Global Set Research Articles

Rabies control in Bangladesh and prediction of human rabies cases by 2030: a One Health approach

Bangladesh is making progress toward achieving zero dog-mediated rabies deaths by 2030, a global goal set in2015. Drawing from multiple datasets, including patient immunisation record books and mass dog vaccination (MDV) databases, we conducted a comprehensive analysis between 2011 and 2023 to understand the effectiveness of rabies control programmes and predict human rabies cases in Bangladesh by 2030 using time-series forecasting models. We also compared rabies virus sequences from GenBank in Bangladesh and other South Asian countries. The estimated dog population in Bangladesh was determined to be 1,668,140, with an average dog population density of 12.83 dogs/km2 (95% CI 11.14-14.53) and a human-to-dog ratio of 86.70 (95% CI 76.60-96.80). The MDV campaign has led to the vaccination of an average of 21,295 dogs (95% CI 18,654-23,935) per district annually out of an estimated 26,065 dogs (95% CI 22,898-29,230). A declining trend in predicted and observed human rabies cases has been identified, suggesting that Bangladesh is poised to make substantial progress towards achieving the 'Zero by 30' goal, provided the current trajectory continues. The phylogenetic analysis shows that rabies viruses in Bangladesh belong to the Arctic-like-1 group, which differs from those in Bhutan despite sharing a common ancestor. Bangladesh's One Health approach demonstrated that an increase in MDV and anti-rabies vaccine (ARV) resulted in a decline in the relative risk of human rabies cases, indicating that eliminating dog-mediated human rabies could be achievable. The study was supported by the Communicable Disease Control (CDC) Division of the Directorate General of Health Services (DGHS) of the People's Republic of Bangladesh.

The extent of interruptions to primary care medical officers' consultations in the Western Cape.

Administrative tasks are an increasing burden for primary care doctors globally and linked to burnout. Many tasks occur during consultations. They cause interruptions with possible effects on patients' and doctors' experiences and care. The burden and typology of interruptions of doctors in primary care consultations have not been studied in South Africa. Given the link between administrative loads and burnout, describing the extent of these interruptions would help. This study's aim was to assess the extent of interruptions on primary care doctors in the Western Cape. This was a descriptive cross-sectional survey. Doctors from rural and urban primary care clinics in the Western Cape answered an online self-administered survey on the types of interruptions experienced during consultations. Interruptions were categorised and their prevalence calculated. Clinical and non-clinical interruption categories were compared. There were 201 consultations from 30 doctors. Most interruptions were from retrieving and recording the current patient's information (93.0%), paperwork for other patients (50.7%), and telephone calls about the current patient (41.8%). Other prevalent interruptions were for emergencies (39.8%) and acquiring consumables (37.3%). The median (interquartile range [IQR]) of four (2-4) interruption types per consultation was higher than global settings. Doctors experienced many interruptions during consultations. Their wide range included interruptions unrelated to the current patient.Contribution:This study adds insights from the global south on clinicians' administrative burden. It elaborates on the types of activities that interrupt consultations in an upper-middle income primary care setting. Exploration of interventions to decrease this burden is suggested.

A more equitable approach to economic evaluation: Directly developing conceptual capability wellbeing attributes for Tanzania and Malawi

Capability wellbeing can potentially provide a holistic outcome for health economic evaluation and the capability approach seems promising for African countries. As yet there is no work that has explored the evaluative space needed for health and care decision making at the whole population level and procedures that merely translate existing measures developed in the global north to contexts in the global south risk embedding structural inequalities. This work seeks to elicit the concepts within the capability wellbeing evaluative space for general adult populations in Tanzania and Malawi. Semi-structured interviews with 68 participants across Tanzania and Malawi were conducted between October 2021 and July 2022. Analysis used thematic coding frames and the writing of analytic accounts. Interview schedules were common across the two country settings, however data collection and analysis were conducted independently by two separate teams and only brought together once it was clear that the data from the two countries was sufficiently aligned for a single analysis. Eight common attributes of capability wellbeing were found across the two countries: financial security; basic needs; achievement and personal development; attachment, love and friendship; participation in community activities; faith and spirituality; health; making decisions without unwanted interference. These attributes can be used to generate outcome measures for use in economic evaluations comparing alternative health interventions. By centring the voices of Tanzanians and Malawians in the construction of attributes that describe a good life, the research can facilitate greater equity within economic evaluations across different global settings.

Sustainable Development Goals Need for India to Refocus on Measurement and Monitoring

The first and most important Global Goal set in the Charter of Sustainable Development Goals (SDGs), adopted by the United Nations in 2015, is “NO POVERTY.” Countries estimate the extremely poor population based on the International Poverty Level (IPL), which uses Global Purchase power parities (PPP) set by the World Bank International Comparison program. Some claims state that India has made substantial progress in fighting extreme poverty during the last few decades. Published data shows there is no headcount below the National Poverty line. This paper attempts to study the relevance of the national statistical data sets on the limits and levels for the poverty line in India as against the international poverty level, taking into consideration of the Purchasing Power Index, Gross GDP, and per capita GDP, Gross National Income, and Per capita Income, minimum wedge regulations, and the critical parameters for the Hunger Index.

Satellite mapping and demarcation analysis for coastal regulation zones assessment

Rapid urbanization and expanding tourism have led to widespread encroachments, particularly in flood-prone areas, where land degradation is more likely. Conventional methods of on-foot inspections for detecting these encroachments are intricate and time-consuming. A scarcity of data has resulted in undocumented violations, prompting the need for advanced technologies like satellite remote sensing. The current paper focuses on demonstrating the effectiveness of satellite remote sensing in detecting large-scale encroachments near flood-prone zones. Due to frequent undetected illegal constructions, Coastal Regulation Zones (CRZ) are a specific area of interest. This study employs a well-established method of analysis acquired from an extensive literature review to investigate illegal construction and encroachments via remote sensing advances. The research advocates for a practical analysis to combat illegal constructions in CRZs, presenting a comprehensive database through a concise portal for easy accessibility and analysis. The case study in Kerala, India, a region prone to natural disasters like monsoon floods, provides crucial data for measuring the boundaries required to preserve the ecosystem. The research underscores the significance of satellite remote sensing in efficiently addressing environmental threats posed by encroachments, offering insights applicable to regions facing similar challenges. This analysis has proven effective in diverse global settings and offers a standardized approach for demarking CRZ throughout the globe. Its adaptability and reliability across different terrain types and climatic conditions underscore its potential as a valuable tool in mapping encroachments. The current study contributes to the discourse on sustainable urban development, aiming to inform policies promoting resilience and ecological consciousness in rapid urbanization and tourism expansion.

Addressing Challenges for Psychotherapy Supervision in Global Mental Health: Experiential Learnings From Rural Nepal.

As the field of global mental health grows, many psychotherapy trainees will work across cultures in low-resource settings in high-income countries or in low- and middle-income countries. Faculty members and mentors may face several challenges in providing supervision for psychologists in low-resource settings. As such, there is a need to develop best practices for psychotherapy supervision in global mental health. We describe the common challenges and potential strategies in psychotherapy supervision based on our research, clinical, and academic partnerships between academic institutions, a nonprofit organization, and the Nepali government. The strategies and considerations we have found helpful include focusing on therapies with strong behavioral and interpersonal (rather than emotional or cognitive) components and using locally validated therapies or standard manuals that have been endorsed by the WHO for low-resource settings. Other strategies include providing psychotherapy training for local psychiatrists who may be in supervisory roles and gaining competence in navigating different expectations of social structures and family dynamics. Supervisors face many challenges while supporting trainees and early psychologists in global mental health settings. While ensuring local adaptation, key considerations can be developed into best practices to support psychiatrists, supervisors, and trainees based in low- and middle-income countries.

The 2023 Gerard W. Ostheimer Lecture. A Contemporary Narrative Review of Maternal Mortality and Morbidity: Opportunities to Improve Peripartum Outcomes.

The Gerard W. Ostheimer lecture is given annually to members of the Society for Obstetric Anesthesia and Perinatology. This lecture summarizes new and emerging literature that informs the clinical practice of obstetric anesthesiology. This is a narrative review of 2022 literature pertinent to maternal morbidity and mortality in all income settings globally. Themes associated with worse maternal mortality rate (MMR), challenges health care workers face, public health priority areas, and initiatives to help countries achieve the United Nations Sustainable Development Goal targets for MMR are discussed. MMRs are higher in low- and middle-income countries (LMICs) compared to high-income countries (HICs). Cesarean delivery rates are rising most rapidly in LMICs, warranting urgent maternal health care workforce planning efforts in these settings. Globally racial, ethnic, and geographical disparities in maternal mortality continue to be evident in global health care settings. In the United States, the MMR is rising. The evolving changes in abortion legislation in the United States may further negatively impact maternal morbidity and mortality. The need to implement American Society of Anesthesiologists-recommended obstetric anesthesia quality metrics to facilitate benchmarking and to improve patient experience and outcomes is discussed as well as the need for professional society guidance on minimum staffing levels in American labor and delivery units.

Strengthening and Preserving a Culture of Academic Integrity in Global Higher Educational Settings

Despite efforts to eradicate academic dishonesty in educational settings, the phenomenon persists and cheating is increasingly becoming easier due to the advancement of information technology. Factors like peer pressure, time constraints, stress, and workload contribute to dishonest behavior among students. This article emphasizes the importance of academic integrity in higher education, aiming to prevent dishonesty, understand its effects, and discourage fraudulent activities. Solutions to this problem include fostering a culture of academic integrity throughout institutions and encouraging students to critically evaluate theories, maintain morality, produce unique work, and properly credit sources contributes to preserving a culture of academic integrity. Text-matching and proctored software can aid in detecting offenders and reinforces academic integrity

Including the voice of children

Despite evidence of the benefits of including children's voices in global health research, they continue to be underrepresented. Implementation of how to include children's voices appears to remain an obstacle to their inclusion in global health research. In this manuscript, we present an epistemological frame that advocates children as experts of their own experiences and knowledge-bearers. Then we provide four case studies, to illustrate ongoing efforts to build equity in the design and execution of paediatric health research. Ensuring children's equitable inclusion requires recognizing them as active participants in their health and wellbeing, and empowering them to employ their agency in all interactions with researchers, while recognizing the dialogical nature of those interactions. Successfully involving children in global health research can lead to important psychosocial and clinical insights, that could be leveraged to inform future treatment and care practices. We present four case studies describing the inclusion of children in research and research development related to prevention, treatment and/or care of chronic and acute diseases (tuberculosis, HIV, cervical and other forms of cancer) in a number of global settings including India, Philippines, South Africa, United States, Zambia. The exemplars detail novel applications of a diversity of arts-based methods that are rooted in frameworks for participatory action research. They highlight the need to invest funds, training, time and resources for early and sustained engagement with children throughout the research process. We conclude by offering principles for equitably engaging children in global health research.

RWD130 European Health Data Space (EHDS) Requires Secure Processing Environments (SPEs) – Comparison of SPESiOR to Other SPE-Type Environments from Finnish, Nordic, European, and Global Settings

RWD130 European Health Data Space (EHDS) Requires Secure Processing Environments (SPEs) – Comparison of SPESiOR to Other SPE-Type Environments from Finnish, Nordic, European, and Global Settings

Development and external validation of the ‘Global Surgical-Site Infection’ (GloSSI) predictive model in adult patients undergoing gastrointestinal surgery

Abstract Background Identification of patients at high risk of surgical-site infections may allow surgeons to minimize associated morbidity. However, there are significant concerns regarding the methodological quality and transportability of models previously developed. The aim of this study was to develop a novel score to predict 30-day surgical-site infection risk after gastrointestinal surgery across a global context and externally validate against existing models. Methods This was a secondary analysis of two prospective international cohort studies: GlobalSurg-1 (July–November 2014) and GlobalSurg-2 (January–July 2016). Consecutive adults undergoing gastrointestinal surgery were eligible. Model development was performed using GlobalSurg-2 data, with novel and previous scores externally validated using GlobalSurg-1 data. The primary outcome was 30-day surgical-site infections, with two predictive techniques explored: penalized regression (least absolute shrinkage and selection operator (‘LASSO’)) and machine learning (extreme gradient boosting (‘XGBoost’)). Final model selection was based on prognostic accuracy and clinical utility. Results There were 14 019 patients (surgical-site infections = 12.3%) for derivation and 8464 patients (surgical-site infections = 11.4%) for external validation. The LASSO model was selected due to similar discrimination to extreme gradient boosting (AUC 0.738 (95% c.i. 0.725 to 0.750) versus 0.737 (95% c.i. 0.709 to 0.765)), but greater explainability. The final score included six variables: country income, ASA grade, diabetes, and operative contamination, approach, and duration. Model performance remained good on external validation (AUC 0.730 (95% c.i. 0.715 to 0.744); calibration intercept −0.098 and slope 1.008) and demonstrated superior performance to the external validation of all previous models. Conclusion The ‘Global Surgical-Site Infection’ score allows accurate prediction of the risk of surgical-site infections with six simple variables that are routinely available at the time of surgery across global settings. This can inform the use of intraoperative and postoperative interventions to modify the risk of surgical-site infections and minimize associated harm.

Etiology of hospital mortality in children living in low- and middle-income countries: a systematic review and meta-analysis.

In 2019, 80% of the 7.4 million global child deaths occurred in low- and middle-income countries (LMICs). Global and regional estimates of cause of hospital death and admission in LMIC children are needed to guide global and local priority setting and resource allocation but are currently lacking. The study objective was to estimate global and regional prevalence for common causes of pediatric hospital mortality and admission in LMICs. We performed a systematic review and meta-analysis to identify LMIC observational studies published January 1, 2005-February 26, 2021. Eligible studies included: a general pediatric admission population, a cause of admission or death, and total admissions. We excluded studies with data before 2,000 or without a full text. Two authors independently screened and extracted data. We performed methodological assessment using domains adapted from the Quality in Prognosis Studies tool. Data were pooled using random-effects models where possible. We reported prevalence as a proportion of cause of death or admission per 1,000 admissions with 95% confidence intervals (95% CI). Our search identified 29,637 texts. After duplicate removal and screening, we analyzed 253 studies representing 21.8 million pediatric hospitalizations in 59 LMICs. All-cause pediatric hospital mortality was 4.1% [95% CI 3.4%-4.7%]. The most common causes of mortality (deaths/1,000 admissions) were infectious [12 (95% CI 9-14)]; respiratory [9 (95% CI 5-13)]; and gastrointestinal [9 (95% CI 6-11)]. Common causes of admission (cases/1,000 admissions) were respiratory [255 (95% CI 231-280)]; infectious [214 (95% CI 193-234)]; and gastrointestinal [166 (95% CI 143-190)]. We observed regional variation in estimates. Pediatric hospital mortality remains high in LMICs. Global child health efforts must include measures to reduce hospital mortality including basic emergency and critical care services tailored to the local disease burden. Resources are urgently needed to promote equity in child health research, support researchers, and collect high-quality data in LMICs to further guide priority setting and resource allocation.

Modeling the distribution of enzymes on lipid vesicles: A novel framework for surface-mediated reactions in coagulation

Blood coagulation is a network of biochemical reactions wherein dozens of proteins act collectively to initiate a rapid clotting response. Coagulation reactions are lipid-surface dependent, and this dependence is thought to help localize coagulation to the site of injury and enhance the association between reactants. Current mathematical models of coagulation either do not consider lipid as a variable or do not agree with experiments where lipid concentrations were varied. Since there is no analytic rate law that depends on lipid, only apparent rate constants can be derived from enzyme kinetic experiments. We developed a new mathematical framework for modeling enzymes reactions in the presence of lipid vesicles. Here the concentrations are such that only a fraction of the vesicles harbor bound enzymes and the rest remain empty. We call the lipid vesicles with and without enzyme TF:VIIa+ and TF:VIIa− lipid, respectively. Since substrate binds to both TF:VIIa+ and TF:VIIa− lipid, our model shows that excess empty lipid acts as a strong sink for substrate. We used our framework to derive an analytic rate equation and performed constrained optimization to estimate a single, global set of intrinsic rates for the enzyme–substrate pair. Results agree with experiments and reveal a critical lipid concentration where the conversion rate of the substrate is maximized, a phenomenon known as the template effect. Next, we included product inhibition of the enzyme and derived the corresponding rate equations, which enables kinetic studies of more complex reactions. Our combined experimental and mathematical study provides a general framework for uncovering the mechanisms by which lipid mediated reactions impact coagulation processes.

Strategies for academic nursing to advance global and planetary health: A call to action

Nurses play a crucial role in addressing human health influenced by global forces such as pandemics, and political conflicts that displace millions; in leading efforts to promote planetary health; and in achieving the United Nations (UN) Sustainable Development Agenda. Academic nursing programs have a significant role in actualizing nursing's impact on global health (GH) and planetary health (PH). This paper describes how nursing programs can actualize their GH and PH nursing perspectives to benefit students and society, thereby increasing nursing's effectiveness and improving health outcomes in local and global settings. Numerous strategies to actualize GH and PH perspectives were derived from current literature and an assessment of eleven nursing program websites. Nursing programs may adopt program-wide strategies such as reflecting GH and PH in their mission statement; through education, in courses; and through faculty or student scholarship, policy endeavors, and/or partnerships. Now is the time to take such action, recommitting to GH and PH nursing and deepening nursing's impact. Academic nursing programs' leadership role in society, and their role in preparing nurses to lead, educate, discover, and advocate is essential for the health of populations and the planet long into the future.

A Shape-Preserving Variational Spline Approximation Problem for Hole Filling in Generalized Offset Surfaces

In the study of some real cases, it is possible to encounter well-defined geometric conditions, of an industrial or design type—for example, the case of a specific volume within each of several holes. In most of these cases, it is recommended to fulfil a function defined in a domain in which information is missing in one or more sub-domains (holes) of the global set, where the function data are not known. The problem of filling holes or completing a surface in three dimensions appears in many fields of computing, such as computer-aided geometric design (CAGD). A method to solve the shape-preserving variational spline approximation problem for hole filling in generalized offset surfaces is presented. The existence and uniqueness of the solution of the studied method are established, as well as the computation, and certain convergence results are analyzed. A graphic and numerical example complete this study to demonstrate the effectiveness of the presented method. This manuscript presents the resolution of a complicated problem due to the study of some criteria that can be traduced via an approximation problem related to generalized offset surfaces with holes and also the preservation of the shape of such surfaces.

Capacity assessment of railway axle journal bearing addressing a localized rolling contact fatigue failure mechanism

Abstract A framework for assessing the capacity of railway axle journal bearings is presented after elaborating on the locale rolling contact fatigue (RCF) failure mechanism. Three phases are conducted, including the determination of bearing service loads, finite element analysis (FEA) on the localized RCF stresses of bearing components, and the life-related capacity assessment on the bearings and bearing components. Results prove that wheel-track (WT) contact forces inspected by an instrumented wheel set can be transferred into bearing service loads. Two-step FEA from the global wheel set to the local bearings is used to obtain localized RCF stresses at dangerous locations around the bearing contact regions. After determining the locations, a life-related capacity assessment is performed by evaluating equivalent RCF stresses and lives at the locations to determine the weakest bearing component. Typical practice is given in agreement with FEA. This method deals with the FEA of bearing structures, material cyclic stress-strain curves, and probabilistic RCF life curves. Therefore, this work greatly enhances the development of rail-bearing materials, innovative structures, and capacity assessment.

Innovative performance-based remuneration model for oncologists: Balancing productivity with quality of care in a Brazilian healthcare setting.

e23089 Background: Traditional fee-for-service (FFS) models in oncology often lead to biased healthcare delivery, prioritizing quantity over quality of care. Our objective was to develop and implement a comprehensive remuneration model for oncologists in Brazil that emphasizes both productivity and quality in patient care. Methods: The '4E' model forms the basis of our remuneration strategy. 'Effectiveness' measures clinical productivity through patient consultations, treatments, and participation in multidisciplinary activities. 'Structure' evaluates academic credentials and scientific contributions, 'Efficiency' examines adherence to clinical and administrative protocols, and 'Excellence' assesses quality interactions with patients and healthcare systems. These elements provide nuanced bonus adjustments to the effectiveness score, facilitating a balanced and comprehensive compensation approach. Adapted to various healthcare settings, the model accommodates different budgeting methodologies. Results: Implemented in February 2020, the model has led to significant improvements in service delivery. Between May 2020 and August 2023, consultations in private services increased by 36.8%, and patient numbers grew by 42.2%. The financial impact was notable, with more than a doubling of revenue, reflecting the model's success in enhancing both the volume and quality of healthcare provision. Conclusions: This multi-level remuneration model offers a comprehensive, ethical approach, aligning physician compensation with a broad range of professional activities and responsibilities. It demonstrates potential for enhancing healthcare delivery quality while ensuring financial sustainability. However, a limitation of our study is the lack of longitudinal quality measurement, an aspect we aim to address in future research. This suggests the model's replicability in diverse global oncology settings and underscores its relevance in the current healthcare landscape.

A Mobile Health Design Process to Improve User Engagement

It has been shown that less than 25 percent of people continue to use health and wellness apps after the first time they use them. Despite the importance of user engagement for the efficacy of such apps and mobile health (mHealth) systems, many of these interventions frequently do not incorporate user-engaging attributes. This is partly because user needs and other sociocultural contexts are overlooked during the mHealth design, development, and implementation stages. These sociocultural contexts influence users' behaviours, and thus it is critical to capture this across the various stages of mHealth design and development. Based on this, a research gap was identified, leading to the development of the following research question targeting community health workers in Global South settings: How can a design framework be developed to improve community health workers (CHWs) engagement in mHealth technologies? The aim is PhD thesis is to develop an mHealth design process (or framework) called the Design Process Engagement Enhancement System (DECENT) which takes account of socio-cultural contexts in the design process of mHealth systems and improves community health workers' engagement with the designed mHealth technology. This framework is intended to be used by mHealth designers and developers in the field of mHealth. There are three contributions from this thesis. First, the expansion of O'Briens and Toms' engagement model. The process of expanding the engagement model resulted in the identification of engagement themes that have an impact on stages of engagement with mHealth that end users encounter in an mHealth setting. Second, this work makes an important contribution to practice. The DECENT framework is intended to be used by NGOs and mHealth practitioners. Finally, the contribution to theory by developing an analytical and methodological framework for analyzing frameworks based on activity the (AT) and communicative ecology framework (CEF).

Estimation of the optimal radiotherapy utilization rate for childhood neuroblastoma

Background and purposeThe optimal utilization rate of radiotherapy (oRUR) serves as a benchmark for assessing service demand and improving access to cancer care. While it is estimated that approximately 50 % of adult cancer patients require external beam radiotherapy during their treatment, there is a scarcity of data regarding the optimal use of radiotherapy in pediatric cancer. In this study, we adopted an established method and developed a model to estimate the oRUR in childhood neuroblastoma. Materials and methodsWe developed a decision tree model to calculate the oRUR using indications for radiotherapy and corresponding epidemiological data collected through systematic review and meta-analysis. Sensitivity analyses were performed to evaluate the impact of variations in radiotherapy indications between treatment protocols and variables in the model. We calculated and compared the oRUR for global, high-income, and low- and middle-income settings. ResultsThe oRUR for pediatric neuroblastoma was 64 % (95 % CI: 58 %–71 %) in the global setting, 50 % in high-income countries, and 68 % in low- and middle-income countries. The impact of variation in radiotherapy indications between major international treatment protocols was negligible. ConclusionThe knowledge of oRUR is crucial for evaluating current practices, identifying gaps in access, and planning future radiotherapy services for treating childhood cancer. Based on our results, 64 % of children with neuroblastoma have an indication for radiotherapy. Patients in low- and middle-income countries have more indications for radiotherapy than those in high-income countries, due to a more adverse tumour stage distribution caused by limited access to healthcare resources.

Strategies Adopted by Employees Toward Meeting the Requirements of International Company Needs and Developing Global Efficiency

"In the modern world, the international company cultivates a culture on a global scale. Employees face challenges in adapting to critical international cultural levels. Employees need to develop skills, language proficiency, and cultural understanding based on the needs and requirements of international company strategies for the work culture. Employees must develop communication skills to interact with colleagues and clients worldwide. Employees are encouraged to learn multiple languages to engage with different cultures for global business activities. They can leverage technology to bridge geographical gaps. With the rise of virtual collaboration tools, employees can now work seamlessly across borders. By embracing digital platforms and staying up-to-date with the latest technology trends, employees can enhance their productivity and contribute to global efficiency. They can seek training opportunities that specifically address the challenges of working in an international context, such as cross-cultural communication or global project management. By embracing cultural intelligence, enhancing language skills, leveraging technology, and investing in continuous learning, employees can play a vital role in driving the success of international organizations in today's interconnected world. To achieve these goals, employees can adopt several strategies that help them navigate the challenges of working in a global setting."