Adequate Time Frame Research Articles

Deep Learning-Enhanced Hand Grip and Release Test for Degenerative Cervical Myelopathy: Shortening Assessment Duration to 6 Seconds.

Hand clumsiness and reduced hand dexterity can signal early signs of degenerative cervical myelopathy (DCM). While the 10-second grip and release (10-s G&R) test is a common clinical tool for evaluating hand function, a more accessible method is warranted. This study explores the use of deep learning-enhanced hand grip and release test (DL-HGRT) for predicting DCM and evaluates its capability to reduce the duration of the 10-s G&R test. The retrospective study included 508 DCM patients and 1,194 control subjects. Propensity score matching (PSM) was utilized to minimize the confounding effects related to age and sex. Videos of the 10-s G&R test were captured using a smartphone application. The 3D-MobileNetV2 was utilized for analysis, generating a series of parameters. Additionally, receiver operating characteristic curves were employed to assess the performance of the 10-s G&R test in predicting DCM and to evaluate the effectiveness of a shortened testing duration. Patients with DCM exhibited impairments in most 10-s G&R test parameters. Before PSM, the number of cycles achieved the best diagnostic performance (area under the curve [AUC], 0.85; sensitivity, 80.12%; specificity, 74.29% at 20 cycles), followed by average grip time. Following PSM for age and gender, the AUC remained above 0.80. The average grip time achieved the highest AUC of 0.83 after 6 seconds, plateauing with no significant improvement in extending the duration to 10 seconds, indicating that 6 seconds is an adequate timeframe to efficiently evaluate hand motor dysfunction in DCM based on DL-HGRT. DL-HGRT demonstrates potential as a promising supplementary tool for predicting DCM. Notably, a testing duration of 6 seconds appears to be sufficient for accurate assessment, enhancing the test more feasible and practical without compromising diagnostic performance.

Reducing Time to Postintubation Sedation in a Pediatric Emergency Department.

Inadequate postintubation sedation (PIS) can lead to unplanned extubations, conscious paralysis, and overall unsafe care of patients. From 2018 to 2020, we realized at our hospital that ∼25% of children received sedation in an adequate time frame in the pediatric emergency department, with 2 unplanned dislodgements of the endotracheal tube. Our objective was to reduce time to initiating PIS from a mean of 39 minutes to less than 15 minutes in our pediatric emergency department by September 2021. A multidisciplinary team was formed in March 2020 to develop a key driver diagram and a protocol to standardize PIS. Baseline data were obtained from December 2017 through March 2020. The primary measure was time from intubation to administration of first sedation medication. Plan-do-study-act cycles informed interventions for protocol development, awareness, education, order set development, and PIS checklist. The secondary measure was unplanned extubations and the balancing measure was PIS-related hypotension requiring pressors. An X-bar and S chart were used to analyze data. Protocol implementation was associated with decrease in mean time to PIS from 39 minutes to 21 minutes. Following educational interventions, order set implementation, and the addition of PIS plan to the intubation checklist, there was a decrease in mean time to PIS to 13 minutes, which was sustained for 9 months without any observed episodes of PIS-related hypotension or unplanned extubations. Quality improvement methodology led to a sustained reduction in time to initiation of PIS in a pediatric emergency department.

OP93 The Cost Effectiveness Of Antiretroviral Therapy Adherence Interventions In HIV/AIDS Patients: A Systematic Review Of Decision Analytic Models

IntroductionPeople living with HIV/AIDS (PLWHA) frequently struggle to maintain optimal adherence to antiretrovirals (ARVs). Different adherence-improving interventions have been developed and examined through decision analytic model-based health technology assessments. Therefore, we aimed to conduct a systematic review of all decision analytic models developed to improve adherence in PLWHA.MethodsThe review protocol was registered on Prospero (CRD42022270039) and relevant studies published from inception to 23 October 2022 were identified through searches of the following databases: PubMed, Embase, the National Health Service Economic Evaluation Database, PsycINFO, the Health Economic Evaluations Database, and EconLit. Studies were included if they were modeling works of full economic evaluations, including cost-effectiveness analyses (CEA), cost-utility analyses, cost-benefit analyses, and cost-consequence analyses. The primary outcome was the cost effectiveness of adherence interventions reported as the incremental cost per additional quality-adjusted life-year (QALY). Study quality was assessed with the Quality of Health Economics Studies instrument. Due to the heterogeneity of the data, a permutation matrix was used for quantitative data synthesis rather than a meta-analysis.ResultsThe 15 studies identified were conducted in North America (8/15), Africa (4/15), and Europe (3/15). The time horizon was one year in one study, ten years in one study, 20 years in three studies, and a lifetime horizon in ten studies. The types of interventions were smartphone-based (5/15), nurse involved (2/15), directly observed therapy (2/15), case manager involved (1/15), simplification of regimens (1/15), Link4Health (1/15), and others (3/15) that involved multicomponent intervention. The interventions gained higher QALYs with cost savings in all 15 studies and gained QALYs at a higher cost at an acceptable incremental cost-effectiveness ratio in 80 percent (12/15) of studies. The studies were of fair (13%) to high quality (87%).ConclusionsThis study is the first systematic review of decision analytic model-based CEAs of adherence interventions in the management of PLWHA. Most of the identified studies recently published good quality cost-effectiveness analyses with an adequate timeframe.

Effectiveness of Legal Framework on the Prevalence of Malpractices in Public Procurement of LGAs: A Case of Kasulu District Council, Kigoma Tanzania

Purpose: To ensure accountability, LGAs should have effective and speedy procurement procedures. The rules and regulations in LGAs make it easier for malpractice to happen in public procurement. The effectiveness of legal frameworks on preventing malpractices in public procurement by LGAs is the focus of this paper. Procurement and tendering decisions in organizations are based on Strategic Choice Theory, as discovered in the study.
 Methodology: Data were collected from employees of the Kasulu district council and suppliers located in Kasulu district. Data were collected from 112 responses to questionnaires and 12 Key Informants Interviewers responded to in-depth interviews. Simple random sampling techniques and purposive sampling techniques were used to select the sample. Data were analyzed using Statistical Package for Social Science (SPSS) Version 27; where Multiple Linear Regression analysis and descriptive analysis were conducted to answer the research objectives triangularly with context analysis of the qualitative data.
 Findings: The study found that application and coverage of Legal and regulatory framework (ACLRF); publishing and advertising rules, and adequate timeframe (PARAT); as well as participatory rules and regulations (PRR) have a significant negative impact on MPP. However, defining procurement methods and circumstances appropriate (DPMCA) had no significant relationship with MPP. The legal and regulatory framework affects malpractices in public procurement in the LGA. It was further found that the more additional units the LGA invests in the effectiveness of the legal framework, the more the prevalence of malpractices in public procurement will be prevented.
 Unique Contribution to the Theory, Practice and Policy: The study recommends to the LGAs that tendering procedures must be observed and that PPRA policy correspond with organizational goals. The study highlights the importance of maintaining a legal procurement structure in LGA without political interference. Furthermore, the study emphasizes the need to promote legal structure in procurement practice in LGA without any interference from political leaders.

Utilizing Advanced Bipolar Membranes in Next Generation Electrodialysis Systems

Bipolar membrane electrodialysis (BPMED) is an essential process used in various industrial applications, such as water purification and acid/base production. Additionally, advanced BPMED systems are an integral component of larger CO2 sequestration technologies, allowing for ease of pH control within these systems. Improving these systems is vital to mitigating the global effects of climate change. To develop a viable advanced BPMED scheme, it is necessary to acquire bipolar membranes (BPMs) that operate at minimal voltage loss, high current density, and exhibit little ion crossover, while maintaining high performance over an industrially adequate timeframe. Researchers, such as Oener et al., have advanced BPM designs with the introduction of metal oxide catalysts to the interface of the cation- and anion-exchange layers of the BPM. These advanced BPM have shown a significant reduction in the energetic requirements of water dissociation. Applying these findings to BPMED has the potential to significantly improve the efficiency of BPMED systems, however, the BPM electrolyzer used for the development of these BPM are not directly analogous to an electrodialysis system. Thus, I present here a custom-built BPMED system that allows for the assessment of the specific voltage contributions of each component within the overall BPMED system. Using this tool, we aim to identify and address the performance and durability limitations of advanced BPM in BPMED by monitoring signs of degradation, such as blistering and delamination, and by monitoring changes in the potential drop across the BPM as conditions within the BPMED system are manipulated. This will lead to enhanced efficiencies and increased durability in BPMED applications, allowing for its integration into emerging CO2 sequestration systems, as well as other stacked membrane systems.

The Essential Role of Thyroid Scintigraphy and High Resolution Ultrasound for The Etiological Diagnosis of Congenital Hypothyroidism

Congenital hypothyroidism (CH) is the most common congenital endocrine disorder and is a common, preventable cause of mental retardation and growth failure if thyroid hormone replacement is ensured at the proper time and dose. It is well documented that without L-thyroxine replacement from early life, CH causes irreversible neuro-developmental impairment. The three main causes of congenital hypothyroidism are: a) dysembryogenesis, i.e., thyroid dysgenesis, b) dyshormonogenesis and c) transient hypothyroidism. Thyroid dysgenesis includes agenesis and/or the complete absence of the thyroid gland.The diagnosis of CH through new born screening (NBS) program in Bangladesh has greatly contributed to the start of treatment within an adequate time frame since 1999 but the etiological diagnosis is usually delayed until the age of 3 years. This reported case of a 13 years old teenage girl emphasized the importance to find the etiology of her CH diagnosed on day 10 after her birth. The importance of assessing biochemical status of thyroid along with high resolution neck ultrasound (HRUS) and 99mTc-thyroid scintigraphy could change the entire scenario and ensure proper treatment of CH in a place far away from the capital city. Bangladesh J. Nuclear Med. 25(2): 138-142, 2022

Online Learning As a Tool for the Education System in the Context of Digitalisation

Online learning has tended to increase its use in the education system since the beginning of the pandemic. The article aims to empirically investigate the effectiveness of online learning as a tool for the education system in the context of digitalization. The study is based on the use of a structured interview technique and an analysis of the results of a survey of Ukrainian university students. To ensure organization and self-discipline, comprehension, learning, and assimilation of learning material, it is important to ensure a sufficient level of interactivity and teacher-student interaction, feedback, and guidance to students in an adequate time frame. A well-functioning feedback system is a supportive and essential element for student learning. Classical deadlines set by the teacher for assignments are also a valid method in online learning. Students noted the importance of creativity in the teacher's presentation of the task and the importance of the limitations of the methods by which the task can be solved. Timely revision, and evaluation by the teacher of the work, the task also encourage students to put a higher level of effort into their online learning. Online synchronous seminars in ZOOM are more impactful and motivating than recorded video lectures, and presentations which are available to students in asynchronous mode. An essential method of online learning was noted by the students to complete individual written assignments on the studied topic immediately after its presentation. The teacher's explanations and live synchronous conversation were also effective in online learning. Continuous, systematic educator monitoring of the progress and attendance at the online classes encouraged students to attend lectures but was not a major method for ensuring synchronous attendance.

Ultrasonographic stabilization of hydronephrosis after pyeloplasty: Key determinant of postoperative follow-up?

Although more than 1500 pediatric pyeloplasties are performed in the United States per year, there is a lack of consensus on the adequate imaging modality and timing of follow-up after surgery. The aim of this study is to evaluate if ultrasonographic stabilization in the grade of hydronephrosis after pyeloplasty is an adequate parameter to define the optimal length of follow-up after surgery and to detect failed procedures. Secondarily, we want to analyze clinical variables that could impact ultrasonographic stabilization. This is a retrospective chart review of patients who underwent pyeloplasty between 2012 and 2020. Patients were included if they were ≤21 years-old at the time of surgery, had pre and postoperative renal-ultrasounds, had ≥3 months of postoperative follow-up, and had met the criteria for ultrasonographic stabilization after surgery. Ultrasonographic stabilization was defined as 2 consecutive ultrasounds after pyeloplasty, a minimum of 1-month apart, with the same degree of hydronephrosis according to the Society for Fetal Urology (SFU) grading system. Data concerning clinical, surgical, and postoperative variables were collected. A total of 143 pyeloplasties met the inclusion criteria. Median age at surgery was 10.5 months with a median post-operative follow-up time of 29 months. Ultrasonographic stabilization was achieved in a mean time of 14.5 months post-operatively. Compared to the preoperative US SFU grade, at ultrasonographic stabilization 127 (88.9%) patients had an improvement of ≥1 grades of hydronephrosis. There were 9 pyeloplasty failures that were diagnosed and surgically corrected in a median of 7.5 months after the initial surgery. No clinical or surgical variables were associated with time to achieve ultrasonographic stabilization. There is great variability in the length of follow-up after pyeloplasty, ranging from 3-months to 7-years. In our cohort, the bast majority of patients had achieved ultrasonographic stabilization and displayed improvement in their initial grade of hydronephrosis by 14.5 months after surgery. Timeframe in which surgical failures were diagnosed and corrected. There were not clinical or surgical variables associated to time to achieve stabilization. Similar results have been reported in the literature; however, most of them have evaluated as their main outcome resolution and not stabilization of hydronephrosis. Ultrasonographic stabilization is a suitable and non-invasive parameter for determining the length of follow-up after unilateral pyeloplasty, as it is an adequate timeframe for identifying failed pyeloplasties, observing improvement or stabilization of hydronephrosis, and performing any additional procedure required after the primary repair.

Impact of an estrogen replacement regimen on live birth rate in frozen-thawed good-quality embryo transfer.

To assess the impact of an estrogen replacement regimen on frozen embryo transfer (FET) cycle outcome. In the present retrospective cohort study, data of infertile women undergoing FET with good-quality embryos were reviewed. The first group received 2 mg of estradiol hemihydrate (EH) once daily for 6 to 7 days, then twice daily for 4 to 5 days, and then three times a day until embryo transfer. The second group received EH twice daily for 7 to 8 days, then three times a day. The third group received EH three times a day constantly. The main outcome measure was live birth rate. In total, 394 FET cycles were included. The fixed 6-mg group required the highest estradiol hemihydrate dose. The duration of estrogen treatment was significantly longer in the first group. Maximal endometrial thickness was highest in the second group (10.2± 1.3 mm vs. 9.6± 1.4 mm vs. 8.6± 0.9 mm, respectively; P< 0.001). The clinical pregnancy rates in the groups were 41.1%, 55.2%, and 42.2%, respectively (P= 0.035). Live birth rates were 40.8%, 50.9%, and 48.1%, respectively (P= 0.320). In FET cycles with hormone replacement therapy, a step-up 4-mg regimen provides thicker endometrium with optimal-dose estrogen in an adequate time frame. The tendency for increased clinical pregnancy and live birth rates is remarkable.

Initiative to Improve Postintubation Sedation in a Pediatric Emergency Department.

Previous research has shown that appropriate pediatric postintubation sedation (PIS) after rapid sequence intubation only occurs 28% of the time. Factors such as high provider variability, cognitive overload, and errors of omission can delay time to PIS in a paralyzed patient. To increase the proportion of children receiving timely PIS by 20% within 6 months. A multidisciplinary team identified key drivers and targeted interventions to improve timeliness of PIS. The primary outcome of "sedation in an adequate time frame" was defined as a time to post-Rapid Sequence Intubation sedative administration less than the duration of action of the RSI sedative agent. Secondary outcomes included the proportion of patients receiving any sedation and time to PIS administration. Pediatric postintubation sedation in an adequate time was improved from 27.9% of intubated patients to 55.6% after intervention (p = .001). The number of patients receiving any PIS improved from 74% to 94% (p = .006). The median time from RSI to PIS was reduced from 13 to 9 minutes (p < .001). Process control charts showed a reduction in PIS variability and a centerline reduction from 19 to 10 minutes. Implementation of an intubation checklist and a multidisciplinary approach improved the rate of adequate pediatric PIS.

Terrorist campaigns and the growth of the Muslim population: a reply

AbstractA recently published paper in this journal (Choi, 2021) establishes a statistical link between, on the one hand, Islamist terrorist campaigns – including terrorist attacks and online propaganda – and, on the other the growth of the Muslim population. The author explains this result by stating that successful campaigns lead some individuals to convert to Islam. In this commentary, we intend to reply to this article by focusing on the impact of terrorist attacks on religious conversion. We first show that Choi's results suffer from theoretical flaws – a failure to comprehensively unpack the link between violence and conversion – and methodological shortcomings – a focus on all terrorist groups over a period where Islamist attacks were rare. This leads us to replicate Choi's analysis by distinguishing Islamist and non-Islamist terror attacks on a more adequate timeframe. By doing so, we no longer find empirical support for the relationship between terror attacks and the growth of the Muslim population. However, our analyses suggest that such a hypothesis may hold but only in contexts where the level and intensity of political violence are high.

Honey-Based Medicinal Formulations: A Critical Review

Honey, a concentrated natural product, is produced by honeybees (Apis mellifera) from the nectar of flowers. It contains over 200 compounds that exert various biological or pharmacological activities, ranging from antioxidant, anti-inflammatory, antimicrobial, and antihypertensive to hypoglycemic effects. Due to the presence of a plethora of bioactive compounds, as well as unique physicochemical properties, honey has been widely used as medicine throughout human history along with its extensive utilization as common food and flavoring agent. The application of neat honey for therapeutic purpose, however, poses some difficulties such as the maintenance of a required therapeutic concentration over an adequate timeframe due to the problem of liquefaction and leakage. This has driven researchers to incorporate honey into a range of formulations, for example, hydrogels, dressings, ointments, pastes, or lozenges. After a brief discussion of the chemistry and medicinal use of honey, this review focuses on commercial honey-based medicinal formulations as well as in vitro, in vivo, and clinical studies on noncommercial honey formulations for the treatment of various ailments. In addition to this, it also covers the application of honey formulations and the evidence underpinning their use.

Deep learning‐based pose estimation for African ungulates in zoos

The description and analysis of animal behavior over long periods of time is one of the most important challenges in ecology. However, most of these studies are limited due to the time and cost required by human observers. The collection of data via video recordings allows observation periods to be extended. However, their evaluation by human observers is very time‐consuming. Progress in automated evaluation, using suitable deep learning methods, seems to be a forward‐looking approach to analyze even large amounts of video data in an adequate time frame.In this study, we present a multistep convolutional neural network system for detecting three typical stances of African ungulates in zoo enclosures which works with high accuracy. An important aspect of our approach is the introduction of model averaging and postprocessing rules to make the system robust to outliers.Our trained system achieves an in‐domain classification accuracy of >0.92, which is improved to >0.96 by a postprocessing step. In addition, the whole system performs even well in an out‐of‐domain classification task with two unknown types, achieving an average accuracy of 0.93. We provide our system at https://github.com/Klimroth/Video‐Action‐Classifier‐for‐African‐Ungulates‐in‐Zoos/tree/main/mrcnn_based so that interested users can train their own models to classify images and conduct behavioral studies of wildlife.The use of a multistep convolutional neural network for fast and accurate classification of wildlife behavior facilitates the evaluation of large amounts of image data in ecological studies and reduces the effort of manual analysis of images to a high degree. Our system also shows that postprocessing rules are a suitable way to make species‐specific adjustments and substantially increase the accuracy of the description of single behavioral phases (number, duration). The results in the out‐of‐domain classification strongly suggest that our system is robust and achieves a high degree of accuracy even for new species, so that other settings (e.g., field studies) can be considered.

Conservation decision-making in the field: a case study

Conservation treatments are optimally informed by consideration of all options and materials, with time dedicated to research, analysis and testing, and performed with the benefit of an adequate budget and time frame that allows for a careful treatment. In practice, treatment decisions are often crucially shaped by other factors, including the availability and accessibility of materials and equipment, the experience and treatment habits of the conservator, budget constraints, time available for research and testing, treatment deadlines, and the needs of or requests from invested parties. This article discusses the treatment of a seventh century BCE clay cuneiform tablet that was conserved at several different venues over five field seasons at the Tayinat Archaeological Project in Turkey. It focusses on treatment decision-making in response to limited resources, deadlines, and research and display needs, with the intent of adding to the growing body of conservation literature that investigates how conservators problem-solve.

Citizens' Participation in Electoral Governance: A Redistricting Process

Citizens’ participation in electoral governance can be considered as a means for insuring electoral integrity. Some cases and problems of this participation are discussed in contemporary literature. Less attention has been paid to institutional forms of citizens’ participation in electoral redistricting. The paper presents a systematic picture to fill this gap, it also reveals the prospects of citizens’ participation in this area of electoral governance. Methodological framework for the study is contemporary theory of citizens’ participation and the S. Arnstein`s “ladder” of citizens’ participation. Making cross-case generalisations, the paper addresses the empirical material from Australia, New Zealand, Canada, India, Great Britain, the USA and Russia. It is conceivable that the adequate time frame for citizens’ participation and transparency are the most significant conditions for citizens` engagement.

Telemedicine Practice: Review of the Current Ethical and Legal Challenges.

Background: Telemedicine involves medical practice and information and communications technology. It has been proven to be very effective for remote health care, especially in areas with poor provision of health facilities. However, implementation of these technologies is often hampered by various issues. Among these, ethical and legal concerns are some of the more complex and diverse ones. In this study, an analysis of scientific literature was carried out to identify the ethical and legal challenges of telemedicine.Materials and Methods: English literature, published between 2010 and 2019, was searched on PubMed, Scopus, and Web of Science by using keywords, including “Telemedicine,” “Ethics,” “Malpractice,” “Telemedicine and Ethics,” “Telemedicine and Informed consent,” and “telemedicine and malpractice.” Different types of articles were analyzed, including research articles, review articles, and qualitative studies. The abstracts were evaluated according to the selection criteria, using the Newcastle–Ottawa Scale criteria, and the final analysis led to the inclusion of 22 articles.Discussion: From the aforementioned sample, we analyzed elements that may be indicative of the efficacy of telemedicine in an adequate time frame. Ethical aspects such as informed consent, protection data, confidentiality, physician's malpractice, and liability and telemedicine regulations were considered.Conclusions: Our objective was to highlight the current status and identify what still needs to be implemented in telemedicine with respect to ethical and legal standards. Gaps emerged between current legislation, legislators, service providers, different medical services, and most importantly patient interaction with his/her data and the use of that data.

Fungal Infections in Burn Patients.

Background: Fungal burn wound infections are among the most devastating complications in patients who are severely burned. Increasing incidence of burn wound infections caused by fungi led to new challenges in diagnostic and therapeutic approaches. The wide use of broad-spectrum antibiotic agents, an increased prevalence of molds and non-Candida albicans spp., and the variety of available antifungal agents underline the importance of identifying the causative species, to initiate adequate therapy within an adequate timeframe. Methods: Review of the pertinent English and German literature. Results: Fungal burn wound infections go along with a delay of identifying the causative fungus species and can be mistaken for early bacterial burn wound infection. Recently, an increase of uncommon fungal pathogens and fungi resistance against antifungal agents has been reported. Amphotericin B and voriconazole remain the antifungal drugs used most commonly. Conclusions: Adequate therapy remains challenging. Early radical debridement and wound closure play an imperative part, particularly in preventing infections caused by yeasts and molds or any other agent. Prophylactic empiric pharmacologic treatment is reserved for those highly at risk for invasive burn wound infection only. Because of the emergence of drug-resistant fungi, the development of new antifungal drugs is essential for the battle against fungal burn wound infections.

Asset management – the overlooked gains from efficiency projects

Abstract Efficiency is a key topic nowadays in the water sector as customers' expectations are continuously increasing, legislation becomes more demanding, utilities become more exposed to public opinion and expectations are increasing towards a high-quality service at an affordable cost and both combined with high risk avoidance. The implementation of efficiency projects, such as non-revenue water (NRW) reduction projects are fundamental both from an economic and an environmental perspective. However, decisions on the implementation of these projects are often reduced to short-term economic criteria or to a cost-benefit analysis at best, not considering an adequate timeframe that would potentially allow the accommodation of the adopted NRW reduction measures (capital and operational expenditures). Infrastructure asset management requires a strategic view on water systems based on the long-term balance of performance, cost and risk aiming at the adequate management of utilities' physical, human, technological and intangible assets. Water managers should take these principles into consideration when deciding whether to implement efficiency projects, since the long-term effect of current water systems' inefficiencies can translate into significant capital expenditures in the future. This paper presents an evaluation of tangible and intangible gains that result from NRW reduction projects and why intangible gains should be part of decision-making processes on whether to implement them or not.

Distributed deduplication with fingerprint index management model for big data storage in the cloud

As data progressively grows within data centers, the cloud storage models face several issues while storing data and offers abilities needed to shift data in an adequate time frame. This study aims to develop a distributed deduplication model to achieve scalable throughput and capacity utilizing many data servers for duplicating data in parallel with minimal loss. This paper proposes a new cloud storage model based on a distributed deduplication with the fingerprint index management (DDFI) model. The DDFI model operates on three main stages. At the initial stage, the DDFI model makes use of an effective routing technique depending upon the similarity level of the data, which leads to low network overhead by rapid identification of storage locations. In the second stage, the duplicate data identification procedure is carried out by the use of the MD5 algorithm. At the final stage, a fingerprint index management process is executed where a fingerprint index comprises fingerprints and its corresponding position details of every written chunk. For optimizing the results of the deduplication performance, the DDFI model manages the fingerprint index in storage space and only sometimes writes to disk at the same time as the cloud database scheme is idle. The simulation outcome exhibited that the presented DDFI model offered maximum results with a higher deduplication ratio (DR) with a minimum overhead of network bandwidth. From the detailed comparative analysis, it is inferred that the presented DFFI model offered maximum relative DR, maximum duplication performance, minimum read bandwidth, and write bandwidth.

Action research and health system strengthening: the case of the health sector support programme in Mauritania, West Africa

BackgroundAccess to qualitative and equitable healthcare is a major challenge in Mauritania. In order to support the country’s efforts, a health sector strengthening programme was set up with participatory action research at its core. Reinforcing a health system requires a customised and comprehensive approach to face the complexity inherent to health systems. Yet, limited knowledge is available on how policies could enhance the performance of the system and how multi-stakeholder efforts could give rise to changes in health policy. We aimed to analyse the ongoing participatory action research and, more specifically, see in how far action research as an embedded research approach could contribute to strengthening health systems.MethodsWe adopted a single-case study design, based on two subunits of analysis, i.e., two selected districts. Qualitative data were collected by analysing country and programme documents, conducting 12 semi-structured interviews and performing participatory observations. Interviewees were selected based on their current position and participation in the programme. The data analysis was designed to address the objectives of the study, but evolved according to emerging insights and through triangulation and identification of emergent and/or recurrent themes along the process.ResultsAn evaluation of the progress made in the two districts indicates that continuous capacity-building and empowerment efforts through a participative approach have been key elements to enhance dialogue between, and ownership of, the actors at the local health system level. However, the strong hierarchical structure of the Mauritanian health system and its low level of decentralisation constituted substantial barriers to innovation. Other constraints were sociocultural and organisational in nature. Poor work ethics due to a weak environmental support system played an important role. While aiming for an alignment between the flexible iterative approach of action research and the prevailing national linear planning process is quite challenging, effects on policy formulation and implementation were not observed. An adequate time frame, the engagement of proactive leaders, maintenance of a sustained dialogue and a pragmatic, flexible approach could further facilitate the process of change.ConclusionOur study showcases that the action research approach used in Mauritania can usher local and national actors towards change within the health system strengthening programme when certain conditions are met. An inclusive, participatory approach generates dynamics of engagement that can facilitate ownership and strengthen capacity. Continuous evaluation is needed to measure how these processes can further develop and presume a possible effect at policy level.