Rigorous Protocol Research Articles

Operational Procedures of Forensic Science Laboratories and Protocols for Sample Collection

This research paper delves into the operational procedures employed within forensic science laboratories, with a specific focus on the protocols governing sample collection. Forensic science plays a crucial role in the criminal justice system, providing evidence and expert analysis to aid investigations and legal proceedings. Effective operational procedures and rigorous protocols for sample collection are essential to maintain the integrity and reliability of forensic evidence. Through an in-depth examination of existing literature, case studies, and expert insights, this paper aims to provide a comprehensive understanding of the methodologies and guidelines employed in forensic laboratories worldwide. Additionally, it explores the challenges faced by forensic scientists in sample collection and processing, along with recommendations for improving practices and enhancing the quality of forensic evidence.

Prospective validation of the Global Leadership Initiative on Malnutrition criteria for identifying malnutrition in hospitals: A protocol and feasibility pilot study.

The aim of this study was to pilot a protocol for prospective validation of the Global Leadership Initiative on Malnutrition (GLIM) criteria in hospital patients and evaluate its feasibility and patient acceptability. The validation protocol follows the GLIM consortium's rigorous methodological guidance. Protocol feasibility was assessed against criteria on recruitment (≥50%) and data collection completion (≥80%); protocol acceptability was assessed via patient satisfaction surveys and interviews. Adult inpatients in a tertiary hospital underwent four nutrition assessments (each by a different assessor); two Subjective Global Assessments (SGAs) and two GLIM assessments. All five GLIM criteria were assessed with bioelectrical impedance analysis used for muscle mass. Interrater reliability, criterion validity, and predictive validity were reported to detect trends. All primary feasibility criteria were met (consent rate 76%; data for GLIM criterion validity collected on 83% participants). Of predictive outcome data, 100% of hospital-related data, 82% of 6-month mortality data, and 39% of 6-month health-related quality of life data were collected. The mean (SD) age of participants was 61.0 ± 16.2 years, and 51.5% were male. The median (interquartile range) length of stay and body mass index were 7 (4-15) days and 25.6 (24.2-33.0) kg/m2, respectively. GLIM criteria diagnosed 70% of the patients as malnourished vs 55% with SGA. Most patients found the data collection acceptable with minimal burden. The methods outlined in this rigorous GLIM validation protocol are feasible to undertake in hospitals and acceptable to patients. This paper provides practical methodological guidance for future prospective GLIM validation studies.

Assess The Workload Management Model and Enhanced Quality Control in The Central Sterile Supply Department: A Study Protocol.

Introduction The Central Sterile Supply Department (CSSD) plays a crucial role in ensuring the safety and efficacy of medical instruments and equipment used in healthcare settings. Effective workload management and quality control are essential for maintaining high standards of patient care and minimizing the risk of healthcare-associated infections. This study protocol aims to assess the implementation and impact of a new workload management model and enhanced quality control measures in a CSSD setting. Methods The study will employ a mixed-methods approach, including quantitative analysis of workload data, qualitative interviews with CSSD staff, and observational assessments of workflow and quality control procedures. The workload management model under investigation involves the allocation of resources based on demand patterns and the implementation of scheduling algorithms to optimize staff efficiency. Enhanced quality control measures include the implementation of advanced sterilization technologies, rigorous inspection protocols, and continuous staff training initiatives. Results The study expects to provide insights into the effectiveness of the workload management model in optimizing resource allocation and improving staff productivity. Additionally, it aims to evaluate the impact of enhanced quality control measures on the reliability and safety of instrument sterilization processes. Findings from this study will inform recommendations for further improvements in CSSD operations and contribute to the advancement of best practices in sterile supply management. Conclusion The successful implementation of an effective workload management model and enhanced quality control measures in the CSSD is crucial for maintaining patient safety and ensuring the efficient functioning of healthcare facilities. By systematically evaluating the implementation and impact of these interventions, this study protocol seeks to contribute to the ongoing improvement of CSSD operations and the enhancement of healthcare quality.

What qualitative systems mapping is and what it could be: integrating and visualizing diverse knowledge of complex problems

Researchers in sustainability science deal with increasingly complex problems that cross administrative, geographical, disciplinary, and sectoral boundaries, and are characterized by high stakes and deep uncertainties. This in turn creates methodological challenges to frame, structure, and solve complex problems in science and practice. There is a long tradition in visualizing systems as diagrams, and concept and cognitive maps, but there is insufficient differentiation and comparison between these methods and no clear umbrella term has yet been established. Against this background, we systematically review three foundational methods from different academic disciplines—causal diagrams, concept mapping, and cognitive mapping. Comparing and contrasting them, we facilitate a coherent understanding of qualitative systems mapping (QSM) as an umbrella term. We then proceed to explore the evident intersections between these methods to showcase some of the inter- and transdisciplinary opportunities and challenges crystallizing in integrated QSM approaches. Finally, we share case study insights from the food–water–biodiversity nexus in Austria and elaborate on some of the methodological nuances to data integration in QSM. Overall, with this overview paper, we lay the groundwork for a systematic, transparent, and yet flexible development and application of QSM methods to support mixed-methods research design and clear case study documentation, as well as fostering effective inter- and transdisciplinary communication in sustainability science. Further research needs to explore these QSM applications in depth across alternative sustainability science contexts, particularly with respect to efficient and rigorous protocols for knowledge and data integration vis-a-vis complex problems and transdisciplinary research processes.

Empowering Tomorrow: Strategic Decision-Making in Energy Planning A Balance of Renewables, Non-Renewables, and Nuclear Innovation (A Short Approach)

This article delves into the intricate landscape of energy decision-making, exploring the dynamic interplay between renewable, non-renewable, and nuclear energy sources, along with the integration of Advanced Reactor Concepts (ARCs) and Vernova’s innovative approach. Through a comprehensive examination of tactical and strategic planning, it elucidates the challenges and opportunities inherent in shaping a sustainable energy future. Renewable energy emerges as a beacon of sustainability, offering promise in mitigating climate change and reducing reliance on finite resources. However, its intermittent nature necessitates innovative solutions in energy storage and grid management. Non-renewable resources continue to provide baseload power, while nuclear energy presents both promise and controversy, demanding rigorous safety protocols and responsible waste management. The integration of ARCs introduces new dimensions to the energy landscape, promising enhanced safety, efficiency, and resource sustainability. Vernova’s forward-thinking approach emphasizes technological innovation, sustainability, and community engagement, driving the transition towards a cleaner, more resilient energy future. Through collaboration, innovation, and a commitment to sustainability, decision-makers can navigate the complexities of energy planning, paving the way for a brighter tomorrow where energy is abundant, accessible, and in harmony with the planet.

Administration of Drugs for Pharmacotherapy of Tuberculosis According to GSP Requirements

This research paper outlines the findings from a comprehensive investigation focused on the dispensation and management of antituberculosis medications in pharmaceutical practices. The examination of antituberculosis medications was conducted using various classification systems, including ATC codes, clinical and pharmacological, classification and legal, nomenclature and legal groups. The study provides a detailed analysis of the harmonization process for GxP standards within Ukraine, offering a thorough understanding of the current practices. Additionally, the research looks into the supply chain dynamics of antituberculosis medication distribution. Developed within the study are strategic guidelines for the proper storage of these medications, essential for maintaining their efficacy and safety. A systematic proposal for the spatial organization of storage facilities in the wholesale sector is presented, ensuring compliance with GSP. The study’s goal was to refine the methodologies involved in the storage and management of antituberculosis drugs, with the ultimate aim of enhancing the efficiency of tuberculosis treatment protocols. This, in turn, is expected to elevate the caliber of healthcare delivery and pharmaceutical care available to patients afflicted with tuberculosis. Expanding on the study's contributions, the paper highlights the implications of these findings for public health policy and the potential to streamline pharmaceutical organization. By drawing attention to the criticality of adherence to rigorous storage protocols, the research underscores the necessity of meticulous oversight in the pharmaceutical supply chain. The insights gained from the study are not only pivotal for healthcare providers but also for policymakers tasked with the mandate of curbing the tuberculosis epidemic. The proposed recommendations provide a scaffold for future enhancements in drug management practices.

The “Angel-Wing” Combined Labia Minoraplasty/Majoraplasty

Background: Reduction of prominent/hypertrophic/ptotic vulvar labia minora and/or labia majora is an increasingly common surgical procedure in the hands of plastic and cosmetic surgeons and female genital cosmetic and reconstructive surgeons. While several techniques for these reductions are described in the literature and are individually modified by experienced practitioners, 2 procedures for the minora (linear and wedge-type reductions), and the vertically-aligned reduction of redundant majora are the most utilized techniques. It is not unusual for a woman to present to her potential surgeon requesting “work” on both minora and majora. Historically, this has necessitated two separate incision lines (minora and majora) bilaterally, often resulting in a long case, difficult recovery, and a significant potential for visible incision lines and gaping of the vaginal introitus. Objective: To introduce a novel single-incision-line technique for combining labia minoraplasty and labia majoraplasty. Methods: A modification of a classic central V-Wedge technique is affected by “shifting” the wedge incision line across the interlabial fold to encompass a portion of the medial labum majorum, both reducing redundancy and “lifting” the lowermost portion of the majora to correct ptosis. This is accomplished in one incision line with “en-bloc” closure of both minora and majora, placing the incision line mostly within the interlabial fold. Results: The author has completed eight wedge-type combined labia minora-majoraplasties without complication and with 2.5-36 months of follow-up. Discussion: This modification in Wedge design converts two separate procedures into one, making the surgery both less time-consuming, easier to recover from, and more visually esthetic for those patients who are capable of the more rigorous recovery protocol that wedge procedures mandate. Conclusion: The “Angel-Wing combined labia minoraplasty + labia majoraplasty appears to be a relevant option for combined labia minor hypertrophy and labia majora deflation and redundancy.

From MNIST to ImageNet and back: benchmarking continual curriculum learning

Continual learning (CL) is one of the most promising trends in recent machine learning research. Its goal is to go beyond classical assumptions in machine learning and develop models and learning strategies that present high robustness in dynamic environments. This goal is realized by designing strategies that simultaneously foster the incorporation of new knowledge while avoiding forgetting past knowledge. The landscape of CL research is fragmented into several learning evaluation protocols, comprising different learning tasks, datasets, and evaluation metrics. Additionally, the benchmarks adopted so far are still distant from the complexity of real-world scenarios, and are usually tailored to highlight capabilities specific to certain strategies. In such a landscape, it is hard to clearly and objectively assess models and strategies. In this work, we fill this gap for CL on image data by introducing two novel CL benchmarks that involve multiple heterogeneous tasks from six image datasets, with varying levels of complexity and quality. Our aim is to fairly evaluate current state-of-the-art CL strategies on a common ground that is closer to complex real-world scenarios. We additionally structure our benchmarks so that tasks are presented in increasing and decreasing order of complexity—according to a curriculum—in order to evaluate if current CL models are able to exploit structure across tasks. We devote particular emphasis to providing the CL community with a rigorous and reproducible evaluation protocol for measuring the ability of a model to generalize and not to forget while learning. Furthermore, we provide an extensive experimental evaluation showing that popular CL strategies, when challenged with our proposed benchmarks, yield sub-par performance, high levels of forgetting, and present a limited ability to effectively leverage curriculum task ordering. We believe that these results highlight the need for rigorous comparisons in future CL works as well as pave the way to design new CL strategies that are able to deal with more complex scenarios.

The Development of Computer Assisted Vocabulary Learning (CAVL) to Improve English Lexical Retention of Nursing Students

Vocabulary mastery is crucial for nursing students to effectively communicate in English. This study aimed to develop and validate a tailored computer-assisted vocabulary learning (CAVL) intervention to improve nursing students' retention of English lexicon, which is essential for healthcare communications. The CAVL program was designed using the Moodle platform and focused on four thematic units that targeted essential nursing vocabulary. The learning process followed research-based principles of vocabulary instruction, including multimodal introduction, reinforced retrieval, and contextual repetition. This study utilized a research and development methodology to conduct iterative needs analyses, design refinement, and rigorous evaluation protocols. Expert reviews, prototype testing, post-intervention vocabulary tests, and delayed assessments were used to gather data and make data-driven improvements. Quantitative analysis evaluated the effectiveness of this approach for 100 Indonesian nursing students. Vocabulary assessments were administered before, immediately after, and two weeks after the intervention, revealing significant improvements in terminology knowledge following the implementation of CAVL. Importantly, scores remained stable during the delayed assessment, demonstrating durable retention. These results are consistent with previous literature on the benefits of contextual and multimodal vocabulary learning. The CAVL prototype facilitated learning and effectively improved vocabulary retention outside of the classroom. This research provides an adaptable framework for technologically-assisted language mastery, which is essential for the next generation of nursing education. Further studies can explore the application of this framework in allied healthcare fields and the transition to practice in nursing education.

COVID-19 impact on blood donor characteristics and seroprevalence of transfusion-transmitted infections in southern Thailand between 2018 and 2022

Blood safety is a critical aspect of healthcare systems worldwide involving rigorous screening, testing, and processing protocols to minimize the risk of transfusion-transmitted infections (TTIs). The present study offers a comprehensive assessment of the prevalence of hepatitis B virus (HBV), hepatitis C virus (HCV), human immunodeficiency virus (HIV), and syphilis among blood donors in southern Thailand. It explores the consequences of the COVID-19 pandemic on the blood transfusion service, donor characteristics, and the prevalence of TTIs. A retrospective analysis of 65,511 blood donors between 2018 and 2022 was conducted at Songklanagarind Hospital, Thailand. The socio-demographic characteristics of the donors were examined using the Chi-square test to assess the relationship between TTIs serological positivity and donor characteristics. The donors were divided into pre-COVID-19 (2018–2019) and during COVID-19 (2020–2022) groups to evaluate the impacts of COVID-19. The study found that HBV had the highest overall prevalence at 243 per hundred thousand (pht), followed by syphilis (118 pht), HCV (32 pht), and HIV (31 pht) over a five-year period of study. After COVID-19, the prevalence of HBV decreased by 21.8%; HCV decreased by 2.1%; HIV increased by 36.4%; and syphilis increased by 9.2%. The socio-demographic characteristics and TTIs prevalence were significantly altered over time. This study provides insights into blood donor characteristics and TTIs prevalence in southern Thailand, highlighting the understanding of the impact of COVID-19 on the spread of TTIs.

Priorities in school eye health in low and middle-income countries a scoping review.

School eye health (SEH) has been on the global agenda for many years, and there is mounting evidence available to support that school-based visual screenings are one of the most effective and cost-efficient interventions to reach children over five years old. A scoping review was conducted in MEDLINE, Web of Science, PubMed, and CINHAL between February and June 2023 to identify current priorities in recent literature on school eye health in low- and middle-income countries (LMICs). Selection of relevant publications was performed with Covidence, and the main findings were classified according to the WHO Health Promoting Schools framework (HPS). A total of 95 articles were included: cross-sectional studies (n = 55), randomised controlled trials (n = 7), qualitative research (n = 7) and others. Results demonstrate that multi-level action is required to implement sustainable and integrated school eye health programmes in low and middle-income countries. The main priorities identified in this review are: standardised and rigorous protocols; cost-effective workforce; provision of suitable spectacles; compliance to spectacle wear; efficient health promotion interventions; parents and community engagement; integration of programmes in school health; inter-sectoral, government-owned programmes with long-term financing schemes. Even though many challenges remain, the continuous production of quality data such as the ones presented in this review will help governments and other stakeholders to build evidence-based, comprehensive, integrated, and context-adapted programmes and deliver quality eye care services to children all over the world.

Validation and Psychometric Properties of the German Version of the Adolescent Motor Competence Questionnaire

Introduction/Background: In 2016, the Adolescent Motor Competence Questionnaire (AMCQ) was developed in Australia. The AMCQ was developed to assess perceived motor competence in adolescents between the ages of 12 and 18 years. The 26 items represent four factors: participation in physical activity and sports, activities of daily living, public performance, and peer comparison. Aims/Objectives: Currently, no validated German-language self-report screening instrument exists for assessing perceived motor competence among adolescents. This study aimed to validate the German version of the AMCQ (AMCQ-GER). Methods/Approach: The German translation’s factor structure and psychometric properties were analyzed based on a community sample of 635 healthy children and adolescents between 10 and 18 years of age (12.9 ± 2.31 years, 321 boys and 312 girls) and 100 healthy young adults between 19 and 30 years of age (23.0 ± 2.92 years, 49 men and 51 women). The previously validated cutoff score of ≤83 out of 104 was used to group the sample into high and low motor competence. Results: The mean AMCQ-GER score was 84.9 (SD = 8.59), and 38.8% of the participants identified with low motor competence. The principle component analysis revealed clear evidence for a three-factorial structure comprising physical activity and sports, general clumsiness, and activities of daily living (with an explained variance of 29.2%). Reliability for all scales was excellent, with a McDonald’s ϖ of at least .70. The overall conclusion of the Rasch analysis supported the confirmatory factor analysis, although with an overall smaller number of items (18 instead of 26). The AMCQ-GER was positively correlated with age (.26**) and participation in organized club sports (.19**). It was negatively correlated with body mass index (−.23**) and school grade in physical activity (−.40**). Conclusions/Relevance: Our rigorous validation protocol has generated a remarkable reproduction of the AMCQ in German. These results suggest that the language and structure of the questionnaire is appropriate for German-speaking countries.

Hypothermia amongst neonatal admissions in Kenya: a retrospective cohort study assessing prevalence, trends, associated factors, and its relationship with all-cause neonatal mortality.

Reports on hypothermia from high-burden countries like Kenya amongst sick newborns often include few centers or relatively small sample sizes. This study endeavored to describe: (i) the burden of hypothermia on admission across 21 newborn units in Kenya, (ii) any trend in prevalence of hypothermia over time, (iii) factors associated with hypothermia at admission, and (iv) hypothermia's association with inpatient neonatal mortality. A retrospective cohort study was conducted from January 2020 to March 2023, focusing on small and sick newborns admitted in 21 NBUs. The primary and secondary outcome measures were the prevalence of hypothermia at admission and mortality during the index admission, respectively. An ordinal logistic regression model was used to estimate the relationship between selected factors and the outcomes cold stress (36.0°C-36.4°C) and hypothermia (<36.0°C). Factors associated with neonatal mortality, including hypothermia defined as body temperature below 36.0°C, were also explored using logistic regression. A total of 58,804 newborns from newborn units in 21 study hospitals were included in the analysis. Out of these, 47,999 (82%) had their admission temperature recorded and 8,391 (17.5%) had hypothermia. Hypothermia prevalence decreased over the study period while admission temperature documentation increased. Significant associations were found between low birthweight and very low (0-3) APGAR scores with hypothermia at admission. Odds of hypothermia reduced as ambient temperature and month of participation in the Clinical Information Network (a collaborative learning health platform for healthcare improvement) increased. Hypothermia at admission was associated with 35% (OR 1.35, 95% CI 1.22, 1.50) increase in odds of neonatal inpatient death. A substantial proportion of newborns are admitted with hypothermia, indicating a breakdown in warm chain protocols after birth and intra-hospital transport that increases odds of mortality. Urgent implementation of rigorous warm chain protocols, particularly for low-birth-weight babies, is crucial to protect these vulnerable newborns from the detrimental effects of hypothermia.

Cardiac Magnetic Resonance and Cardiac Implantable Electronic Devices: Are They Truly Still "Enemies"?

The application of cardiac magnetic resonance (CMR) imaging in clinical practice has grown due to technological advancements and expanded clinical indications, highlighting its superior capabilities when compared to echocardiography for the assessment of myocardial tissue. Similarly, the utilization of implantable cardiac electronic devices (CIEDs) has significantly increased in cardiac arrhythmia management, and the requirements of CMR examinations in patients with CIEDs has become more common. However, this type of exam often presents challenges due to safety concerns and image artifacts. Until a few years ago, the presence of CIED was considered an absolute contraindication to CMR. To address these challenges, various technical improvements in CIED technology, like the reduction of the ferromagnetic components, and in CMR examinations, such as the introduction of new sequences, have been developed. Moreover, a rigorous protocol involving multidisciplinary collaboration is recommended for safe CMR examinations in patients with CIEDs, emphasizing risk assessment, careful monitoring during CMR, and post-scan device evaluation. Alternative methods to CMR, such as computed tomography coronary angiography with tissue characterization techniques like dual-energy and photon-counting, offer alternative potential solutions, although their diagnostic accuracy and availability do limit their use. Despite technological advancements, close collaboration and specialized staff training remain crucial for obtaining safe diagnostic CMR images in patients with CIEDs, thus justifying the presence of specialized centers that are equipped to handle these type of exams.

Pioneering Maintenance Strategies for Enhanced Reliability of Low Voltage Switchboards

This study highlights the critical need for rigorous maintenance protocols, focusing on routine inspections, preventative measures, and timely corrective actions. Low voltage switch panels (PHB-TR) are vital for ensuring the efficiency and reliability of electricity distribution systems. Through systematic analysis of existing maintenance procedures and field evaluations across diverse setups, the research confirms that structured maintenance not only mitigates the risk of failures but also significantly reduces workplace accidents. The findings advocate for strict adherence to standard operating procedures and improved coordination among technicians, suggesting these strategies as global standards for enhancing the safety and functionality of electrical distribution networks. Highlights: Proper maintenance ensures optimal performance and reduces the risk of system failure. Adherence to applicable SOPs is crucial to prevent work accidents. Coordination and adherence to job distribution streamline work execution. Keywords: PHB-TR Maintenance, Split Switch Panel Maintenance, Low Voltage Split Switch Board

Study Design and Research Protocol for diagnostic or prognostic studies in the Age of Artificial Intelligence: A Biostatistician’s Perspective

Introduction: As the integration of Artificial Intelligence (AI) in healthcare continues to advance, the need for rigorous study design and research protocols tailored to diagnostic and prognostic studies becomes paramount.Aim: The primary objective of this work is to highlight the biostatistician’s point of view about the key points of the research protocol involving AI. Methods: Assessing the current state-of-the-art guidelines, we outline the methodological challenges faced by biostatisticians when collaborating on research protocols in the era of AI-driven medical research. Results: The proposed overview on research protocol involving AI elucidates key considerations in study design, encompassing evaluations of data quality, analysis of biases, methodological approaches, determination of sample size, and validation strategies tailored specifically to AI applications. This position paper underscores the pivotal role of strong statistical frameworks in ensuring the reliability, validity, and applicability of findings derived from AI-based diagnostic and prognostic models. Moreover, the paper seeks to highlight the critical importance of incorporating transparent reporting standards to enhance the reproducibility and clarity of AI-driven studies. Conclusions: By offering a comprehensive biostatistician’s viewpoint, this paper strives to significantly contribute to the methodological progression of diagnostic and prognostic studies in the era of Artificial Intelligence.

The impact of online learning platform in the English teaching -learning process

The research examines the impact of online learning platforms on English language teaching, exploring their influence on student-teacher interaction, personalized learning, and associated challenges. Adopting a qualitative approach, interviews were conducted with teachers and students, in addition to the observation of online resources. Teachers revealed a dichotomy in their perceptions, highlighting benefits such as flexibility and challenges such as the lack of face-to-face interaction. Students valued interactivity but expressed concerns about emotional connection. The diversity of online materials was observed, emphasizing the need to address challenges in quality and relevance. The findings highlight diversity in platform adoption and the importance of emotional connection. Continuous teacher training programs are recommended, as well as the establishment of rigorous content evaluation protocols. This study contributes to a comprehensive understanding of the impact of online learning platforms on English language teaching, offering recommendations for the continuous improvement of these educational tools.

Overview of safety challenges associated with integration of hydrogen-based propulsion systems for climate neutral aviation

Electrification through hydrogen-based fuel cells as well as hydrogen combustion in gas turbines is a key strategy in aviation for achieving substantial reduction of emissions. However, this transition presents multifaceted challenges. Besides the development and improvement of technologies required for such hydrogen-fuelled aero engines, the safety of hydrogen storage and distribution systems on aircraft is paramount. Challenges associated with hydrogen in terms of its material properties, the design and selection of components for the conditioning and distribution, as well as the system design are being presented and discussed in this work. This includes the consideration of high diffusivity, flammability and reactivity of hydrogen and the consequences of these traits: hydrogen embrittlement, hydrogen-induced cracking and leakage, for instance. The challenges elaborated in this work are pertinent to both hydrogen fuel cell-based propulsion systems and hydrogen combusting gas turbines. Design considerations were derived and are being outlined in this work. These are transferable to applications in other industries such as automotive and stationary power plants. The need for novel rigorous safety protocols to enable a sustainable future in aviation is being highlighted.

Transportation management practices and Performance of Electoral Systems in Kenya.

Elections are becoming democracy’s bedrock. Even before the great development of African states were created, antagonists attempted to corrupt, undermine, or otherwise disrupt democracy by seeking to subvert elections. The threats on the electoral process are as old as the vote itself: from adversarial governments, terrorist organizations, strikers for the Boss Tweed vote, people who try to wreak havoc hence the survival of democracy demands for the protection of elections. As a consequence, after the 90s Election Administration in African nations, the tendency of some individuals to impede elections has not changed, mentioning a number of electoral fraud cases in the history of African States. In recent years, some of the tactics of such attempts to overthrow democracy have become distinct. Attacks that exploit vulnerabilities in digital networks today improve conventional approaches and have become an increasingly successful strategy. Therefore, the study sought to determine the relationship between transportation management practices and Performance of Electoral Systems in Kenya.The research design that was used in this study was an exploratory research design. The population for this study consisted of 373 Commission Secretary/Chief Executive Officer (CS/CEO), Deputy Commission Secretary (DCS), Directors, Managers, County Election Managers, and Constituency Election Coordinators within 290 constituencies of Kenya's August 2017 election. A total of 373 respondents were used as the sample size for the study. Data was used as primary and secondary. While self-administered questionnaire and interview guide were used to collect primary data, the study reviewed the previous evaluation reports to seek the secondary data on performance of election systems in Kenya. The data was collected and then analyzed by both descriptive and inferential statistical tools. The results of this study benefited policy makers, managers, administrators, citizens all whole, researchers, consultants, scholars, and trainers involved in election administration. This study tested the null hypotheses that transportation management practices had no significant relationship in the performance of electoral systems in Kenya. Pragmatism paradigm approach and mixed method research were adopted in this study. The questionnaire tested both validity and reliability. Quantitative and qualitative techniques were used to analyze the collected data with the assistance of Statistical Package for Social Sciences (SPSS) software version 25. Multiple regression and correlation analysis were carried out. The results revealed a positive correlation (R = 0.712) between transportation management practices and electoral system performance, with approximately 50.7% of the variance explained by transportation management practices. The consequences of these findings are relevant for electoral authorities and policymakers that aim to improve the dependability, participation rate, uniformity, and trustworthiness of election systems through the use of strategic transportation management practices. The study recommends key strategies to enhance the performance of Kenyan electoral systems through improved Transportation Management Practices. It suggests adopting advanced route optimization software for efficient delivery of voting materials, emphasizing GPS tracking and real-time monitoring. Comprehensive inspections before departure are urged to identify and rectify potential issues. Rigorous security protocols, including background checks, sealed containers, and security escorts, are proposed to address Transportation Security concerns. For Reverse Logistics, a meticulously designed plan is recommended for systematic collection, packaging, and timely pickup of materials post-election. Thorough examination and authentication of returned materials are crucial for ensuring accuracy and reliability. Proper maintenance of equipment is emphasized to guarantee optimal functionality for future electoral processes.

Congenital Cytomegalovirus Testing Outcomes From the ValEAR Trial.

To determine the positivity rate of congenital cytomegalovirus (cCMV) testing among universal, hearing-targeted CMV testing (HT-cCMV) and delayed targeted dried blood spot (DBS) testingnewborn screening programs, and to examine the characteristics of successful HT-cCMV testing programs. Prospective survey of birth hospitals performing early CMV testing. Multiple institutions. Birth hospitals participating in the National Institutes of Health ValEAR clinical trial were surveyed to determine the rates of cCMV positivity associated with 3 different testing approaches: universal testing, HT-cCMV, and DBS testing. A mixed methods model was created to determine associations between successful HT-cCMV screening and specific screening protocols. Eighty-two birth hospitals were surveyed from February 2019 to December 2021. Seven thousand six hundred seventy infants underwent universal screening, 9017 infants HT-cCMV and 535 infants delayed DBS testing. The rates of cCMV positivity were 0.5%, 1.5%, and 7.3%, respectively. The positivity rate for universal CMV screening was less during the COVID-19 pandemic than that reported prior to the pandemic. There were no statistically significant drops in positivity for any approach during the pandemic. For HT-cCMV testing, unique order sets and rigorous posttesting protocols were associated with successful screening programs. Rates of cCMV positivity differed among the 3 approaches. The rates are comparable to cohort studies reported in the literature. Universal CMV prevalence decreased during the pandemic but not significantly. Institutions with specific order set for CMV testing where the primary care physician orders the test and the nurse facilitates the testing process exhibited higher rates of HT-cCMV testing.