Operational Factors Research Articles

Physical Restraint Use in Hospitalized Patients: A Study of Routinely Collected Health Records Data.

The use of restraints in hospitalized patients is associated with physical and psychological adversity for patients and staff. The minimization of restraint use is a key goal in the hospital setting. Reaching this goal requires an accurate assessment of existing patterns of use across clinical settings. This study reports the rate of physical restraints among patients hospitalized within a multi-entity healthcare network along with stratification by care context, diagnostic, and demographic factors, and examines the sensitivity and specificity of ICD-10 code Z78.1 "physical restraint status" for defining physical restraints relative to electronic health record (EHR) documentation. The EHR was used for a retrospective analysis of all adults hospitalized between 2017 and 2022. Hospitalized adults. Patient demographics, structured diagnostic information, care area, length of stay, and in-hospital mortality, Z78.1 coding for physical restraints, restraint documentation in orders and flowsheets. Among 742,607 hospitalizations, 6.3% (n=47,041) involved the use of physical restraint based on coding or EHR documentation. Treatment in the intensive care unit (ICU) included restraint in 39% of encounters whereas treatment outside the ICU included restraint use in 1.3% of encounters. Besides critical illness, demographic factors including increasing age (adjusted odds ratio (aOR)=1.21 [1.19-1.23]), male gender (aOR=1.56, [1.52-1.60]), unknown race (aOR=1.27 [1.19-1.35]), and preferred language other than English (aOR=1.24, [1.18-1.29]) were associated with higher odds of restraint utilization. As compared to EHR orders or documentation of restraint, the ICD-10 code for physical restraint had a sensitivity of 1.5% and a specificity of 99.99%. Among adults admitted to acute care hospitals, clinical, demographic, and operational factors were associated with increased odds of restraint, with care in the ICU associated with greatly increased odds of restraint. Research into restraint utilization using coded administrative claims data is likely limited by the sensitivity of physical restraint coding.

Impact of Combining Iliac Branch Endoprosthesis and Physician-Modified Fenestrated-Branched Endovascular Repair for Complex Abdominal and Thoracoabdominal Aortic Aneurysms with Concomitant Iliac Artery Aneurysms

ObjectivesTreatment of iliac artery aneurysms (IAA) with the Iliac Branch Endoprosthesis (IBE) during endovascular repair of infrarenal abdominal aortic aneurysm (EVAR) has been well-documented as effective. However, limited data exists evaluating the safety and efficacy of treating complex abdominal (cAAA) and thoracoabdominal aortic aneurysms (TAAA) with associated IAA with combined physician-modified fenestrated branched endovascular aortic repair (PM-FBEVAR) and IBE. Moreover, limited studies exist assessing the impact of adding IBE on the outcomes following PM-FBEVAR. Therefore, we compared the clinical outcomes of patients who underwent PM-FBEVAR with and without IBE for the treatment of cAAA and TAAA. MethodsA single institution retrospective review of consecutive patients who underwent PM-FBEVAR between September 2015 and February 2021 was conducted. Patients with both unilateral and bilateral IBE implantation were included. Infected aneurysms and pseudoaneurysms were excluded. Demographics, technical success, and operative factors were analyzed. Primary outcomes were incidence of pelvic ischemia including buttock and thigh claudication, bowel and spinal cord ischemia, patency of internal and external limbs of IBE, and target vessel instability. Secondary outcomes included technical success, 30-day major adverse events (MAE), 30-day and all-cause mortality, and endoleaks. ResultsAmong 183 patients identified who underwent PM-FBEVAR, 22 patients underwent PM-FBEVAR and IBE with 3 patients treated with bilateral IBEs. There was no pelvic ischemia in the PM-FBEVAR and IBE group. Technical success, fluoroscopy time, and procedure time were comparable between the two groups. Contrast usage was higher in the PM-FBEVAR and IBE group (p=0.01). Thirty-day MAE and mortality were not statistically different between the two groups. At mean follow-up of 23 months, all-cause mortality was similar for both groups (21% vs 27%; p=0.47). Patency of internal iliac artery limb and external iliac artery limb of the IBE were 96% (24 of 25) and 100%, respectively, during mean follow-up of 23 months. The patient with occlusion of internal iliac limb was asymptomatic and received no re-intervention. ConclusionTreatment of cAAA and TAAA associated with IAA using combined PM-FBEVAR and IBE is feasible with high efficacy and safety, and without adverse effect on outcomes. Long-term follow-up is planned to assess durability of repair with PM-FBEVAR and IBE.

Effect of Gas Exchange Rate, Vessel Type, Planting Density, and Genotype on Growth, Photosynthetic Activity, and Ion Uptake of In Vitro Potato Plants.

The growth of high-quality in vitro potato plants (Solanum stenotomum subsp. stenotomum, Solanum stenotomum subsp. goniocalyx, and Solanum tuberosum subsp. andigena) is affected by multiple biological, operational, and environmental factors. Research on in vitro culture is frequently focused on the species, explant, composition of the culture medium, and incubation conditions, but only limited information is available on the effect of the gas exchange rate and volume of in vitro culture vessels under variable planting densities. In the present study, these factors were evaluated with a set of seven diverse potato landraces. The results were compared to the plants' responses in routinely used in vitro culture vessels, i.e., 13 × 100 mm and 25 × 150 mm test tubes, and GA7® magenta vessels. In vitro potato plants grown in plastic vessels equipped with a HEPA filter delivering a high gas exchange rate developed thicker stems (0.95 mm), a higher total average leaf area (2.51 cm2), increased chlorophyll content in leaves (32.2 ppm), and lower moisture content in their tissues (90.1%) compared to filter systems with lower gas exchange rates. A high planting density of 10 × 10 plants per vessel (360 and 870 mL) negatively affected the average stem width and root length but increased the plant height (3.4 cm). High fluctuations of ion-uptake of NO3-, Ca++, K+, and Na+ were observed between genotypes, with some accessions having a 4.6-times higher Ca++-ion concentration in their tissues (190-234 ppm). The in vitro plants developed more robust stems, longer roots, and larger leaves within in vitro culture vessels equipped with a HEPA filter (high gas exchange rate) compared to the control vessels, in contrast to the chlorophyll content in leaves, which was higher in plants grown in narrow test tubes. Depending on the purpose of the subculture of in vitro plants, their growth and development can be molded using different gas exchange rates, planting densities, and vessel volumes.

Comprehensive Analysis of Needle Bearing Failures in Fuel Transfer Pumps: Insights from Testing and Finite Element Analysis

<div>This study investigates the failure mechanisms of needle bearings within fuel transfer pump assemblies through a comprehensive approach combining endurance testing, detailed inspection, the Dykem blue method, proximity sensors, and finite element analysis (FEA). The findings reveal critical insights into the causes of failure, highlighting significant axial displacement, with a maximum of 0.37 mm measured by proximity sensors. The Dykem technique identified distinct wear patterns across various components, pinpointing areas of high stress and potential failure. Detailed bearing inspections uncovered trunnion damage and abrasive wear, corroborated by FEA, which quantified displacements of 0.144 mm in the x-direction, 0.030 mm in the y-direction, and 0.015 mm in the z-direction. The primary operational factors contributing to bearing failure were contamination and inadequate axial control. These insights are pivotal, as they align with and expand upon established literature on bearing failures, providing a deeper understanding of the interplay between mechanical wear and operational conditions. Despite the robustness of the methodology, challenges included ensuring the accuracy of axial displacement measurements and replicating real-world operational stresses in a controlled environment. The study proposes several recommendations to enhance axial support and optimize system design to mitigate the identified issues. The societal impact of this research is significant, offering potential improvements in machinery reliability, which can lead to enhanced industrial efficiency and safety standards. This work advances the current knowledge in the field and provides practical solutions for extending the lifespan and performance of critical mechanical components in fuel transfer systems.</div>

Relationship Between Operational Factors and Cost Efficiency in Defined Contributions Pension Schemes

Pension schemes in Kenya provide income for individuals who attain the retirement age and consequently boost economic growth as well as accelerate domestic savings. The industry is regulated by the Retirement Benefits Authority (RBA). The purpose of the study was to determine the relationship between operational practices on cost efficiency in defined contributions pension schemes in Kenya. The specific objectives were to determine the relationship between service provider costs on cost efficiency in defined contributions pension schemes, to examine the relationship between fund size on cost efficiency in defined contributions pension schemes, to determine the relationship between portfolios mix on cost efficiency in defined contributions pension schemes and to examine the relationship between investment strategy on cost efficiency in defined contributions pension schemes. The study will be significant to the management of defined contributions pension schemes in Kenya and other researchers. The study adopted a descriptive research design. The target population was all the 1,262 pension schemes in Kenya. Stratified random sampling was employed to select small schemes, medium schemes, large schemes and mega pension schemes in Kenya and obtained a total of 304 sample population. The study used secondary data. Descriptive statistics was performed by getting frequencies, means, and standard deviation for the purpose of understanding the results, which was displayed in tables, charts, and graphs. A multiple regression model was fitted to the data and the results revealed that there was a relationship between cost efficiency and service provision expenses, portfolio mix, fund size and investment strategies. Service provision expenses for a pension scheme should be able to cover the cost of administration without unduly compromising the growth of pension savings. Further, while a substantial fund size offered advantages, it should be complemented by strategic acumen and diligent oversight to ensure the scheme delivers on its mandate. A balanced and diversified portfolio is considered a cornerstone providing a buffer against market volatility and therefore enhancing the prospects of sustainable goals and cost efficiency. Finally, the cost associated with portfolio mix and risk management was a necessary investment in securing the long-term sustainability and stability of the pension fund. Recommendation for further studies on cost efficiency of defined benefits schemes should be done as well as further studies on challenges facing pension schemes in Kenya

Bibliometric Analysis of Global Research on Port Infrastructure Vulnerability to Climate Change (2012–2023): Key Indices, Influential Contributions, and Future Directions

This article analyzes the climate vulnerability of seaports through a bibliometric review of 45 articles published between 2012 and 2023. The research highlights the increase in publications focusing on the vulnerability of port infrastructure to climate impacts, a topic that previously received less attention compared to operational, economic, and logistical factors, which are frequently discussed in the existing literature. The analysis reinforces the relevance of this study, with the United States, Spain, and the United Kingdom emerging as the most influential countries in this research area. This article also reveals the predominance of methods based on the Coastal Vulnerability Index (CVI), which includes ports in its assessments, and emphasizes the need to develop a more robust index for evaluating port vulnerability. Additionally, it discusses current topics, such as sea level rise and the use of global climate models and suggests future research directions to enhance the assessment of port vulnerability in the face of climate change.

Operational and Design Factors in Air Staging and Their Effects on Fouling from Biomass Combustion

Operational and Design Factors in Air Staging and Their Effects on Fouling from Biomass Combustion

Anastomotic Leak and its Implications: A Multicenter Analysis of “Type C” Esophageal Atresia / Tracheo-esophageal fistula (EA/TEF)

PurposeRepair of type C esophageal atresia with tracheo-esophageal fistula (EA/TEF) may be complicated by esophageal anastomotic leak. Risk factors associated with leak and the impact of leak on inpatient outcomes remains uncertain. Our objectives are to estimate the associations between clinical factors and esophageal anastomotic leak and quantify the association of leak with length of stay (LOS) in infants who underwent repair of type C EA/TEF. MethodsUsing the Children’s Hospitals Neonatal Database (CHND), we identified infants with type C EA/TEF from 2021-2023. The main outcomes were anastomotic leak and LOS. Multivariable associations between patient and clinical factors and these outcomes were quantified using logistic regression (leak) and Cox proportional hazards modelling (LOS). ResultsAmong 365 infants at 36 centers, anastomotic leak occurred in 55 (15.1%) infants, and thoracoscopic approach, lower birthweight, small for gestational age less than 10th percentile, male sex, staged repair, ventricular septal defect, and center were independently associated with leak (area under receiver operating curve = 0.853). Also, LOS was increased in infants with leak compared to those without [hazard ratio (HR): 0.655, 95% CI = 0.431 – 0.996, p=0.044], independent of birth weight, surgical approach, male sex, or VSD. The adjusted LOS demonstrated a 11-fold inter-center variation (p=0.034). ConclusionsSeveral clinical and operative factors are associated with esophageal anastomotic leak in infants after type C EA/TEF repair. Leak significantly prolongs LOS. The magnitude of inter-center variability in LOS also suggests that identifying best practices could aid in improving patient care in this patient population. Type of StudyRetrospective Comparative Study Level of EvidenceIII

Comparison of Telemedicine Usage at Two Distinct Medicaid-Focused Pediatric Clinics.

Objective: To compare telemedicine versus office visit use at two Medicaid-focused pediatric primary care clinics. Methods: Retrospective cohort study from March 15, 2020 - March 15, 2021 at two Medicaid-focused pediatric primary care clinics. Site A and Site B care for different populations (Site B care for mostly immigrant families with preferred language Spanish). Outcomes included the percent of visits conducted through telemedicine and reason for visit. Descriptive statistics, univariable and multivariable mixed multilevel logistic regression, were used to assess relationship between patient demographics and telemedicine use. Results: Out of 17,142 total visits, 13% of encounters at Site A (n = 987) and 25% of encounters at Site B (n = 2,421) were conducted using telemedicine. Around 13.8% of well-child care (n = 1,515/10,997), 36.2% of mental health care (n = 572/1,581), and 25.0% of acute care/follow-up (n = 1,893/7,562) were telemedicine visits. After adjustment for covariates, there was no difference in odds of a patient having any telemedicine use by preferred language, sex, or payor. Patients 1-4 years of age had the lowest odds of telemedicine use. At Site A, patients who identified as Non-Hispanic Black (odds ratio [OR] = 0.33, 95% confidence interval [CI] = 0.24-0.45), Hispanic/Latinx (OR = 0.40, 95% CI = 0.24-0.66), or other race/ethnicity (OR = 0.35, 95% CI = 0.23-0.55) had lower odds of telemedicine use in comparison to Non-Hispanic White. Conclusions: Telemedicine was successfully accessed by Medicaid enrollees for different types of pediatric primary care. There was no difference in telemedicine use by preferred language and payor. However, differences existed by age at both sites and by race/ethnicity at one site. Future research should explore operational factors that improve telemedicine access for marginalized groups.

Bioprocess strategies for enhanced performance in single‐use bioreactors for biomolecule synthesis: A biokinetic approach

AbstractSingle‐use bioreactors (SUB) have made a significant impact on the field of bioprocessing, becoming increasingly popular for biomolecule synthesis due to their many advantages, such as minimizing contamination risks and streamlining processes. Extensive research has been conducted on the hydrodynamic conditions within single‐use bioreactors, with a focus on parameters like mixing time, oxygen transfer rate, and stress levels to improve cell cultivation procedures. Several studies have demonstrated that SUB can effectively nurture various cell types, including those that generate monoclonal antibodies, yielding outcomes similar to conventional bioreactor systems, thus highlighting their adaptability and effectiveness in biomolecule processing. SUB equipped with wave mechanisms have shown to display comparable metabolic behaviors and fermentation consistency to conventional bioreactors, confirming their dependability in supporting fungal growth and metabolite generation. Mechanical stirring for agitation leads to high shear forces alongside enhanced monitoring and control, influencing microbial physiology and macro‐morphologies. This underscores the importance of operational factors such as rocking speed, rocking angle, and gas flow rate. Overall, the integration of single‐use bioreactors in biomolecule synthesis is expected to expand, driven by the need for increased yields and cost‐effective manufacturing solutions.

Pengaruh Faktor Pengungkapan Corporate Social Responsibility

Research objective: To empirically test the influence of business risk, financial risk and operational risk on corporate social responsibility. The research object is gas, oil and coal sub-sector companies listed on the Indonesian stock exchange. The total sample was 17 companies for 5 years. Hypothesis testing uses the F test and t test. The results of the F test show that simultaneously business risk factors, financial risk factors and operational risk factors influence corporate social responsibility. Meanwhile, the results of the hypothesis using tests show that each factor of business risk, financial risk and operational risk has a partial effect on corporate social responsibility.

Systematization of the application of polymer composite materials in the design of bridge structures

Background. This study systematizes the principles of using polymer composite materials in bridge structure design, outlining the fundamental principles for calculating load-bearing structures of bridge spans featuring these materials. Aim. The goal is to enhance the strength and durability of bridge spans during construction and maintenance, while optimizing costs through the use of polymer composite materials. Materials and Methods. The research employs a modern approach to bridge structure design, utilizing mathematical statistics for experimental data analysis and numerical methods for calculating bridge structures using nonlinear deformation models of anisotropic materials. Results. Developed principles for designing bridge spans with polymer composite elements include methods for strengthening and reinforcing concrete bridge structures. These methods account for operational factors such as long-term constant and temporary loads, low and elevated temperatures, as well as methods for designing all-composite spans pedestrian and road bridges Conclusion. The principles of designing bridge spans with elements made of polymer composite materials have been introduced into the practice of transport construction in the Russian Federation. The technical and economic efficiency of using polymer composite materials in bridge structures of transport infrastructure has been confirmed.

Assessment of Energy Recovery Potential in Urban Underground Utility Tunnels: A Case Study

Underground spaces contain abundant geothermal energy, which can be recovered for building ventilation, reducing energy consumption. However, current research lacks a comprehensive quantitative assessment of its energy recovery. This research evaluates the energy recovery potential of the Xingfu Forest Belt Urban Underground Utility Tunnels. Field experiments revealed a 7 °C temperature difference in winter and a 2.5 °C reduction during the summer-to-autumn transition. A computational fluid dynamics (CFD) model was developed to assess the impact of design and operational factors such as air exchange rates on outlet temperatures and heat exchange efficiency. The results indicate that at an air change rate of 0.5 h−1, the tunnel outlet temperature dropped by 10.5 °C. A 200 m tunnel transferred 8.7 × 1010 J of heat over 30 days, and a 6 m × 6 m cross-sectional area achieved 1.1 × 1011 J of total heat transfer. Increasing the air exchange rate and cross-sectional area reduces the inlet–outlet temperature difference while enhancing heat transfer capacity. However, the optimal buried depth should not exceed 8 m due to cost and safety considerations. This study demonstrates the potential of shallow geothermal energy as an eco-friendly and efficient solution for enhancing building ventilation systems.

Energy consumption analysis and operating characteristics research on small time scale of variable refrigerant flow air conditioning systems in public buildings

In order to analyze the energy consumption and operation characteristics of the variable refrigerant flow (VRF) air-conditioning system on small time scale and put forward effective energy-saving suggestions, the VRF system operation experiments are carried out under different indoor set temperatures, different indoor unit opening quantities and different indoor set air velocities. This experiment studies the main influencing factors of energy consumption and operation of the VRF system, such as indoor temperature difference, indoor air velocity, outdoor environment temperature and so on. The results show that the rated power of indoor unit is linearly related to the energy consumption of the VRF system. The total active power changes greatly when the VRF starts and stops, and the outdoor ambient temperature changes. The indoor set air velocities have a great influence on the energy consumption and operation of the VRF system. The performance parameters increase first and then decrease with the increase of compressor frequency and load rate. When the load rate is 40 %∼60 %, the performance parameters can reach 3.2 ∼ 4.2.

Multi-objective optimization of micro crystalline cellulose and montmorillonite filled poly lactic acid bio–composite and its characterizations

In this research study, the synthesis of poly lactic acid (PLA) based bio composite material factors contributions were investigated through the Taguchi-based grey relational analysis (GRA) technique. Effects of micro crystalline cellulose (MCC) and montmorillonite (MTT) nano clay filler, sorbitol (S) plasticizer, and temperature (T) operating factor on the PLA matrix through melt-mixing preparation method. The tensile strength (TS), Young modulus (YM), flexural strength (FS), flexural modulus (FM), hardness, impact strength (IS), water absorption (WA), and density properties of bio composite material were investigated for each experimental setup (orthogonal array, L16). Additionally, neat PLA and optimal sample structural, thermal, and morphological properties were examined through Fourier transform infrared spectroscopy (FTIR), X-Ray diffraction (X-RD), thermal gravimetry analysis/differential thermal gravimetry (TGA/DTG), and DSC and SEM analyses. The obtained result for optimal mechanical and physical properties of MCC/MTT/S/PLA bio composite was MCC at level 3 (6%), MTT at level 4 (9%), S at level 2 (10%), and T at level 4 (175 °C). Analysis of variance (ANOVA) shows that MTT has the greatest significant effect on mechanical and physical properties of MCC/MTT/S/PLA bio composite followed by MCC, T, and S. The confirmation test indicates that the improvement of weighted grey relational grade (GRG) from 0.7896 to 0.846 and the FTIR, XRD, thermal gravimetry/differential scanning calorimetry (TG/DSC), and scanning electron microscopy (SEM) results indicates that the good interaction between PLA and fillers, improvement of thermal and morphological properties of optimal (6MCC/9MTT/10S/175 °C) bio composite samples. Therefore, the multi-response characteristics of MCC/MTT/S/PLA bio composite can be highly improved by this technique.

Impact of infectious complications after gastrectomy on non‑gastric cancer‑related deaths.

Infectious complications (ICs) have been reported as major causes of postoperative mortality in patients with cancer. However, to the best of our knowledge, the impact of ICs after gastrectomy on non-gastric cancer-related deaths (NGCDs) remains unexplored. The present study aimed to identify the impact of ICs after gastrectomy on NGCDs. A retrospective analysis of 712 patients with gastric cancer who underwent curative gastrectomy was conducted. The participants were categorized into IC and non-IC groups based on the incidence of postoperative IC. Clinicopathological factors and non-gastric cancer-related survival (NGCS) rates were compared between groups. Further NGCD and associated risk factor analyses were performed in a background factor-adjusted cohort using multivariate analysis. Among the 712 patients, 112 developed ICs (Clavien-Dindo classification grade ≥II). In the entire cohort, the IC group had a significantly worse 5-year cumulative incidence of NGCD (17.8 vs. 10.6%; Gray's P=0.021) compared with the non-IC group. Although a number of clinicopathological factors differed between the groups, including patient background, operative factors and tumor factors, the risk factors for NGCD identified in the multivariate analysis were older age, low prognostic nutritional index, low skeletal muscle index and Charlson comorbidity index ≥1, excluding IC incidents. The IC group exhibited more background factors contributing to NGCDs, suggesting a potential increase in NGCD regardless of IC incidence.

Natural history of autologous sperm cryostorage.

What is the natural history of elective autologous sperm cryostorage prior to gonadotoxic treatment? We estimate large sample median times to transfer for use, to the man's death or to discard of sperm, and their determinants, as the key operational outcomes of sperm cryostorage. No large sample studies of the natural history of sperm cryostorage prior to gonadotoxic treatment are reported. This observational single-centre study covered 45 years of outcomes with a survival analysis for sperm cryostorage prior to scheduled gonadotoxic treatment, and its determinants. This study included 3923 men (mean age 30 years) who sought sperm cryostorage for a wide range of cancers and other diseases requiring gonadotoxic treatments. The median time to transfer for use (n = 371 men 9%) was 2.4 years (quartiles 1.0, 6.0), the median time to death (n = 553 men, 14%) was 1.7 (0.9, 3.3) years, and the median time to discard (n = 1807 men, 46%) was 7.7 (1.7, 11.1) years. In multivariate Cox model regression, the underlying disease, number of storage visits and follow-up visits, and whether sperm were seen at follow-up visits were consistent predictors of times to outcomes. This study did not investigate sperm cryostorage for reasons other than gonadotoxic treatment, nor the fertilization outcomes of the cryostored sperm. These data provide estimates of the key operational factors for sperm cryostorage programs, prior to potentially sterilizing gonadotoxic treatments, and free from financial or insurance restrictions. There was no specific funding for this study. D.J.H. has provided expert witness testimony to antidoping and professional standards tribunals and is supported by an NHMRC Investigator Grant. The other authors have no disclosures. N/A.

Identifying the Factors Influencing Youths Decision in Afghanistan for the Purpose of Smartphone Purchasing

The current study aims to investigate the variables influencing customer intent to purchase smartphones and to smooth the way and increase investor interest in investing in Afghanistan considering the identified factors (Subjective Norm, Personal Factor, Operational Factor, Software Performance, and Product Physical Features). Data was collected through a Google Forms structured questionnaire, which was developed from previous studies, using a 5-point Likert scale. This study determined that a sample size of 800–1000 respondents would be appropriate for the survey; 892 replies in all were gathered. The factor analysis test was applied to test the variables' validity. In the study, Binary Logistic Regression Analysis (LR) was performed to assess whether there is a significant relationship between smartphone purchasing decisions and the following factors: Subjective Norm, Personal Factor, Operational Factor, Software Performance, and Product Physical Features. The research showed that there is a significant relationship between the mentioned factors and smartphone purchase decisions. There are a variety of elements that influence consumers' intentions to buy smartphones, but subjective norms, personal factors, operational factors, software performance, and physical features are the factors that drive consumers to purchase.

Optimizing the Delivery of Routine Malaria Data Quality Assessments: A Two-Level Logistic Regression Model to Inform an Institutionalized Approach in Mozambique.

Mozambique has implemented routine data quality assessments (DQAs) to improve accuracy of health facility (HF) malaria reporting since 2019. However, despite this being a resource-intensive exercise, the impact of operational factors on DQAs has not yet been systematically investigated. This analysis aimed to provide insights into optimizing the operational delivery of routine DQAs. A two-level logistic regression model based on 1,354 DQAs conducted across 195 HFs (16 districts, November 2019-December 2022) was used to estimate the impact of relevant operational factors, namely number of DQAs received, baseline reporting accuracy, HF setting, workload, malaria transmission intensity, and the shift to digital reporting, on accurate reporting by HFs. A report was considered accurate if the deviation between number of confirmed malaria cases in reports and register books was less than 10%. A statistically significant interaction was observed between baseline reporting accuracy and number of DQAs. For HFs with a baseline accuracy of ≤90%, each additional DQA increased the odds of accurate reporting by 102.8% (95% CI: 71.1-140.2%). For HFs with inaccurate data at baseline, the probability of accurate reporting increased to >80% after five DQAs, whereas HFs with accurate baseline data did not improve beyond the baseline visit. Other operational factors did not significantly affect reporting accuracy. Prioritizing HFs with low baseline accuracy for more frequent DQAs (every 6 months) with at least one visit to all HFs every 3 years might optimize resource allocation in Mozambique. Similar analytic approaches can be applied in other countries to optimize resource allocations for the delivery of routine DQAs.

Adsorption ability of sugar scum as industrial waste for crystal violet elimination: Experimental and advanced statistical physics modeling

Recycling solid industrial waste into useful resources is the most critical aspect of managing waste. Herein, for detoxifying poisonous crystal violet dye (CV) in aqueous media, sugar scum (SS) as an underutilized industrial discard has been tested as a promising adsorbent.The SS was thoroughly analyzed beforehand and after the adsorption process through various characterization techniques. Several operational factors, including pH, biosorbent dosage, dye concentration, and temperature, were optimized, reaching 24 mg.g-1 at (pH 10, 2 g.L−1 of SS, 10 mg.L−1 of CV and 25 °C). The bioadsorbent's performance was assessed through a range of studies involving kinetic, equilibrium (using both conventional and statistical physics models), and thermodynamic investigations.Based on the results, the equilibrium curves best fit the Freundlich model, indicating that multilayer adsorption occurs on a heterogeneous active sites surface. The statistical physics models provided detailed physiochemical insights, the double-layer with two energies model was most accurately describing the data, with a high saturation capability of 371 mg.g−1. Most interactions occur at a single adsorption site (70 %), with the remaining 30 % at two sites, involving both parallel and non-parallel orientations. The mesoporous structure of the SS surface provides an optimum size for CV adsorption. Pore filling, Van der Waals forces, hydrogen bonding, π-π and electrostatic interactions are proposed as the possible mechanisms in the CV-SS system. Thermodynamic measurements indicate that CV adsorption is spontaneous (ΔG° < 0) and exothermic ΔH° (− 41.390 kJ mol−1).The SS recyclability was assessed, exhibiting encouraging sustainability with a slight fall in effectiveness (∼7 %) after 5 sequential usages. Altogether, this study makes a substantial contribution to the promotion of ecological water treatment strategies, which highlights the utility of using SS as an environmental alternative to water contaminant remediation.