Technical Support Research Articles

Service center in electricity distribution sector with variable peak electricity time: A two-stage queuing model approach with nested simulation

Customer service is essential for any business, significantly impacting customer satisfaction, brand reputation, and reducing associated costs. In the electricity industry, this importance is heightened due to the critical nature of electricity in daily life and growing usage rate of new technologies. Effective customer service in electric distribution companies involves handling a wide range of inquiries, from billing issues to technical support, requiring both remote and on-site assistance. The variability in customer calls, influenced by factors such as peak electricity hours, and different service and customer types, presents unique challenges in designing efficient service centers. This research develops a tailored model for the service center operations of a power distribution company, focusing on optimal staffing levels within budget constraints. A two-stage queuing model is proposed to address the needs of residential and non-residential customers. The study employs nested simulation techniques to account for variability in customer arrival times and peak hours. Key performance indicators (KPIs) are used to evaluate the effectiveness of staffing policies, considering both quantitative and qualitative costs. The study integrates stochastic optimization and ranking and selection methods to identify the best staffing configurations. The findings offer actionable insights for improving customer service efficiency and operational effectiveness in electricity customer service centers.

Strengths and weaknesses of computerized clinical decision support systems: insights from a digital control center (C3 COVID-19) for early and personalized treatment for COVID-19.

Clinical Decision Support Systems (CDSS) are computer-based tools that leverage the analysis of large volumes of health data to assist healthcare professionals in making clinical decisions, whether preventive, diagnostic, or therapeutic. This review examines the impact of CDSS on clinical practice, highlighting both their potential benefits and their limitations and challenges. We detail the experience of clinical medical professionals in the development of a virtual control center for COVID-19 patients (C3 COVID-19) in Spain during the SARS-CoV-2 pandemic. This tool enabled real-time monitoring of clinical data for hospitalized COVID-19 patients, optimizing personalized and informed medical decision-making. CDSS can offer significant advantages, such as improving the quality of inpatient care, promoting evidence-based clinical and therapeutic decision-making, facilitating treatment personalization, and enhancing healthcare system efficiency and productivity. However, the implementation of CDSS presents challenges, including the need for physicians to become familiar with the systems and software, and the necessity for ongoing updates and technical support of the systems.

Design and Application of Real‐Time and High‐Precision Seismic Acquisition Station in Antarctic Region

ABSTRACTIn this study, a polar seismic acquisition station based on the FPGA + ARM architecture was successfully developed. This system can achieve real‐time multifunctional acquisition and transmission of seismic signals and environmental information in the extreme low‐temperature environment of Antarctica at −40°C. The system adopts a modular design, with high‐precision data acquisition encoded by the main controller and uploaded to the host computer in real‐time. Integrated display controls enable real‐time data display and acquisition station location mapping for user interaction. We propose improving data transmission in traditional seismic acquisition stations by adopting a distributed computing model with data segment return. Integrating the first arrival picking algorithm as an IP core will reduce computational demands on the data processing center. This acquisition system features high precision (24‐bit), a wide dynamic range (> 130dB), low noise (0.5 V rms@40dB), and high‐precision timing control (200 ns). It supports real‐time wireless data transmission over 120 channels up to 1 km. The system also implements a self‐storage plus wired and wireless networking solution, allowing flexible networking based on actual needs. Test results indicate that the ice sheet thickness at the acquisition site is approximately 526.49 m, validating the experimental design's effectiveness and providing technical support for subsequent drilling and seismic exploration.

Multimodal flexible electronic skin with adjustable module size for robot collision detection

Purpose This paper aims to present a modular multimodal flexible electronic skin that can be used for robot collision detection in human–robot interactions. This type of electronic skin will meet the requirements of performance indicators such as sensing mode, sensing domain coverage and dynamic data update rate in human–robot interactions. Design/methodology/approach The electronic skin uses a modular architecture, and the sensing module is designed to be adjustable in size so that it can be easily deployed on complex robot surfaces, increasing area coverage, reducing power consumption, and improving data update rates. Findings The authors evaluated electronic skin through experiments using a UR5 robot. Electronic skin has high static scene perception differentiation and dynamic scene perception abilities. Moreover, the robot realizes a high-speed collision response based on the electronic skin proposed in this study. Originality/value The proposed electronic skin provides crucial technical support for advancing robotic technologies, and holds promising prospects for industrial applications.

Efficient Semantic Segmentation for Large-Scale Agricultural Nursery Managements via Point Cloud-Based Neural Network

Remote sensing technology has found extensive application in agriculture, providing critical data for analysis. The advancement of semantic segmentation models significantly enhances the utilization of point cloud data, offering innovative technical support for modern horticulture in nursery environments, particularly in the area of plant cultivation. Semantic segmentation results aid in obtaining tree components, like canopies and trunks, and detailed data on tree growth environments. However, obtaining precise semantic segmentation results from large-scale areas can be challenging due to the vast number of points involved. Therefore, this paper introduces an improved model aimed at achieving superior performance for large-scale points. The model incorporates direction angles between points to improve local feature extraction and ensure rotational invariance. It also uses geometric and relative distance information for better adjustment of different neighboring point features. An external attention module extracts global spatial features, and an upsampling feature adjustment strategy integrates features from the encoder and decoder. A specialized dataset was created from real nursery environments for experiments. Results show that the improved model surpasses several point-based models, achieving a Mean Intersection over Union (mIoU) of 87.18%. This enhances the precision of nursery environment analysis and supports the advancement of autonomous nursery managements.

Optimize Stormwater Management for Green Roofs Based on IoT Technology and Sensor Networks

The intensification of global climate change and the significant increase of extreme rainfall events have made traditional urban drainage systems face great adjustments. As a key component of green infrastructure to avoid urban flood risk, green roofs are receiving increasing attention due to their unique capabilities in stormwater management. This paper explores the potential of Internet of Things (IoT) technology and sensor networks to enhance green roof stormwater management. Integrated real-time monitoring of key environmental parameters, including soil moisture, temperature and rainfall, enables the system to dynamically adjust roof drainage and irrigation strategies. This greatly improves the rainwater retention capacity and reduces the pressure on the municipal sewage system. The results show that the combination of IoT technology and sensor networks not only improves the efficiency of green roof management in combating climate change, but also promotes the efficient use of water resources and enhances the adaptability and sustainability of the system. This research provides the necessary technical support for the wider adoption of green roofs in urban environments and offers viable solutions to future challenges posed by climate change.

A Groundbreaking Prevalence Survey Conducted in Mauritania for Enhanced Sickle Cell Control

Abstract Issue/Problem Sickle cell disease is a major concern in sub-Saharan Africa, with a prevalence of 0.5 to 2% among children and a mortality rate exceeding 50% in untreated cases. However, the lack of reliable data hampers effective public health policies and resource allocation. To address this, Mauritania’s Ministry of Health, with technical support from NGO Santé Sud, conducted its first prevalence survey in 2023-24. The findings will support advocacy for a national strategy on the disease and offer valuable insights for neighboring countries with similar challenges. Description of the problem The prevalence survey comprised 3 field missions over 7 weeks, conducted across 24 primary healthcare facilities during immunization days, in Nouakchott, Dakhlet-Nouadibou, Trarza, Ghorgol, Brakna, Guidimakha and Assaba regions: 1,642 infants (0-9 months) underwent screening for sickle cell disease, with parents’ consent, and 30 paramedics and laboratory technicians were trained to administer point-of-care tests. Results The survey found that 9.7% of tested children were carriers of hemoglobinopathies, with 0.6% diagnosed with sickle cell disease. Lab technicians and nurses have improved knowledge about the disease and are better equipped for point-of-care testing. This initiative is expected to enhance sickle cell disease control by providing crucial data for advocacy and may lead to a nationwide newborn screening program, in line with WHO recommendations. Lessons This initiative highlighted the efficiency of screening infants for sickle cell disease, emphasizing the need for effective organization involving stakeholders from central to local levels. Screening during immunization days proved highly efficient in testing numerous children. Success depends on adequate human resources, technical skills, and dedicated health personnel. Additionally, having a team member to inform and counsel families, especially when test results are positive, proved crucial. Key messages • A prevalence survey on sickle cell disease to generate robust data for advocacy efforts in Mauritania. • Conducting a prevalence survey on sickle cell disease in Mauritania for a better control of the disease.

The EU-funded action to strengthen health information systems

Abstract The European Commission initiative to build a European Health Union recognizes the need to address in a coordinated fashion the effects of the pandemic in health and social sectors and to strengthen the resilience, accessibility and effectiveness of health systems through co-operation, best practice exchange, training schemes, technical support and improved data and knowledge management. To make the most of the potential of health data, the European Health Data Space (EHDS) is being established as one of the central building blocks of a strong European Health Union. The EHDS sets out rules, common standards, infrastructures and a governance framework for the use of electronic health data for healthcare, research, innovation and policy making. In line with these policy goals, the European Commission is funding the Action ‘Supporting Member States in the WHO European Region in strengthening health information systems and boosting health data governance’. This Action will be implemented by WHO Regional Office for Europe and aims to boost the use and reuse of health data, including by promoting, where possible, the principles and solutions developed and implemented for the EHDS. It will also contribute to the objectives of the EU Global Health Strategy to improve global health security and deliver better health for all in a changing world. In addition, the Action is designed to strengthen countries’ capacity across critical programmatic areas of health data and digital health such as data quality (including appropriate data management and analytics) and digital health literacy across the 53 Member States in the WHO European region. The main objectives of the Action are to establish a Health Information Network for strategic guidance; and develop and implement tools and capacities to strengthen health information systems, health data governance, data quality and interoperability in countries.

Implementation of the international health regulations – global challenges and the COVID-19 pandemic

Abstract The International Health Regulations (IHR) govern how 196 countries and the World Health Organization (WHO) collectively manage global disease spread while preserving international travel and commercial trade. The COVID-19 pandemic set an unprecedented challenge to the IHR commitments. To address this gap, two scoping reviews were conducted: one identifying global challenges in IHR implementation and the other analyzing challenges, successes and limitations of the IHR during the COVID-19 pandemic. The scoping reviews followed Arksey and O’Malley’s framework and PRISMA methodology, utilizing the PubMed, Medline, World of Science, SCOPUS, and Google Scholar databases, plus backwards citation chaining. Data selection and analysis were guided by pretest forms. From 128 articles screened, 52 met inclusion criteria for the IHR implementation review. 135 challenges were identified, in these categories: (1) requirement of financial and technical resources, (2) lack of enforcement and accountability mechanisms, (3) need for rules clarification, (4) deterrents to reporting, (5) inadequate governance, (6) insufficient cooperation between countries, (7) sovereignty issues, (8) scarcity of guidance and technical support from WHO, (9) lack of inclusion of roles for relevant non-state actors, (10) conflicts and emergencies. In the COVID-19 review, 15 articles were included. Although the role of the IHR during Health Emergencies was acknowledged, most countries faced limitations in its implementation during the pandemic. Key lessons included reinforcing the global health security strategy, reviewing the IHR to address current challenges and strengthening countries and states’ commitment to resolutions compliance. The ongoing debate over IHR updates confirms the need for its revision to safeguard global health. A more effective response grounded on the IHR is needed to face upcoming and expected events of COVID-19’s magnitude and severity.

Assessment of Integrated Care Pathways for dementia in Italy according to the National Guidance

Abstract Background Italy counts 1 million people with dementia and 3 million caregivers. An integrated management system provides comprehensive care for people with non-communicable diseases, including dementia, through integrated care pathways (ICPs). Our study identified available dementia ICPs and assessed their compliance with the National Guidance on ICPs for People with Dementia (NGICPD). The project is carried out with the technical and financial support of the Ministry of Health (Chapter 2302). Methods We located ICPs by browsing all the websites of regions and Local Health Authorities (LHAs), contacting by email all LHAs, collecting ICPs from a survey carried out by the Dementia Observatory of the Italian National Institute of Health, and communicating with regional contacts. We included the ICPs produced after the NGICPD by the end of 2023. We applied a checklist developed on NGICPD consisting of 3 domains: Reference framework (0-15), Elements of the ICP (0-14), Construction of the ICP (0-14). ICPs were assessed by two researchers; a third solved the conflict points. The concordance was expressed by the intra-class correlation coefficient. Results We analysed 39 ICPs (11 regional, 28 LHAs) out of 87 collected. 15/21 regions and 30/110 LHAs developed an ICP. The observed mean total score was 23.5±7.9 for the regional ICPs and 23.1±5 for the LHAs ICPs. We observed low compliance with NGICPD, particularly in domain 3. The development of a health information system was included in 5/11 of regional and 12/28 of ICPs of LHAs; a monitoring system was present in 8/11 of regional and 25/28 LHAs ICPs. Concordance analysis showed an excellent correlation for regional ICPs and good for LHAs ICPs. Conclusions Our analysis highlighted low compliance of ICPs with the NGICPD and critical issues in monitoring. Our analysis stresses the need for all regions and LHAs to develop or update ICPs in line with NGICPD and the Italian Guidance on diagnosis and treatment of dementia. Key messages • Developing a pathway of efficient and coordinated care is essential to guarantee the quality of care for people with dementia and their families. All regions and LHAs must develop or update ICPs. • Monitoring ICP with indicators is crucial to planning cost-effective healthcare services.

ESPRIT study, analysis of the results of the pre-intervention survey in upper secondary schools

Abstract Background Sexually transmitted infections are a major public health problem, and their number is increasing in Italy. However, affective sexuality education is not yet part of the curricula. Therefore, a project entitled ESPRIT was launched, involving 3 regions (Friuli-Venezia Giulia, Lazio and Sicily), the IRCSS ‘Burlo Garofolo’ and the Istituto Superiore di Sanità, and implemented with the technical and financial support of the Ministry of Health - CCM. Methods A multicenter prospective intervention study was designed involving public upper secondary school students (grade 10-11). All target groups completed a KAP (knowledge, attitude, practice) questionnaire before and after participation in the educational intervention to measure its effectiveness. The questionnaires from the first phase were collected between January and April 2024, and the results were analyzed using R statistical software. Results The analysis of the overall results (463 students in total; female 58%, male 39%, other 2%; FVG 49%, Lazio 25%, Sicily 26%) showed that the group of upper secondary school students, targeted by peer education answered the knowledge part correctly by 56.6±13.8% on average. Applying the Kruskal-Wallis test showed that the percentage was significantly higher for females than males (p-value=0.005) and for licei students compared to technical and vocational schools (p-value=0.000). In terms of to attitudes, only 17% of students talked at length about sexually transmitted infections, and in 86.6% of cases, the interlocutors were friends or peers. Conclusions The results of the first phase show differences between the sexes and between the different types of educational institutions. The current level of knowledge still leaves much room for intervention and improvement. Analyzing the results of the follow-up phase will allow us to understand the effectiveness of the peer education intervention. Key messages • Adolescents’ knowledge of sexually transmitted infections needs to be improved. • Gender and the type of school attended affect the level of knowledge.

Exploring Stakeholder Perspectives on the Implementation of WHO iSupport for Dementia Program: A Qualitative Study.

To explore the stakeholders' perspectives and develop a conceptual framework for promotion strategies to implement the iSupport-based intervention for family caregivers of people with dementia. A descriptive qualitative design was adopted. Semi-structured interviews were conducted with 49 stakeholders of people with dementia from July to December 2023. The Consolidated Framework for Implementation Research was applied to guide the development of the interview guide, data collection and analysis. Directed content analysis was employed to identify facilitators and barriers, with data analysed based on the framework and the established its codebook. These findings were then summarised into a conceptual framework of critical components. The identified 16 barriers and 28 facilitators were distributed across all Consolidated Framework for Implementation Research domains. All facilitators and barriers were integrated into a conceptual framework guiding the implementation of iSupport. This four-tier, eight-component conceptual framework guides the global promotion of the web-based dementia care model, covering state, society, hospitals, individuals and strategies. The components included comprehensive and balanced national medical guidelines, a friendly social culture, adequate hospital collaboration, cooperative healthcare workers, responsible family caregivers, a comprehensive intervention system, appropriate learning content and digital health support. The 'iSupport for Dementia' program is seen positively for its potential to improve dementia care by providing mental and technical support to family caregivers. Successful implementation requires addressing barriers, enhancing facilitators and adapting to China's conditions and policies. Mobilising local healthcare resources and gaining stakeholder recognition is crucial. This approach may help develop a localised version of iSupport that suits the needs and habits of Chinese family caregivers, with the potential for broader dissemination. The 'iSupport for Dementia' program could greatly improve dementia care in China by addressing barriers and utilising facilitators. This study offers critical insights for future policy development and effective implementation strategies. Adherence to the COREQ guidelines for reporting qualitative research was maintained. No patient or public contribution.

Effects of pyrolysis temperatures on the structural properties of straw biochar and its adsorption of tris-(1-chloro-2-propyl) phosphate

To investigate the effect of pyrolysis temperature on the adsorption behavior of the emerging organic pollutant tris-(1-chloro-2-propyl) phosphate (TCIPP) on biochar, corn stover was used as raw materials to prepare biochars at different pyrolysis temperatures (250, 350, 500, 700 °C) through limited oxygen carbonization. Elemental analysis, Boehm titration, FTIR, XPS, and other analytical methods were used to reveal the effect of pyrolysis temperature on the physicochemical properties of biochar and its mechanism of TCIPP adsorption. The results showed that the pyrolysis temperature had a significant impact on the physicochemical properties of biochar. As the pyrolysis temperature increases, the specific surface area of biochar rises from 3.083 m2/g to 435.573 m2/g, the pH value increases from 6.60 to 10.66, the mass percentage of C increases from 63.10 to 80.58%, and the mass percentage of O decreases from 26.42 to 9.20%. Additionally, the hydrophobicity and aromaticity of biochar also increase with rising pyrolysis temperature, while its polarity decreases. Boehm titration, FTIR, and XPS analysis showed that the total amount of functional groups on the surface of biochar decreased relatively with increasing temperature. Functional groups such as -OH, C = C/C = O, and C-O-C participated in the adsorption of TCIPP on biochar, and ester groups were produced after adsorption. The adsorption process of TCIPP on biochar fits best with the pseudo-second-order equation, indicating that the adsorption process is mainly chemical adsorption, and the main rate-controlling stage is intraparticle diffusion. The isothermal adsorption results were more in line with the Temkin model, indicating that the adsorption process of TCIPP on biochar was mainly surface adsorption. As the pyrolysis temperature increases, the maximum adsorption capacity of biochar increases from 0.8837 mg/g to 2.2574 mg/g. The adsorption process of TCIPP on biochar mainly included pore filling, hydrogen bonding, P-π interaction, hydrophobic interaction, and electrostatic attraction. Among them, pore filling, P-π interaction, and hydrophobic interaction were significantly enhanced with increasing temperature, while hydrogen bonding was relatively weakened. This study will provide a theoretical basis and technical support for the removal of TCIPP from water using biochar adsorption.

Asphalt pavement raveling recognition based on deep learning algorithms

Abstract Pavement raveling can lead to the development of issues such as potholes. Monitoring and providing real-time early warnings for road surface developments is crucial for timely maintenance planning and effectively controlling the occurrence and progression of surface issues. To achieve intelligent identification of raveling distress on asphalt pavement surfaces, we utilized a portable laser-based pavement surface scanning device to collect raveling images, followed by histogram equalization to eliminate noise caused by environmental factors. Additionally, data enhancement strategies such as rotation and mirroring were used to enrich training data and expand the sample size. A Convolutional Neural Network (CNN) was employed to perform multi-layer convolution and pooling operations on the images to quickly extract features of distress. Finally, five pre-trained transfer learning models—ResNet-18, DenseNet, VGG16, Inception, and EfficientNet—were introduced to identify the asphalt surface disease data and the normal surface data. The results showed that the accuracy and loss of the training sets of several models exhibited a positive trend, with the EfficientNet model demonstrating stable and superior performance under the same training conditions. The precision matrix, confusion matrix, precision, recall, and F1 score were used as evaluation indexes to assess the effectiveness of the models for identifying pavement raveling. The EfficientNet and Inception models had the best accuracy and comprehensive performance, with accuracy rates of 0.96 and 0.95, respectively. The precision, recall, and F1 score are 0.95, 0.96, and 0.96 for the EfficientNet model respectively. A total of 146 images correctly predicted raveling disease and only 4 normal images were incorrectly predicted as diseased. For example, the EfficientNet model’s identification accuracy for pockmark disease on the PC platform was 0.963, verifying the model’s feasibility in practical applications. The principal contribution of this paper lies in the efficient and precise identification of asphalt pavement raveling, which adversely affects vehicular traveling comfortability. This provides theoretical and technical support for the intelligent identification of asphalt pavement defects and enhancing road asset maintenance management in the pavement engineering industry.

Digital health in the EP lab: routine implementation of remote access and technical support for complex ablation procedures

Abstract Background Complex electrophysiological procedures are performed using three-dimensional (3D) electroanatomical mapping (EAM) systems, which are usually operated on site, by field technical engineers (FTE). Due to a lack of skilled personnel, the engineers usually must travel between different hospitals and the procedures have to be planed in advance. Remote access (RA) technologies were recently implemented in clinical practice, aiming to increase the flexibility in the EP lab and maximise healthcare resources use. Methods Electroanatomical mapping was performed remotely by means of an integrated audio-visual solution for RA. The operator and the FTE communicated exclusively using the RA system, while the latter worked only in home office. Consecutive procedures were prospectively enrolled and analysed in terms of indication, procedural characteristics, feasibility and saved travelled time by the FTA. Results Between September 2022 and July 2023, a total of 133 EP procedures were performed in a high volume, tertiary electrophysiological centre in Germany. The mean age was 67 (57.5, 75.5) years. Women represented 39.8% of the population. The median BMI was 26.2 (23.1, 30.3) Kg/m2. A total of 56 (42.1%) patients underwent an atrial fibrillation ablation procedure (37.5% paroxysmal), 22 (16.5%) an atrial tachycardia ablation, 13 (9.8%) cavotricuspid isthmus ablation, 15 (11.3%) supraventricular tachycardia ablation, 14 (10.5%) a premature ventricular contraction ablation, 12 (9%) ventricular tachycardia ablations and 1 patient an electrophysiological diagnostic study. The median time length of procedure was 130 (96.5, 168) minutes. The median number of radiofrequency applications was 63.5 (22.3, 109.5), while the median RF time was 14.2 (6.9, 25.1) minutes. The fluoroscopy time was 9.2 (6.5, 12.6) minutes, with a median radiation dose of 408.5 (233.0, 631.8) cGy x cm2. The median amount of contrast media was 40 (8.75, 50.0) ml and the median amount of heparin administered was 12000 (8000, 16000) UI. Protamine was used in 9 cases, with a median of 7000 (5000, 7000) UI. Except for one supraventricular procedure, where no arrhythmia induction was possible, all procedures were successful. One major complication was observed. In one case, the internet-based headphone connection was not stable. Therefore, the communication was established via a conventional smartphone. No change to on-site support was needed. The travel time reduction was available in 130 cases. In total, 290 travel hours could be saved. Conclusion The routine implementation of RA for complex EP procedures proved to be safe and efficient. This approach has the potential to increase the feasibility in case of emergency procedures, reduce travel times for FTE and streamline healthcare resources allocation.

Research on wireless channel model based on improved ray tracing algorithm that considers multiple diffuse scattering and employs pyramid-shaped ray tubes as the carrier

This paper extensively utilizes fine three dimensional environmental data obtained from laser point clouds. Based on theories such as geometrical optics and effective roughness theory, a deterministic wireless channel model is established, which integrates higher-order diffuse scattering. This model is referred to as the ray tracing fusion with higher-order diffuse scattering model. To expedite the collision calculation between rays and the scene, this paper introduces a combined approach of voxelization and signed distance field, resulting in a remarkable 16-fold improvement in computational speed. Moreover, aiming to balance accuracy and efficiency, the paper systematically analyzes the optimization computation parameters of the model. Finally, the proposed model is validated using measurement data in the frequency range of 1 GHz to 6 GHz in mountainous terrain. The results indicate that the predicted outcomes of the proposed model have an accuracy within 6 dB compared to the measurement results, and are superior to ITU-R P.1546, which is an international standard recommended by the International Telecommunication Union for modeling electromagnetic wave propagation in undulating terrain. This provides necessary technical support for network planning and optimization.

Our clock is truly ticking – a qualitative study on patients’ experiences of tumour treating fields (TTFields)

Abstract Background TTFields is recommended internationally for treatment of glioblastoma. In Sweden, TTFields requires a possibly challenging collaboration between the patient, next-of-kin, healthcare and the private company providing the device, both from an ethical and practical perspective. Little is known about glioblastoma patients’ own experiences of TTFields treatment. Methods Semi-structured individual interviews were conducted with 31 patients with glioblastoma who had been offered TTFields by the healthcare. These were analysed by qualitative content analysis. Results Participants described there being multiple actors around them as TTFields users; 1) device prescription from physicians, sometimes providing insufficient information, 2) practical assistance from next-of-kin, necessary to access treatment, 3) home visits from the private company staff for device control, where close bonds between patients and TTFields staff occurred. TTFields treatment created hope and a feeling of control in an otherwise hopeless situation, sometimes evoking worries at the time of planned treatment stop. Some refrained from TTFields or discontinued early due to fear or experience of negative effect on quality of life. Others described finding practical and mental solutions for coping with the treatment in everyday life. Conclusions Our study identified a need for better support and information from healthcare providers for TTFields. A solution is necessary for assistance with TTFields for those without support from next-of-kin. The study raises the question of possible advantages of the healthcare handling the technical support of the device instead of a private company, thereby avoiding a true or perceived influence on the patient’s decision to continue or stop treatment.

Investigation of a Norovirus GII outbreak in a primary school in Portugal,2023

Abstract Background The onset of acute gastroenteritis cases among students in a primary school class on September 19, 2023, prompted an immediate response from the local Public Health unit. A collaborative effort was initiated to investigate and contain the outbreak. Methods Epidemiological questionnaires were distributed to 166 students and 8 staff members, defining cases as individuals exhibiting symptoms including diarrhoea, vomiting, or nausea between September 19th and September 24th, 2023. Additionally, stool samples were collected from three individuals. Results Out of 166 students and 8 staff members, 39 individuals met the case definition, resulting in attack rates of 22% (37/166) and 25% (2/8) among students and staff, respectively. Laboratory analysis confirmed two cases of Norovirus GII among the tested specimens, with five students requiring medical attention. Conclusions Our investigation underscores the significance of continuous epidemiological surveillance and swift implementation of infection control measures in school settings. The detection of Norovirus transmission emphasizes the necessity for rigorous adherence to infection control best practices. Our findings advocate for sustained technical support from public health authorities to prevent and manage similar outbreaks effectively. Key messages • Study on Norovirus outbreak in a primary school highlights the imperative of infection control measures, emphasizing the importance of ongoing support from public health authorities. • The Norovirus outbreak investigation underscores the vital role of surveillance and swift response in containing infectious diseases within educational settings safeguarding all.

11.H. Round table: Making the case for public investment in health

Abstract Across the European Union (EU), public budgets are facing pressures and policy makers are becoming increasingly concerned about how to adequately and sustainably fund their health systems to keep up with need and demand. In recognition of this, in 2022 a Technical Support Instrument (TSI) project funded by the Directorate-General for Structural Reform Support (DG REFORM) was launched together with three European Union (EU) Member States with the goal of strengthening capacity to make the case for public investments in health. To support these efforts, the European Observatory on Health Systems and Policies (OBS) conducted an exercise to map relevant analytical approaches and tools for making the case for public investment in health. As a contribution to this workshop, OBS will present the key results from this exercise, including a framework that has been designed to support health policy makers, advisors and advocates by providing five key lines of argument and selected examples of tools, data, indicators and methods that can be used to successfully make the case for public funding for health. This will be complemented by two presentations on country experiences (in Austria and Malta) of navigating negotiations between health and finance and securing public funding for health. These will highlight both successes and challenges in practice. By looking at examples from MS on making the case for public investment in health, these presentations will frame the panel discussion that follows. The chairs will facilitate a discussion closely engaging the audience on how to build better narratives and exchanges which facilitate trust and alignment between health and finance stakeholders in the pursuit of strengthening the capacity to make the case for public investment in health. The workshop will highlight five lines of argument and practical examples of tools, data, indicators and methods that can be used to support the case for public investment in health. It will also focus on the important enablers (e.g. cooperation, communication, transparency, accountability, trust) for successful budget negotiations and discuss how these can be facilitated. Key messages • Budget cases for public funds for health tend to be most successful when they align well with the goals and objectives of finance stakeholders, and certain narratives and arrangements can foster this. • Data and evidence can help steer decision makers to make good choices (or at least avoid bad ones), but other factors serve as the fuel to push the budget case for health forward successfully. Speakers/Panelists Rebecca Forman European Observatory on Health Systems and Policies, London, UK Jonathan Cylus European Observatory on Health Systems and Policies, London, UK Stefan Eichwalder Ministry of Health, Vienna, Austria Neville Calleja Department of Health Information and Research, G’Mangia, Malta

Investigation of a Norovirus GII.4Sydney[P16] outbreak in a care facility in Portugal, 2022

Abstract Background On the 29th of April 2022 the local Public Health unit was notified of 12 cases of acute gastroenteritis in residents of a long-term care facility (LTCF). A joint epidemiological investigation team was established and initiated an outbreak investigation to characterize the outbreak and implement infection control measures. Methods Epidemiological questionnaires were administered to staff (n = 44) and residents (n = 60). Case definition was LTCF residents or staff members with at least one of the following symptoms: diarrhoea, vomiting, nausea, between April 25th and May 14th, 2022. Stool or vomit samples were collected for 11 individuals. To assess environmental contamination fifteen food samples from previous meals and six surface samples from toilet faucets, wash tubs, and cutting boards were collected. Spatial distribution of cases within the LTCF was performed to guide infection control implementation. Results A total of 43 people met the case definition. Attack rates in residents and staff were 37% (23/63) and 42% (20/48), respectively. Of the total tested specimens, six (6/8) from residents and two (2/3) from staff were positive for the Norovirus (NoV) GII.4 Sydney [P16] variant by genotyping. Two (2/6) samples from surface swabs from the toilet faucet in the resident’s living room were also positive for NoV GII. Food samples were negative for major bacterial agents implicated in gastrointestinal outbreaks. Cases were distributed throughout the LTCF wards with no clear clustering. Four residents required hospital admission. Conclusions Results suggest person-to-person as well as environmental transmission of NoV. Identification of behavioural and spatial patterns of residents and staff and subsequent enactment of infection control strategies mitigated the outbreak. These findings reinforce the need for public health to maintain continuous technical support to LTCF on the implementation of infection control best practices. Key messages • Outbreak investigation in LTCF confirms Norovirus transmission, emphasizing the importance of infection control measures in long-term care facilities. • Study reveals Norovirus outbreak in LTCF, underscores the role of person-to-person and environmental transmission, highlighting the need for robust infection control protocols.