Success Of The Rollins Epidemiology Fellowship In Rebuilding Georgia's Epidemiologic Workforce.

Over the course of the past two decades, attrition within the US governmental public health workforce has passed concerning and become dire. The practice sector has struggled to recruit and retain new talent, despite the infusion of considerable federal investment in workforce expansion initiatives. In 2020, Emory University's Rollins School of Public Health partnered with the Georgia Department of Public Health to establish the Rollins Epidemiology Fellowship Program. Initially created to recruit and place early-career master of public health-level epidemiologists into Georgia's public health system for COVID-19 pandemic response, the two-year service-learning program has evolved into an effective and replicable model of direct academic involvement in strengthening the governmental public health workforce. Here we describe the program's structure and early results, spotlighting it for consideration by the federal government and other jurisdictions interested in directly engaging academia in efforts to revitalize the public health workforce.

Extending the discussion on inconsistency in forensic decisions and results.

The subject of inter- and intra-laboratory inconsistency was recently raised in a commentary by Itiel Dror. We re-visit an inter-laboratory trial, with which some of the authors of this current discussion were associated, to diagnose the causes of any differences in the likelihood ratios (LRs) assigned using probabilistic genotyping software. Some of the variation was due to different decisions that would be made on a case-by-case basis, some due to laboratory policy and would hence differ between laboratories, and the final and smallest part was the run-to-run difference caused by the Monte Carlo aspect of the software used. However, the net variation in LRs was considerable. We believe that most laboratories will self-diagnose the cause of their difference from the majority answer and in some, but not all instances will take corrective action. An inter-laboratory exercise consisting of raw data files for relatively straightforward mixtures, such as two mixtures of three or four persons, would allow laboratories to calibrate their procedures and findings.

An inter-laboratory comparison of probabilistic genotyping parameters and evaluation of performance on DNA mixtures from different laboratories.

Probabilistic genotyping (PG) is becoming the preferred standard for evidence interpretation, amongst forensic DNA laboratories, especially those in the United States. Various groups have expressed concern about reliability of PG systems, especially for mixtures beyond two contributors. Studies involving interlaboratory testing of known mixtures have been identified as ways to evaluate the reliability of PG systems. Reliability means different things in different contexts. However, it suffices here to think about it as a mixture of precision and accuracy. We might also consider whether a system is prone to producing misleading results - for example large likelihood ratios (LRs) when the POI is truly not a contributor, or small LRs when the POI is a truly a contributor. In this paper we show that the PG system STRmix™ is relatively unaffected by differences in parameter settings. That is, a DNA mixture that is analyzed in different laboratories using STRmix™ will result in different LRs, but less than 0.05% of these LRs would result in a different, or misleading conclusion as long as the LR is greater than 50. For the purposes of this study, we define LRs assigned using different parameters for the same mixtures as similar if the LR of the true POI is greater than the LRs generated for 99.9% of the general population. These findings are based on an interlaboratory study involving eight laboratories that provided twenty known DNA mixtures of two to four contributors and their individual laboratory STRmix™ parameters. The eight sets of laboratory parameters included differences in STR kits and PCR cycles as well as the peak, stutter, and locus specific amplification efficiency variances.

Developing an interpretation model for body fluid identification.

Criminal investigations, particularly sexual assaults, frequently require the identification of body fluid type in addition to body fluid donor to provide context. In most cases this can be achieved by conventional methods, however, in certain scenarios, alternative molecular methods are required. An example of this is the detection of menstrual fluid and vaginal material, which are not able to be identified using conventional techniques. Endpoint reverse-transcription PCR (RT-PCR) is currently used for this purpose to amplify body fluid specific messenger RNA (mRNA) transcripts in forensic casework. Real-time quantitative reverse-transcription PCR (RT-qPCR) is a similar method but utilises fluorescent markers to generate quantitative results in the form of threshold cycle (Cq) values. Despite the uncertainty surrounding body fluid identification, most interpretation guidelines utilise categorical statements. Probabilistic modelling is more realistic as it reflects biological variation as well as the known performance of the method. This research describes the application of various machine learning models to single-source mRNA profiles obtained by RT-qPCR and assesses their performance. Multinomial logistic regression (MLR), Naïve Bayes (NB), and linear discriminant analysis (LDA) were used to discriminate between the following body fluid categories: saliva, circulatory blood, menstrual fluid, vaginal material, and semen. We identified that the performance of MLR was somewhat improved when the quantitative dataset of the original Cq values was used (overall accuracy of approximately 0.95) rather than presence/absence coded data (overall accuracy of approximately 0.94). This indicates that the quantitative information obtained by RT-qPCR amplification is useful in assigning body fluid class. Of the three classification methods, MLR performed the best. When we utilised receiver operating characteristic curves to observe performance by body fluid class, it was clear that all methods found difficulty in classifying menstrual blood samples. Future work will involve the modelling of body fluid mixtures, which are common in samples analysed as part of sexual assault investigations.

A diagnosis of the primary difference between EuroForMix and STRmix™.

There is interest in comparing the output, principally the likelihood ratio, from the two probabilistic genotyping software EuroForMix (EFM) and STRmix™. Many of these comparison studies are descriptive and make little or no effort to diagnose the cause of difference. There are fundamental differences between EFM and STRmix™ that are causative of the largest set of likelihood ratio differences. This set of differences is for false donors where there are many instances of LRs just above or below 1 for EFM that give much lower LRs in STRmix™. This is caused by the separate estimation of parameters such as allele height variance and mixture proportion using MLE under Hp and Ha for EFM. This can result in very different estimations of these parameters under Hp and Ha . It results in a departure from calibration for EFM in the region of LRs just above and below 1.

Classification of firing pin impressions using HOG-SVM.

Crimes, such as robbery and murder, often involve firearms. In order to assist with the investigation into the crime, firearm examiners are asked to determine whether cartridge cases found at a crime scene had been fired from a suspect's firearm. This examination is based on a comparison of the marks left on the surfaces of cartridge cases. Firing pin impressions can be one of the most commonly used of these marks. In this study, a total of nine Ruger model 10/22 semiautomatic rifles were used. Fifty cartridges were fired from each rifle. The cartridge cases were collected, and each firing pin impression was then cast and photographed using a comparison microscope. In this paper, we will describe how one may use a computer vision algorithm, the Histogram of Orientated Gradient (HOG), and a machine learning method, Support Vector Machines (SVMs), to classify images of firing pin impressions. Our method achieved a reasonably high accuracy at 93%. This can be used to associate a firearm with a cartridge case recovered from a scene. We also compared our method with other feature extraction algorithms. The comparison results showed that the HOG-SVM method had the highest performance in this classification task.

The random presence of glass and paint on the clothing and footwear of members of the general population: A US baseline survey at various seasons.

This study assists the interpretation of glass and paint evidence by filling an existing gap in the background occurrence that reflects the socioeconomic and demographic circumstances in the United States. The collection was performed in a college US city (Morgantown, West Virginia) to determine the effect of the type of clothing worn at different seasons on the presence of glass and paint. Tape lifts and sole scrapings (1038) were collected from 210 participants and up to six clothing and footwear areas per individual. Glass fragments were analyzed via polarized light microscopy (PLM), refractive index (RI), micro-X-Ray fluorescence (µXRF), and scanning electron microscopy-energy dispersive spectroscopy (SEM-EDS), while paint specimens were examined by light microscopy and infrared spectroscopy (µFTIR). Higher occurrences of glass and paint were found in the winter season. The winter collection yielded 10 glass fragments and 68 paint particles, whereas the summer collection resulted in one glass fragment and 23 paint particles. The percentage of individuals with traces varied between seasons; 7% of individuals in the winter and 0.9% in the summer had glass, whereas 36% of individuals in the winter and 19% in the summer bore paint. Lastly, when considering the overall garment and footwear areas, glass was detected in 1.4% of the winter set, compared to 0.2% in the summer collection; paint was found in 9.2% of the winter collection, whereas only 4.2% was found in the summer set. There were no instances where both glass and paint were detected on the clothing and footwear of the same individual.

Guiding proposition setting in forensic DNA interpretation.

There is a general reluctance to use conditioning profiles when forming propositions for cases where the evidence is a DNA mixture. However, the use of conditioning profiles improves the ability to differentiate true from false donors. There are at least four situations where this decision making is at its most difficult. These are:Rigorous mathematical treatment, given by Slooten and others, appears to offer strong guidance for these situations. This treatment assumes that the prior probabilities for conditioning, or not conditioning, on any individual are not extreme. It is when these prior probabilities appear ambiguous that the decision to condition or not can appear to be problematic. This is often the situation found in casework. In this paper we attempt to show that such situations may benefit most from following such guidance. A lower bound on the Bayes factor can be obtained by finding the highest LR that includes the POI and dividing by the highest LR that does not include the POI. These two highest LRs may be found with and without the disputed conditioning profile. The resultant lower bound is on the BF for the inclusion of the POI without directly assuming the disputed conditioning profile. Adopting this approach would both minimize adventitious inclusions and approximate an exhaustive set of propositions.

The number of alleles in DNA mixtures with related contributors.

The maximum allele count (MAC) across loci and the total allele count (TAC) are often used to gauge the number of contributors to a DNA mixture. Computational strategies that predict the total number of alleles in a mixture arising from a certain number of contributors of a given population have been developed. Previous work considered the restricted case where all of the contributors to a mixture are unrelated. We relax this assumption and allow mixture contributors to be related according to a pedigree. We introduce an efficient computational strategy. This strategy based on first determining a probability distribution on the number of independent alleles per locus, and then conditioning on this distribution to compute a distribution of the number of distinct alleles per locus. The distribution of the number of independent alleles per locus is obtained by leveraging the Identical by Descent (IBD) pattern distribution which can be computed from the pedigree. We explain how allelic dropout and a subpopulation correction can be accounted for in the calculations.

A mixed DNA profile controversy revisited.

Semaan et al. (J Forensic Res, 2020, 11, 453) discuss a mock case "where eight different individuals [P1 through P8 ] could not be excluded in a mixed DNA analysis. Even though … expert DNA mixture analysis software was used." Two of these are the true donors. The LRs reported are incorrect due to the incorrect entry of propositions into LRmix Studio. This forced the software to account for most of the alleles as drop-in, resulting in LRs 60-70 orders of magnitude larger than expected. P1 , P2 , P4 , P5 , and P8 can be manually excluded using peak heights. This has relevance when using LRmix which does not use peak heights. We extend the work using the same two reference genotypes who were the true contributors as Semaan et al. (J Forensic Res, 2020, 11, 453). We simulate three two-donor mixtures with peak heights using these two genotypes and analyze using STRmix™. For the simulated 1:1 mixture, one of the non-donors' LRs supported him being a contributor when no conditioning was used. When considered in combination with any other potential donors (i.e., with conditioning), this non-donor was correctly eliminated. For the 3:1 mixture, all results correctly supported that the non-donors were not contributors. The low-template 4:1 mixture LRs with no conditioning showed support for all eight profiles as donors. However, the results from pair-wise conditioning showed that only the two ground truth donors had LRs supporting that they were contributors to the mixture. We recommend the use of peak heights and conditioning profiles, as this allows better sensitivity and specificity even when the persons share many alleles.

A comparison of likelihood ratios obtained from EuroForMix and STRmix™.

Likelihood ratios (LR) differences between the probabilistic genotyping software EuroForMix and STRmix™ are examined. After considering differences in the allele probabilities, the LRs from both software for an unambiguous single-source profile were identical (four significant figures). LRs from both software for an unambiguous single-source profile with alleles previously unseen in the allele frequency database (rare alleles) were the same (three significant figures) for θ = 0.01. Due to differences in the minimum allele frequencies, the LRs differed by three orders of magnitude when θ = 0. For both software, the LRs for a single-source dilution series decreased as the input amount decreased. The LRs from both software were within an order of magnitude for known contributors. The largest difference was where the target input amount was 0.0156 ng: The LREuroForMix was 2.1 × 1025 and the LRSTRmix was 8.0 × 1024 . Both software show similar LR behavior with respect to mixture ratio. For two person mixtures the LR increases for both the major and the minor as the ratio moves away from 1:1. The LR for the major stabilizes at about 3:1 whereas the LR for the minor reaches its maximum at about 3:1 and then declines. Greater differences in LR were observed between EuroForMix and STRmix™ for mixtures. One-hundred and twenty-nine mixtures from the PROVEDIt dataset were compared. LRs for 84% of the comparisons for known contributors without rare alleles were within two orders of magnitude. Five divergent results were investigated, and a manual intervention approach was applied where appropriate.

Reflections on 40 Years of AIDS.

June 2021 marks the 40th anniversary of the first description of AIDS. On the 30th anniversary, we defined priorities as improving use of existing interventions, clarifying optimal use of HIV testing and antiretroviral therapy for prevention and treatment, continuing research, and ensuring sustainability of the response. Despite scientific and programmatic progress, the end of AIDS is not in sight. Other major epidemics over the past decade have included Ebola, arbovirus infections, and coronavirus disease (COVID-19). A benchmark against which to compare other global interventions is the HIV/AIDS response in terms of funding, coordination, and solidarity. Lessons from Ebola and HIV/AIDS are pertinent to the COVID-19 response. The fifth decade of AIDS will have to position HIV/AIDS in the context of enhanced preparedness and capacity to respond to other potential pandemics and transnational health threats.

Modeling allelic analyte signals for aSTRs in NGS DNA profiles.

We describe an adaption of Bright et al.'s work modeling peak height variability in CE-DNA profiles to the modeling of allelic aSTR (autosomal short tandem repeats) read counts from NGS-DNA profiles, specifically for profiles generated from the ForenSeq™ DNA Signature Prep Kit, DNA Primer Mix B. Bright et al.'s model consists of three key components within the estimation of total allelic product-template, locus-specific amplification efficiencies, and degradation. In this work, we investigated the two mass parameters-template and locus-specific amplification efficiencies-and used MLE (maximum likelihood estimation) and MCMC (Markov chain Monte Carlo) methods to obtain point estimates to calculate the total allelic product. The expected read counts for alleles were then calculated after proportioning some of the expected stutter product from the total allelic product. Due to preferential amplicon selection introduced by the sample purification beads, degradation is difficult to model from the aSTR outputs alone. Improved modeling of the locus-specific amplification efficiencies may mask the effects of degradation. Whilst this model could be improved by introducing locus specific variances in addition to locus specific priors, our results demonstrate the suitability of adapting Bright et al.'s allele peak height model for NGS-DNA profiles. This model could be incorporated into continuous probabilistic interpretation approaches for mixed DNA profiles.

Comparing multiple POI to DNA mixtures.

In casework, laboratories may be asked to compare DNA mixtures to multiple persons of interest (POI). Guidelines on forensic DNA mixture interpretation recommend that analysts consider several pairs of propositions; however, it is unclear if several likelihood ratios (LRs) per person should be reported or not. The propositions communicated to the court should not depend on the value of the LR. As such, we suggest that the propositions should be functionally exhaustive. This implies that all propositions with a non-zero prior probability need to be considered, at least initially. Those that have a significant posterior probability need to be used in the final evaluation. Using standard probability theory we combine various propositions so that collectively they are exhaustive. This involves a prior probability that the sub-proposition is true, given that the primary proposition is true. Imagine a case in which there are two possible donors: i and j. We focus our analysis first on donor i so that the primary proposition is that i is one of the sources of the DNA. In this example, given that i is a donor, we would further consider that j is either a donor or not. In practice, the prior weights for these sub-propositions may be difficult to assign. However, the LR is often linearly related to these priors and its behaviour is predictable. We also believe that these priors are unavoidable and are hidden in alternative methods. We term the likelihood ratio formed from these context-exhaustive propositions LRi/i¯. LRi/i¯ is trialed in a set of two- and three-person mixtures. For two-person mixtures, LRi/i¯ is often well approximated by LRij/ja, where the subscript ij describes the proposition that i and j are the donors and ja describes the proposition that j and an alternate, unknown individual (a), who is unrelated to both i and j, are the donors. For three-person mixtures, LRi/i¯ is often well approximated by LRijk/jka where the subscript ijk describes the proposition that i, j, and k are the donors and jka describes the proposition that j, k, and an unknown, unrelated (to i, j, and k) individual (a) are the donors. In our simulations, LRij/ja had fewer inclusionary LRs for non-contributors than the unconditioned LR (LRia/aa).

Relaxing the assumption of unrelatedness in the numerator and denominator of likelihood ratios for DNA mixtures.

DNA mixtures will have multiple donors under both the prosecution and alternate propositions when assigning a likelihood ratio for forensic DNA evidence. These donors are usually assumed to be unrelated to each other. In this paper, we make a small, preliminary examination of the potential effect of relaxing this assumption. We consider the simple situation of a two-person mixture with no dropout and a two-person major/minor mixture with dropout of the minor contributor. We make no adjustment for subpopulation effects. Mixtures were simulated under two assumptions: 1. that the donors were siblings 2. or that they were unrelated. Both unresolvable and major/minor mixtures were considered. We compared the likelihood ratio assuming sibship with the likelihood ratio assuming no relatedness. The LR for hypotheses assuming no relatedness is less than the LR assuming relatedness approximately 95% of the time when relatives are present in the mixture.

When evaluating DNA evidence within a likelihood ratio framework, should the propositions be exhaustive?

We seek to develop a rational approach to forming propositions when little information is available from the outset, as this often happens in casework. If propositions used when evaluating evidence are not exhaustive (in the context of the case), then there is a theoretical risk that an LR greater than one may be associated with a proposition in the numerator that - if all meaningful propositions had been considered - would in fact have a lower posterior probability after consideration of the evidence. Ideally, all propositions should be considered. However, with multiple propositions, some terms will be larger than others and for simplification very small terms can be neglected without changing the order of magnitude of the value of the evidence (i.e. LR). Our analysis shows that mathematically a contributor's DNA can be assumed to be present under both prosecution and alternative propositions (Hp and Ha) if there is a reasonable prior probability of their DNA being present and their inclusion is supported by the profile. This is because the terms associated to these sub-propositions will dominate our LR. For example, in the absence of specific information, when considering two persons of interest (POI) as potential contributors to a mixed DNA profile we suggest the assumption of one when examining the presence of the other, after checking that both collectively explain the profile well. This represents more meaningful propositions and allows better discrimination. Slooten and Caliebe have shown that the overall LR is the weighted average of LRs with the same number of contributors (NoC) under both propositions. The weights involve both an assessment of the probability of the crime scene DNA profile and the probability of this NoC given the background information.

A Data Visualization and Dissemination Resource to Support HIV Prevention and Care at the Local Level: Analysis and Uses of the AIDSVu Public Data Resource.

BACKGROUND: AIDSVu is a public resource for visualizing HIV surveillance data and other population-based information relevant to HIV prevention, care, policy, and impact assessment. OBJECTIVE: The site, AIDSVu.org, aims to make data about the US HIV epidemic widely available, easily accessible, and locally relevant to inform public health decision making. METHODS: AIDSVu develops visualizations, maps, and downloadable datasets using results from HIV surveillance systems, other population-based sources of information (eg, US Census and national probability surveys), and other data developed specifically for display and dissemination through the website (eg, pre-exposure prophylaxis [PrEP] prescriptions). Other types of content are developed to translate surveillance data into summarized content for diverse audiences using infographic panels, interactive maps, local and state fact sheets, and narrative blog posts. RESULTS: Over 10 years, AIDSVu.org has used an expanded number of data sources and has progressively provided HIV surveillance and related data at finer geographic levels, with current data resources providing HIV prevalence data down to the census tract level in many of the largest US cities. Data are available at the county level in 48 US states and at the ZIP Code level in more than 50 US cities. In 2019, over 500,000 unique users consumed AIDSVu data and resources, and HIV-related data and insights were disseminated through nearly 4,000,000 social media posts. Since AIDSVu's inception, at least 249 peer-reviewed publications have used AIDSVu data for analyses or referenced AIDSVu resources. Data uses have included targeting of HIV testing programs, identifying areas with inequitable PrEP uptake, including maps and data in academic and community grant applications, and strategically selecting locations for new HIV treatment and care facilities to serve high-need areas. CONCLUSIONS: Surveillance data should be actively used to guide and evaluate public health programs; AIDSVu translates high-quality, population-based data about the US HIV epidemic and makes that information available in formats that are not consistently available in surveillance reports. Bringing public health surveillance data to an online resource is a democratization of data, and presenting information about the HIV epidemic in more visual formats allows diverse stakeholders to engage with, understand, and use these important public health data to inform public health decision making.