network degrees. Specifically, we analyze by finite size scaling analysis the datasets of real networks to check whether the purported departures from power law behavior are due to the finiteness of sample size. We find that a large number of the networks follows a finite size scaling hypothesis without any self-tuning. This is the case of biological protein interaction networks, technological computer and hyperlink networks, and informational networks in general. Marked deviations appear in other cases, especially involving infrastructure and transportation but also in social networks. We conclude that underlying scale invariance properties of many naturally occurring networks are extant features often clouded by finite size effects due to the nature of the sample data.

Modelled effects of prawn aquaculture on poverty alleviation and schistosomiasis control.

Recent evidence suggests that snail predators may aid efforts to control the human parasitic disease schistosomiasis by eating aquatic snail species that serve as intermediate hosts of the parasite. Potential synergies between schistosomiasis control and aquaculture of giant prawns are evaluated using an integrated bio-economic-epidemiologic model. Combinations of stocking density and aquaculture cycle length that maximize cumulative, discounted profit are identified for two prawn species in sub-Saharan Africa: the endemic, non-domesticated Macrobrachium vollenhovenii, and the non-native, domesticated Macrobrachium rosenbergii. At profit maximizing densities, both M. rosenbergii and M. vollenhovenii may substantially reduce intermediate host snail populations and aid schistosomiasis control efforts. Control strategies drawing on both prawn aquaculture to reduce intermediate host snail populations and mass drug administration to treat infected individuals are found to be superior to either strategy alone. Integrated aquaculture-based interventions can be a win-win strategy in terms of health and sustainable development in schistosomiasis endemic regions of the world.

The geography of COVID-19 spread in Italy and implications for the relaxation of confinement measures.

The pressing need to restart socioeconomic activities locked-down to control the spread of SARS-CoV-2 in Italy must be coupled with effective methodologies to selectively relax containment measures. Here we employ a spatially explicit model, properly attentive to the role of inapparent infections, capable of: estimating the expected unfolding of the outbreak under continuous lockdown (baseline trajectory); assessing deviations from the baseline, should lockdown relaxations result in increased disease transmission; calculating the isolation effort required to prevent a resurgence of the outbreak. A 40% increase in effective transmission would yield a rebound of infections. A control effort capable of isolating daily  ~5.5% of the exposed and highly infectious individuals proves necessary to maintain the epidemic curve onto the decreasing baseline trajectory. We finally provide an ex-post assessment based on the epidemiological data that became available after the initial analysis and estimate the actual disease transmission that occurred after weakening the lockdown.

Generation and application of river network analogues for use in ecology and evolution.

Several key processes in freshwater ecology are governed by the connectivity inherent to dendritic river networks. These have extensively been analyzed from a geomorphological and hydrological viewpoint, yet structures classically used in ecological modeling have been poorly representative of the structure of real river basins, often failing to capture well-known scaling features of natural rivers. Pioneering work identified optimal channel networks (OCNs) as spanning trees reproducing all scaling features characteristic of natural stream networks worldwide. While OCNs have been used to create landscapes for studies on metapopulations, biodiversity, and epidemiology, their generation has not been generally accessible.Given the increasing interest in dendritic riverine networks by ecologists and evolutionary biologists, we here present a method to generate OCNs and, to facilitate its application, we provide the R-package OCNet. Owing to the stochastic process generating OCNs, multiple network replicas spanning the same surface can be built; this allows performing computational experiments whose results are irrespective of the particular shape of a single river network. The OCN construct also enables the generation of elevational gradients derived from the optimal network configuration, which can constitute three-dimensional landscapes for spatial studies in both terrestrial and freshwater realms. Moreover, the package provides functions that aggregate OCNs into an arbitrary number of nodes, calculate several descriptors of river networks, and draw relevant network features.We describe the main functionalities of the package and its integration with other R-packages commonly used in spatial ecology. Moreover, we exemplify the generation of OCNs and discuss an application to a metapopulation model for an invasive riverine species.In conclusion, OCNet provides a powerful tool to generate realistic river network analogues for various applications. It thereby allows the design of spatially realistic studies in increasingly impacted ecosystems and enhances our knowledge on spatial processes in freshwater ecology in general.

Biological fluid dynamics of airborne COVID-19 infection.

ABSTRACT: We review the state of knowledge on the bio-fluid dynamic mechanisms involved in the transmission of the infection from SARS-CoV-2. The relevance of the subject stems from the key role of airborne virus transmission by viral particles released by an infected person via coughing, sneezing, speaking or simply breathing. Speech droplets generated by asymptomatic disease carriers are also considered for their viral load and potential for infection. Proper understanding of the mechanics of the complex processes whereby the two-phase flow emitted by an infected individual disperses into the environment would allow us to infer from first principles the practical rules to be imposed on social distancing and on the use of facial and eye protection, which to date have been adopted on a rather empirical basis. These measures need compelling scientific validation. A deeper understanding of the relevant biological fluid dynamics would also allow us to evaluate the contrasting effects of natural or forced ventilation of environments on the transmission of contagion: the risk decreases as the viral load is diluted by mixing effects but contagion is potentially allowed to reach larger distances from the infected source. To that end, our survey supports the view that a formal assessment of a number of open problems is needed. They are outlined in the discussion.

Achieving coordinated national immunity and cholera elimination in Haiti through vaccination: a modelling study.

BACKGROUND: Cholera was introduced into Haiti in 2010. Since then, more than 820 000 cases and nearly 10 000 deaths have been reported. Oral cholera vaccine (OCV) is safe and effective, but has not been seen as a primary tool for cholera elimination due to a limited period of protection and constrained supplies. Regionally, epidemic cholera is contained to the island of Hispaniola, and the lowest numbers of cases since the epidemic began were reported in 2019. Hence, Haiti may represent a unique opportunity to eliminate cholera with OCV. METHODS: In this modelling study, we assessed the probability of elimination, time to elimination, and percentage of cases averted with OCV campaign scenarios in Haiti through simulations from four modelling teams. For a 10-year period from January 19, 2019, to Jan 13, 2029, we compared a no vaccination scenario with five OCV campaign scenarios that differed in geographical scope, coverage, and rollout duration. Teams used weekly department-level reports of suspected cholera cases from the Haiti Ministry of Public Health and Population to calibrate the models and used common vaccine-related assumptions, but other model features were determined independently. FINDINGS: Among campaigns with the same vaccination coverage (70% fully vaccinated), the median probability of elimination after 5 years was 0-18% for no vaccination, 0-33% for 2-year campaigns focused in the two departments with the highest historical incidence, 0-72% for three-department campaigns, and 35-100% for nationwide campaigns. Two-department campaigns averted a median of 12-58% of infections, three-department campaigns averted 29-80% of infections, and national campaigns averted 58-95% of infections. Extending the national campaign to a 5-year rollout (compared to a 2-year rollout), reduced the probability of elimination to 0-95% and the proportion of cases averted to 37-86%. INTERPRETATION: Models suggest that the probability of achieving zero transmission of Vibrio cholerae in Haiti with current methods of control is low, and that bolder action is needed to promote elimination of cholera from the region. Large-scale cholera vaccination campaigns in Haiti would offer the opportunity to synchronise nationwide immunity, providing near-term population protection while improvements to water and sanitation promote long-term cholera elimination. FUNDING: Bill & Melinda Gates Foundation, Global Good Fund, Institute for Disease Modeling, Swiss National Science Foundation, and US National Institutes of Health.