Exploring Pathways for Building Trust in Vaccination and Strengthening Health System Resilience

Background: Trust is critical to generate and maintain demand for vaccines in low and middle income countries. However, there is little documentation on how health system insufficiencies affect trust in vaccination and the process of re-building trust once it has been compromised. We reflect on how disruptions to immunizations systems can affect trust in vaccination and can compromise vaccine utilization. We then explore key pathways for overcoming system vulnerabilities in order to restore trust, to strengthen the resilience of health systems and communities, and to promote vaccine utilization. Methods: Utilizing secondary data and a review of the literature, we developed a causal loop diagram (CLD) to map the determinants of building trust in immunizations. Using the CLD, we devised three scenarios to illustrate common vulnerabilities that compromise trust and pathways to strengthen trust and utilization of vaccines, specifically looking at weak health systems, harmful communication channels, and role of social capital. Spill-over effects, interactions and other dynamics in the CLD were then examined to assess leverage points to counter these vulnerabilities. Results: Trust in vaccination arises from the interactions among experiences with the health system, the various forms of communication and social capital – both external and internal to communities. When experiencing system-wide shocks such as the case in Ebola-affected countries, distrust is reinforced by feedback between the health and immunization systems where distrust often lingers even after systems are restored and spills over beyond vaccination in the broader health system. Vaccine myths or anti-vaccine movements reinforce distrust. Social capital – the collective value of social networks of community members – plays a central role in increasing levels of trust. Conclusions: Trust is important, yet underexplored, in the context of vaccine utilization. Using a CLD to illustrate various scenarios helped to explore how common health and vaccine vulnerabilities can reinforce and spill over distrust through vicious, reinforcing feedback. Restoring trust requires a careful balance between eliminating vulnerabilities and strengthening social capital and interactions among communication channels

Detailed Anatomical and Electrophysiological Models of Human Atria and Torso for the Simulation of Atrial Activation

Atrial arrhythmias, and specifically atrial fibrillation (AF), induce rapid and irregular activation patterns that appear on the torso surface as abnormal P-waves in electrocardiograms and body surface potential maps (BSPM). In recent years both P-waves and the BSPM have been used to identify the mechanisms underlying AF, such as localizing ectopic foci or high-frequency rotors. However, the relationship between the activation of the different areas of the atria and the characteristics of the BSPM and P-wave signals are still far from being completely understood. In this work we developed a multi-scale framework, which combines a highly-detailed 3D atrial model and a torso model to study the relationship between atrial activation and surface signals in sinus rhythm. Using this multi scale model, it was revealed that the best places for recording P-waves are the frontal upper right and the frontal and rear left quadrants of the torso. Our results also suggest that only nine regions (of the twenty-one structures in which the atrial surface was divided) make a significant contribution to the BSPM and determine the main P-wave characteristics.This work was partially supported by the "VI Plan Nacional de Investigacion Cientifica, Desarrollo e Innovacion Tecnologica" from the Ministerio de Economia y Competitividad of Spain and the European Commission (European Regional Development Funds - ERDF - FEDER), Award Number: TIN2012-37546-C03-01 (Recipient: Ana Ferrer); the "Programa Estatal de Investigacion, Desarrollo e Innovacion Orientado a los Retos de la Sociedad" from the Ministerio de Economia y Competitividad and the European Commission (European Regional Development Funds - ERDF - FEDER), Award Number: TIN2014-59932-JIN (Recipient: Rafael Sebastion); and the "Programa Prometeo" from the Generalitat Valenciana, Award Number: 2012/030 (Recipient: Laura Martinez).Ferrer Albero, A.; Sebastián Aguilar, R.; Sánchez Quintana, D.; Rodriguez, JF.; Godoy, EJ.; Martinez, L.; Saiz Rodríguez, FJ. (2015). Detailed Anatomical and Electrophysiological Models of Human Atria and Torso for the Simulation of Atrial Activation. PLoS ONE. 10(11):1-29. https://doi.org/10.1371/journal.pone.0141573S129101

Application of ordinary kriging to reconstruct and visualise the relief in the location of an open pit sand mine

W niniejszym artykule zaprezentowano jeden ze sposobów odtwarzania rzeźby (sprzed rozpoczęcia eksploatacji piasku na cele podsadzkowe) czterech pól piaskowych dawnego wyrobiska „Siemonia”. Morfologia analizowanego terenu została zwizualizowana w oparciu o archiwalną mapę geologiczną (arkusz Wojkowice) z zastosowaniem metod geostatystycznych, w tym m.in. krigingu zwyczajnego. Jest to jedna ze znanych technik estymacji (szacowania), nazywana B.L.U.E. (best linear unbiased estimator). Zgodność dopasowania matematycznych modeli sferycznych do wariogramu empirycznego potwierdzono w procedurze kross-walidacji. Uzyskane wartości błędów (błąd średni, błąd średni kwadratowy oraz błąd średni kwadratowy standaryzowany) są w znacznym stopniu zgodne z notowanymi w literaturze naukowej. Wygenerowana rzeźba badanego terenu pod postacią modelu trójwymiarowgo w wyniku przeprowadzonej pełnej analizy geostatystycznej jest dość mocno uwydatniona w porównaniu do modelu otrzymanego bez zastosowania analizy strukturalnej i kross-walidacji.Extraction of mineral resources, including rocks, usually causes some significant changes of the landscape. Transformation of the relief which character and scale can be analysed by means of cartographic materials seems to be the most interesting. Reconstruction of the relief of the period prior to the exploitation is a starting point for such investigation. It can be done basing on archival cartographic materials which are difficult to obtain. However, too varied morphological material of the area can lead to erroneous conclusions which suggests interpretation of three-dimensional models of the relief. Hence, the paper deals with reconstruction and visualisation of the relief (in the period before the exploitation) of four sand fields of the old sand mine excavation “Siemonia”. A geological map of Poland (Wojkowice sheet) has been used for the purpose. A geostatical analysis by means of the programmes Surfer 8. and ArcGIS 10.1. has been performed on the map. An estimation method called ordinary kriging, which is related to B.L.U.E. (best linear unbiased estimator), where the condition of the lack of weight of the measurement (the sum of weight is equal to 1) is fulfilled, has been applied. The calculated values of errors (mean error, mean squared error and mean squared standardised error) obtained as a result of application of the cross-validation procedure are, to a large extent, in agreement with predetermined values of errors given by numerous authors in the scientific literature. It confirms proper “manual” adjustment of two mathematical models of spherical variograms and empirical variograms. The generated contour map of the investigated area (based on estimated points of sampling in nodes of the interpolation grid) together with its three-dimensional digital model are more adequate (due to significant marking of the relief) to the previous state of the investigated area than the two other presented types of cartographic visualisations made without application of the geostatistical methods. Hence, the graphic presentation of results, mentioned as the last one, can be only applied to visualise the relief without any detailed geomorphological interpretations due to its inaccuracy. It seems to be obvious that detailed analyses can be performed basing on a digital model of the terrain accompanied by its contour map obtained when reconstruction of the relief is made by means of geostatistical methods (especially ordinary kriging)

Theory of fuzzy sets in edge location of the posterior cruciate ligament region

An approach to location of a region including the posterior and anterior cruciate ligament in the MR knee images has been developed. The proposed method of the PCL location in T1-weighted MR knee images is based on entropy (or energy) measure of fuzziness and fuzzy C-means (FCM) algorithm. Then, edges of a region of interest containing the ligament are found. The procedure has been tested on clinical T1- and T2- weighted MR knee images resulting in a 3D visualisation

It doesn't matter what they say, it matters how they behave: Parental influences and changes in body mass among overweight and obese adolescents

© 2015 Elsevier Ltd. Objective: This study investigated whether the relationships between perceived parental behaviors (dietary behaviors, physical activity, and verbal pressure) and changes in adolescents' body mass index (BMI) were mediated by adolescents' physical activity and dietary behaviors. The associations were tested among overweight and obese adolescents. Design: Longitudinal data were collected three times, with a 2-month interval between Time 1 (T1) and Time 2 (T2), and a 13-month interval between T2 and Time 3 (T3) in the group of adolescents (. N = 100) aged 13-19. There was no experimental manipulation. Mediation analyses with two sequential mediators were conducted. Main measures: Participants completed the questionnaires assessing their dietary behaviors, physical activity (mediators), perceived parental behaviors, and verbal pressure (independent variables). Adolescents' weight and height were measured objectively (with BMI constituting the outcome variable). Results: Adolescents who perceived that their parents engaged in a healthy diet and frequent physical activity (T1) self-reported a healthier diet (T2 and T3), higher levels of physical activity (T2 and T3), and their combined index of healthy lifestyle was higher (T2 and T3). In turn, adolescents' behaviors (T2 and T3) were related to lower BMI (T3). Perceived behaviors of parents had a significant, indirect effect on a BMI reduction. There were no effects of the perceived parental verbal pressure (T1) through adolescents' behaviors (T2) on adolescents' BMI (T3). Conclusion: Perceived parental modeling of healthy diet and frequent physical activity, but not verbal pressure, predicted adolescents' behaviors (diet, physical activity, and a combined lifestyle index) and, in turn, a reduction in their BMI. The role of parents' health behaviors (diet and physical activity) should be taken into account when considering adolescents' overweight and obesity prevention and treatment programs

Optimization of the closed-loop controller of a discontinuous capsule drive using a neural network

In this paper the construction of a neural-network based closed-loop control of a discontinuous capsule drive is analyzed. The foundation of the designed controller is an optimized open-loop control function. A neural network is used to determine the dependence between the output of the open-loop controller and the state of the system. Robustness of the neural controller with respect to variation of parameters of the controlled system is analyzed and compared with the original optimized open-loop control. It is expected that the presented method can facilitate the construction of closed-loop controllers for which alternative methods are not effective, such as non-smooth or discontinuous ones

Performance of chromium nitride and titanium nitride coatings during plastic injection moulding

Monolithic coatings of chromium nitride, titanium nitride and multilayer titaniumychromium nitride coatings were produced by r.f. and d.c. reactive magnetron sputtering in order to determine their potential to be used as protective coatings for machinery parts of plastic injection moulding or extruding machines. The tribological and mechanical behaviour of these coatings were studied. Monolithic coatings showed lower wear rates, measured by pin-on-disc experiments, when compared with multilayer coatings. The oxidation of the surface was also lower in monolithic coatings. The performance of the coatings during plastic processing was tested in a dye fitted to an injection moulding machine and using glass reinforced thermoplastic. The wear rates of the nitride-based coatings during plastic processing was more than two orders of magnitude better then some traditional methods of protecting the surfaces such as hardening the steel by heat treatment, electrodepositing hard chromium or nitriding the steel surface. The physical vapour deposition coatings also showed higher corrosion protection during plastic processing tests