Operability, acceptability, and usefulness of a mobile app to track routine immunization performance in rural Pakistan: Interview study among vaccinators and key informants

Background: There has been a recent spate of mobile health (mHealth) app use for immunizations and other public health concerns in low- and middle-income countries. However, recent evidence has largely focused on app development or before-and-after effects on awareness or service coverage. There is little evidence on the factors that facilitate adoption of mHealth programs, which is critical to effectively embed digital technology into mainstream health systems. Objective: This study aimed to provide the qualitative experiences of frontline health staff and district managers while engaging with real-time digital technology to improve the coverage of routine childhood immunization in an underserved rural district in Pakistan. Methods: An Android-based app was iteratively developed and used for a 2-year period in 11 union councils of the Tando Muhammad Khan district, an underserved rural district with poor immunization coverage in Pakistan. We used iterative methods to examine the (1) acceptability and operability of the app, (2) validity of the collected data, and (3) use of the collected data. In addition, we collected the barriers and enablers for uptake of the mHealth app. Each of these topics was further explored related to changes in work as well as the enabling factors for and barriers to app use. In-depth interviews were conducted with the 26 vaccinators posted in the 11 union councils and 7 purposively selected key informants (government district managers) involved with the Expanded Program for Immunization. Findings were triangulated in line with the three broad research areas. Results: Digital immunization tracking was considered acceptable by vaccinators and district managers. Real-time immunization data were used to monitor vaccination volume, track children with incomplete vaccinations, develop outreach visit plans, correct existing microplans, and disburse a fuel allowance for outreach sessions. The validity of the app data was perceived to be superior to that of data from manual records. Ease of operability, satisfaction with data, personal recognition, links to field support, and a sense of empowerment served as powerful enablers. Taking twice the time to complete both manual and digital entries and outdated phones over time were considered constraints. An unintended knock-on effect was improved coordination and strengthening of Expanded Program for Immunization review platforms across district stakeholders through digitalized data. Conclusions: Embedding digital technology into mainstream health systems relies on use by both end users and district stakeholders. Ease of operability, satisfaction with data reliability, personal recognition, links to field support, and empowerment are powerful enablers, whereas improved coordination as a result of easy, transparent data access can be an important by-product of digitalization. Findings are relevant not only for wide-scale implementation of immunization tracking apps in Pakistan but also for informing the use of digital technology for results-based delivery by frontline health workers

Enhanced mechanical and corrosion protection properties of pulse electrodeposited NiP-ZrO2 nanocomposite coatings

Pulse electrodeposition is a technique of particular interest, which offers promising advantages such as ease of processing, compositional control, uniformity in structure, and grain refinement. In the present study, NiP-ZrO2 nanocomposite coatings containing various concentrations of ZrO2 nanoparticles (ZONPs) were deposited on low alloy steel (30CrMnSi) through pulse electrodeposition technique. The ZONPs in concentration of 0.0, 0.25, 0.50, 0.75, and 1.0 g/L were added in the electrolyte bath to obtain NiP-ZrO2 nanocomposite coatings. Furthermore, to elucidate the role of ZONPs in the NiP matrix, the structural, morphological, mechanical, and electrochemical properties of NiP-ZrO2 nanocomposite coatings were studied thoroughly. FESEM and EDX results reveal the successful incorporation of ZONPs into the NiP matrix. XRD and XPS analysis confirm the formation of a pure phase NiP structure without any noticeable defects. A considerable improvement in the mechanical response was observed with an increasing amount of ZONPs, reaching to highest values (hardness 6.7 GPa, modulus of elasticity 21.72 GPa) for NiP-1.0 ZrO2 coating composition. Similarly, the electrochemical results show a gradual increase in corrosion protection behavior of the NiP-ZrO2 coatings with increasing ZONP concentration, reaching an eventual value ~5.8 kΩ cm−2 at NiP-1.0 ZrO2 coating composition, which is six times greater than the pure NiP coatings. These improvements in the mechanical and electrochemical response of NiP-ZrO2 nanocomposite coatings highlight their suitability for applications such as oil and gas pipelines

Comparison of the antiplatelet and antithrombotic effects of bivalirudin versus unfractionated heparin: A platelet substudy of the HEAT PPCI trial

In randomised trials, bivalirudin has been associated with higher rates of acute stent thrombosis (AST) compared to unfractionated heparin (UFH), without mechanistic explanation. Furthermore, data are discrepant regards the antiplatelet effects of bivalirudin. This prespecified study, part of a larger HEAT-PPCI Platelet Substudy, aimed to compare the antiplatelet and antithrombotic effects of bivalirudin and UFH using short thrombelastography (s-TEG), an ex vivo whole blood platelet function assay. In HEAT-PPCI, patients were randomised to receive UFH or bivalirudin before angiography. Assay with s-TEG was performed in 184 patients (10.2%) at end of procedure (EOP) and repeated at 24 h. In addition to adenosine diphosphate- (ADP) and arachidonic acid- (AA) mediated platelet aggregation, thrombin-mediated clotting (TMC) was assessed using kaolin with and without heparinase. There were no significant differences between UFH and bivalirudin in ADP- and AA-mediated platelet aggregation at EOP or 24 h. Whilst UFH obliterated TMC at EOP, bivalirudin prolonged R time (19.7 min [15.9-25.4] vs. 8.4 min [7.5-10]; P &lt; 0.0001), K time (2.4 min [1.9-3.4] vs. 2.2 min [1.8-2.7]; P = 0.007) and significantly increased maximum clot strength (MA 62.7 mm [58.7-67.4] vs. 58.6 [55-63]; P = 0.0005), compared to control. In conclusion, there were no significant differences in the antiplatelet effects of UFH and bivalirudin. However, whilst UFH obliterated TMC, bivalirudin prolonged clot initiation but potentiated maximum clot strength. As AST is likely multifactorial in aetiology, in patients treated with bivalirudin, increased clot strength may contribute to this hazard in some individuals and this observation warrants further investigation.</p

Electrochemical and thermodynamic study on the corrosion performance of API X120 steel in 3.5% NaCl solution

The present work studied the effect of temperature on the corrosion behavior of API X120 steel in a saline solution saturated with CO2 in absence and presence of polyethyleneimine (PEI) as an environmentally safe green inhibitor. The effect of PEI on the corrosion behavior of API X120 steel was investigated using destructive and non-destructive electrochemical techniques. The overall results revealed that PEI significantly decreases the corrosion rate of API X120 steel with inhibition efficiency of 94% at a concentration of 100 μmol L−1. The adsorption isotherm, activation energy and the thermodynamic parameters were deduced from the electrochemical results. It is revealed that the adsorption of PEI on API X120 steel surface follows Langmuir adsorption isotherm adopting a Physi-chemisorption mechanism. Finally, the samples were characterized using scanning electron microscopy (SEM) and atomic force microscopy (AFM) techniques to elucidate the effect of aggressiveness of corrosive media on the surface morphology and the corrosion performance of API X120 steel. The surface topography result indicates that the API X120 steel interface in PEI presence is smoother than CO2 with Cl− ions or Cl− ions only. This is attributed to the compact protective film limits the aggressive ions transfer towards the metallic surface and reduces the corrosion rate. Moreover, PEI inhibition mechanism is based on its CO2 capturing ability and the PEI adsorption on the steel surface beside the siderite layer which give the PEI molecules the ability to reduce the scale formation and increase the corrosion protection due to capturing the CO2 from the brine solution

Privacy-aware relationship semantics–based XACML access control model for electronic health records in hybrid cloud

State-of-the-art progress in cloud computing encouraged the healthcare organizations to outsource the management of electronic health records to cloud service providers using hybrid cloud. A hybrid cloud is an infrastructure consisting of a private cloud (managed by the organization) and a public cloud (managed by the cloud service provider). The use of hybrid cloud enables electronic health records to be exchanged between medical institutions and supports multipurpose usage of electronic health records. Along with the benefits, cloud-based electronic health records also raise the problems of security and privacy specifically in terms of electronic health records access. A comprehensive and exploratory analysis of privacy-preserving solutions revealed that most current systems do not support fine-grained access control or consider additional factors such as privacy preservation and relationship semantics. In this article, we investigated the need of a privacy-aware fine-grained access control model for the hybrid cloud. We propose a privacy-aware relationship semantics–based XACML access control model that performs hybrid relationship and attribute-based access control using extensible access control markup language. The proposed approach supports fine-grained relation-based access control with state-of-the-art privacy mechanism named Anatomy for enhanced multipurpose electronic health records usage. The proposed (privacy-aware relationship semantics–based XACML access control model) model provides and maintains an efficient privacy versus utility trade-off. We formally verify the proposed model (privacy-aware relationship semantics–based XACML access control model) and implemented to check its effectiveness in terms of privacy-aware electronic health records access and multipurpose utilization. Experimental results show that in the proposed (privacy-aware relationship semantics–based XACML access control model) model, access policies based on relationships and electronic health records anonymization can perform well in terms of access policy response time and space storage

Improved Generalization for Secure Data Publishing

In data publishing, privacy and utility are essential for data owners and users respectively, which cannot coexist well. This incompatibility puts the data privacy researchers under an obligation to find newer and reliable privacy preserving tradeoff-techniques. Data providers like many public and private organizations (e.g. hospitals and banks) publish microdata of individuals for various research purposes. Publishing microdata may compromise the privacy of individuals. To prevent the privacy of individuals, data must be published after removing personal identifiers like name and social security numbers. Removal of the personal identifiers appears as not enough to protect the privacy of individuals. K-anonymity model is used to publish microdata by preserving the individual's privacy through generalization. There exist many state-of-the-arts generalization-based techniques, which deal with pre-defined attacks like background knowledge attack, similarity attack, probability attack and so on. However, existing generalization-based techniques compromise the data utility while ensuring privacy. It is an open question to find an efficient technique that is able to set a trade-off between privacy and utility. In this paper, we discussed existing generalization hierarchies and their limitations in detail. We have also proposed three new generalization techniques including conventional generalization hierarchies, divisors based generalization hierarchies and cardinality-based generalization hierarchies. Extensive experiments on the real-world dataset acknowledge that our technique outperforms among the existing techniques in terms of better utility