This paper addresses the problem of health information systems (HIS) sustainability in developing countries. Two interrelated questions are addressed. 1) How do we mobilise the local networks in the present settings of shortage of human and capital resources? 2) In which ways are these networks sustained for the sake of the HIS sustainability? With empirical material from the information systems integration project for the Zanzibar healthcare sector, the analysis is centred on the communities of practice concept in conjunction with the networks of action concept. The study reveals that building communities through organised practical works helps to build such networks at the lowest level of the HIS bureaucracy, enhancing learning at minimal resource usage. To make the networks themselves sustainable, participation in the larger networks of similar activities to enable wider exchange of knowledge and material resources is very important. This direct involvement not only helps in knowledge and resource exchange but also helps to forge political establishment which is highly important in influencing decisions concerning HIS related issues.
Reliable seasonal prediction of groundwater levels is not always possible when the quality and the amount of available on-site groundwater data are limited. In the present work, a hybrid K-Nearest Neighbor-Random Forest (KNN-RF) is used for the prediction of variations in groundwater levels (L) of an aquifer with the groundwater relatively close to the surface (<10 m) is proposed. First, the time-series smoothing methods are applied to improve the quality of groundwater data. Then, the ensemble K-Nearest Neighbor-Random Forest (KNN-RF) model is treated using hydro-climatic data for the prediction of variations in the levels of the groundwater tables up to three months ahead. Climatic and groundwater data collected from eastern Rwanda were used for validation of the model on a rolling window basis. Potential predictors were: the observed daily mean temperature (T), precipitation (P), and daily maximum solar radiation (S). Previous day’s precipitation P (t − 1), solar radiation S (t), temperature T (t), and groundwater level L (t) showed the highest variation in the fluctuations of the groundwater tables. The KNN-RF model presents its results in an intelligible manner. Experimental results have confirmed the high performance of the proposed model in terms of root mean square error (RMSE), mean absolute error (MAE), Nash–Sutcliffe (NSE), and coefficient of determination (R2).
Intracardiac blood cysts (ICBC) are cardiac pseudoneoplasm commonly seen in infants below two months of age. ICBC typically resolve spontaneously; however, they can sometimes persist in adults and can cause detrimental consequences. A 47-year-old female presented to our facility with complaints of chest pain and was found to have an incidental subvalvular chordal mitral apparatus echolucent mass on transthoracic echocardiogram (TTE). A stress echocardiography was performed, which revealed transient left ventricle outflow tract (LVOT) obstruction in the absence of anginal symptoms. A cardiac magnetic resonance imaging (MRI) showed no evidence of increased mass enhancement confirming the diagnosis of a benign blood cyst of mitral apparatus. The cyst was treated conservatively with carvedilol to prevent worsening of exertional LVOT obstruction. A follow-up study done at six months showed stable exertional hemodynamics. There is no general consensus while managing ICBC. In asymptomatic, non-surgical patients stress echocardiography can offer valuable information by assessing the hemodynamic implications resulting from the cyst.
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