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This systematic review describes herpes zoster (HZ) economic burden in terms of healthcare resource use and cost outcomes in the Latin America and Caribbean (LAC) region. We searched online databases from 1 January 2000 to 20 February 2020 to identify eligible publications. We identified 23 publications that reported direct costs, indirect costs, and resources associated with HZ and its complications. The primary direct medical resources reported in the different studies were visits to doctors, transportation, days in the hospital, nursing, medication schedules, and physical therapy. Direct total costs per patient ranged from $99.99 to $4177.91. The highest cost was found in Brazil. Direct costs are, in average, 81.39% higher than indirect costs. The cost per patient that includes postherpetic neuralgia treatment is 115% higher on average for the directs and 73% for the indirect costs. Brazil reported a higher total cost per patient than Argentina and Mexico, while for indirect costs per patient, Brazil and Argentina had higher costs than Mexico, respectively. A meta-analysis on the number of days due to HZ hospitalization, performed on non-immunosuppressed patients over 65 years of age from three studies, resulted in a cumulative measure of 4.5 days of hospitalization. In the LAC region, the economic burden of HZ and associated complications is high, particularly among high-risk populations and older age groups. Preventative strategies such as vaccination could help avoid or reduce the HZ-associated disease economic burden in the LAC region.

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BACKGROUND AND OBJECTIVE: The coronavirus disease 2019 Living OVerview of Evidence (COVID-19 L·OVE) is a public repository and classification platform for COVID-19 articles. The repository contains more than 430,000 articles as of September 20, 2021 and intends to provide a one-stop shop for COVID-19 evidence. Considering that systematic reviews conduct high-quality searches, this study assesses the comprehensiveness and currency of the repository against the total number of studies in a representative sample of COVID-19 systematic reviews. METHODS: Our sample was generated from all the studies included in the systematic reviews of COVID-19 published during April 2021. We estimated the comprehensiveness of COVID-19 L·OVE repository by determining how many of the individual studies in the sample were included in the COVID-19 L·OVE repository. We estimated the currency as the percentage of studies that was available in the COVID-19 L·OVE repository at the time the systematic reviews conducted their own search. RESULTS: We identified 83 eligible systematic reviews that included 2,132 studies. COVID-19 L·OVE had an overall comprehensiveness of 99.67% (2,125/2,132). The overall currency of the repository, that is, the proportion of articles that would have been obtained if the search of the reviews was conducted in COVID-19 L·OVE instead of searching the original sources, was 96.48% (2,057/2,132). Both the comprehensiveness and the currency were 100% for randomized trials (82/82). CONCLUSION: The COVID-19 L·OVE repository is highly comprehensive and current. Using this repository instead of traditional manual searches in multiple databases can save a great amount of work to people conducting systematic reviews and would improve the comprehensiveness and timeliness of evidence syntheses. This tool is particularly important for supporting living evidence synthesis processes.

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Autonomous navigation in mining tunnels is challenging due to the lack of satellite positioning signals and visible natural landmarks that could be exploited by ranging systems. Solutions requiring stable power feeds for locating beacons and transmitters are not accepted because of accidental damage risks and safety requirements. Hence, this work presents an autonomous navigation approach based on artificial passive landmarks, whose geometry has been optimized in order to ensure drift-free localization of mobile units typically equipped with lidar scanners. The main contribution of the approach lies in the design and optimization of the landmarks that, combined with scan matching techniques, provide a reliable pose estimation in modern smoothly bored mining tunnels. A genetic algorithm is employed to optimize the landmarks' geometry and positioning, thus preventing that the localization problem becomes ill-posed. The proposed approach is validated both in simulation and throughout a series of experiments with an industrial skid-steer CAT 262C robotic excavator, showing the feasibility of the approach with inexpensive passive and low-maintenance landmarks. The results show that the optimized triangular and symmetrical landmarks improve the positioning accuracy by 87.5% per 100 m traveled compared to the accuracy without landmarks. The role of optimized artificial landmarks in the context of modern smoothly bored mining tunnels should not be understated. The results confirm that without the optimized landmarks, the localization error accumulates due to odometry drift and that, contrary to the general intuition or belief, natural tunnel features alone are not sufficient for unambiguous localization. Therefore, the proposed approach ensures grid-based SLAM techniques can be implemented to successfully navigate in smoothly bored mining tunnels.

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Disease surveillance data are needed to monitor trends in disease activity, inform decision-making in public health and evaluate disease prevention/control measures. The Sistema Regional de Vacunas (SIREVA) supports laboratory-based surveillance of invasive pneumococcal disease (IPD) in Latin American countries, providing information on identification, distribution, and anti-microbial susceptibility of pneumococcal strains. We estimated the proportion of pneumococcal meningitis and sepsis/bacteremia cases captured by SIREVA, by comparing the number of SIREVA-reported isolates in Argentina, Brazil, Chile, Colombia, Ecuador and Mexico with the estimated expected number of cases based on regional estimates of disease incidence. In all six countries, the number of isolates reported by SIREVA was consistently lower than the number of cases expected, across all years with data available. The proportion of SIREVA-reported isolates was highest in Chile (43-83%) and lowest in Mexico (1.4-3.5%). Passive surveillance systems such as SIREVA are important tools for monitoring circulating strains that could be related to pneumococcal disease, but our results show that SIREVA is likely to underestimate pneumococcal disease incidence. This under-reporting will limit the precision of surveillance data in monitoring changes in the incidence of IPD after vaccine introduction, and this should be considered when assessing the impact of vaccination programs.

PLAIN LANGUAGE SUMMARYWhat is the context?Infectious disease surveillance is an important epidemiological tool to monitor the health of a population.Surveillence can be used to detect trends in disease activity and to trigger disease control measures.In Latin America, the SIREVA surveillance system monitors occurrence of bacterial pneumonia, sepsis/bacteremia and meningitis.However, passive surveillence systems may understimate disease occurrence.What is new?We compared the number of isolates of invasive pneumococcal disease (IPD), specifically meningitis and sepsis/bacteremia, in children aged <5 years reported in SIREVA data in six countries in Latin America with the expected number of cases based on regional estimates of IPD incidence.Our results show that the number of isolates reported by SIREVA was consistently lower than the estimated number of cases, across all six countries and all the years available.The percent difference between SIREVA-reported isolates and estimated number of cases was variable between countries, ranging from 43-83% in chile to 1.4-3.5% in Mexico.What is the impact?Passive surveillance systems such as SIREVA are important tools for monitoring disease incidence, but they are likely to underestimate pneumococcal disease occrruence.This under-reporting will limit the precision of surveillance data in monitoring changes in disease incidence after vaccine introduction, and this needs to be considered when assessing vaccine impact.

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The epidemiology and burden of Herpes Zoster (HZ) are largely unknown, and there are no recent reviews summarizing the available evidence from the Latin America and Caribbean (LAC) region. We conducted a systematic review and meta-analysis to characterize the epidemiology and burden of HZ in LAC. Bibliographic databases and grey literature sources were consulted to find studies published (January 2000 -February 2020) with epidemiological endpoints: cumulative incidence and incidence density (HZ cases per 100,000 person-years), prevalence, case-fatality rates, HZ mortality, hospitalization rates, and rates of each HZ complication. Twenty-six studies were included with most studies coming from Brazil. No studies reported the incidence of HZ in the general population. In population at higher risk, the cumulative incidence ranged from 318-3,423 cases of HZ per 100,000 persons per year of follow-up. The incidence density was 6.4-36.5 cases per 1,000 person-years. Age was identified as a major risk factor towards HZ incidence which increase significantly in people >50 years of age. Hospitalization rates ranged from 3%-35.7%. The in-hospital HZ mortality rate ranged from 0%-36%. Overall, HZ mortality rates were found to be higher in females across all age groups and countries. The incidence of HZ complications (such as post-herpetic neuralgia, ophthalmic herpes zoster, and Ramsay Hunt syndrome) was higher in the immunosuppressed compared to the immunocompetent population. Acyclovir was the most frequently used therapy. Epidemiological data from Ministry of Health databases (Argentina, Brazil, Colombia, Chile y Mexico) and Institute for Health Metrics and Evaluation's Global Burden of Disease project reported stable rates of hospitalizations and deaths over the last 10 years. High-risk groups for HZ impose a considerable burden in LAC. They could benefit from directed healthcare initiatives, including adult immunization, to prevent HZ occurrence and its complications.

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Background: Human respiratory physiology changes significantly in high altitude settings and these changes are particularly marked during sleep. It is estimated that 170 million people live above 2,500 m in environments where normal sleep parameters differ from those established at sea level or low altitude. Methods: We conducted a systematic review of publications reporting sleep studies in healthy children living at high altitude. For this purpose, data from PubMed, EMBASE, SciELO and Epistemomikos bases were retrieved up to August 2021. Results: Six articles met specified inclusion criteria; all reporting data were from South America involving 245 children (404 sleep studies) in children aged 0.6 months to 18 years, at altitudes between 2,560 to 3,775 m. The main results were: (1) Central apnea index decreased as the age increased. (2) The obstructive apnea/hypopnea index showed a bimodal profile with an increase in young infants up to age of 4 months, decreasing to 15 months of age, and then a second peak in children aged 4 to 9 years of age, dropping in older schoolchildren and adolescents. (3) Periodic breathing in the first months of life is more marked with increasing altitude and decreases with age. Conclusions: There are few studies of sleep physiology in children living at high altitude. The international parameters defining normal apnea indices currently used at low altitude cannot be applied to high altitude settings. The interpretation of sleep studies in children living at high altitude is complex because there are important developmental changes across childhood and a wide range of altitude locations. More normative data are required to determine thresholds for respiratory pathology at a variety of high altitude settings.

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Introduction: Evidence on the interchangeability between the two pediatric pneumococcal conjugate vaccines (PCVs) - pneumococcal non-typeable Haemophilus influenzae protein D-conjugate vaccine (PHiD-CV) and 13-valent PCV (PCV13) - is limited but growing. We performed a systematic literature review to summarize evidence for PHiD-CV/PCV13 interchangeability regarding immunogenicity, safety, and effectiveness against pneumococcal disease. Areas covered: Seven records disclosing results from six studies on PHiD-CV/PCV13 interchangeability were identified. Four clinical trials showed that mixed schedules with a PHiD-CV-to-PCV13 switch at boosting or a PCV13-to-PHiD-CV switch during priming or at boosting were immunogenic with no apparent safety concerns. Two observational studies in the context of a programmatic PHiD-CV-to-PCV13 switch showed similarly high effectiveness against overall invasive pneumococcal disease with a mixed PHiD-CV/PCV13 schedule and a PCV13-only schedule. No effectiveness data for a PCV13-to-PHiD-CV switch and no immunogenicity/safety/effectiveness data for a PHiD-CV-to-PCV13 switch during priming were found. Expert opinion: For epidemiological or programmatic reasons, several local/national authorities have switched PCVs in their immunization programs. Consequently, children have received mixed schedules. Although herd immunity may obscure the individual effect, the limited data are reassuring. Additional evidence from these settings - especially effectiveness or impact data - may provide the necessary information for authorities to make informed decisions on interchanging PCVs.

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