A stochastic model for MRSA transmission within a hospital ward incorporating environmental contamination.

Methicillin-resistant Staphylococcus aureus (MRSA) transmission in hospital wards is associated with adverse outcomes for patients and increased costs for hospitals. The transmission process is inherently stochastic and the randomness emphasized by the small population sizes involved. As such, a stochastic model was proposed to describe the MRSA transmission process, taking into account the related contribution and modelling of the associated microbiological environmental contamination. The model was used to evaluate the performance of five common interventions and their combinations on six potential outcome measures of interest under two hypothetical disease burden settings. The model showed that the optimal intervention combination varied depending on the outcome measure and burden setting. In particular, it was found that certain outcomes only required a small subset of targeted interventions to control the outcome measure, while other outcomes still reported reduction in the outcome distribution with up to all five interventions included. This study describes a new stochastic model for MRSA transmission within a ward and highlights the use of the generalized Mann-Whitney statistic to compare the distribution of the outcome measures under different intervention combinations to assist in planning future interventions in hospital wards under different potential outcome measures and disease burden.

Elastohydrodynamics of the eyelid wiper.

This paper presents an elastohydrodynamic model of the human eyelid wiper. Standard lubrication theory is applied to the fluid layer between the eyelid wiper and ocular surface. The role of the lubrication film is to reduce the shear stresses by preventing solid to solid contact between the eyelid wiper and ocular surface. For the lubrication film to be effective, it is required that the orientation of the eyelid wiper changes between the opening and closing phases of a blink. In order to model this, the hydrodynamic model is coupled with an elastic mattress model for the soft tissue of the eyelid wiper and ocular surface. This leads to a one-dimensional non-linear partial differential equation governing the fluid pressure in the lubrication film. In order to solve the differential equation, a loading condition or constraint equation must be specified. The resulting system is then solved numerically. The model allows predictions of the tear film flux from under the upper eyelid, as well as normal and shear stresses acting on the ocular surface. These factors are important in relation to dry eye syndrome, deformation of the cornea and contact lens design. It is found that the pressure and shear stress under the eyelid act across a length of approximately 0.1 mm which is consistent with clinical observations. It order to achieve a flow of tears from under the upper eyelid during a blink, the model requires that the normal force the eyelid applies to the ocular surface during the closing phase of the blink is significantly higher than during the opening phase of the blink.

The effect of the lipid layer on tear film behaviour.

This paper investigates the effect of surfactants during tear film deposition and subsequent thinning. The surfactants occur naturally on the surface of the tear film in the form of a lipid layer. A lubrication model is developed that describes lipid spreading and film height evolution. It is shown that lipids may play an important role in drawing the tear film up the cornea during the opening phase of the blink. Further, nonuniform distributions of lipids may lead to a rapid thinning of the tear film behind the advancing lipid front (shock). Experiments using a fluorescein dye technique and using a tearscope were undertaken in order to visualise the motion of the lipid layer and any associated shocks immediately after a blink. It is found that the lipid layer continues to spread upwards on the cornea after the opening phase of the blink, in agreement with the model. Using the experimental data, lipid particles were tracked in order to determine the surface velocity and these results are compared to the model predictions.

Dynamics of tear film deposition and draining.

This paper investigates the deposition of the tear film on the cornea of the human eye. The tear film is laid down by the motion of the upper eyelid and then subsequently flows and thins. Of particular interest is the stability of the tear layer and the development of dry patches on the cornea. While there has been significant research on the behaviour of tear films between blinks, this paper focuses on understanding the mechanisms which control the shape and thickness of the deposited film and how this affects the subsequent film behaviour. Numerical and analytical methods are applied to a lubrication model which includes the effects of surface tension, viscosity, gravity and evaporation. The model reveals the importance of the eyelid velocity, motion of the surface lipid layer and the storage of tear film between blinks.

The metapopulation dynamics of an infectious disease: tuberculosis in possums.

An SEI metapopulation model is developed for the spread of an infectious agent by migration. The model portrays two age classes on a number of patches connected by migration routes which are used as host animals mature. A feature of this model is that the basic reproduction ratio may be computed directly, using a scheme that separates topography, demography, and epidemiology. We also provide formulas for individual patch basic reproduction numbers and discuss their connection with the basic reproduction ratio for the system. The model is applied to the problem of spatial spread of bovine tuberculosis in a possum population. The temporal dynamics of infection are investigated for some generic networks of migration links, and the basic reproduction ratio is computed-its value is not greatly different from that for a homogeneous model. Three scenarios are considered for the control of bovine tuberculosis in possums where the spatial aspect is shown to be crucial for the design of disease management operations.

Periodic triggering of an inducible gene for control of a wild population.

A possible method of control for the management of wild populations consists of continual introgression of an inducible transgene by releasing transgenic individuals, with periodic exposure of the population to a trigger. Exposure to the trigger causes death or sterility in carriers of the transgene, but is otherwise benign. We investigate the effectiveness of various strategies for control. We show that suppression of the population density below any pre-specified level is possible using this technique. At the same time we show that too frequent or too efficient exposure to the trigger can select for non-transgenic genotypes at an intensity such that the population density will be largely unaffected by the trigger. Choices for management parameters can ensure that the latter scenario is avoided. We show that releasing individuals carrying the transgene at more than one locus facilitates density control.

Swimming of spermatozoa in a linear viscoelastic fluid.

A modified resistive force theory is developed for a spermatozoon swimming in a general linear viscoelastic fluid. The theory is based on a Fourier decomposition of the flagellar velocity, which leads to solving the Stokes flow equations with a complex viscosity. We use a model spermatozoon with a spherical head which propagates small amplitude sinusoidal waves along its flagellum. Results are obtained for the velocity of propulsion and the rate of working for a free swimming spermatozoon and the thrust on a fixed spermatozoon. There is no change in propulsive velocity for a viscoelastic fluid compared to a Newtonian fluid. The rate of working does change however, decreasing with increasing elasticity of the fluid, for a Maxwell fluid. Thus the theory predicts that a spermatozoon can swim faster in a Maxwell fluid with the same expenditure of energy for a Newtonian fluid.

Hydrodynamics of filter feeding.

A fluid mechanical model is developed for the filtering mechanism in mussels that enables estimates to be made of the pressure drop through the gill filaments due to (i) the latero-frontal filtering cilia, (ii) the lateral (pumping) cilia and through the non-ciliated zone at the ventral end of the filament. Calculations indicate that the lateral cilia can generate a sufficient pressure change to 'pump' water through the gill filaments. The velocity profile across the filaments indicates that a backflow can occur in the centre of the channel. Normally the latero-frontal cilia would damp out this backflow but in the case when all the cilia are upright, two 'standing' eddies may form at the mouth of the channel, forcing the incoming water to the side.

Muco-ciliary transport in the lung.

A two-layer Newtonian fluid model for muco-ciliary transport in the lung is developed where the viscosity of the upper mucous layer is very much greater than the viscosity of the lower periciliary layer. Theory is presented for both cases when the cilia penetrate, and do not penetrate, the very viscous mucous layer. Calculations suggest that, in normal circumstances, it is not essential for the cilia to penetrate the mucus to provide positive transport. However, it does suggest that there is a weak optimal penetration depth of the cilia of between 10-20% of the cilium length. In the case of high ciliary inactivity (e.g. 90% inactive), penetration of cilia into the mucus is essential for normal transport rates suggesting the mucociliary system may be deliberately overdesigned to cater for a whole range of pathological circumstances.