Cerebral Myiasis, An Unexpected Intraoperative Finding - A Case Report and Systematic Review.

Postoperative complications, exemplified by surgical site infections, are commonplace in the realm of daily surgical interventions. Conversely, certain infectious entities, such as cerebral myiasis (CM), are distinctly rare. This report elucidates the clinical presentation of a 74-year-old female afflicted with a CSF fistula, within the context of a preceding surgical microvascular decompression employing a suboccipital craniotomy approach. Notably, the course of evaluation and treatment unveiled an intraoperative manifestation of severe CM. This case report underscores the critical significance of prompt identification, precise diagnostic elucidation, and comprehensive multidisciplinary management to optimize patient outcomes in instances of CM. Furthermore, a systematic literature review on CM supplements this report, contributing to the understanding of this infrequent complication.

A generalized framework for estimating snakebite underreporting using statistical models: A study in Colombia.

BACKGROUND: Snakebite envenoming is a neglected tropical disease affecting deprived populations, and its burden is underestimated in some regions where patients prefer using traditional medicine, case reporting systems are deficient, or health systems are inaccessible to at-risk populations. Thus, the development of strategies to optimize disease management is a major challenge. We propose a framework that can be used to estimate total snakebite incidence at a fine political scale. METHODOLOGY/PRINCIPAL FINDINGS: First, we generated fine-scale snakebite risk maps based on the distribution of venomous snakes in Colombia. We then used a generalized mixed-effect model that estimates total snakebite incidence based on risk maps, poverty, and travel time to the nearest medical center. Finally, we calibrated our model with snakebite data in Colombia from 2010 to 2019 using the Markov-chain-Monte-Carlo algorithm. Our results suggest that 10.19% of total snakebite cases (532.26 yearly envenomings) are not reported and these snakebite victims do not seek medical attention, and that populations in the Orinoco and Amazonian regions are the most at-risk and show the highest percentage of underreporting. We also found that variables such as precipitation of the driest month and mean temperature of the warmest quarter influences the suitability of environments for venomous snakes rather than absolute temperature or rainfall. CONCLUSIONS/SIGNIFICANCE: Our framework permits snakebite underreporting to be estimated using data on snakebite incidence and surveillance, presence locations for the most medically significant venomous snake species, and openly available information on population size, poverty, climate, land cover, roads, and the locations of medical centers. Thus, our algorithm could be used in other countries to estimate total snakebite incidence and improve disease management strategies; however, this framework does not serve as a replacement for a surveillance system, which should be made a priority in countries facing similar public health challenges.

Estimating and forecasting the burden and spread of Colombia's SARS-CoV2 first wave.

Following the rapid dissemination of COVID-19 cases in Colombia in 2020, large-scale non-pharmaceutical interventions (NPIs) were implemented as national emergencies in most of the country's municipalities, starting with a lockdown on March 20th, 2020. Recently, approaches that combine movement data (measured as the number of commuters between units), metapopulation models to describe disease dynamics subdividing the population into Susceptible-Exposed-Asymptomatic-Infected-Recovered-Diseased and statistical inference algorithms have been pointed as a practical approach to both nowcast and forecast the number of cases and deaths. We used an iterated filtering (IF) framework to estimate the model transmission parameters using the reported data across 281 municipalities from March to late October in locations with more than 50 reported deaths and cases in Colombia. Since the model is high dimensional (6 state variables in every municipality), inference on those parameters is highly non-trivial, so we used an Ensemble-Adjustment-Kalman-Filter (EAKF) to estimate time variable system states and parameters. Our results show the model's ability to capture the characteristics of the outbreak in the country and provide estimates of the epidemiological parameters in time at the national level. Importantly, these estimates could become the base for planning future interventions as well as evaluating the impact of NPIs on the effective reproduction number ([Formula: see text]) and the critical epidemiological parameters, such as the contact rate or the reporting rate. However, our forecast presents some inconsistency as it overestimates the deaths for some locations as Medellín. Nevertheless, our approach demonstrates that real-time, publicly available ensemble forecasts can provide short-term predictions of reported COVID-19 deaths in Colombia. Therefore, this model can be used as a forecasting tool to evaluate disease dynamics and aid policymakers in infectious outbreak management and control.

Disentangling snakebite dynamics in Colombia: How does rainfall and temperature drive snakebite temporal patterns?

The role of climate driving zoonotic diseases' population dynamics has typically been addressed via retrospective analyses of national aggregated incidence records. A central question in epidemiology has been whether seasonal and interannual cycles are driven by climate variation or generated by socioeconomic factors. Here, we use compartmental models to quantify the role of rainfall and temperature in the dynamics of snakebite, which is one of the primary neglected tropical diseases. We took advantage of space-time datasets of snakebite incidence, rainfall, and temperature for Colombia and combined it with stochastic compartmental models and iterated filtering methods to show the role of rainfall-driven seasonality modulating the encounter frequency with venomous snakes. Then we identified six zones with different rainfall patterns to demonstrate that the relationship between rainfall and snakebite incidence was heterogeneous in space. We show that rainfall only drives snakebite incidence in regions with marked dry seasons, where rainfall becomes the limiting resource, while temperature does not modulate snakebite incidence. In addition, the encounter frequency differs between regions, and it is higher in regions where Bothrops atrox can be found. Our results show how the heterogeneous spatial distribution of snakebite risk seasonality in the country may be related to important traits of venomous snakes' natural history.

How disease risk awareness modulates transmission: coupling infectious disease models with behavioural dynamics.

Epidemiological models often assume that individuals do not change their behaviour or that those aspects are implicitly incorporated in parameters in the models. Typically, these assumptions are included in the contact rate between infectious and susceptible individuals. However, adaptive behaviours are expected to emerge and play an important role in the transmission dynamics across populations. Here, we propose a theoretical framework to couple transmission dynamics with behavioural dynamics due to infection awareness. We modelled the dynamics of social behaviour using a game theory framework, which is then coupled with an epidemiological model that captures the disease dynamics by assuming that individuals are aware of the actual epidemiological state to reduce their contacts. Results from the mechanistic model show that as individuals increase their awareness, the steady-state value of the final fraction of infected individuals in a susceptible-infected-susceptible (SIS) model decreases. We also incorporate theoretical contact networks, having the awareness parameter dependent on global or local contacts. Results show that even when individuals increase their awareness of the disease, the spatial structure itself defines the steady state.

Ventriculo-atrial shunt. Comparison of an ultrasound-guided peel-away technique versus conventional technique in the management of normal pressure hydrocephalus: A retrospective cohort.

BACKGROUND: Normal pressure hydrocephalus (NPH) is a common neurodegenerative syndrome among the elderly characterized by ventriculomegaly and the classic triad of symmetric gait disturbance, cognitive decline and urinary incontinence. To date, the only effective treatment is a cerebrospinal fluid shunting procedure that can either be ventriculo-atrial, ventriculo-peritoneal, or lumbo-peritoneal shunt. The conventional ventriculo-atrial shunt uses venodissection, whereas the peel-away is a percutaneous ultrasound (US)-guided technique that shows some advantages over conventional technique. We sought to compare perioperative complication rates, mean operating time and clinical outcomes for both techniques in NPH patients at our institution. METHODS: A retrospective cohort-type analytical study was conducted, using clinical record data of patients diagnosed with NPH and treated at our center from January 2009 to September 2019. Parameters to be compared include: Perioperative complication rates, intraoperative bleeding, mortality, and mean operating time. Perioperative complication rates are those device-related such as shunt infection, dysfunction, and those associated with the procedure. Complications are further classified in immediate (occurring during the first inpatient stay), early (within the first 30 days of surgery), and late (after day 30 of surgery). RESULTS: A total of 123 patients underwent ventriculo-atrial shunt. Eighty-two patients (67%) underwent conventional venodissection technique and 41 patients (33%) underwent a peel-away technique. Immediate complications were 3 (3.6%) and 0 for conventional and peel-away groups, respectively. Early complications were 0 and 1 (2.4%) for conventional and peel-away groups, respectively. Late complications were 5 (6.1%) and 2 (4.9%) for conventional and peel-away groups, respectively. Mean operating time was lower in the peel-away group (P = 0.0000) and mortality was 0 for both groups. CONCLUSION: Ventriculo-atrial shunt is an effective procedure for patients with NPH. When comparing the conventional venodissection technique with a percutaneous US-guided peel-away technique, the latter offers advantages such as shorter operating time and lower perioperative complication rates.

Entomological characterization of Aedes mosquitoes and arbovirus detection in Ibagué, a Colombian city with co-circulation of Zika, dengue and chikungunya viruses.

BACKGROUND: Dengue, Zika and chikungunya are arboviruses of significant public health importance that are transmitted by Aedes aegypti and Aedes albopictus mosquitoes. In Colombia, where dengue is hyperendemic, and where chikungunya and Zika were introduced in the last decade, more than half of the population lives in areas at risk. The objective of this study was to characterize Aedes spp. vectors and study their natural infection with dengue, Zika and chikungunya in Ibagué, a Colombian city and capital of the department of Tolima, with case reports of simultaneous circulation of these three arboviruses. METHODS: Mosquito collections were carried out monthly between June 2018 and May 2019 in neighborhoods with different levels of socioeconomic status. We used the non-parametric Friedman, Mann-Whitney and Kruskal-Wallis tests to compare mosquito density distributions. We applied logistic regression analyses to identify associations between mosquito density and absence/presence of breeding sites, and the Spearman correlation coefficient to analyze the possible relationship between climatic variables and mosquito density. RESULTS: We collected Ae. aegypti in all sampled neighborhoods and found for the first time Ae. albopictus in the city of Ibagué. A greater abundance of mosquitoes was collected in neighborhoods displaying low compared to high socioeconomic status as well as in the intradomicile compared to the peridomestic space. Female mosquitoes predominated over males, and most of the test females had fed on human blood. In total, four Ae. aegypti pools (3%) were positive for dengue virus (serotype 1) and one pool for chikungunya virus (0.8%). Interestingly, infected females were only collected in neighborhoods of low socioeconomic status, and mostly in the intradomicile space. CONCLUSIONS: We confirmed the co-circulation of dengue (serotype 1) and chikungunya viruses in the Ae. aegypti population in Ibagué. However, Zika virus was not detected in any mosquito sample, 3 years after its introduction into the country. The positivity for dengue and chikungunya viruses, predominance of mosquitoes in the intradomicile space and the high proportion of females fed on humans highlight the high risk for arbovirus transmission in Ibagué, but may also provide an opportunity for establishing effective control strategies.

Measuring spatial co-occurrences of species potentially involved in Leishmania transmission cycles through a predictive and fieldwork approach.

The Leishmaniases are a group of neglected tropical diseases caused by different species of the protozoan parasite Leishmania, transmitted to its mammalian hosts by the bites of several species of female Phlebotominae sand flies. Many factors have contributed to shifts in the disease distribution and eco epidemiological outcomes, resulting in the emergence of Cutaneous Leishmaniasis outbreaks and the incrimination of vectors in unreported regions. New research development is vital for establishing the new paradigms of the present transmission cycles, hoping to facilitate new control strategies to reduce parasite transmission. Hereafter, this work aims to model and infer the current transmission cycles of Cutaneous Leishmaniasis in Colombia defined by vector and mammal species distributed and interacting in the different regions and validate them by performing sand fly and mammal collections. Vector-host co-occurrences were computed considering five ecoregions of the Colombian territory defined by the World Wide Fund for Nature (WWF) and downloaded from The Nature Conservancy TNC Maps website. Four validation sites were selected based on Cutaneous Leishmaniasis prevalence reports. Sand flies and mammals captured in the field were processed, and species were defined using conventional taxonomic guidelines. Detection of infection by Leishmania was performed to identify transmission cycles in the selected areas. This study uses predictive models based on available information from international gazetteers and fieldwork to confirm sand fly and mammalian species' sustaining Leishmania transmission cycles. Our results show an uneven distribution of mammal samples in Colombia, possibly due to sampling bias, since only two departments contributed 50% of the available samples. Bats were the vertebrates with the highest score values, suggesting substantial spatial overlap with sand flies than the rest of the vertebrates evaluated. Fieldwork allowed identifying three circulating Leishmania species, isolated from three sand fly species. In the Montane Forest ecosystem, one small marsupial, Gracilinanus marica, was found infected with Leishmania panamensis, constituting the first record of this species infected with Leishmania. In the same locality, an infected sand fly, Pintomyia pia, was found. The overall results could support the understanding of the current transmission cycles of Leishmaniasis in Colombia.

Rhodnius prolixus Colonization and Trypanosoma cruzi Transmission in Oil Palm (Elaeis guineensis) Plantations in the Orinoco Basin, Colombia.

Trypanosoma cruzi is the etiological agent of Chagas disease that infects more than seven million people in Latin America. The parasite is transmitted by triatomine insects, of which some species are often associated with palms. The establishment of oil palm plantations (Elaeis guineensis) in the Orinoco region (Colombia) has been rapidly growing, possibly constituting a new environment for the establishment and increase in triatomine populations. In this study, the potential of Rhodnius prolixus to colonize E. guineensis plantations and maintain T. cruzi transmission was assessed. Fieldwork was conducted in two areas located in the department of Casanare for sampling E. guineensis and Attalea butyracea palms, sampling for triatomines to determine their abundance and prevalence of T. cruzi infection. To assess T. cruzi transmission potential in the area, sylvatic and domestic mammals were sampled. Results showed that palm infestation with triatomines was higher in A. butyracea than in E. guineensis palms and T. cruzi infection in triatomines varied between habitats for one study area, but was constant in the other site. Trypanosoma cruzi-infected mammals in the E. guineensis plantations were mainly generalist rodents, suggesting that these mammals could have an important role in T. cruzi transmission in plantations. In conclusion, E. guineensis plantations in the Orinoco region are suitable habitats for R. prolixus and T. cruzi transmission.

Estimating snakebite incidence from mathematical models: A test in Costa Rica.

BACKGROUND: Snakebite envenoming is a neglected public health challenge that affects mostly economically deprived communities who inhabit tropical regions. In these regions, snakebite incidence data is not always reliable, and access to health care is scare and heterogeneous. Thus, addressing the problem of snakebite effectively requires an understanding of how spatial heterogeneity in snakebite is associated with human demographics and snakes' distribution. Here, we use a mathematical model to address the determinants of spatial heterogeneity in snakebite and we estimate snakebite incidence in a tropical country such as Costa Rica. METHODS AND FINDINGS: We combined a mathematical model that follows the law of mass action, where the incidence is proportional to the exposed human population and the venomous snake population, with a spatiotemporal dataset of snakebite incidence (Data from year 1990 to 2007 for 193 districts) in Costa Rica. This country harbors one of the most dangerous venomous snakes, which is the Terciopelo (Bothrops asper, Garman, 1884). We estimated B. asper distribution using a maximum entropy algorithm, and its abundance was estimated based on field data. Then, the model was adjusted to the data using a lineal regression with the reported incidence. We found a significant positive correlation (R2 = 0.66, p-value < 0.01) between our estimation and the reported incidence, suggesting the model has a good performance in estimating snakebite incidence. CONCLUSIONS: Our model underscores the importance of the synergistic effect of exposed population size and snake abundance on snakebite incidence. By combining information from venomous snakes' natural history with census data from rural populations, we were able to estimate snakebite incidence in Costa Rica. The model was able to fit the incidence data at fine administrative scale (district level), which is fundamental for the implementation and planning of management strategies oriented to reduce snakebite burden.

Aneurysmal Subarachnoid Hemorrhage Associated with Small Aneurysms in Smokers and Women: A Retrospective Analysis.

BACKGROUND: Previous studies have shown low rupture rates for small aneurysms (<10 mm), suggesting that the risk of treatment could exceed the benefits. However, evidence has changed, showing crescent rates of aneurysmal subarachnoid hemorrhage (aSAH) associated with small aneurysms. We report trends in size, localization, clinical characteristics, and outcomes of intracranial aneurysms (IAs). METHODS: In this retrospective study, a total of 200 clinical histories of patients diagnosed with IAs over an 8-year period were analyzed. Variables considered included age, sex, tobacco consumption, morphological characteristics of the aneurysm, complications, vasospasm, and mortality. Qualitative variables were assessed by measurements of absolute and relative frequency. Smoking behavior, aneurysm size, and aneurysm rupture (AR) were compared using 1-way analysis of variance. Categorical variables were analyzed using Pearson's χ2 test. RESULTS: The average age at presentation was 58 years. The average size of ruptured aneurysms in the general group was 2.5-7.5 mm, and AR was most common in women (76%) and in patients age 50-60 years (33%). The rate of vasospasm was 19%, and mortality was 37%. Smokers composed 32% of the cohort. Heavy smokers had a 57% rate of aSAH, with an average size of rupture of 5 mm. The most common location of aneurysms and AR was the AComA (33%). CONCLUSIONS: Our results suggest increasing AR rates in aneurysms smaller than 10 mm. This trend is seen especially in individuals with heavy tobacco consumption and in women of perimenopausal age. Our findings show a tendency of AR in accordance with previous results and are expected to serve as basis for further research on aneurysm management.

Generalist host species drive Trypanosoma cruzi vector infection in oil palm plantations in the Orinoco region, Colombia.

BACKGROUND: Oil palm plantation establishment in Colombia has the potential to impact Chagas disease transmission by increasing the distribution range of Rhodnius prolixus. In fact, previous studies have reported Trypanosoma cruzi natural infection in R. prolixus captured in oil palms (Elaeis guineensis) in the Orinoco region, Colombia. The aim of this study is to understand T. cruzi infection in vectors in oil palm plantations relative to community composition and host dietary specialization by analyzing vector blood meals and comparing these results to vectors captured in a native palm tree species, Attalea butyracea. METHODS: Rhodnius prolixus nymphs (n = 316) were collected from A. butyracea and E. guineensis palms in Tauramena, Casanare, Colombia. Vector blood meals from these nymphs were determined by amplifying and sequencing a vertebrate-specific 12S rRNA gene fragment. RESULTS: Eighteen vertebrate species were identified and pigs (Sus scrofa) made up the highest proportion of blood meals in both habitats, followed by house mouse (Mus musculus) and opossum (Didelphis marsupialis). Individual bugs feeding only from generalist mammal species had the highest predicted vector infection rate, suggesting that generalist mammalian species are more competent hosts for T. cruzi infection . CONCLUSIONS: Oil palm plantations and A. butyracea palms found in altered areas provide a similar quality habitat for R. prolixus populations in terms of blood meal availability. Both habitats showed similarities in vector infection rate and potential host species, representing a single T. cruzi transmission scenario at the introduced oil palm plantation and native Attalea palm interface.

Diversity patterns, Leishmania DNA detection, and bloodmeal identification of Phlebotominae sand flies in villages in northern Colombia.

Leishmaniases are neglected tropical diseases exhibiting complex transmission cycles due to the number of parasite species circulating, sand fly species acting as vectors and infected mammals, including humans, which are defined in the New World as accidental hosts. However, current transmission scenarios are changing, and the disease is no longer exclusively related to forested areas but urban transmission foci occur, involving some species of domestic animals as suspected reservoirs. The aim of this study was to determine the transmission cycles in urban environments by evaluating sand fly diversity, detection of Leishmania DNA, and bloodmeal sources through intra and peridomestic collections. The study was carried out in Colombia, in 13 municipalities of Cordoba department, implementing a methodology that could be further used for the evaluation of vector-borne diseases in villages or towns. Our sampling design included 24 houses randomly selected in each of 15 villages distributed in 13 municipalities, which were sampled in two seasons in 2015 and 2016. Sand flies were collected using CDC light traps placed in intra and peridomestic habitats. In addition to the morphological identification, molecular identification through DNA barcodes was also performed. A total of 19,743 sand flies were collected and 13,848 of them (10,268 females and 3,580 males) were used in molecular procedures. Circulation of two known parasite species-Leishmania infantum and Leishmania panamensis was confirmed. Blood source analyses showed that sand flies fed on humans, particularly in the case of the known L. infantum vector, P. evansi; further analyses are advised to evaluate the reservoirs involved in parasite transmission. Our sampling design allowed us to evaluate potential transmission cycles on a department scale, by defining suspected vector species, parasite species present in different municipalities and feeding habits.

Theoretical perspectives on central chemosensitivity: CO2/H+-sensitive neurons in the locus coeruleus.

Central chemoreceptors are highly sensitive neurons that respond to changes in pH and CO2 levels. An increase in CO2/H+ typically reflects a rise in the firing rate of these neurons, which stimulates an increase in ventilation. Here, we present an ionic current model that reproduces the basic electrophysiological activity of individual CO2/H+-sensitive neurons from the locus coeruleus (LC). We used this model to explore chemoreceptor discharge patterns in response to electrical and chemical stimuli. The modeled neurons showed both stimulus-evoked activity and spontaneous activity under physiological parameters. Neuronal responses to electrical and chemical stimulation showed specific firing patterns of spike frequency adaptation, postinhibitory rebound, and post-stimulation recovery. Conversely, the response to chemical stimulation alone (based on physiological CO2/H+ changes), in the absence of external depolarizing stimulation, showed no signs of postinhibitory rebound or post-stimulation recovery, and no depolarizing sag. A sensitivity analysis for the firing-rate response to the different stimuli revealed that the contribution of an applied stimulus current exceeded that of the chemical signals. The firing-rate response increased indefinitely with injected depolarizing current, but reached saturation with chemical stimuli. Our computational model reproduced the regular pacemaker-like spiking pattern, action potential shape, and most of the membrane properties that characterize CO2/H+-sensitive neurons from the locus coeruleus. This validates the model and highlights its potential as a tool for studying the cellular mechanisms underlying the altered central chemosensitivity present in a variety of disorders such as sudden infant death syndrome, depression, and anxiety. In addition, the model results suggest that small external electrical signals play a greater role in determining the chemosensitive response to changes in CO2/H+ than previously thought. This highlights the importance of considering electrical synaptic transmission in studies of intrinsic chemosensitivity.

Modelling the influence of host community composition in a sylvatic Trypanosoma cruzi system.

Species composition of wild reservoir hosts can influence the transmission and maintenance of multi-host vector borne pathogens. The 'pace of life' hypothesis proposes that the life history strategy of reservoir hosts can influence pathogen transmission of vector borne generalist pathogens. We use empirical data to parameterize a mathematical model that investigates the impacts of host life history traits on vector transmission dynamics of the vector-borne multi-host parasite Trypanosoma cruzi in habitats characterized by different degrees of deforestation and varying host community structure. The model considers susceptible and infected vector and host populations. When comparing the proportion of vectors infected with T. cruzi predicted by the model with empirical data, we found a trend of increasing vector infection as anthropogenic landscape disturbance increases for both data and model output. The model's vector infection rates were significantly lower than empirical results, but when incorporating host congenital transmission in the model, vector infection approaches field data. We conclude that intervened habitats associated with r-selected host species communities predict higher proportions of infected vectors.

Modeling the effects of palm-house proximity on the theoretical risk of Chagas disease transmission in a rural locality of the Orinoco basin, Colombia.

BACKGROUND: Chagas disease is a major public health concern in Latin America and it is transmitted by insects of the subfamily Triatominae, including Rhodnius spp. Since palm trees are ubiquitous in Colombia and a habitat for Rhodnius spp., the presence of palms near villages could increase contact rates between vectors and humans. Therefore, knowing whether a relationship exists between the proximity of palms to villages and the abundance and distribution of vectors therein, may be critical for Chagas disease prevention programs. Adapting a mathematical model for R. prolixus population dynamics in a small village, we model the implications of changing distances between palms and dwellings, to the risk of Chagas disease infection. METHODS: We implemented a mathematical model that reflects R. prolixus population dynamics in a small village located in the department of Casanare (Colombia) to study the role of palm-house proximity. We varied the distance between palms and houses by monitoring the network global efficiency metric. We constructed 1,000 hypothetical villages varying distances and each one was run 100 times. RESULTS: According to the model, as palm-house proximity increases, houses were more likely to be visited by triatomine bugs. The number of bugs per unit time increased progressively in a non-linear fashion with high variability. We stress the importance of village configuration on the model output. CONCLUSIONS: From a theoretical perspective, palm-house proximity may have a positive effect on the incidence of Chagas disease. The model predicts a 1% increase in new human cases per year when houses and palms are brought closer by 75%.

Using agent based modeling to assess the effect of increased Bus Rapid Transit system infrastructure on walking for transportation.

The effect of transport infrastructure on walking is of interest to researchers because it provides an opportunity, from the public policy point of view, to increase physical activity (PA). We use an agent based model (ABM) to examine the effect of transport infrastructure on walking. Particular relevance is given to assess the effect of the growth of the Bus Rapid Transit (BRT) system in Bogotá on walking. In the ABM agents are assigned a home, work location, and socioeconomic status (SES) based on which they are assigned income for transportation. Individuals must decide between the available modes of transport (i.e., car, taxi, bus, BRT, and walking) as the means of reaching their destination, based on resources and needed travel time. We calibrated the model based on Bogota's 2011 mobility survey. The ABM results are consistent with previous empirical findings, increasing BRT access does indeed increase the number of minutes that individuals walk for transportation, although this effect also depends on the availability of other transport modes. The model indicates a saturation process: as more BRT lanes are added, the increment in minutes walking becomes smaller, and eventually the walking time decreases. Our findings on the potential contribution of the expansion of the BRT system to walking for transportation suggest that ABMs may prove helpful in designing policies to continue promoting walking.

TransMilenio, a Scalable Bus Rapid Transit System for Promoting Physical Activity.

Transport systems can play an important role in increasing physical activity (PA). Bogotá has been recognized for its bus rapid transit (BRT) system, TransMilenio (TM). To date, BRTs have been implemented in over 160 cities worldwide. The aim of this study was to assess the association between PA and the use of TM among adults in Bogotá. The study consists of a cross-sectional study conducted from 2010 to 2011 with 1000 adults. PA was measured using the International Physical Activity Questionnaire. In a subsample of 250 adults, PA was objectively measured using ActiGraph accelerometers. Analyses were conducted using multilevel logistic regression models. The use of TM was associated with meeting moderate-to-vigorous PA (MVPA). TM users were more likely to complete an average of >22 min a day of MVPA (odds ratio [OR] = 3.1, confidence interval [CI] = 95 % 1.4-7.1) and to walk for transportation for ≥150 min per week (OR = 1.5; CI = 95 % 1.1-2.0). The use of TM was associated with 12 or more minutes of MVPA (95 % CI 4.5-19.4, p < 0.0001). Associations between meeting PA recommendations and use of TM did not differ by socioeconomic status (p value = 0.106) or sex (p value = 0.288). The use of TM is a promising strategy for enhancing public health efforts to reduce physical inactivity through walking for transport. Given the expansion of BRTs, these results could inform the development of transport PA programs in low- to high-income countries.

The role of light in Chagas disease infection risk in Colombia.

BACKGROUND: Chagas disease is the most important vector-borne disease in Latin America and Rhodnius prolixus is the main vector in Colombia. Control strategies in this region have shown poor outcomes due to the insect's ability to disperse between the sylvatic and the domestic habitat. Because insect migration to houses is responsible to sustain contact rates between vectors and humans, understanding the risk factors that promote migration could be important in designing control strategies. In this respect, it has been reported that adult triatomines have the ability to move over long ranges at night attracted by artificial light. Thus, light bulbs could be playing a critical role in house invasion. The main objective of this study is to understand the role of artificial light, or simply light, in house infestation by R. prolixus. METHODS: To investigate the role of light, we combined fieldwork in the village of Chavinave, Casanare, Colombia and a mathematical model of Rhodnius prolixus dynamics. The model allowed us to simulate insect mobility and distribution in the village based on field results. We created 11 scenarios representing different amounts of light in the village (from 0 to 100%, with increments of 10%) with 100 simulations each for a time of 1000 days (2.7 years) and compare the results between the scenarios. RESULTS: None of the Gomez-Nuñez traps were positive at any stage of the study, suggesting that insects do not colonize houses. The model predicts that with current village connections the proportion of houses that have visiting insects should be around 98%. Additionally we showed that an increase in light allows for insect spreading and migration to previously un-infested areas. CONCLUSIONS: Increments in light could increase the contact rates between vectors and humans; a two-fold increase in human cases for a 30% increase in the use and visibility of light on this particular village was estimated with the model.