Annual Coverage Research Articles

Development of a methodological approach to estimate vegetation biomass using remote sensing in the Brazilian semiarid NE region.

The accurate estimation of vegetation biomass over large areas is still a significant challenge. The evolution of low-cost geotechnologies is rapidly facilitating this task, but their use to estimate biomass on tropical dry forests (TDFs) is still scarce. TDFs cover large areas and are currently among the most threatened global ecosystems due to intense anthropic pressures. Therefore, there is a need for the development of tools capable of monitoring the complex spatial-temporal dynamics of these highly variable ecosystems. We developed a methodology to estimate aboveground biomass stocks in a tropical dry forest (known as “Caatinga”), native to the semiarid region of Northeast Brazil, using field and orbital data, regression models, and high-performance computation. We combined twenty types of vegetation spectral indices and isolated spectral bands of the Landsat 8 satellite OLI sensor to generate regression model equations that could predict biomass stocks. The selected models were applied in a cloud processing routine developed using Google Earth Engine (GEE) to estimate the biomass (30 m pixel resolution) in the entire semiarid region of Pernambuco state (85,900 km2), using the years 2017 and 2018 as references. The regression models were capable of predicting the biomass in dense Caatinga (μ 32.6 Mg ha−1 - R2 0.52), open Caatinga (μ 11.4 Mg ha−1- R2 0.56), and pasturelands (μ 4.2 Mg ha−1-R2 0.94). Using the equations previously defined and the map of the Brazilian Annual Coverage and Land Use Mapping (Mapbiomas) we developed a workflow script in GEE to plot a map that represents the biomass stock over the entire semiarid region of Pernambuco. The system plotted the distribution and amount of biomass with similar results to those available in the literature. Given the large area of the region, the biomass was estimated with reasonable precision in spatial and temporal distribution, while demanding little time and hardware costs. Future refinements of the method will be pursued, but the proposed version represents an improvement in the capability to provide reliable estimates and contributes to monitor the biomass dynamics in the in semiarid region of NE Brazil.

EVALUATION OF SOCIAL MOBILIZATION COMPONENT OF THE SECOND YEAR OF LIFE (2YL) PROJECT ON IMMUNIZATION COVERAGE IN ADAKLU DISTRICT, GHANA

Ghana has had relatively high immunization coverage of more than 85% for infant antigens in the first year of life. However, there is decline in immunization coverage for vaccines provided during the second year of life (2YL) of the child. As part of the 2YL project implemented in Ghana to strengthen the 2YL immunization platform, social mobilization strategies were utilized to help improve coverage for vaccines provided in the 2YL of a child. This study aims to evaluate the impact of social mobilization components of the 2YL project on immunization coverage in Adaklu district, Volta region, Ghana. A pre-experimental design; single-group pretest-posttest design was utilized to assess whether there was a significant change in immunization coverage pre- and post-intervention. Data on health facilities’ immunization coverage were collected from DHMIS II before, during and after the intervention. The Pearson chi square, fisher’s exact, Wilcoxon sign rank test and paired t-test were used to evaluate the impact of the intervention implemented in 2017 on identified outcomes mainly Penta3, MR1, MR2 and MenA. The results indicated a significant improvement in dropout rate between first and second dose of Measles Rubella vaccines in health facilities within the district. The number of health facilities that recorded negative rate increased to 70% in 2018 from 25% in 2016. Also, the annual district immunization coverage for Second dose of Measles increased form 73% in 2016 to 84% in 2017 and 82.5% in 2018. The implementation of the social mobilization had a positive effect on immunization coverage in the district. The intervention resulted in increased immunization coverage and significantly reduced measles Rubella dropout rate.

Impact of mass distribution of insecticide-treated nets in Mozambique, 2012 to 2025: Estimates of child lives saved using the Lives Saved Tool.

Malaria was the leading cause of post-neonatal deaths in Mozambique in 2017. The use of insecticide treated nets (ITNs) is recognized as one of the most effective ways to reduce malaria mortality in children. No previous analyses have estimated changes in mortality attributable to the scale-up of ITNs, accounting for provincial differences in mortality rates and coverage of health interventions. Based upon annual provincial ownership coverage of ITNs, the Lives Saved Tool (LiST), a multi-cause mathematical model, estimated under-5 lives saved attributable to increased household ITN coverage in 10 provinces of Mozambique between 2012 and 2018, and projected lives saved from 2019 to 2025 if 2018 coverage levels are sustained. An estimated 14,040 under-5 child deaths were averted between 2012 and 2018. If 2018 coverage levels are maintained until 2025, an additional 33,277 child deaths could be avoided. If coverage reaches at least 85% in all ten provinces by 2022, then a projected 36,063 child lives can be saved. From 2012 to 2018, the estimated number of lives saved was highest in Zambezia and Tete provinces. Increases in ITN coverage can save a substantial number of child lives in Mozambique. Without continued investment, thousands of avoidable child deaths will occur.

The Effect of Vegetative Coverage and Altitude on the Vegetation Water Consumption in the Alpine Inland River Basin of the Northeastern Qinghai–Tibet Plateau

Estimating accurately the vegetation water consumption (VWC) in the Qinghai Lake Basin (QLB) is conducive to the effective utilization and management of water resources in the QLB, which is of great significance to the construction of a national park in the QLB. We used Geographic Information System (GIS) technology and remote sensing (RS) technology based on potential evapotranspiration data to calculate the VWC in the QLB from 2000 to 2020, and analyzed the influencing factors of the VWC in the QLB from 2000 to 2020. The results showed that (1) the average value of the VWC in the QLB varied from 242.96 mm to 287.99 mm, the average value of the VWC was 267.07 mm, and the average value of the total VWC was 79.05 × 108 m3 from 2000 to 2020. (2) In terms of spatial variation of the VWC, the VWC in the QLB did not increase significantly from 2000 to 2014, however, the VWC in the QLB showed a significant increase from 2015 to 2020. (3) As the altitude gradient increases, the VWC in the QLB from 2000 to 2020 showed a significant downward trend with the increase in altitude. When the altitude increases by 100 m, the value of the VWC decreases by 13.47 mm from 2000 to 2014 and 22.8 mm from 2015 to 2020, respectively. (4) Exploring the influencing factors of the VWC in the QLB from 2000 to 2020, the results showed that the VWC was mainly affected by the average annual precipitation and normalized difference vegetation index (NDVI) from 2000 to 2014. It was mainly affected by the combined effects of annual temperature, precipitation, and vegetation coverage from 2015 to 2020. The VWC was mainly affected by the average annual temperature, precipitation, and vegetation coverage along the altitude gradient from 2000 to 2014. It was mainly affected by the average annual temperature and vegetation coverage in the QLB from 2015 to 2020. Obviously, vegetation coverage was the most important factor affecting the VWC regardless of spatial or altitude gradient variations.

A Study on Dental Health Insurance Cost Perception of Dental Hygienists: Focusing on Expanding Insurance Coverage of Dental Scaling

Objectives: This study was conducted to understand the dental hygienists experiences and cost perceptions of scaling. Methods: From 15 August to 30 September 2021, 217 dental hygienists were surveyed about the dental hygienists experiences and cost perceptions of scaling. The data were analyzed with frequency analysis, Cross-analysis with spss 26.0 program. Results: Dental hygienists recognized that the appropriate insurance claim cost was 41,000~60,000 won. As for the perception of co-payment and insurance claim cost according to the experience of dental hygienists performing scaling, the higher the age, the lower the co-payment and insurance claim cost. In response to the appropriate insurance claim cost, the higher the age, the higher the cost. Conclusions: Reflecting the recognition of dental hygienists who are experts in scaling, should be made in consideration of the number and cost of annual scaling insurance coverage.

Short-Acting Beta-2-Agonist Exposure and Severe Asthma Exacerbations: SABINA Findings From Europe and North America

Expert national/global asthma management recommendations raise the issue whether a safe threshold of short-acting beta-2 agonist (SABA) use without concomitant inhaled corticosteroids (ICS) exists. To examine SABA and maintenance therapy associations with severe asthma exacerbations across North America and Europe. Observational analyses of 10 SABa use IN Asthma (SABINA) datasets involving 1,033,564 patients (≥12 y) from Canada, France, the Netherlands, Poland, Spain, the United Kingdom, and the United States. Negative binomial models (incidence rate ratio [IRR] [95% CI adjusted for prespecified-covariates]) evaluated associations between SABA and exacerbations. Across severities, 40.2% of patients were prescribed/possessed 3 or more SABA canisters/y. Per the Global Initiative for Asthma (GINA) 2018 definitions, steps 3 to 5-treated patients prescribed/possessing 3 or more versus 1 or 2 SABAs experienced more severe exacerbations (IRR 1.08 [95% CI 1.04‒1.13], U.S. Medicare; IRR 2.11 [95% CI 1.96‒2.27], Poland). This association was not observed in all step 1 or 2-treated patients (the Netherlands, IRR 1.25 [95% CI 0.91‒1.71]; U.S. commercial, IRR 0.92 [95% CI 0.91‒0.93]; U.S. Medicare, IRR 0.74 [95% CI 0.71‒0.76]). We hypothesize that this inverse association between SABA and severe exacerbations in the U.S. datasets was attributable to the large patient population possessing fewer than 3 SABA and no maintenance therapy and receiving oral corticosteroid bursts without face-to-face health care provider encounters. In U.S. SABA monotherapy-treated patients, 3 or more SABAs were associated with more emergency/outpatient visits and hospitalizations (IRR 1.31 [95% CI 1.29‒1.34]). Most GINA 2 to 5-treated study patients (60.6%) did not have maintenance therapy for up to 50% of the time; however, the association of 3 or more SABAs and severe exacerbations persisted (IRR 1.32 [95% CI 1.18‒1.49]) after excluding these patients and the independent effect was further confirmed when U.K. SABA data were analyzed as a continuous variable in patients with up to 100% annual coverage for ICS-containing medications. Increasing SABA exposure is associated with severe exacerbation risk, independent of maintenance therapy. As addressed by GINA, based on studies across asthma severities where as-needed fast-acting bronchodilators with concomitant ICS decrease severe exacerbations compared with SABA, our findings highlight the importance of avoiding a rescue/reliever paradigm utilizing SABA monotherapy.

Impact of Testing Strategies to Combat a Major Syphilis Outbreak Among Australian Aboriginal and Torres Strait Islander Peoples: A Mathematical Modeling Study

BackgroundA syphilis outbreak among Australian Aboriginal and Torres Strait Islander people (respectfully referred to as Aboriginal) has resulted in almost 4000 notifications by 2020, with several congenital syphilis cases and infant deaths. Outbreak control efforts became coordinated under a National enhanced test and treat response in 2017. We evaluated the impact of these efforts and of expansion of testing interventions on syphilis prevalence.MethodsWe developed an individual-based mathematical model of infectious syphilis transmission among young heterosexual Aboriginal people aged 15–34 years living in and moving between regional and remote areas, and we assessed the impact of existing and hypothetical outbreak control responses on syphilis prevalence.ResultsThe increased testing coverage achieved through the response (from 18% to 39% over 2011–2020) could stabilize the epidemic from 2021. To return to pre-outbreak prevalence (<0.24%) by 2025, testing coverage must reach 60%. The addition of annual community-wide screening, where 30% of youth in communities are tested over 6 weeks, would reduce prevalence to the pre-outbreak level within 4 years. If testing coverage had been scaled-up to 60% at the start of outbreak in mid-2011, the outbreak would have been mitigated.ConclusionsOur results suggest that to control the syphilis outbreak, the response needs to be delivered to enable the maximum coverage of testing to be reached in the shortest time to reduce the prevalence to pre-outbreak levels. Reduction could be hastened with community-wide screening at similar time periods across all communities together with increases in annual testing coverage.

Changing epidemiology of yellow fever virus in Oyo State, Nigeria

BackgroundYellow Fever is an acute viral hemorrhagic disease endemic in tropical Africa and Latin America and is transmitted through infected mosquitoes. The earliest outbreak of yellow fever in Nigeria was reported in Lagos in 1864 with subsequent regular outbreaks reported until 1996. A large epidemic of yellow fever occurred in Oyo State in April and May 1987 following an epidemic of sylvatic yellow fever in Eastern Nigeria the previous year. For 21 years, no further confirmed cases were reported until September 2017 following which Nigeria has been responding to successive outbreaks. The renewed onset of yellow fever outbreaks in Nigeria followed a global trend of reports and from other African countries. Yellow Fever disease has no cure, but control is through vaccination and vector control. Eliminating Yellow fever Epidemic (EYE) strategy to improve high-risk countries’ prevention, preparedness, detection, management, and response to yellow fever outbreaks was developed by the WHO in 2017 and launched in Nigeria in April 2018. Yet, poor vaccination coverage continues to be a cause for concern.Materials and methodsWe conducted a retrospective cross-sectional study that examines the resurgence of Yellow fever cases and outbreaks from 2013 to 2020 in Oyo State, Nigeria. The Yellow Fever data for both surveillance and routine Expanded Programme on Immunization (EPI) were the focus of the review. Surveillance data were retrieved from the State’s database reported by all 33 LGAs, maintained by the State and supported by the World Health Organization at the Zonal and State levels. The routine EPI data were retrieved from District Health Information Software (DHIS_2). The proportion of LGAs reporting at least one case of suspected yellow fever with a blood specimen and the number of suspected cases reported for each year within the period under review was measured. We also assessed the trend of confirmed cases and the incidence per 100,000 persons. Also, suspected cases of yellow fever were categorized into four age groups and their vaccination status was assessed. The State’s annual administrative routine vaccination coverage for yellow fever vaccine was compared with the number of confirmed cases for each year.ResultsThe proportion of LGAs reporting at least a case of suspected yellow fever, with blood samples collected, ranged from 6.1 to 84.9% between 2014 and 2020 while a total of 9 confirmed (8 cases) and probable (1 case) cases of yellow fever were recorded. However, there were no confirmed cases from the year 2013 to 2016, including 2018 but an upward trend of incidence of the disease per 100,000 persons from 0% to 2013 through 2018, to 3.5% in 2019, and then to 5.6% in 2020 was observed. 93 of 240 (39%) suspected yellow fever cases reported during the given period were observed to have received yellow fever vaccine.ConclusionsIn conclusion, the increase in the circulation of the yellow fever virus in the state reiterates the state is at a high risk of yellow fever transmission and underlines the need for viable interventions such as environmental hygiene to rid the environment of the disease vector’s ecological niche and improving routine EPI coverage to provide population immunity.

Car accidents, smartphone adoption and 3G coverage

This paper examines the relationship between smartphone use by drivers and traffic accidents in California between 2001 and 2013. In order to estimate smartphone use, we first show that widespread adoption of modern smartphones began in 2009 after the release of the iPhone 3G and T-Mobile G1. This information is combined with annual 3G coverage maps that are constructed from cellular tower information in a machine learning framework. In a difference-in-differences framework, we estimate the combined effect of smartphone adoption and 3G coverage along quarter-mile road segments. Controlling for census tract population density, road and year fixed effects, Poisson regression results show that there is a statistically significant increase in the traffic accident rate along a road segment when smartphone use becomes possible. Our preferred specification suggests smartphones caused accident rates to increase by 2.9 percent, resulting in 3500 additional accidents per year in California. Event study results rule out the possibility that our smartphone treatment is capturing a trend in the accident rate. The results are robust to a variety of specifications and consistent with individual-level studies showing that cell phone use leads to lower driving quality. The findings also provide guidance for policies aimed at reducing cell phone related accidents and distracted driving.

Wild Plant Habitat Characterization in the Last Two Decades in the Nile Delta Coastal Region of Egypt

Environmental and land-use changes put severe pressure on wild plant habitats. The present study aims to assess the biodiversity of wild plant habitats and the associated spatiotemporal environmental changes in the coastal region of Dakahlia Governorate following an integrated approach of remote sensing, GIS, and samples analysis. Thirty-seven stands were spatially identified and studied to represent the different habitats of wild plants in the Deltaic Mediterranean coastline region. Physical and chemical characteristics of soil samples were examined, while TWINSPAN classification was used to identify plant communities. Two free Landsat images (TM and OLI) acquired in 1999 and 2019 were processed to assess changes via the production of land use and cover maps (LULC). Moreover, NDSI, NDMI, and NDSI indices were used to identify wild plant habitats. The floristic composition indicated the existence of 57 species, belonging to 51 genera of 20 families. The largest families were Asteraceae, Poaceae, and Chenopodiaceae. The classification of vegetation led to the identification of four groups. Canonical Correspondence Analysis (CCA) revealed that electrical conductivity, cations, organic carbon, porosity, chlorides, and bicarbonates are the most effective soil variables influencing vegetation. The results of the spectral analysis indicated an annual coverage of bare lands (3.56 km2), which is strongly related to the annual increase in vegetation (1.91 km2), water bodies (1.22 km2), and urban areas (0.43 km2). The expansion of urban and agricultural regions subsequently increased water bodies and caused occupancy of bare land, resulting in the development of wild plant habitats, which are mostly represented by the sparse vegetation class as evaluated by NDVI. The increase in mean moisture values (NDMI) from 0.03 in 1999 to 0.15 in 2019 might be explained by the increase in total areas of wild plant habitats throughout the study period (1999–2019). This may improve the adequacy of environments for wild habitats, causing natural plant proliferation.

HPV vaccination coverage in women between 15 and 55years old in Spain: Temporal trend during the period 2007-2020.

The objective of this study was to analyse the temporal trend of HPV vaccination coverage (VC) in Spain in women aged 15-55 years not included in systematic vaccination programmes during the period 2007-2020. We assessed the vaccine coverage rate in this population based on three estimations: 1) annual vaccination coverage with at least one dose (VCR≥1d), 2) annual VC for the full schedule (VCR3d), and 3) cumulative VC for the full schedule (aVCR). Annual VCR≥1d and VCR3d were highest in 2008 (2.40% and 0.66% respectively) and subsequently decreased drastically in 2011 (0.55% and 0.15%). From 2017 to 2019 there was an increase from 1.4-fold to 1.6-fold, respectively, which decreased in 2020. In relation to aVCR, there was an increasing trend throughout the study period with approximately 4.03% of the study population having been vaccinated against HPV in 2020. In Spain, the cumulative vaccination coverage against HPV in women between 15-55 years old not included in current vaccination programmes remains very low. Nonetheless, the temporal trend has shown a slight increase in recent years. Despite the COVID-19 pandemic in 2020, no significant negative impact on vaccination coverage has been observed in this population.

Anthropogenic Factors Affecting the Vegetation Dynamics in the Arid Middle East

Abstract The spatiotemporal variability of vegetation in the Middle East was investigated for the period 2001–2019 using the Moderate Resolution Imaging Spectroradiometer (MODIS) 16-day/500 m composites of the Normalized Difference Vegetation Index (NDVI; MOD13A1). The results reveal a strong increase in NDVI coverage in the Middle East during the study period (R = 0.75, p-value = 0.05). In Egypt, the annual coverage exhibits the strongest positive trend (R = 0.99, p-value = 0.05). In Turkey, both the vegetation coverage and density increased from 2001 to 2019, which can be attributed to the construction of some of the biggest dams in the Middle East, such as the Atatürk and Ilisu dams. Significant increases in the annual coverage and maximum and average NDVI in Saudi Arabia are due to farming in the northern part of the country for which groundwater and desalinated seawater are used. The results of this study suggest that one of the main factors affecting vegetation coverage in the Middle East are governmental policies. These policies could lead to an increase in vegetation coverage in some countries such as Egypt, Saudi Arabia, Qatar, Kuwait, Iran, and Turkey.

Estimating NDVI and LAI as a precursor for monitoring air pollution along the BBN industrial corridor of Himachal Pradesh, India

The research conducted is to establish the role of Normalized Difference Vegetative Index (NDVI) and Leaf Area Index (LAI) as a tool for monitoring air pollution through resolution multispectral images for Baddi Barotiwala Nalagarh (BBN Industrial Corridor). The air pollution is estimated in terms of Respirable Suspended Particulate Matter (RSPM). The LAI was estimated through high-resolution Multi-spectral imageries for the years (2001 to 2021). LAI analysis reveals that the majority of the study is covered under moderate to very high plant canopy density region. Analysis of the 2016 image revealed vegetation indices ranging between −0.9 to 2. Decrease of the forest vegetation quality was observed between 2001 and 2021 also causes the increase in the absorption of air pollutants while at the same time. In the year 2009 the RSPM of the areas has been registered at an average of 76 ug/m3. Between 2010 and 2011 the average air quality registered at 106.67, 105.50, 83.33. The results indicate the air quality has been worsening through the years (2009 and 2020) RSPM of these regions has doubled increasing the toxicity of the pollutants. Analysis of the decadal change in NDVI and LAI shows the reduction of the annual forest coverage of the BBN industrial corridor coupled with the decrease in the air quality of the region. The study shows a clear relation between decreasing vegetation cover and the air quality of the region.

Knowledge, Attitudes and Practices Towards Human Papillomavirus Vaccination Among Medical Doctors at a Tertiary Hospital: A Cross Sectional Study.

BackgroundHuman papillomavirus (HPV) infection is a common sexually transmitted disease, characterised by persistent infection with high-risk strains leading to malignant conditions such as cervical cancer. The HPV vaccine is a well-known primary preventive measure for HPV infections. Previous studies have shown that medical doctors’ vaccine recommendation is one of the key strategies in improving HPV vaccine uptake. In 2019, Zambia rolled out the free national HPV vaccination program targeting 14-year-old girls. However, the annual coverage for HPV vaccination is variable, with rates as low as 33% for 2021.Materials and MethodsWe conducted a cross-sectional study between September and December 2020 at the University Teaching Hospitals in Lusaka, Zambia. We used analysis of variance to assess the mean differences in the overall scores for knowledge, attitude and practices towards the HPV vaccine. In addition, we used structural equation modelling (SEM) to test the traditional education theory as medical doctors’ HPV vaccine knowledge, attitude, and practices cover several facets, and SEM can model latent variables.ResultsWe enrolled 121 medical doctors, of whom 67 (44.6%) were male. The majority, 76 (62.8%), were registrars and 79 (65.3%) had more than ten years of clinical experience. The overall mean knowledge, attitude, and practice score of the HPV vaccine mean (SD) were 70.2 (15.1), 72.1 (18.5) and 77.1 (28.9), respectively. More than half of the medical doctors would advise anyone eligible to take the HPV vaccine 66 (54.6%). There was a positive correlation between attitude and practice towards the HPV vaccine (β = .03, P = .017). Conversely, there was no evidence of a correlation between overall HPV knowledge and attitude (β = .01, P = .670) and rank of the medical doctors (β = −7.87, P = .355).ConclusionKnowledge was high with good attitudes and practices among medical doctors, which are vital in vaccine recommendation and subsequent uptake.

Automated mapping of the seasonal evolution of surface meltwater and its links to climate on the Amery Ice Shelf, Antarctica

Abstract. Surface meltwater is widespread around the Antarctic Ice Sheet margin and has the potential to influence ice shelf stability, ice flow and ice–albedo feedbacks. Our understanding of the seasonal and multi-year evolution of Antarctic surface meltwater is limited. Attempts to generate robust meltwater cover time series have largely been constrained by computational expense or limited ice surface visibility associated with mapping from optical satellite imagery. Here, we add a novel method for calculating visibility metrics to an existing meltwater detection method within Google Earth Engine. This enables us to quantify uncertainty induced by cloud cover and variable image data coverage, allowing time series of surface meltwater area to be automatically generated over large spatial and temporal scales. We demonstrate our method on the Amery Ice Shelf region of East Antarctica, analysing 4164 Landsat 7 and 8 optical images between 2005 and 2020. Results show high interannual variability in surface meltwater cover, with mapped cumulative lake area totals ranging from 384 to 3898 km2 per melt season. By incorporating image visibility assessments, however, we estimate that cumulative total lake areas are on average 42 % higher than minimum mapped values. We show that modelled melt predictions from a regional climate model provide a good indication of lake cover in the Amery region and that annual lake coverage is typically highest in years with a negative austral summer SAM index. Our results demonstrate that our method could be scaled up to generate a multi-year time series record of surface water extent from optical imagery at a continent-wide scale.

Community-based naloxone coverage equity for the prevention of opioid overdose fatalities in racial/ethnic minority communities in Massachusetts and Rhode Island.

Opioid-related overdose death rates continue to rise in the United States, especially in racial/ethnic minority communities. Our objective was to determine if US municipalities with high percentages of non-white residents have equitable access to the overdose antidote naloxone distributed by community-based organizations. We used community-based naloxone data from the Massachusetts Department of Public Health and the Rhode Island non-pharmacy naloxone distribution program for 2016-18. We obtained publicly available opioid-related overdose death data from Massachusetts and the Office of the State Medical Examiners in Rhode Island. We defined the naloxone coverage ratio as the number of community-based naloxone kits received by a resident in a municipality divided by the number of opioid-related overdose deaths among residents, updated annually. We used a Poisson regression with generalized estimating equations to analyze the relationship between the municipal racial/ethnic composition and naloxone coverage ratio. To account for the potential non-linear relationship between naloxone coverage ratio and race/ethnicity we created B-splines for the percentage of non-white residents; and for a secondary analysis examining the percentage of African American/black and Hispanic residents. The models were adjusted for the percentage of residents in poverty, urbanicity, state and population size. Between 2016 and 2018, the annual naloxone coverage ratios range was 0-135. There was no difference in naloxone coverage ratios among municipalities with varying percentages of non-white residents in our multivariable analysis. In the secondary analysis, municipalities with higher percentages of African American/black residents had higher naloxone coverage ratios, independent of other factors. Naloxone coverage did not differ by percentage of Hispanic residents. There appear to be no municipal-level racial/ethnic inequities in naloxone distribution in Rhode Island and Massachusetts, USA.

Sex-specific effects of aging on humoral immune responses to repeated influenza vaccination in older adults

Older adults (≥65 years of age) bear a significant burden of severe disease and mortality associated with influenza, despite relatively high annual vaccination coverage and substantial pre-existing immunity to influenza. To test the hypothesis that host factors, including age and sex, play a role in determining the effect of repeated vaccination and levels of pre-existing humoral immunity to influenza, we evaluated pre- and post-vaccination strain-specific hemagglutination inhibition (HAI) titers in adults over 75 years of age who received a high-dose influenza vaccine in at least four out of six influenza seasons. Pre-vaccination titers, rather than host factors and repeated vaccination were significantly associated with post-vaccination HAI titer outcomes, and displayed an age-by-sex interaction. Pre-vaccination titers to H1N1 remained constant with age. Titers to H3N2 and influenza B viruses decreased substantially with age in males, whereas titers in females remained constant with age. Our findings highlight the importance of pre-existing immunity in this highly vaccinated older adult population and suggest that older males are particularly vulnerable to reduced pre-existing humoral immunity to influenza.

Projections of human papillomavirus (HPV) vaccination impact in Ethiopia, India, Nigeria and Pakistan: a comparative modelling study

IntroductionCervical cancer is the second most common cancer among women in Ethiopia, India, Nigeria and Pakistan. Our study objective was to assess similarities and differences in vaccine-impact projections through comparative...

Integrating Oceanographic Data and Benthic Community Structure Temporal Series to Assess the Dynamics of a Marginal Reef

Reefs are the richest marine ecosystems. Their benthic communities generate structural complexity and participate in nutrient cycles, providing habitat and food for many marine species. These ecosystems have been threatened by local and global anthropogenic impacts and changes in community structure have led to loss of biodiversity, ecosystem function and services worldwide. Most studies about these structural changes have been conducted in Caribbean and Indo-Pacific coral reefs. In the Southwestern Atlantic, where reefs are naturally algae-dominated, these efforts are incipient, especially at oceanic islands where local anthropic impacts tend to be lower, and natural and climate-induced fluctuations might be easily detected. We conducted the first temporal assessment of benthic communities and the influence of oceanographic parameters between 2013 and 2019 in Fernando de Noronha (FNA), the largest Brazilian oceanic archipelago. We annually sampled benthic communities in FNA’s shallow reefs (2–21 m) using photoquadrats, quantified and gathered organisms in major groups according to their functional roles. We also characterized and tested “sea surface temperature,” “marine heatwaves,” “diffuse attenuation coefficient,” and “wave energy” influence for the same period. The most abundant groups were epilithic algal matrix (EAM; mean annual coverage: 23–60%), macroalgae (15–35%) and calcifiers (15–29%), followed by cyanobacteria (1–37%), suspension/filter-feeders (&amp;lt;2%), zoanthids (&amp;lt;1%) and other invertebrates (&amp;lt;0.1%). EAM was negatively correlated with “marine heatwaves” and positively correlated with “wave energy,” while macroalgae and calcifiers showed opposite responses to “marine heatwaves” and “wave energy,” respectively. Cyanobacteria was positively correlated with “marine heatwaves.” The dominance of EAM and macroalgae was already described for reefs along the Brazilian Province and we demonstrated the persistence of this structure over the years in FNA, with the exception of 2019 when there was a substantial increase of cyanobacteria after a strong marine heatwave. Our results suggest a flickering dynamic between EAM and macroalgae, which vary according to the oceanographic conditions, reinforcing its distinct dynamics from most tropical coral reefs. However, the increase of cyanobacteria added to projections of more frequent and stronger marine heatwaves worldwide indicate possible structural changes in this community. Continued monitoring of community and oceanographic drivers is key for better understanding and predicting changes in important marginal reefs.

Regional variations in annual influenza vaccination coverage among U.S. adults

Regional variations in annual influenza vaccination coverage among U.S. adults