Visualization for epidemiological modelling: challenges, solutions, reflections and recommendations.

We report on an ongoing collaboration between epidemiological modellers and visualization researchers by documenting and reflecting upon knowledge constructs-a series of ideas, approaches and methods taken from existing visualization research and practice-deployed and developed to support modelling of the COVID-19 pandemic. Structured independent commentary on these efforts is synthesized through iterative reflection to develop: evidence of the effectiveness and value of visualization in this context; open problems upon which the research communities may focus; guidance for future activity of this type and recommendations to safeguard the achievements and promote, advance, secure and prepare for future collaborations of this kind. In describing and comparing a series of related projects that were undertaken in unprecedented conditions, our hope is that this unique report, and its rich interactive supplementary materials, will guide the scientific community in embracing visualization in its observation, analysis and modelling of data as well as in disseminating findings. Equally we hope to encourage the visualization community to engage with impactful science in addressing its emerging data challenges. If we are successful, this showcase of activity may stimulate mutually beneficial engagement between communities with complementary expertise to address problems of significance in epidemiology and beyond. See https://ramp-vis.github.io/RAMPVIS-PhilTransA-Supplement/. This article is part of the theme issue 'Technical challenges of modelling real-life epidemics and examples of overcoming these'.

FAIR data pipeline: provenance-driven data management for traceable scientific workflows.

Modern epidemiological analyses to understand and combat the spread of disease depend critically on access to, and use of, data. Rapidly evolving data, such as data streams changing during a disease outbreak, are particularly challenging. Data management is further complicated by data being imprecisely identified when used. Public trust in policy decisions resulting from such analyses is easily damaged and is often low, with cynicism arising where claims of 'following the science' are made without accompanying evidence. Tracing the provenance of such decisions back through open software to primary data would clarify this evidence, enhancing the transparency of the decision-making process. Here, we demonstrate a Findable, Accessible, Interoperable and Reusable (FAIR) data pipeline. Although developed during the COVID-19 pandemic, it allows easy annotation of any data as they are consumed by analyses, or conversely traces the provenance of scientific outputs back through the analytical or modelling source code to primary data. Such a tool provides a mechanism for the public, and fellow scientists, to better assess scientific evidence by inspecting its provenance, while allowing scientists to support policymakers in openly justifying their decisions. We believe that such tools should be promoted for use across all areas of policy-facing research. This article is part of the theme issue 'Technical challenges of modelling real-life epidemics and examples of overcoming these'.

Spatial and temporal analysis of sheep scab notifications in Scotland, 2014-2019.

BACKGROUND: Sheep scab is considered an endemic disease of great welfare and economic significance in the UK. METHOD: This paper provides an up-to-date assessment of the impact of Sheep Scab (Scotland) Order 2010 on sheep scab notifications in Scotland between 1 January 2014 and 31 December 2019, using data collected by the APHA. RESULTS: In total, 564 sheep scab notifications were reported from 503 unique holdings, of which 44 holdings (8.7%) reported more than one incident. The number of notifications did not differ between years, with 81, 84, 93, 101, 109 and 97 notifications recorded in 2014, 2015, 2016, 2017, 2018 and 2019, respectively: representing an average annual notification prevalence of 0.63% (1/159 flocks/year). A total of 413/564 records documented how notifications were resolved, with macrocyclic lactone and organophosphate treatments accounting for 79.6% and 20.4% of resolutions, respectively. CONCLUSION: Our results suggest that the Order has facilitated the notification of sheep scab in Scotland (including trends and preferred methods of resolution), allowed industry and government to identify previously unidentified potentially free areas as well as recurrent incidents on sheep farms, and start to understand better the geographical and temporal nature of scab outbreaks. However, concerns remain about a potential lack of engagement, evidenced by the low notification prevalence and stagnant annual notification rates.

Exploiting Scanning Surveillance Data to Inform Future Strategies for the Control of Endemic Diseases: The Example of Sheep Scab.

Scanning surveillance facilitates the monitoring of many endemic diseases of livestock in Great Britain, including sheep scab, an ectoparasitic disease of major welfare and economic burden. There is, however, a drive to improve the cost-effectiveness of animal health surveillance, for example by thoroughly exploiting existing data sources. By analysing the Veterinary Investigation Diagnosis Analysis (VIDA) database, this study aimed to enhance the use of existing scanning surveillance data for sheep scab to identify current trends, highlighting geographical "hotspots" for targeted disease control measures, and identifying a denominator to aid the interpretation of the diagnostic count data. Furthermore, this study collated and assessed the impact of past targeted disease control initiatives using a temporal aberration detection algorithm, the Farrington algorithm, to provide an evidence base towards developing cost-effective disease control strategies. A total of 2,401 positive skin scrapes were recorded from 2003 to 2018. A statistically significant decline in the number of positive skin scrapes diagnosed (p < 0.001) occurred across the study period, and significant clustering was observed in Wales, with a maximum of 47 positive scrapes in Ceredigion in 2007. Scheduled ectoparasite tests was also identified as a potential denominator for the interpretation of positive scrapes by stakeholders. Across the study period, 11 national disease control initiatives occurred: four in Wales, three in England, and four in Scotland. The majority (n = 8) offered free diagnostic testing while the remainder involved knowledge transfer either combined with free testing or skills training and the introduction of the Sheep Scab (Scotland) Order 2010. The Farrington algorithm raised 20 alarms of which 11 occurred within a period of free testing in Wales and one following the introduction of the Sheep Scab (Scotland) Order 2010. In summary, our analysis of the VIDA database has greatly enhanced our knowledge of sheep scab in Great Britain, firstly by identifying areas for targeted action and secondly by offering a framework to measure the impact of future disease control initiatives. Importantly this framework could be applied to inform future strategies for the control of other endemic diseases.

Risk of hypoglycaemia associated with professional, recreational, and traffic-related activities in patients with type 2 diabetes: a cross-sectional study by questionnaire.

AIMS: We aimed to quantify the exposure to physical exercise associated with professional, recreational, or traffic-related activities in patients with type 2 diabetes, which may provoke or aggravate hypoglycaemic episodes, and to assess whether such risks determine the choice of medications minimizing the risk of hypoglycaemia. METHODS: In total, 203 patients with type 2 diabetes (98 women, 105 men, age 65 [56;72; median, inter-quartile range] years, diabetes duration 10 [5;15] years) were recruited from a German diabetes practice. A questionnaire assessed their engagement in professional, recreational, or traffic-related activities. The prescription insulin or sulphonylureas was quantified in relation to the number of such activities. RESULTS: 63.5% of the patients were treated with insulin, 7.4% with sulphonylureas, and 70.9% with either. Sixty-six patients (22.7%) were professionally active: 36 (54.4%) of those were professionally exposed to risky behaviour (14 [31.8%] patients with exposure to multiple risks and 20 (30.3%) who experienced hypoglycaemic episodes in the past year). In total, 194 (95.6%) patients were exposed to risky behaviour during recreational activities, 129 (63.6%) to multiple ones. All patients were exposed to traffic-related activities, 144 (70.9%) were exposed to more than being pedestrian, and 24 (11.8%) experienced hypoglycaemic episodes while in traffic. CONCLUSIONS: Patients with type 2 diabetes are exposed to risks associated with professional, recreational, and traffic-related activities. We recommend a careful assessment of such risks before glucose-lowering medications with a potential for provoking hypoglycaemic episodes are prescribed.

Uptake of Diagnostic Tests by Livestock Farmers: A Stochastic Game Theory Approach.

Game theory examines strategic decision-making in situations of conflict, cooperation, and coordination. It has become an established tool in economics, psychology and political science, and more recently has been applied to disease control. Used to examine vaccination uptake in human medicine, game theory shows that when vaccination is voluntary some individuals will choose to "free-ride" on the protection provided by others, resulting in insufficient coverage for control of a vaccine-preventable disease. Here, we use game theory to examine farmer uptake of a new diagnostic ELISA test for sheep scab-a highly infectious disease with an estimated cost exceeding £8M per year to the UK industry. The stochastic game models decisions made by neighboring farmers when deciding whether to adopt the newly available test, which can detect subclinical infestation. A key element of the stochastic game framework is that it allows multiple states. Depending on infestation status and test adoption decisions in the previous year, a farm may be at high, medium or low risk of infestation this year-a status which influences the decision the farmer makes and the farmer payoffs. Ultimately, each farmer's decision depends on the costs of using the diagnostic test vs. the benefits of enhanced disease control, which may only accrue in the longer term. The extent to which a farmer values short-term over long-term benefits reflects external factors such as inflation or individual characteristics such as patience. Our results show that when using realistic parameters and with a test cost around 50% more than the current clinical diagnosis, the test will be adopted in the high-risk state, but not in the low-risk state. For the medium risk state, test adoption will depend on whether the farmer takes a long-term or short-term view. We show that these outcomes are relatively robust to change in test costs and, moreover, that whilst the farmers adopting the test would not expect to see large gains in profitability, substantial reduction in sheep scab (and associated welfare implications) could be achieved in a cost-neutral way to the industry.

Manipulation of contact network structure and the impact on foot-and-mouth disease transmission.

The movements of livestock between premises and markets can be characterised as a dynamic network where the structure of the network itself can critically impact the transmission dynamics of many infectious diseases. As evidenced by the 2001 foot-and-mouth disease (FMD) epidemic in the UK, this can involve transmission over large geographical distances and can result in major economic loss. One consequence of the FMD epidemic was the introduction of mandatory livestock movement restrictions: a 13-day standstill in Scotland for cattle and sheep after moving livestock onto a farm (allowing many exemptions) and a 6-day standstill for cattle and sheep in England and Wales (with minor exemptions, e.g. direct movements to slaughter). Such standstills are known to be effective but commercial considerations result in pressures to relax them. When contemplating legislative changes such as a change in length of movement restrictions we need to consider the consequent effect these could have on the emergent properties of the system, i.e. the network structure itself. In this study, we investigate how disease dynamics change when the local contact structure of the recorded livestock movement network in Scotland is altered through rewiring movements between premises. The network rewiring used here changes the structure of the recorded trade network through a combination of altered movement restrictions and redirection of movements between holdings and markets to avoid nonsensical activity (e.g. movements to markets on days when they are inactive) while conserving other characteristics (e.g. movement date as closely as possible and market sales of the correct animal production type). Rewiring results in networks with higher clustering coefficients and lower network density. The impact of rewiring on a hypothetical foot-and-mouth disease outbreak in Scotland was assessed by stochastic simulation, considering scenarios with and without exemptions to the standstill rules. As expected, rewiring leads to a decrease in outbreak size and - if standstill exemptions are prohibited - higher probability of smaller outbreaks. Without exemptions, a shorter movement standstill is almost as effective as a longer standstill period, indicating that a simpler biosecurity system would offer minimal additional risk for FMD. These results suggest that explicitly manipulating the contact network structure in a sensible way has the potential to significantly impact disease control.

Listening to Limericks: a pupillometry investigation of perceivers' expectancy.

What features of a poem make it captivating, and which cognitive mechanisms are sensitive to these features? We addressed these questions experimentally by measuring pupillary responses of 40 participants who listened to a series of Limericks. The Limericks ended with either a semantic, syntactic, rhyme or metric violation. Compared to a control condition without violations, only the rhyme violation condition induced a reliable pupillary response. An anomaly-rating study on the same stimuli showed that all violations were reliably detectable relative to the control condition, but the anomaly induced by rhyme violations was perceived as most severe. Together, our data suggest that rhyme violations in Limericks may induce an emotional response beyond mere anomaly detection.