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Informing Additive Manufacturing (AM) technology adoption decisions, this paper investigates the relationship between build volume capacity utilisation and efficient technology operation in an inter-process comparison of the costs of manufacturing a complex component used in the packaging industry. Confronting the reported costs of a conventional machining and welding pathway with an estimator of the costs incurred through an AM route utilising Direct Metal Laser Sintering (DMLS), we weave together four aspects: optimised capacity utilisation, ancillary process steps, the effect of build failure and design adaptation. Recognising that AM users can fill unused machine capacity with other, potentially unrelated, geometries, we posit a characteristic of ‘fungible’ build capacity. This aspect is integrated in the cost estimation framework through computational build volume packing, drawing on a basket of sample geometries. We show that the unit cost in mixed builds at full capacity is lower than in builds limited to a single type of geometry; in our study, this results in a mean unit cost overstatement of 157%. The estimated manufacturing cost savings from AM adoption range from 36 to 46%. Additionally, we indicate that operating cost savings resulting from design adaptation are likely to far outweigh the manufacturing cost advantage. [ABSTRACT FROM PUBLISHER]

Introduction: High-quality evidence is crucial for guiding effective humanitarian responses, yet conducting rigorous research, particularly randomised controlled trials, in humanitarian crises remains challenging. The TISA ("traitement intégré de la sous-nutrition aiguë") trial aimed to evaluate the impact of a Water, Sanitation and Hygiene (WASH) intervention on the standard national treatment of uncomplicated Severe Acute Malnutrition (SAM) in children aged 6-59 months. Implemented in two northern Senegalese regions from December 22, 2021, to February 20, 2023, the trial faced numerous challenges, which this paper explores along with the lessons learned., Methods: The study utilised trial documentation, including field reports, meeting minutes, training plans, operational monitoring data and funding proposals, to retrace the trial timeline, identify challenges and outline implemented solutions. Contributions from all TISA key staff-current and former, field-based and headquarters-were essential for collecting and interpreting information. Challenges were categorised as internal (within the TISA consortium) or external (broader contextual issues)., Results: The TISA trial, executed by a consortium of academic, operational, and community stakeholders, enrolled over 2000 children with uncomplicated SAM across 86 treatment posts in a 28,000 km 2 area. The control group received standard outpatient SAM care, while the intervention group also received a WASH kit and hygiene promotion. Initially planned to start in April 2019 for 12 months, the trial faced a 30-month delay and was extended to 27 months due to challenges like the COVID-19 pandemic, national strikes, health system integration issues and weather-related disruptions. Internal challenges included logistics, staffing, data management, funding and aligning diverse stakeholder priorities., Discussion and Conclusion: Despite these obstacles, the trial concluded successfully, underscoring the importance of tailored monitoring, open communication, transparency and community involvement. Producing high-quality evidence in humanitarian contexts demands extensive preparation and strong coordination among local and international researchers, practitioners, communities, decision-makers and funders from the study's inception., Trial Registration: Clinicaltrials.gov NCT04667767 ., (© 2024. The Author(s).)

The paper presents a new method of forecasting the durability of piston-rings-cylinder (PRC) liner assembly of the internal combustion engine on the basis of observed changes of physical and chemical properties of engine oil. Methods used so far for the durability evaluation of the PRC group required collecting information about the moments when the assembly reached its boundary state or used kinetic models of wear designed using accelerated research of real objects. In the proposed method, for the evaluation of durability of engine cylinders information gathered form engine oil is used. Course of changes of the proposed index of change intensity of kinematic viscosity at the temperature of 100°C – Cv100 allows for evaluation of the durability of PRC assembly of an IC engine. Obtained value was positively verified using forecasting method related to the technical criteria based on the assessment of the wear intensity.

Abstract Background In Sierra Leone (SL), a low-income country in West Africa, dental care is very limited, largely private, and with services focused in the capital Freetown. There is no formal dental education. Ten dentists supported by a similar number of dental care professionals (DCPs) serve a population of over 7.5 million people. The objective of this research was to estimate needs-led requirements for dental care and human resources for oral health to inform capacity building, based on a national survey of oral health in SL. Methods A dedicated operational research (OR) decision tool was constructed in Microsoft Excel to support this project. First, total treatment needs were estimated from our national epidemiological survey data for three key ages (6, 12 and 15 years), collected using the ‘International Caries Classification and Management System (ICCMS)’ tool. Second, oral health needs were extrapolated to whole population levels for each year-group, based on census demographic data. Third, full time equivalent (FTE) workforce capacity needs were estimated for mid-level providers in the form of Dental Therapists (DTs) and non-dental personnel based on current oral disease management approaches and clinical timings for treatment procedures. Fourth, informed by an expert panel, three oral disease management scenarios were explored for the national population: (1) Conventional care (CC): comprising oral health promotion (including prevention), restorations and tooth extraction; (2) Surgical and Preventive care (S 5&6 P and S 6 P): comprising oral health promotion (inc. prevention) and tooth extraction (D5 and D6 together, & at D6 level only); and (3) Prevention only (P): consisting of oral health promotion (inc. prevention). Fifth, the findings were extrapolated to the whole population based on demography, assuming similar levels of treatment need. Results To meet the needs of a single year-group of childrens’ needs, an average of 163 DTs (range: 133–188) would be required to deliver Conventional care (CC); 39 DTs (range: 30–45) to deliver basic Surgical and Preventive care (S 6 P); 54 DTs for more extended Surgical and Preventive care (S 5&6 P) (range 38–68); and 27 DTs (range: 25–32) to deliver Prevention only (P). When scaled up to the total population, an estimated 6,147 DTs (range: 5,565–6,870) would be required to deliver Conventional care (CC); 1,413 DTs (range: 1255–1438 DTs) to deliver basic Surgical and Preventive care (S 6 P); 2,000 DTs (range 1590–2236) for more extended Surgical and Preventive care (S 5&6 P) (range 1590–2236); and 1,028 DTs to deliver Prevention only (P) (range: 1016–1046). Furthermore, if oral health promotion activities, including individualised prevention, could be delivered by non-dental personnel, then the remaining surgical care could be delivered by 385 DTs (range: 251–488) for the S 6 P scenario which was deemed as the minimum basic baseline service involving extracting all teeth with extensive caries into dentine. More realistically, 972 DTs (range: 586–1179) would be needed for the S 5&6 P scenario in which all teeth with distinctive and extensive caries into dentine are extracted. Conclusion The study demonstrates the huge dental workforce needs required to deliver even minimal oral health care to the Sierra Leone population. The gap between the current workforce and the oral health needs of the population is stark and requires urgent action. The study also demonstrates the potential for contemporary epidemiological tools to predict dental treatment needs and inform workforce capacity building in a low-income country, exploring a range of solutions involving mid-level providers and non-dental personnel.

Introduction: Community participation gained its importance from the Alma Ata declaration in 1978. Improving coverage of these services depends on factors like availability, accessibility, and quality of service delivery. Involving Community Health Volunteers to deliver health services would help in decentralizing health care delivery. Methods: A mixed-method approach (Sequential experimental design) was employed to evaluate the contributions of CHVs. The data collection methods included Key Informant Interviews (KII) and a pre-tested semi-structured self-introspection questionnaire to capture both volunteer's and health system side perspectives of the intervention. The study was conducted from October 2017 to May 2018. Results: At the end of the intervention, only 33 volunteers (51%) had contributed to health care delivery in their respective anganwadis. We compiled the contributions made by the CHV during the intervention period. We explored the facilitating, hindering factors that influenced the outcome and gathered suggestions for the same. The CHVs felt that they have contributed adequately to the delivery of health care. Discussion and conclusion: The study explores the contributions of CHVs and their evaluation using a mixed-methods design capturing the perspectives of various stakeholders. Our study results highlight the spectrum of contributions that can be rendered through CHV's if adequately trained, who can be utilized as an effective workforce in resource-poor settings.

In 2021, an operational research study in two tertiary hospitals in Freetown showed poor hand hygiene compliance. Recommended actions were taken to improve the situation. Between February–April 2023, a cross-sectional study was conducted in the same two hospitals using the World Health Organization hand hygiene tool to assess and compare hand hygiene compliance with that observed between June–August 2021. In Connaught hospital, overall hand hygiene compliance improved from 51% to 60% (p < 0.001), and this applied to both handwash actions with soap and water and alcohol-based hand rub. Significant improvements were found in all hospital departments and amongst all healthcare worker cadres. In 34 Military Hospital (34MH), overall hand hygiene compliance decreased from 40% to 32% (p < 0.001), with significant decreases observed in all departments and amongst nurses and nursing students. The improvements in Connaught Hospital were probably because of more hand hygiene reminders, better handwash infrastructure and more frequent supervision assessments, compared with 34MH where interventions were less well applied, possibly due to the extensive hospital reconstruction at the time. In conclusion, recommendations from operational research in 2021 contributed towards the improved distribution of hand hygiene reminders, better handwash infrastructure and frequent supervision assessments, which possibly led to improved hand hygiene compliance in one of the two hospitals. These actions need to be strengthened, scaled-up and guided by ongoing operational research to promote good hand hygiene practices elsewhere in the country.

An operational research study was conducted in 2019 to assess the quality of data submitted by antimicrobial resistance (AMR) surveillance sites in the Bagmati Province of Nepal to the National Public Health Laboratory for Global Antimicrobial Resistance and Use Surveillance System (GLASS). Measures were implemented to enhance the quality of AMR surveillance by strengthening capacity, improving infrastructure, implementing data sharing guidelines, and supervision. The current study examined reports submitted by surveillance sites in the same province in 2022 to assess whether the data quality had improved since 2019. The availability of infrastructure at the sites was assessed. Of the nine surveillance sites in the province, seven submitted reports in 2022 versus five in 2019. Completeness in reporting improved significantly from 19% in 2019 to 100% in 2022 (p < 0.001). Timely reports were received from two sites in 2019 and only one site in 2022. Specimen–pathogen consistency in accordance with the GLASS guidelines for urine, feces, and genital swab specimens improved, with ≥90% consistency at all sites. Overall, the pathogen–antibacterial consistency improved significantly for each GLASS priority pathogen. The study highlights the importance of dedicated infrastructure and institutional arrangements for AMR surveillance. Similar assessments covering all provinces of the country can provide a more complete country-wide picture.

In Sierra Leone, two operational research (OR) studies in 2019 and 2021 showed deficiencies in the data being captured by the Integrated Animal Disease Surveillance and Reporting (IADSR) system. This third OR study was conducted in 2023 to assess whether the second OR study’s results and recommendations were disseminated with the key stakeholders, the uptake of the recommendations, improvements in data capture in the IADSR system, and to describe the data on livestock disease and antimicrobial use. In 2022, on seven occasions, the authors of the second OR study disseminated the study’s findings. Of the four recommendations, the one on improving laboratory infrastructure for confirmation of animal disease was not implemented. The district animal health weekly surveillance reports received through the IADSR system were sustained at 88% between the second (2021) and third (2023) studies. In both studies, the proportion of sick animals receiving antibiotics (25%) remained the same, but the use of “critically important antimicrobials for veterinary use” declined from 77% (in 2021) to 69% (in 2023). The IADSR system has improved considerably in providing information on animal health and antibiotic use, and sequential OR studies have played a key role in its improvement.

Cutaneous leishmaniasis (CL) is common in Ethiopia, but the national guideline does not offer specific treatment recommendations. Consequently, different treatment regimens are used in the country, without quality evidence. In Boru Meda Hospital, sodium stibogluconate (SSG) is routinely used in combination with allopurinol for systemic CL treatment, although evidence on its effectiveness is limited. An observational cohort study was carried out to document clinical treatment outcomes in patients receiving SSG/allopurinol at the end of each 28-day treatment cycle and after 180 days. Patient-reported outcomes were assessed by asking patients to rate lesion severity, and by the dermatological life quality index. A total of 104 patients were included. After one treatment cycle, only four patients were clinically cured, although patient-reported outcomes significantly improved. The majority (88) of patients were appointed for a second treatment cycle, of whom only 37 (42%) attended. Among the 36 patients who came for final outcome assessment, 50% were cured. Follow-up and treatment were severely affected by conflict; drug stock-outs and insufficient ward capacity for treatment were additional challenges. The treatment outcomes of SSG/allopurinol were relatively poor, and most patients required more than one cycle of treatment. Shortages of drugs and beds indicate the existing gaps in providing CL treatment in Ethiopia.

(1) Background: Surgical antibiotic prophylaxis (SAP) is important for reducing surgical site infections. The development of a dedicated hospital SAP guideline in the Dhulikhel Hospital was a recommendation from a baseline study on SAP compliance. Compliance with this new guideline was enhanced through the establishment of a hospital committee, the establishment of an antibiotic stewardship program and the funding and training of healthcare professionals. Using the baseline and a follow-up study after introducing dedicated hospital SAP guidelines, we compared: (a) overall compliance with the SAP guidelines and (b) the proportion of eligible and non-eligible patients who received initial and redosing of SAP; (2) Methods: A before-and-after cohort study was conducted to compare SAP compliance between a baseline study (July 2019–December 2019) and a follow-up study (January 2023–April 2023); (3) Results: A total of 874 patients were in the baseline study and 751 in the follow-up study. Overall SAP compliance increased from 75% (baseline) to 85% in the follow-up study (p < 0.001). Over 90% of those eligible for the initial dose of SAP received it in both studies. Inappropriate use for those not eligible for an initial dose was reduced from 50% to 38% (p = 0.04). For those eligible for redosing, this increased from 14% to 22% but was not statistically significant (p = 0.272); (4) Conclusions: Although there is room for improvement, introduction of dedicated SAP guidelines was associated with improved overall SAP compliance. This study highlights the role of operational research in triggering favorable interventions in hospital clinical care.

Concerning the development of computational tools and solutions as a decision-making aid, this paper presents the results of the waspasWEB project, which strives to provide decision-makers with a readily accessible mechanism to employ the weighted aggregated sum product assessment (WASPAS) method. The social contribution of the project encompasses the development of a user-friendly and publicly accessible internet tool, as well as a package launched on the Comprehensive R Archive Network (CRAN) to serve the community of users of the R language. The use of operational research methodologies is crucial to justify decisions, and this effort seeks to advance the adoption of such methodologies, offering managers, researchers, and the general public an intuitive and easily accessible multi-criteria decision-making tool. In this way, we present the technical specifications, usability, and interactivity of the user with the computational platform, being validated its viability through a hypothetical case study. At the end of the research, it exposes the limitations and feasibility of the proposed computational model along with future research.

Implementing infection prevention and control (IPC) programmes in line with the World Health Organization’s (WHO) eight core components has been challenging in Sierra Leone. In 2021, a baseline study found that IPC compliance in three tertiary hospitals was sub-optimal. We aimed to measure the change in IPC compliance and describe recommended actions at these hospitals in 2023. This was a ‘before and after’ observational study using two routine cross-sectional assessments of IPC compliance using the WHO IPC Assessment Framework tool. IPC compliance was graded as inadequate (0–200), basic (201–400), intermediate (401–600), and advanced (601–800). The overall compliance scores for each hospital showed an improvement from ‘Basic’ in 2021 to ‘Intermediate’ in 2023, with a percentage increase in scores of 16.9%, 18.7%, and 26.9% in these hospitals. There was improved compliance in all core components, with the majority in the ‘Intermediate’ level for each hospital IPC programme. Recommended actions including the training of healthcare workers and revision of IPC guidelines were undertaken, but a dedicated IPC budget and healthcare-associated infection surveillance remained as gaps in 2023. Operational research is valuable in monitoring and improving IPC programme implementation. To reach the ‘Advanced’ level, these hospitals should establish a dedicated IPC budget and develop long-term implementation plans.

Until 2021, in the Kyrgyz Republic, tuberculosis (TB) was diagnosed and treated only in the public sector. With funding support of the STOP–TB partnership, the private providers in four regions of the country and Bishkek city were mapped, trained and incentivized to screen for and identify presumptive TB patients and refer them to the public facilities for diagnosis and treatment. In this study, we describe the cascade of care of such patients. This was a cohort study involving secondary analysis of routine data. Of 79,352 patients screened during February 2021–March 2022, 2511 (3%) had presumptive TB, of whom 903 (36%) were not tested for TB [pre-diagnostic loss to follow-up]. A total of 323 (13%) patients were diagnosed with TB, of whom, 42 (13%) were not started on treatment [pre-treatment loss to follow-up]. Among 257 patients eligible for outcome assessment, 197 (77%) had treatment success, 29 (11%) were lost-to-follow-up, 13 (5%) died, 4 (2%) had treatment failure and 14 (5%) were not evaluated. While this donor-funded, pioneering initiative was successful in engaging the private sector, we recommend that the national TB programme scales up the initiative nationally with dedicated budgets, activities and plans to monitor progress. Qualitative research is urgently needed to understand the reasons for the gaps in the care cascade.

Introduction: Leprosy is a chronic neglected tropical disease, classified into two groups: multibacillary (MB) and paucibacillary (PB) leprosy based on the number of skin lesions and nerve involvement. A positive skin slit smear (SSS) result automatically puts a patient in the MB category. Although guidelines do not recommend routine use of SSS for classification and diagnosis of leprosy, it is performed for most patients in Ethiopia. However, the added value of performing SSS for the classification of leprosy on top of clinical classification is unclear. Methodology: A cross sectional study was done using routine laboratory and clinical data from September 2018 to January 2020 at Boru Meda General Hospital, Ethiopia. All newly diagnosed leprosy cases were included. Descriptive statistics were performed to calculate frequencies and proportions. Results: We included 183 new leprosy patients in our study, of which 166/183 (90.7%) were MB patients and 17/183 (9.3%) were PB patients. All clinical PB cases and 150/166 (90.4%) clinical MB patients had SSS done. All PB patients had negative SSS result and 68 (45.3%) clinical MB patients had a positive result. Based on the SSS, no patient with a clinical classification of PB was reclassified to MB. Conclusions: SSS microscopy was performed routinely for all leprosy cases without changing the classification and management of patients in Boru Meda Hospital. Therefore, we recommend restricted and rational use of the SSS for PB cases in which SSS could change management. [ABSTRACT FROM AUTHOR]

Introduction: Cutaneous Leishmaniasis (CL) in Ethiopia is caused by a unique species, L. aethiopica. In Ethiopia, there are limited studies that provide detailed clinical descriptions of CL, treatment options, and treatment outcomes. Methodology: We conducted a descriptive study based on routinely collected data in medical files from two hospitals in Bahir Dar, Ethiopia, from 2017 to 2021. Three months following the end of therapy, we retrieved sociodemographic and clinical data, as well as data on the treatment outcome. Result: Between March 2017 and June 2021, 94 patients were diagnosed with CL at the two hospitals. Of those, 46 (48.9%) of individuals had localized CL, 36 (38.3%) mucocutaneous leishmaniasis (MCL), and 12 (12.8%) diffuse CL. Sixty-five (69.1%) of the participants were men. The most prevalent morphologic appearances were plaque (n = 42, 46.2%), nodule (n = 38, 41.8%), infiltrative (n = 34, 36.2%), crusted (n = 32, 34%), and ulcerated (n = 24, 25.5%). Scarred, volcanic, and patchy lesions were also documented. Systemic pentavalent antimonials were the most common treatment (n = 55, 58.5%), curing 21/38 (55%) of the patients. Pentavalent antimonials were also given intralesionally to seventeen patients (18.1%), with 15/16 (94%) of them being cured. Overall, 61% (40/66) of patients with documented treatment outcomes were cured. Conclusions: As CL in Ethiopia has a wide array of clinical presentations, clinicians should be suspicious of patients from endemic areas who present with dermatologic manifestations. Physicians can employ local treatment as a first line before resorting to systemic therapy. [ABSTRACT FROM AUTHOR]

Introduction: Trachomatous trichiasis (TT) is the advanced stage of trachoma where lashes touch the globe of the eye causing permanent damage. Without eyelid surgery, TT can lead to irreversible blindness. In 2015 the Ethiopian Ministry of Health launched the Fast Track Initiative with the aim of enhancing the provision of surgical services for TT. The aims of this study were to determine the productivity of individual surgeons during the 2017 Initiative, to compare this productivity with the Ministry's annual target indicator of = 200 surgeries, and to assess the factors associated with surgical output. Methodology: This retrospective cross-sectional study utilized programmatic data on surgical output from 140 surgeons active from January 2017 through December 2017 in the eastern half of Amhara region, Ethiopia. Data were collected from a surgery monitoring dataset, analyzed, and compared to the performance targets set by the Ministry. Results: The mean annual number of surgeries carried out per surgeon was 169 (standard deviation: 111) for a total of 23,616 surgeries. Among the 140 surgeons, 38% achieved the target set by the Ministry. Location of surgical training site and estimated surgical backlog were signficantly associated with a higher surgery output. Conclusions: An increase in surgical output was observed compared to productivity prior to the Initiative, although the average annual output during the 2017 Fast Track Initiative was lower than the Ministry's target. Using data driven approaches to setting annual productivity goals should be considered, particularly in light of fewer remaining TT cases as a result of the successful Initiative. [ABSTRACT FROM AUTHOR]

Introduction: While ivermectin mass drug administration (MDA) has been implemented since long for onchocerciasis elimination, there is doubt whether this would also be effective for scabies control. If effective, this would allow integration of both programs. We compared scabies prevalence in districts implementing ivermectin MDA for the onchocerciasis elimination program and those not implementing the intervention in Amhara region, Ethiopia. Methodology: We conducted a cross-sectional study comparing the scabies prevalence in 14 districts implementing ivermectin MDA for onchocerciasis elimination program between 2013-2018 and in 28 districts without this intervention in Amhara region Ethiopia. We used 2018 scabies survey data to determine scabies prevalence. All individuals screened for scabies during the survey were included. We collected data on risk factors from the districts database and annual reports. Multivariate linear regression analysis was used to account for potential confounding factors. Results: We included data on 4,319,064 subjects across 42 districts. Except the differences in temperature and population density, districts in both groups were comparable. A total of 371,780 scabies cases were detected in the 2018 survey. The median scabies prevalence was 6% (IQR 2.6-11.9) in the intervention districts and 5.2% (1.8-10.4) in the control districts (p-value 0.77). In adjusted analysis, the difference remained statistically non-significant (coefficient 0.37 (95% confidence interval (-0.93-1.67); p-value 0.554). Conclusions: The implementation of ivermectin MDA for onchocerciasis control was not associated with reduced scabies prevalence. Consequently, standard scabies MDA should be deployed for scabies control. [ABSTRACT FROM AUTHOR]

Introduction: In Sub-Saharan Africa, snakebites are a public health problem. In Ethiopia, clinical cases have been described, but little information exists on snakebites burden and its geographical distribution. The aim of this study was to document the spatial distribution of venomous snakes and snakebites in Ethiopia. Methodology: In a cross-sectional observational study, venomous snakes were collected during snake catching activities in six Ethiopian hotspot areas between April 2015 and September 2020. Species and habitat were described. In the hotspot areas, routine health information data on reported snakebites was collected in 78 districts and subsequently used to map annual incidence per district. Result: A total of 333 snakes were collected and 14 species were identified. The most prevalent species were Bitis arietans, Bitis arietanus somalica, Echis pyramidum, known as vipers, and Naja pallida, known as cobra. The highest number of snakes (75) was observed in the Northwest and Eastern parts of Ethiopia, mostly in cultivation and man-made farm land, wooded and moist dry savanna. In each hotspot a wide variety of species was observed, although composition was different. The highest snakebite incidence overlapped with the high snakes densities in Northwest Ethiopia. The snakebite annual average incidence at district level was very heterogeneous and ranged from < 15 cases/100,000 inhabitants (44% of the districts) to 309.2 cases/100,000 inhabitants. Conclusions: Snake diversity and distribution, linked to high incidence of snakebites in the hotspots, suggests a close interconnection between human, animal and environmental systems and could inform the need for antivenoms per geographical locality. [ABSTRACT FROM AUTHOR]

Introduction: Guinea worm disease is caused by Dracunculus medinensis. Transmission of the disease depends on vectors (copepods). Abate applications in targeted water sources to control copepod is the main intervention. The aim of this study was to assess vector control practice in the guinea worm endemic region of Gambela, Ethiopia and to identify elimination gaps. Methodology: Retrospective analysis of routine program data recorded from 2016 to 2020 was performed. Pre-and post-copepod test is conducted on water ponds to determine the density of copepods. Based on the copepod density, the chemical is applied accordingly. The five years data was obtained from Ethiopian public health institute electronic database with permission. Results: A total of 22,131 water ponds were treated during the past five years. Out of the total treated in 2020, 4,669/7,266 (64%) were found with > 9 Copepods during pre-copepod test. 130/7,266 (1.79%) of water ponds which were post-tested after Abate application failed the requirement of scoring = 9 copepods. Of the 130 water ponds, 115 (88.5%) were observed during the transmission season (April to November). Abate application trend had increased by 28.9% during the 5 years period. According to the database, some of the largest water sources found in infection reporting villages missed their 28 days regular treatment schedule. Conclusions: A single water source that has not been treated effectively could be a source of infection for both humans and animals. The practice of Abate application should be enhanced and monitored regularly. The documenting system should be improved for quality, timely information and action. [ABSTRACT FROM AUTHOR]

Introduction: Timely and appropriate management of snakebites in the tropics is a lifesaver. Many snakebite patients are being bitten in remote rural areas and do not manage to get in due time to healthcare facilities. This study assessed the clinical features and the risk factors associated with treatment outcomes of snakebite patients admitted at two hospitals in the Northwest of Ethiopia. Methodology: In a retrospective cohort study, routinely collected data from 250 patients' medical charts at University of Gondar Hospital and Metema Hospital, between September 2012 and August 2020, were reviewed. Results: The median age of the snakebite cases was 24 years (95% CI = 22-26), with 80.8% male patients. At admission 148/250 patients presented in Clinical stage 1 or 2 (local symptoms only) and 73.7% presented more than 12 hours after the bite, 80.2% received antibiotics and 79.0% antivenom. The median duration of hospitalization was 3 days (95% CI = 3-4); 72% of the patients recovered and were discharged, 10.8% died and 0.5% underwent an amputation. On logistic regression analysis, residence in rural areas (AOR = 2.52, 95 % CI = 1.2-5.3), sign of bacterial superinfection on the bite site (AOR = 4.69. 95% CI = 1.4-15.4), clinical stage 3 or 4 with systemic symptoms or toxic signs at admission (AOR = 4.84, 95% CI = 1.3-18.0) and no treatment with antivenoms (AOR = 6.65, 95% CI = 1.6-27.7) were associated with bad outcome (death, amputation and/or referred/went against medical advice). Conclusions: Timely presentation at early clinical stage, appropriate clinical management and availability of antivenoms are cornerstones to reduce snakebite morbidity and mortality. [ABSTRACT FROM AUTHOR]

Introduction: Rabies remains a global threat, killing approximately 60,000 people every year. In Ethiopia, dogs are the main reservoir of the disease. Animals also estimate the burden of the disease. Methodology: Data from 2016 to 2020 were extracted from a rabies cases recording book of the Ethiopian Public Health Institute. Proportions and trends over time were analyzed. Brain samples of dogs were diagnosed with a Fluorescent Anti Body test. Results: A total of 6,001 dogs inflicting bites were brought to the laboratory. A high proportion of dogs 4,389 73.14% were not vaccinated. The total number of dogs brought to the laboratory was decreasing over the last five years. Among 1,216 dog brain samples examined 855 (70.3%) confirmed rabies. The proportion of rabies cases was increasing from 8.5% in 2016 and 32.6% in 2020. The highest rabies proportion (33.8%) was reported in 2018. Out of the total (2,156) dogs inflicting bites and observed for 10 days, only 468 (21.7%) of the observation report was tracked and reported. Conclusions: There is a high proportion of rabies in dogs inflicting bites in Addis Ababa. The findings are alarming with seven out of ten dogs diagnosed being infected with rabies. Only two dogs were vaccinated out of ten dogs inflicting bites. Rabies became a serious public health problem in the city that needs urgent health action from all sectors including the city administration. [ABSTRACT FROM AUTHOR]

Since the 1990s, fishing production has stagnated and aquaculture has experienced an exponential growth thanks to the production on an industrial scale. One of the major challenges facing aquaculture companies is the management of breeding activity affected by biological, technical, environmental and economic factors. In recent years, decision-making has also become increasingly complex due to the need for managers to consider aspects other than economic ones, such as product quality or environmental sustainability. In this context, there is an increasing need for expert systems applied to decision-making processes that maximize the economic efficiency of the operational process. One of the production planning decisions more affected by these changes is the feeding strategy. The selection of the feed determines the growth of the fish, but also generates the greatest impact of the activity on the environment and determines the quality of the product. In addition, feed is the main production cost in finfish aquaculture. In order to address all these problems, the present work integrates a multiple-criteria methodology with a genetic algorithm that allows determining the best sequence of feeds to be used throughout the fattening period, depending on multiple optimization objectives. Results show its utility to generate and evaluate different alternatives and fulfill the initial hypothesis, demonstrating that the combination of several feeds at precise times may improve the results obtained by one-feed strategies. [ABSTRACT FROM AUTHOR]

This paper presents a new variant of Travelling Salesman Problem (TSP) and its first resolution. In literature there is not any research work that has presented the TSP under pentagonal fuzzy neutrosophic environment yet. TSP is a critical issue for manufacturing companies where all cities need to be visited only once except the starting city with a minimal cost. In real life, information provided (cost, time ... etc.) are generally uncertain, indeterminate or inconsistent that's why in this paper parameters of the TSP are presented as neutrosophic pentagonal fuzzy numbers. To solve this problem, the novel heuristic Dhouib-Matrix-TSP1 (DM-TSP1) is applied using a ranking function in order to transform the fuzzy set to crisp data and range function to select cities. To prove the efficiency of the proposed DM-TSP1 in solving the new variant of TSP, we create novel benchmark instances. Then, a stepwise application of DM-TSP1 is illustrated in details. [ABSTRACT FROM AUTHOR]

Although it is a science in its own right operational research is not so well known in the field of economics and agribusiness but it possesses methods and relationships that could help ensure the natural-agribusiness environmental balance. Operational research is not a strictly mathematical science; it uses mathematical techniques but has a much wider application spectrum representing a systematized approach to solving problems that uses analytical methods in the process of finding the appropriate solution. In the environment-agribusiness interaction, operational research can represent a tool that can contribute to more effective planning, generating scientifically based solutions to current problems and therefore gaining a competitive advantage in relation to similar enterprises. By means of the specific methodology (modeling, simulation, optimization through linear programming, etc.) it can determine the optimization of production flows, establish the most efficient way of determining feed in the livestock sector and realize the optimization of transport networks (e.g. the shortest path problem). The decision-making process under conditions of risk and uncertainty is one of the essential elements in the management of a company that can provide the necessary data for a viable strategic approach, providing optimal solutions to the problems encountered. The work aims to highlight the importance of operational research as a science, to provide an image of how to use specific techniques and methods, indicating the favorability of using it as a strategic tool both in agricultural business and for environmentally friendly policy. [ABSTRACT FROM AUTHOR]

Internet of Things (IoT) has phenomenal applicability in the sectors of energy, industry, retail, transport, consumer, security, and services. However, there is also an ardent need for present healthcare systems to improve informatically. IoT is and will be revolutionizing the healthcare industry by improving proficiency, lowering costs. The main emphasis of healthcare organizations is well-organizing operations and producing enhanced services to their patients. Wireless mobile computing technology has the capability to provide the appropriate advantages and should be a crucial part of today's healthcare information system. E-Health can make the health system stronger by focusing on the interaction between ICT and health system- the development, deployment and the use of these technologies to assist health system aims and purposes. By amalgamation of IT-based communication with healthcare practices, e-Health assures an approach to health information, prognosis, and treatment. The interdisciplinary nature of the IoT model requires collaborative attempts from other fields such as service computing and data mining to strengthen the processing and utilization of the IoT model in the Biomedical Engineering and the health care industry. [ABSTRACT FROM AUTHOR]

Abstract Background Despite considerable institutional experimentation at national and international levels in response to calls for global health security reform, there is little research on organisational models that address outbreak preparedness and response. Created in the aftermath of the 2013–16 West African Ebola epidemic, the United Kingdom’s Public Health Rapid Support Team (UK-PHRST) was designed to address critical gaps in outbreak response illuminated during the epidemic, while leveraging existing UK institutional strengths. The partnership between the government agency, Public Health England, and an academic consortium, led by the London School of Hygiene and Tropical Medicine, seeks to integrate outbreak response, operational research and capacity building. We explored the design, establishment and early experiences of the UK-PHRST as one of the first bodies of its kind globally, paying particular attention to governance decisions which enabled them to address their complex mission. Methods We conducted a qualitative case study using 19 in-depth interviews with individuals knowledgeable about the team’s design and implementation, review of organisational documents, and observations of meetings to analyse the UK-PHRST’s creation, establishment and initial 2 years of operations. Results According to key informants, adopting a triple mandate (response, research and capacity building) established the team as novel in the global epidemic response architecture. Key governance decisions recognised as vital to the model included: structuring the team as a government-academic collaboration which leveraged long-term and complementary UK investments in public health and the higher education sector; adopting a more complex, dual reporting and funding structure to maintain an ethos of institutional balance between lead organisations; supporting a multidisciplinary team of experts to respond early in outbreaks for optimal impact; prioritising and funding epidemic research to influence response policy and practice; and ensuring the team’s activities reinforced the existing global health architecture. Conclusion The UK-PHRST aims to enhance global outbreak response using an innovative and integrated model that capitalises on institutional strengths of the partnership. Insights suggest that despite adding complexity, integrating operational research through the government-academic collaboration contributed significant advantages. This promising model could be adopted and adapted by countries seeking to build similar outbreak response and research capacities.

Abstract Background Chinese Center for Disease Control and Prevention (China CDC) introduced the Structured Operational Research Training Initiative (SORT IT) into China to build a special capacity and equip public health professionals with an effective tool to support developing countries in strengthening their operational research. The paper aims to investigate and analyze the implementation, outcomes and challenges of the first cycle of SORT IT in China. Main text As a result of the successful implementation, SORT IT China, Cycle 1 has demonstrated fruitful outputs as exemplified by the 18-month follow-up to the post-training initiatives of the twelve participants, who all achieved the four milestones required by SORT IT. Eleven of twelve (92%) manuscripts generated that focused on the prevention and control of malaria, influenza, HIV/AIDS, hepatitis B, schistosomiasis, tuberculosis and Japanese encephalitis were published by peer-reviewed international journals with the impact factor ranging from 2.6 to 4.8. The most up-to-date citation count on February 19, 2021 was 53 times out of which 31 times were cited by Science Citation Index papers with 94.827 impact factor in total. Six senior professionals from China CDC also facilitated the whole SORT IT training scheme as co-mentors under the guidance of SORT IT mentors. The twelve participants who gained familiarity with the SORT IT courses and training principles are likely become potential mentors for future SORT IT, but they as the non-first language speakers/users of English also faced the challenge in thoroughly understanding the modules delivered in English and writing English academically to draft the manuscripts. Conclusion The outcomes from the first cycle of SORT IT in China have led to studies contributing to narrowing the knowledge gap among numerous public health challenges nationally and internationally. It is believed the researchers who participated will continue to apply the skills learned within their domain and help build the training capacity for future operational research courses both in China and in developing countries with similar needs. Graphic Abstract

BackgroundDespite high closure rates, residual urinary incontinence remains a common problem after successful closure of a vesico-vaginal fistula. The objective of this study was to identify factors associated with residual urinary incontinence in women with successful fistula closure in sites supported by the Fistula Care Plus project in the Democratic Republic of Congo (DRC).Material and MethodsThis was a retrospective cohort study using routine data extracted from the medical records of women undergoing fistula surgery in three hospitals supported by the Fistula Care Plus project in DRC between 2017 and 2019. We analyzed factors associated with residual urinary incontinence among a subsample of women with closed fistula at discharge. We collected data on sociodemographic, clinical, gynecological-obstetrical characteristics, and case management. Univariate and multivariate analyses were performed to determine the factors associated with residual urinary incontinence.ResultsOverall, 31 of 718 women discharged with closed fistula after repair (4.3%; 95% CI: 3.1–6.1) had residual incontinence. The leading causes identified in these women with residual incontinence were urethral voiding (6 women), short urethra (6 women), severe fibrosis (3 women) and micro-bladder (2 women). The prevalence of residual incontinence was higher among women who received repair at the Heal Africa (6.6%) and St Joseph's (3.7%) sites compared with the Panzi site (1.7%). Factors associated with increased odds of persistent urinary incontinence were the Heal Africa repair site (aOR: 54.18; 95% CI: 5.33–550.89), any previous surgeries (aOR: 3.17; 95% CI: 1.10–9.14) and vaginal surgical route (aOR: 6.78; 95% CI: 1.02–45.21).ConclusionPrior surgery and repair sites were the main predictors of residual incontinence after fistula closure. Early detection and management of urinary incontinence and further research to understand site contribution to persistent incontinence are needed.

As e-commerce expands, more and more products are offered online to attract internet consumers' interest. These products are then shipped to consumers' home by a drop-shipper. Drop-shipping seems to be a good option to sell products in addition to physical stores. Furthermore, both types of products, either sold in store or on Internet can be returned by consumers, with often a higher return ratio for those purchased on Internet. To model these two sales channel and the interactions between them, we consider a News-Vendor (NV) managing both a physical store and an online sale channel that can be fulfilled by a drop-shipping option. We also consider the possibility of reselling products that are returned by consumers during the selling season. The concavity of the expected profit is proven and the optimality condition is obtained. Promising results are obtained from a numerical analysis. In particular, we show that the expected profit can be 14.4% less than the optimal expected profit if the return effect is ignored. Using drop-shipping option can reduce the optimal store inventory by 31.2% and if the NV has no drop-shipping option, the expected profit can be 9% less. [ABSTRACT FROM AUTHOR]

This article aims to test the weight that main sub-components of the global competitiveness index might have on the logistics performance index. We deploy a novel technique based on three newly particularised clusters (‘infrastructure’, ‘institutions’ and ‘human factor’) to look into whether such clusters are related to efficiency in the 28 European Union’s countries. It is manifest that the human factor is far more important for improving the logistics performance index than infrastructure and institutions. It follows that in this new domain of analysis, all initiatives to prioritise investment on the human factor are appropriate means of stimulating innovation and economic outlook, perceived that the logistics sector accounts for an average of 10% of the European Union’s GDP. [ABSTRACT FROM PUBLISHER]