Impact of healthcare capacity disparities on the COVID-19 vaccination coverage in the United States: A cross-sectional study.

Background: The impact of the COVID-19 vaccination campaign in the US has been hampered by a substantial geographical heterogeneity of the vaccination coverage. Several studies have proposed vaccination hesitancy as a key driver of the vaccination uptake disparities. However, the impact of other important structural determinants such as local disparities in healthcare capacity is virtually unknown. Methods: In this cross-sectional study, we conducted causal inference and geospatial analyses to assess the impact of healthcare capacity on the vaccination coverage disparity in the US. We evaluated the causal relationship between the healthcare system capacity of 2417 US counties and their COVID-19 vaccination rate. We also conducted geospatial analyses using spatial scan statistics to identify areas with low vaccination rates. Findings: We found a causal effect of the constraints in the healthcare capacity of a county and its low-vaccination uptake. Counties with higher constraints in their healthcare capacity were more probable to have COVID-19 vaccination rates ≤50, with 35% higher constraints in low-vaccinated areas (vaccination rates ≤ 50) compared to high-vaccinated areas (vaccination rates > 50). We also found that COVID-19 vaccination in the US exhibits a distinct spatial structure with defined "vaccination coldspots". Interpretation: We found that the healthcare capacity of a county is an important determinant of low vaccine uptake. Our study highlights that even in high-income nations, internal disparities in healthcare capacity play an important role in the health outcomes of the nation. Therefore, strengthening the funding and infrastructure of the healthcare system, particularly in rural underserved areas, should be intensified to help vulnerable communities. Funding: None.

Noise-Resilient Acoustic Low Energy Beacon for Proximity-Based Indoor Positioning Systems.

Proximity-Based Indoor Positioning Systems (PIPSs) are a simple to install alternative in large facilities. Besides, these systems have a reduced computational cost on the mobile device of those users who do not continuously demand a high location accuracy. This work presents the design of an Acoustic Low Energy (ALE) beacon based on the emission of inaudible Linear Frequency Modulated (LFM) signals. This coding scheme provides high robustness to in-band noise, thus ensuring a reliable detection of the beacon at a practical range, after pulse compression. A series of experimental tests have been carried out with nine different Android devices to study the system performance. These tests have shown that the ALE beacon can be detected at one meter distance with signal-to-noise ratios as low as -12 dB. The tests have also demonstrated a detection rate above 80% for reception angles up to 50° with respect to the beacon's acoustic axis at the same distance. Finally, a study of the ALE beacon energy consumption has been conducted demonstrating comparable power consumption to commercial Bluetooth Low Energy (BLE) beacons. Besides, the ALE beacon search can save up to 9% more battery of the Android devices than the BLE beacon scanning.

Spatial epidemiology of cutaneous leishmaniasis in Colombia: socioeconomic and demographic factors associated with a growing epidemic.

BACKGROUND: Despite the identification of some environmental factors linked to the cutaneous leishmaniasis (CL) epidemic, little is known about the impact of environmental disturbances caused by human activities. We assessed the association between socioeconomic and demographic factors with the spatial structure of the CL epidemic in Colombia. METHODS: Using data from more than 65 000 CL cases collected across the entire country from publicly available sources, we conducted a spatial clustering analysis to identify high burden areas (clusters) of CL. Associations between CL clusters and socioeconomic variables were investigated. RESULTS: We identified seven statistically significant clusters of CL located across all Colombian biomes. Deforestation and livestock were statistically significantly associated with the spatial clustering of CL. Urbanization, time spent traveling to main cities and water bodies were other factors linked with the clustering of CL. CONCLUSIONS: This study found that human activities such as deforestation linked to agriculture, livestock production and mining activities are key drivers of the spatial distribution of the CL epidemic. The intensity of these human activities, which are projected to increase because of social and economic transformations in progress in Colombia, will potentially exacerbate the already growing CL epidemic in the country.

Simulating the influence of integrated crop-livestock systems on water yield at watershed scale.

Integrated crop-livestock (ICL) systems are being promoted as environmentally favorable alternatives to traditional crop agriculture and livestock production. There are few, if any, evaluation studies of the hydrologic response of watersheds to the implementation of ICL systems. Thus, we applied the Soil and Water Assessment Tool (SWAT) model to simulate the potential impacts of ICL systems on water yield and its hydrological components using a large agricultural dominated watershed. In this study, the integration of grazing operations with cropping systems represented cattle grazing under three typical crop rotations: (i) continuous corn (Zea mays L.; 1-year rotation), (ii) conventional (corn-soybean [Glycine max (L.) Merr.]; 2-year rotation), and (iii) winter cover crops (corn-soybean-oats (Avena sativa L.)/winter barley (Hordeum vulgare L.); 3-year rotation). Modeling results showed a significant reduction in water yield over a long-term period simulation (31 years) when grazing of corn residue or winter barley was scheduled within the rotations. When compared to scenarios without grazing operations, the reduction in water yield was 14.7% under corn-soybean rotation (corn as the forage grazed), 12.5% under continuous corn rotation, 6.4% under corn-soybean-oats/winter barley rotation (corn as the forage grazed), and 3% under corn-soybean-oats/winter barley rotation (winter barley as the forage grazed). Of the three components that constitute water yield (i.e., surface runoff, lateral and groundwater flow), only surface runoff was reduced when integrating grazing into the cropping system. Instead, lateral and groundwater flows increased when ICL systems were scheduled in the watershed. Groundwater flow was the hydrological component with the highest relative impact on streamflow. These results indicate that ICL systems can positively affect processes involved in soil water storage and transit. Runoff reduction benefits of ICL systems might be helpful in improving the environmental quality of receiving waterbodies and in reducing flood-risk potential. These systems over the long-term could benefit the watershed's hydrological cycle through increased baseflow. Overall, this study suggests new watershed-scale benefits of ICL systems with important hydrological implications that might be of interest for agricultural watershed planners.

Environmental and socio-economic determinants associated with the occurrence of cutaneous leishmaniasis in the northeast of Colombia.

Background: Cutaneous leishmaniasis (CL) is a vector-borne disease that is widely distributed in most tropical regions. Colombia has experienced an important increase in its incidence during the last decade. There are CL transmission foci in the Colombian departments of Santander and Norte de Santander. Objectives: To identify environmental and socio-economic variables associated with CL incidence in the municipalities of the northeast of Colombia between 2007 and 2016. Methods: This was an ecological study of CL cases aggregated by municipality. The cases reported during the study period were analyzed with a negative binomial regression to obtain the adjusted incident rate ratio for environmental and socio-economic variables. Findings: During the study period, 10 924 cases of CL were reported, and 110 (86.6%) municipalities reported at least one CL case. The coverages of forest (aIRR 1.05, 95% CI 1.03-1.07), heterogeneous agricultural zones (aIRR 1.04, 95% CI 1.02-1.06) and permanent crops (aIRR 1.07, 95% CI 1.02-1.12) were associated with a higher incidence of CL. Conversely, urban functionality (aIRR 0.95, 95% CI 0.92-0.96), minimal-altitude above sea level (aIRR 0.84, 95% CI 0.79-0.90) and shrub coverage (aIRR 0.98, 95% CI 0.95-1.0) were negatively associated with the incidence of CL in the municipality. Main conclusions: Our results confirm the importance of environmental determinants, such as height above sea level, and coverage of forest, permanent crops and heterogeneous agricultural zones, for the occurrence of CL; these findings also suggest the importance of shrub coverage. Furthermore, urban functionality was a socio-economic determinant independently associated with CL incidence.

Classical familial homocystinuria in an adult presenting as an isolated lens subluxation.

To report a case of late diagnosis of a classical familial homocystinuria based on an ophthalmologic examination. A 35-year-old male with Marfan-like phenotype complained of a progressive increase of myopia during the previous 2 years. Ophthalmologic exploration showed a bilateral subluxation of the lens with inferior and nasal displacement. Biochemical study detected a profile of increased amino acid levels (homocysteinemia) consistent with suspected homocystinuria. Vascular and skeletal studies ruled out Marfan syndrome. Response to treatment demonstrated B(6)-non-responsive homocystinuria. Molecular study showed compound heterozygous T353 N and D444 N mutations of the cystathionine beta-synthase (CBS) gene, and also a C667T homozygous mutation of the methylenetetrahydrofolate-reductase (MTHFR) gene. Family study showed classical homocystinuria in his father and sister, although they did not present any systemic or ocular features of the disease. Homocystinuria is a metabolic disease usually presenting at an early age as vascular, skeletal and neuropsychiatric abnormalities, as well as ectopia lentis. Our case is atypical because of the absence of thromboembolism and the mild phenotype, in spite of being B(6)-non-responsive, and the association of a rare compound heterozygous mutation of the CBS gene and also an homozygous mutation of the MTHFR gene. It is necessary to rule out homocystinuria in patients with ectopia lentis, even in the absence of systemic symptoms.

Bilateral idiopathic orbital inflammation 3 years before systemic Wegener's granulomatosis in a 7-year-old girl.

Wegener's granulomatosis (WG) is a necrotizing granulomatous vasculitis characterized by the involvement of the upper or lower airways, lungs, and kidneys, but it can affect almost any organ including the orbit. WG is rare in childhood. This case report describes a 7-year-old girl who presented bilateral idiophatic orbital inflammation and antineutrophil cytoplasmic antibodies-negative titres. Computed tomography scan and magnetic resonance imaging showed enlargement of both lacrimal glands with infiltration. Treatment with corticosteroids achieved remission of the disease. Three years later, she developed a systemic affectation with tracheal stenosis, pulmonary affectation, renal failure, and respiratory tract mucosa inflammation. Lacrimal gland biopsy showed perivascular nonspecific granulomas and ANCA titres remain negative. Treatment with corticosteroids and cyclophosphamide was done. A relapse occurred 2 years later, with complete remission with antitumor necrosis factor-alpha. No other symptoms have appeared after 9 years of follow-up. Early diagnosis and treatment is crucial to increase the survival rate in these patients.