Micro-regional planning: evidence-based community buy-in for health development in five of Mexico’s poorest rural districts

<p>Abstract</p> <p>Background</p> <p>Community participation was a core tenet of Primary Health Care as articulated in the 1970s. How this could be generated and maintained was less clear. This historical article describes development of protocols for evidence-based community mobilisation in five local administrative units (<it>municipios</it>) in the Mexican state of Guerrero between 1992 and 1995.</p> <p>Methods</p> <p>A sample of five to eight sentinel sites represented each of the most impoverished municipalities of the poorest five of the state's seven regions. A 1992 baseline survey of diarrhoea and its actionable determinants provided the substrate for discussion with local planners and communities. Municipal planners used different strategies to promote participation. In one municipality, new health committees took control of water quality. In another, municipal authorities hired health promoters; a song promoted oral rehydration, and house-to-house interpersonal discussions promoted chlorination. In the poorest and most mountainous municipality, <it>radio casera</it> (home-made radio) soap operas used local "stars". In the largest and most disparate municipality, a child-to-family scheme relied on primary and secondary school teachers. The research team assessed outcomes at intervals and used the results to reinforce local planning and action.</p> <p>Results</p> <p>Diarrhoea rates declined in all five municipalities, and there were several positive intermediate outcomes from the communication strategies – changing knowledge, household practices and uptake of services. There was a strong link between specific contents of the communication package and the changing knowledge or practices.</p> <p>Conclusions</p> <p>Apart from these evidence-based interventions, other factors probably contributed to the decline of childhood diarrhoea. But, by monitoring implementation of planning decisions and the impact this has at community level, micro-regional planning can stimulate and reinforce actions likely to improve the health of communities. The process empowered municipalities to get access to more resources from the state government and international agencies.</p

Social Perception of the Residents of Olón, Montañita, and Valdivia as a Conditioning Factor in the Satisfaction of Tourists

This research aims to understand the social perception of the communities of Olón, Montañita, and Valdivia in the sociocultural, socio-territorial, and socio-cognitive dimensions, as a determining factor in the satisfaction of national and foreign tourists in terms of destination, service, and infrastructure. The design is nonexperimental, with a correlational scope and a mixed approach. Data collection techniques used were a semi-structured interview with 24 residents and a survey of 396 residents and 396 tourists. STATIS Dual and MPLS (multiway partial least squares) were the software used for the treatment of quantitative information. It was determined that the social perception in the three communes was relatively similar, the sociocultural dimension being the best scored for being linked to the tourist development of Olón and Montañita. Whereas a significant difference was observed between the communes in terms of tourist satisfaction, placing Montañita as the leader in all dimensions of the variable, followed by Olón and Valdivia. With an adjustment of 69%, the MPLS model was directly related to the variables, implying that any change in the perception of the residents affects the satisfaction of tourists. Keywords: tourist satisfaction, social perception, spondylus route. Resumen El objetivo de esta investigación es conocer la percepción social de las comunidades de Olón, Montañita y Valdivia en las dimensiones socio cultural, socio territorial y socio cognitivo, como condicionante en la satisfacción de los turistas nacionales y extranjeros en cuanto al destino, servicio e infraestructura. El diseño es no experimental, de alcance correlacional y enfoque mixto; como técnicas de recolección de datos se utilizaron: entrevista semi estructurada a 24 residentes y, encuesta a 396 residentes y 396 turistas. Para el tratamiento de la información cuantitativa se utilizaron software STATIS Dual y MPLS (Multiway partial least squares). Se determinó que la percepción social en las tres comunas es relativamente similar, siendo la dimensión socio cultural la mejor puntuada por encontrarse ligada al desarrollo turístico de Olón y Montañita; mientras que, existe diferencia significativa entre las comunas en cuanto a satisfacción de los turistas, colocando a Montañita como líder en todas las dimensiones de la variable, seguida de Olón y Valdivia. Con un ajuste de 69%, el modelo MPLS relacionó directamente las variables, implicando que cualquier cambio en la percepción de los residentes incide sobre la satisfacción de los turistas. Palabras Clave: satisfacción del turista, percepción social, ruta spondylus

Matter effects in neutrino visible decay at future long-baseline experiments

Neutrino visible decay in the presence of matter is re-evaluated. We study these effects in two future long-baseline experiments where matter effects are relevant: DUNE (1300 km) and a hypothetical beam aimed towards ANDES (7650 km). We find that matter effects are negligible for the visible component of neutrino decay at DUNE, being much more relevant at ANDES. We perform a detailed simulation of DUNE, considering $\nu_\mu$ disappearance and $\nu_e$ appearance channels, for both FHC and RHC modes. The sensitivity to the decay constant $\alpha_3$ can be as low as $2\times10^{-6}$ eV$^2$ at 90% C.L., depending on the neutrino masses and type of coupling. We also show the impact of neutrino decay in the determination of $\theta_{23}$ and $\delta_{\rm CP}$, and find that the best-fit value of $\theta_{23}$ can move from a true value at the lower octant towards the higher octant.Comment: 18 pages; v2: Minor changes, version accepted for publication in EPJ

Exploring population responses to environmental change when there is never enough data: a factor analytic approach

© 2018 The Authors. Methods in Ecology and Evolution published by John Wiley & Sons Ltd on behalf of British Ecological Society Temporal variability in the environment drives variation in vital rates, with consequences for population dynamics and life-history evolution. Integral projection models (IPMs) are data-driven structured population models widely used to study population dynamics and life-history evolution in temporally variable environments. However, many datasets have insufficient temporal replication for the environmental drivers of vital rates to be identified with confidence, limiting their use for evaluating population level responses to environmental change. Parameter selection, where the kernel is constructed at each time step by randomly selecting the time-varying parameters from their joint probability distribution, is one approach to including stochasticity in IPMs. We consider a factor analytic (FA) approach for modelling the covariance matrix of time-varying parameters, whereby latent variable(s) describe the covariance among vital rate parameters. This decreases the number of parameters to estimate and, where the covariance is positive, the latent variable can be interpreted as a measure of environmental quality. We demonstrate this using simulation studies and two case studies. The simulation studies suggest the FA approach provides similarly accurate estimates of stochastic population growth rate to estimating an unstructured covariance matrix. We demonstrate how the latent parameter can be perturbed to show how selection on reproductive delays in the monocarp Carduus nutans changes under different environmental conditions. We develop a demographic model of the fire dependent herb Eryngium cuneifolium to show how a putative driver of the variation in environmental quality can be incorporated with the addition of a single parameter. Using perturbation analyses we determine optimal management strategies for this species. This approach estimates fewer parameters than previous approaches and allows novel eco-evolutionary insights. Predictions on population dynamics and life-history evolution under different environmental conditions can be made without necessarily identifying causal factors. Putative environmental drivers can be incorporated with relatively few parameters, allowing for predictions on how populations will respond to changes in the environment

¿La distrofinopatía de Becker es una contraindicación para el trasplante cardiaco?: experiencia de un centro

Scientific lette

Central venous-catheter related bacteremia: incidence and risk factors in a hospital in western Mexico

AbstractBackgroundCentral venous catheters (CVC) are needed for monitoring and treatment of critically ill patients; however, their use increases the risk of bacteremia. The aim of the study was to quantify the incidence of central venous catheter-related bacteremia (CVCRB) and to identify factors associated with this infection.MethodsA prospective cohort study was conducted in a concentration hospital of western Mexico. The association of CVCRB and study variables was investigated using multivariate Cox regression analysis.ResultsTwo hundred and four patients with CVC were studied. The mean age was 4.6 years; 66.2% were male. Insertion sites of the catheters were subclavian vein 72.5% (n = 148), jugular vein 20.1% (n = 41) and femoral vein 7.4% (n = 15). CVCRB incidence was 6.5 events/1,000 catheter-days; microorganisms identified were gram-positive cocci 37.5% (n = 6), gram-negative bacilli 37.5% (n = 6) and Candida albicans 25% (n = 4). It was observed that the increase in catheter manipulations per day was associated with bacteremia (HR 1.14, 95% CI 1.06–1.23), whereas the use of intravenous antibiotics showed a protective effect (HR 0.84, 95% CI 0.76–0.92).ConclusionsIn addition to the strategies of maximum caution when placing or manipulating the catheter, we recommend decreasing, as much as possible, disconnects between the CVC and the infusion line. Antibiotics showed a protective effect, but the outcome is uncertain and the promotion of antimicrobial resistance should be considered

Reducing model bias in a deep learning classifier using domain adversarial neural networks in the MINERvA experiment

We present a simulation-based study using deep convolutional neural networks (DCNNs) to identify neutrino interaction vertices in the MINERvA passive targets region, and illustrate the application of domain adversarial neural networks (DANNs) in this context. DANNs are designed to be trained in one domain (simulated data) but tested in a second domain (physics data) and utilize unlabeled data from the second domain so that during training only features which are unable to discriminate between the domains are promoted. MINERvA is a neutrino-nucleus scattering experiment using the NuMI beamline at Fermilab. $A$-dependent cross sections are an important part of the physics program, and these measurements require vertex finding in complicated events. To illustrate the impact of the DANN we used a modified set of simulation in place of physics data during the training of the DANN and then used the label of the modified simulation during the evaluation of the DANN. We find that deep learning based methods offer significant advantages over our prior track-based reconstruction for the task of vertex finding, and that DANNs are able to improve the performance of deep networks by leveraging available unlabeled data and by mitigating network performance degradation rooted in biases in the physics models used for training.Comment: 41 page