An Analysis of Risk-Assessment Driven Security Restraint Use during the Transport of Forensic Patients.

Transporting forensic psychiatric patients outside of forensic hospitals has significant risks that pose competing safety and patients' rights interests. Psychiatrists and hospital administrators have a duty to keep their staff and the community safe, but this must be carefully balanced with their obligation to uphold the civil rights and liberty interests of their patients. A critical decision in this balancing is whether to utilize security restraints during patient transportation. Addressing these competing interests while striving to safely transport forensic hospital patients to the community can be challenging as hospital staff and patient advocates may voice strong, and sometimes opposing, opinions about this debate. Very little research has been conducted about these high risk and often contentious actions. Here, we describe the process for assessing risk for violence, self-harm, and elopement prior to transportation at one state forensic hospital using a pretransport risk-assessment tool created specifically for that purpose. We then present the results of research identifying which clinical and legal factors identified by our risk-assessment tool correlate with patients being transported with restraints. We also evaluated the potential for racial/ethnic and gender biases in this transportation risk-assessment process.

A mathematical model of oncolytic virotherapy with time delay.

Oncolytic virotherapy is an emerging treatment modality which uses replication-competent viruses to destroy cancers without causing harm to normal tissues. By the development of molecular biotechnology, many effective viruses are adapted or engineered to make them cancer-specific, such as measles, adenovirus, herpes simplex virus and M1 virus. A successful design of virus needs a full understanding about how viral and host parameters influence the tumor load. In this paper, we propose a mathematical model on the oncolytic virotherapy incorporating viral lytic cycle and virus-specific CTL response. Thresholds for viral treatment and virus-specific CTL response are obtained. Different protocols are given depending on the thresholds. Our results also support that immune suppressive drug can enhance the oncolytic effect of virus as reported in recent literature.

Dynamics of virus and immune response in multi-epitope network.

The host immune response can often efficiently suppress a virus infection, which may lead to selection for immune-resistant viral variants within the host. For example, during HIV infection, an array of CTL immune response populations recognize specific epitopes (viral proteins) presented on the surface of infected cells to effectively mediate their killing. However HIV can rapidly evolve resistance to CTL attack at different epitopes, inducing a dynamic network of interacting viral and immune response variants. We consider models for the network of virus and immune response populations, consisting of Lotka-Volterra-like systems of ordinary differential equations. Stability of feasible equilibria and corresponding uniform persistence of distinct variants are characterized via a Lyapunov function. We specialize the model to a "binary sequence" setting, where for n epitopes there can be [Formula: see text] distinct viral variants mapped on a hypercube graph. The dynamics in several cases are analyzed and sharp polychotomies are derived characterizing persistent variants. In particular, we prove that if the viral fitness costs for gaining resistance to each epitope are equal, then the system of [Formula: see text] virus strains converges to a "perfectly nested network" with less than or equal to [Formula: see text] persistent virus strains. Overall, our results suggest that immunodominance, i.e. relative strength of immune response to an epitope, is the most important factor determining the persistent network structure.

Strong cooperation or tragedy of the commons in the chemostat.

In [11], a proof of principle was established for the phenomenon of the tragedy of the commons, a center piece for many theories on the evolution of cooperation. A general chemostat model with two species, the cooperator and the cheater, was formulated where the cooperator allocates a portion of the nutrient uptake towards the production of a public good which is needed to digest an externally supplied resource. The cheater does not produce the public good, and instead allocates all nutrient uptake towards its own growth. It was proved that if the cheater is present, both the cooperator and the cheater will go extinct. A key assumption was that the cheater and cooperator share a common nutrient uptake rate and yield constant. Here, we relax that assumption and find that although the extinction of both types holds in many cases, it is possible for the cooperator to survive and exclude the cheater if it can evolve so as to have a lower break-even concentration for growth than the cheater. Coexistence of cooperator and cheater is generically impossible.

Tragedy of the commons in the chemostat.

We present a proof of principle for the phenomenon of the tragedy of the commons that is at the center of many theories on the evolution of cooperation. Whereas the tragedy is commonly set in a game theoretical context, and attributed to an underlying Prisoner's Dilemma, we take an alternative approach based on basic mechanistic principles of species growth that does not rely on the specification of payoffs which may be difficult to determine in practice. We establish the tragedy in the context of a general chemostat model with two species, the cooperator and the cheater. Both species have the same growth rate function and yield constant, but the cooperator allocates a portion of the nutrient uptake towards the production of a public good -the "Commons" in the Tragedy- which is needed to digest the externally supplied nutrient. The cheater on the other hand does not produce this enzyme, and allocates all nutrient uptake towards its own growth. We prove that when the cheater is present initially, both the cooperator and the cheater will eventually go extinct, hereby confirming the occurrence of the tragedy. We also show that without the cheater, the cooperator can survive indefinitely, provided that at least a low level of public good or processed nutrient is available initially. Our results provide a predictive framework for the analysis of cooperator-cheater dynamics in a powerful model system of experimental evolution.

Permanence and Stability of a Kill the Winner Model in Marine Ecology.

We focus on the long-term dynamics of "killing the winner" Lotka-Volterra models of marine communities consisting of bacteria, virus, and zooplankton. Under suitable conditions, it is shown that there is a unique equilibrium with all populations present which is stable, the system is permanent, and the limiting behavior of its solutions is strongly constrained.

Persistence versus extinction for a class of discrete-time structured population models.

We provide sharp conditions distinguishing persistence and extinction for a class of discrete-time dynamical systems on the positive cone of an ordered Banach space generated by a map which is the sum of a positive linear contraction A and a nonlinear perturbation G that is compact and differentiable at zero in the direction of the cone. Such maps arise as year-to-year projections of population age, stage, or size-structure distributions in population biology where typically A has to do with survival and individual development and G captures the effects of reproduction. The threshold distinguishing persistence and extinction is the principal eigenvalue of (II−A)(−1)G'(0) provided by the Krein-Rutman Theorem, and persistence is described in terms of associated eigenfunctionals. Our results significantly extend earlier persistence results of the last two authors which required more restrictive conditions on G. They are illustrated by application of the results to a plant model with a seed bank.

A model of optimal dosing of antibiotic treatment in biofilm.

Biofilms are heterogeneous matrix enclosed micro-colonies of bacteria mostly found on moist surfaces. Biofilm formation is the primary cause of several persistent infections found in humans. We derive a mathematical model of biofilm and surrounding fluid dynamics to investigate the effect of a periodic dose of antibiotic on elimination of microbial population from biofilm. The growth rate of bacteria in biofilm is taken as Monod type for the limiting nutrient. The pharmacodynamics function is taken to be dependent both on limiting nutrient and antibiotic concentration. Assuming that flow rate of fluid compartment is large enough, we reduce the six dimensional model to a three dimensional model. Mathematically rigorous results are derived providing sufficient conditions for treatment success. Persistence theory is used to derive conditions under which the periodic solution for treatment failure is obtained. We also discuss the phenomenon of bi-stability where both infection-free state and infection state are locally stable when antibiotic dosing is marginal. In addition, we derive the optimal antibiotic application protocols for different scenarios using control theory and show that such treatments ensure bacteria elimination for a wide variety of cases. The results show that bacteria are successfully eliminated if the discrete treatment is given at an early stage in the infection or if the optimal protocol is adopted. Finally, we examine factors which if changed can result in treatment success of the previously treatment failure cases for the non-optimal technique.

Chemostats and epidemics: competition for nutrients/hosts.

In a chemostat, several species compete for the same nutrient, while in an epidemic, several strains of the same pathogen may compete for the same susceptible hosts. As winner, chemostat models predict the species with the lowest break-even concentration, while epidemic models predict the strain with the largest basic reproduction number. We show that these predictions amount to the same if the per capita functional responses of consumer species to the nutrient concentration or of infective individuals to the density of susceptibles are proportional to each other but that they are different if the functional responses are nonproportional. In the second case, the correct prediction is given by the break-even concentrations. In the case of nonproportional functional responses, we add a class for which the prediction does not only rely on local stability and instability of one-species (strain) equilibria but on the global outcome of the competition. We also review some results for nonautonomous models.

Global dynamics of a discrete two-species Lottery-Ricker competition model.

In this article, we study the global dynamics of a discrete two-dimensional competition model. We give sufficient conditions on the persistence of one species and the existence of local asymptotically stable interior period-2 orbit for this system. Moreover, we show that for a certain parameter range, there exists a compact interior attractor that attracts all interior points except Lebesgue measure zero set. This result gives a weaker form of coexistence which is referred to as relative permanence. This new concept of coexistence combined with numerical simulations strongly suggests that the basin of attraction of the locally asymptotically stable interior period-2 orbit is an infinite union of connected components. This idea may apply to many other ecological models. Finally, we discuss the generic dynamical structure that gives relative permanence.

Allelopathy of plasmid-bearing and plasmid-free organisms competing for two complementary resources in a chemostat.

We consider a model of competition between plasmid-bearing and plasmid-free organisms for two complementary nutrients in a chemostat. We assume that the plasmid-bearing organism produces an allelopathic agent at the cost of its reproductive abilities which is lethal to plasmid-free organism. Our analysis leads to different thresholds in terms of the model parameters acting as conditions under which the organisms associated with the system cannot thrive even in the absence of competition. Local stability of the system is obtained in the absence of one or both the organisms. Also, global stability of the system is obtained in the presence of both the organisms. Computer simulations have been carried out to illustrate various analytical results.

Persistence of bacteria and phages in a chemostat.

The model of bacteriophage predation on bacteria in a chemostat formulated by Levin et al. (Am Nat 111:3-24, 1977) is generalized to include a distributed latent period, distributed viral progeny release from infected bacteria, unproductive adsorption of phages to infected cells, and possible nutrient uptake by infected cells. Indeed, two formulations of the model are given: a system of delay differential equations with infinite delay, and a more general infection-age model that leads to a system of integro-differential equations. It is shown that the bacteria persist, and sharp conditions for persistence and extinction of phages are determined by the reproductive ratio for phage relative to the phage-free equilibrium. A novel feature of our analysis is the use of the Laplace transform.

Bacteriophage-resistant and bacteriophage-sensitive bacteria in a chemostat.

In this paper a mathematical model of the population dynamics of a bacteriophage-sensitive and a bacteriophage-resistant bacteria in a chemostat where the resistant bacteria is an inferior competitor for nutrient is studied. The focus of the study is on persistence and extinction of bacterial strains and bacteriophage.

Bacteriophage and bacteria in a flow reactor.

The Levin-Stewart model of bacteriophage predation of bacteria in a chemostat is modified for a flow reactor in which bacteria are motile, phage diffuse, and advection brings fresh nutrient and removes medium, cells and phage. A fixed latent period for phage results in a system of delayed reaction-diffusion equations with non-local nonlinearities. Basic reproductive numbers are obtained for bacteria and for phage which predict survival of each in the bio-reactor. These are expressed in terms of physical and biological parameters. Persistence and extinction results are obtained for both bacteria and phage. Numerical simulations are in general agreement with those for the chemostat model.

Bacterial competition in serial transfer culture.

A mathematical model of bacterial competition for a single growth-limiting substrate in serial transfer culture is formulated. Each bacterial strain is characterized by a growth response function, e.g. Monod function determined by a maximum growth rate and half-saturation nutrient concentration, and the length of its lag phase following the dilution event. The goal of our study is to understand what factors determine an organisms fitness or competitive ability in serial transfer culture. A motivating question is: how many strains can coexist in serial transfer culture? Unlike competition in the chemostat, coexistence of two strains can occur in serial transfer culture. Numerical simulations suggest that more than two may coexist.

Persistence in a discrete-time stage-structured fungal disease model.

A discrete-time susceptible and infected (SI) epidemic model, with less than 100% vertical disease transmission, for the spread of a fungal disease in a structured amphibian host population, is analysed. Criteria for persistence of the population as well as the disease are established. Stability results for host extinction and for the disease-free equilibrium are presented. Bifurcation theory is used to establish existence of an endemic equilibrium.

Does dormancy increase fitness of bacterial populations in time-varying environments?

A simple family of models of a bacterial population in a time varying environment in which cells can transit between dormant and active states is constructed. It consists of a linear system of ordinary differential equations for active and dormant cells with time-dependent coefficients reflecting an environment which may be periodic or random, with alternate periods of low and high resource levels. The focus is on computing/estimating the dominant Lyapunov exponent, the fitness, and determining its dependence on various parameters and the two strategies-responsive and stochastic-by which organisms switch between dormant and active states. A responsive switcher responds to good and bad times by making timely and appropriate transitions while a stochastic switcher switches continuously without regard to the environmental state. The fitness of a responsive switcher is examined and compared with fitness of a stochastic switcher, and with the fitness of a dormancy-incapable organism. Analytical methods show that both switching strategists have higher fitness than a dormancy-incapable organism when good times are rare and that responsive switcher has higher fitness than stochastic switcher when good times are either rare or common. Numerical calculations show that stochastic switcher can be most fit when good times are neither too rare or too common.

Global dynamics of microbial competition for two resources with internal storage.

We study a chemostat model that describes competition between two species for two essential resources based on storage. The model incorporates internal resource storage variables that serve the direct connection between species growth and external resource availability. Mathematical analysis for the global dynamics of the model is carried out by using the monotone dynamical system theory. It is shown that the limiting system of the model basically exhibits the familiar Lotka-Volterra alternatives: competitive exclusion, coexistence, and bi-stability, and most of these results can be carried over to the original model.

A resource-based model of microbial quiescence.

To analyze the ecological features of microbial quiescence, a model is proposed that involves "wake-up" rate and "sleep" rate at which the population transitions from a quiescent to an active state and back, respectively. These rates depend continuously on the resources and turn on and off at resource thresholds which may not coincide. The usual dichotomy is observed: the population is washed out under environmental stress and a single "survival" steady state exists otherwise. Proportional nutrient enrichment is used to explore analytically as well as numerically the nature of the steady state which bifurcates from the washout state.