System-level determinants of immunization coverage disparities among health districts in Burkina Faso: a multiple case study

<p>Abstract</p> <p>Background</p> <p>Despite rapid and tangible progress in vaccine coverage and in premature mortality rates registered in sub-Saharan Africa, inequities to access remain firmly entrenched, large pockets of low vaccination coverage persist, and coverage often varies considerably across regions, districts, and health facilities' areas of responsibility. This paper focuses on system-related factors that can explain disparities in immunization coverage among districts in Burkina Faso.</p> <p>Methods</p> <p>A multiple-case study was conducted of six districts representative of different immunization trends and overall performance. A participative process that involved local experts and key actors led to a focus on key factors that could possibly determine the efficiency and efficacy of district vaccination services: occurrence of disease outbreaks and immunization days, overall district management performance, resources available for vaccination services, and institutional elements. The methodology, geared toward reconstructing the evolution of vaccine services performance from 2000 to 2006, is based on data from documents and from individual and group interviews in each of the six health districts. The process of interpreting results brought together the field personnel and the research team.</p> <p>Results</p> <p>The districts that perform best are those that assemble a set of favourable conditions. However, the leadership of the district medical officer (DMO) appears to be the main conduit and the rallying point for these conditions. Typically, strong leadership that is recognized by the field teams ensures smooth operation of the vaccination services, promotes the emergence of new initiatives and offers some protection against risks related to outbreaks of epidemics or supplementary activities that can hinder routine functioning. The same is true for the ability of nurse managers and their teams to cope with new situations (epidemics, shortages of certain stocks).</p> <p>Conclusion</p> <p>The discourse on factors that determine the performance or breakdown of local health care systems in lower and middle income countries remains largely concentrated on technocratic and financial considerations, targeting institutional reforms, availability of resources, or accessibility of health services. The leadership role of those responsible for the district, and more broadly, of those we label "the human factor", in the performance of local health care systems is mentioned only marginally. This study shows that strong and committed leadership promotes an effective mobilization of teams and creates the conditions for good performance in districts, even when they have only limited access to supports provided by external partners.</p> <p>Abstract in French</p> <p>See the full article online for a translation of this abstract in French.</p

A comparison of oral omeprazole and intravenous cimetidine in reducing complications of duodenal peptic ulcer

BACKGROUND: Gastrointestinal bleeding is a common problem and its most common etiology is peptic ulcer disease. Ulcer rebleeding is considered a perilous complication for patients. To reduce the rate of rebleeding and to fasten the improvement of patients' general conditions, most emergency departments in Iran use H2-blockers before endoscopic procedures (i.e. intravenous omeprazole is not available in Iran). The aim of this study was to compare therapeutic effects of oral omeprazole and intravenous cimetidine on reducing rebleeding rates, duration of hospitalization, and the need for blood transfusion in duodenal ulcer patients. METHODS: In this clinical trial, 80 patients with upper gastrointestinal bleeding due to duodenal peptic ulcer and endoscopic evidence of rebleeding referring to emergency departments of Imam and Sina hospitals in Tabriz, Iran were randomly assigned to two equal groups; one was treated with intravenous cimetidine 800 mg per day and the other, with 40 mg oral omeprazole per day. RESULTS: No statistically significant difference was found between cimetidine and omeprazole groups in regards to sex, age, alcohol consumption, cigarette smoking, NSAID consumption, endoscopic evidence of rebleeding, mean hemoglobin and mean BUN levels on admission, duration of hospitalization and the mean time of rebleeding. However, the need for blood transfusion was much lower in omeprazole than in cimetidine group (mean: 1.68 versus 3.58 units, respectively; p < 0.003). Moreover, rebleeding rate was significantly lower in omeprazole group (15%) than in cimetidine group (50%) (p < 0.001). CONCLUSION: This study demonstrated that oral omeprazole significantly excels intravenous cimetidine in reducing the need for blood transfusion and lowering rebleeding rates in patients with upper gastrointestinal bleeding. Though not statistically significant (p = 0.074), shorter periods of hospitalization were found for omeprazole group which merits consideration for cost minimization

COMPARISON OF MECHANICAL AND ELECTRICAL PROPERTIES OF PIEZOELECTRIC COMPOSITES PZT/ZnO AND PZT/Al FABRICATED BY POWDER METALLURGY

Lead zirconate titanate (PZT) as a piezoelectric ceramic has been used widely in the fields of electronics, biomedical engineering, mechatronics and thermoelectric. Although, the electrical properties of PZT ceramics is a major considerable, but the mechanical properties such as fracture strength and toughness should be improved for many applications. In this study, lead monoxide, zirconium dioxide and titanium dioxide were used to synthesize PZT compound with chemical formula Pb(Zr 0.52 ,Ti 0.48 )O 3 by calcination heat treatment. Planetary mill with zirconia balls were used for homogenization of materials. Two-stage calcination was performed at temperatures of 600˚C and 850˚C for holding time of 2h. In order to improve the mechanical properties of PZT, various amount of ZnO and/or Al 2 O 3 particles were added to calcined materials and so PZT/ZnO, PZT/Al 2 O 3 and PZT/ZnO+Al 2 O 3 composites were fabricated. Composites samples were sintered at 1100˚C for 2 h in the normal atmosphere. Microstructural component and phase composition were analyzed by XRD and SEM. The density, fracture strength, toughness and hardness were measured by Archimedes method, three-point bending, direct measurement length crack and Vickers method, respectively. Dielectric and piezoelectric properties of the samples were also measured by LCR meter and d33metet tester, respectively. The results showed that by addition of ZnO and Al 2 O 3 to composite materials, the relative density of PZT based composites was increased in conjunction with a signification improvement of mechanical properties such as flexural strength, toughness and hardness. Moreover, the dielectric and piezoelectric properties of PZT such as dielectric constant, piezoelectric coefficient and coupling factor were decreased while the loss tangent was also increased

On the Optimal Design of Convolutional Neural Networks for Earth Observation Data Analysis by Maximization of Information Extraction

Although deep learning architectures are nowadays used in several research fields where automatized investigation of large scale datasets is required, the intrinsic mechanisms of deep learning networks are not fully understood yet. In this paper, a new approach for characterizing how information is processed within convolutional neural networks (CNNs) is introduced. Taking advantage of an analysis based on information theory, we are able to derive an index that is associated with the degree of maximum information extraction a CNN can obtain under ideal circumstances as a function of its hyperparameters setup and of the data to be explored. Experimental results on remote sensing datasets show the robustness of our approach. The outcomes of our analysis can be used to optimize the design of CNNs and maximize the information that can be obtained for the considered problem