Using Novel Multimethod Evaluation Approaches to Understand Complex Food System Interventions: Insights from a Supply Chain Intervention Intended to Improve Nutrition.

Background: A "food system" approach to improve diet quality by intervening within areas such as food supply chains is gaining prominence. However, evidence of such interventions' impact, and understanding of appropriate methods to evaluate them, is lacking. Objectives: We present an impact evaluation of an intervention that aimed to increase consumption of nutritious foods by supporting food-producing firms in Kenya. In doing so, we demonstrate how multiple methods, including those from other disciplines, can be used to evaluate a complex food systems intervention. Methods: Four methods focused on food-producing firms and their management, including a survey of intervention participants (n = 83 individuals), a "laboratory-in-the-field" experiment (n = 83 individuals), baseline/endline data on firm performance (n = 71 firms), and semistructured interviews (n = 19 firms). Three methods focused on consumers in neighborhoods targeted by a supported firm: a randomized field experiment tested effects of making a supported product exhaustively available on consumers' purchases and consumption (n = 1295 consumers); 3 discrete choice experiments (n = 1295 consumers) tested factors influencing consumers' willingness to pay for foods with relevant characteristics. Results: Among firms, we saw suggestive evidence of increased networking and business relationships, while laboratory-in-the-field experiments indicated the intervention might foster cooperation among participants. Qualitative interviews suggested that the intervention enabled firms to increase production, improve management, increase revenues, and lower costs. Baseline/endline data confirmed a positive effect only on the launch of new products and hiring workers. In the field experiment, consumption of the supported product increased in areas where it was made available relative to a control group, but this did not increase overall consumption of the food type or dietary diversity. Conclusions: Results showed positive signs of the intervention improving firm-level outcomes but limited impact on consumers' diet quality. The evaluation also demonstrates how diverse methods can be used to evaluate complex interventions.

Analyzing sustainability in bread production: a life cycle assessment approach to energy, exergy and environmental footprint.

Bread production is a pivotal component of global nutrition. However, its extensive production imposes significant strain on resources and energy, resulting in substantial environmental consequences. This study focuses on a multidimensional assessment of the environmental sustainability of the bread life cycle as a case study in Iran. By integrating four life cycle assessment (LCA) methods, this research demonstrates a comprehensive analysis of environmental effects, energy consumption, and exergy demand in bread production. It also identifies the hotspot stages and inputs within the bread production chain. Eventually, it proposes strategies for mitigating the environmental impacts in line with sustainable development goals. Data collection involved questionnaires by face-to-face interviews. The LCA evaluation was conducted using SimaPro software. Sustainability analysis was assessed using four different methods: CML, ReCiPe, cumulative energy demand (CED), and cumulative exergy demand (CExD) method, from cradle to bakery gate. The CML method results indicate that the highest environmental impacts are associated with marine aquatic ecotoxicity (157.04 to 193.36 kg 1,4-DB eq), fossil fuel depletion (11.05 to 12.73 MJ), eutrophication (4.20 × 10-3 to 4.70 × 10-3 kg PO4-3 eq), acidification (8.09 × 10-3 to 9.16 × 10-3 kg SO2 eq), and global warming (0.61 to 0.69 kg CO2 eq). The ReCiPe method highlights wheat production stages and gas consumption as the most significant contributors to damage in terms of human health, ecosystems, and resource consumption indicators. The CED method reveals that fossil energy accounts for over 97% of the energy consumed during the bread life cycle. Energy consumption per kilogram of bread ranges from 12.07 to 13.93 MJ. The CExD method for producing 1 kg of traditional bread falls between 32.25 and 35.88 MJ. More than 60% of this value is attributed to renewable resources of water used in irrigation during the wheat farming stage, while over 35% is linked to non-renewable fossil resources, primarily due to the consumption of natural gas in bakery operations. To assess the potential decrease in environmental emissions, a sensitivity analysis was performed, considering the effects of substituting natural gas with biogas and grid electricity with photovoltaic electricity in the bakery. Then, three improved scenarios were developed, each demonstrating effective reductions in environmental impacts, with the most remarkable decreases observed in marine aquatic ecotoxicity (55%) and fossil fuel depletion (44%). Overall, the findings demonstrate that Sangak bread production exhibits a more environmentally friendly profile than other types of bread. These results can guide decision-makers in the bread production industry towards implementing sustainable practices that prioritize resource efficiency and environmental conservation. Also, stakeholders can develop strategies to reduce the environmental impacts and work towards a more sustainable future.

Rethinking counterfeit medical supply chains: A critical review of the current literature.

The medical device and pharmaceutical industries include a range of drugs, machines, instruments, and apparatuses used to prevent, diagnose, treat disease and illness, or aid in rehabilitation for patients, and are expected to grow substantially in the coming years. However, they are often targets of criminal organizations who manufacture and profit from fraudulent products, infiltrating the market with counterfeit medical supply chains. In this paper, we discuss and analyze the extent and nature of this problem and make suggestions for mitigation and prevention of this worldwide challenge. Ultimately, we argue that a holistic approach is essential to addressing this problem, including the creation and dissemination of reliable and good quality data, developing healthcare systems to be more robust, establishing/enhancing intra- and international cooperation around this issue, and employing effective technological solutions, such as digital tracing.

Convergent technologies to tackle challenges of modern food authentication.

The authentication process involves all the supply chain stakeholders, and it is also adopted to verify food quality and safety. Food authentication tools are an essential part of traceability systems as they provide information on the credibility of origin, species/variety identity, geographical provenance, production entity. Moreover, these systems are useful to evaluate the effect of transformation processes, conservation strategies and the reliability of packaging and distribution flows on food quality and safety. In this manuscript, we identified the innovative characteristics of food authentication systems to respond to market challenges, such as the simplification, the high sensitivity, and the non-destructive ability during authentication procedures. We also discussed the potential of the current identification systems based on molecular markers (chemical, biochemical, genetic) and the effectiveness of new technologies with reference to the miniaturized systems offered by nanotechnologies, and computer vision systems linked to artificial intelligence processes. This overview emphasizes the importance of convergent technologies in food authentication, to support molecular markers with the technological innovation offered by emerging technologies derived from biotechnologies and informatics. The potential of these strategies was evaluated on real examples of high-value food products. Technological innovation can therefore strengthen the system of molecular markers to meet the current market needs; however, food production processes are in profound evolution. The food 3D-printing and the introduction of new raw materials open new challenges for food authentication and this will require both an update of the current regulatory framework, as well as the development and adoption of new analytical systems.

Recycling channel strategy in the presence of free-riding in the carbon neutrality era.

Recycling has become a critical response to the goals of reaching a carbon peak and achieving carbon neutrality. This study explores the effects of consumer free-riding behavior, the quality of recycling services, and the costs of channel transfers on the profitability of manufacturers and retailers in a dual-channel closed-loop supply chain (CLSC), focusing on the importance of recycling practices for carbon neutrality. Using consumer utility theory and a Stackelberg game model, we analyze the dynamics among these factors. Our results show that: (i) Consumer free-riding behavior slightly increases market demand and recycling volumes, enhancing profitability for both manufacturers and retailers in the dual-channel CLSC. (ii) The quality of recycling services and the transfer costs associated with retailer free-riding behavior jointly influence the profits of manufacturers and retailers. (iii) The effect of free-riding behavior on recycling services affects both forward sales and reverse recycling channels equally. This study provides valuable insights for decision-making in sustainable development practices in the recycling sector, significantly contributing to the goal of achieving carbon neutrality.

Materials Challenges in the Electric Vehicle Transition.

The ongoing transition toward electric vehicles (EVs) is changing materials used for vehicle production, of which the consequences for the environmental performance of EVs are not well understood and managed. We demonstrate that electrification coupled with lightweighting of automobiles will lead to significant changes in the industry's demand not only for battery materials but also for other materials used throughout the entire vehicle. Given the automotive industry's substantial consumption of raw materials, changes in its material demands are expected to trigger volatilities in material prices, consequently impacting the material composition and attractiveness of EVs. In addition, the materials recovered during end-of-life recycling of EVs as the vehicle fleet turns over will impact recycled material supplies both positively and negatively, impacting material availabilities and the economic incentive to engage in recycling. These supply chain impacts will influence material usage and the associated environmental performance of not only the automotive sector but also other metal-heavy industries such as construction. In light of these challenges, we propose the need for new research to understand the dynamic materials impacts of the EV transition that encompasses its implications on EV adoption and fleet life cycle environmental performance. Effectively coordinating the coevolution of material supply chains is crucial for making the sustainable transition to EVs a reality.

Benchmarking circularity in supply chains: A systematic literature review.

The challenges posed by unsustainable practices in today's economy underscore the urgent need for a transition toward a circular economy (CE) and a holistic supply chain (SC) perspective. Benchmarking plays a pivotal role in managing circular SCs, offering a metric to gauge progress. However, the lack of consensus on the optimal benchmarking approach hampers effective implementation of circular business practices. To address this gap, we conducted a systematic review of the literature, identifying 29 pertinent publications. The analysis revealed 30 unique attributes and sub-attributes for benchmarking circularity, which were clustered into five main attributes. The main attributes are goals, subjects, key performance indicators (KPIs), data sources, and evaluation methods, while the sub-attributes are organised as features of the main attributes and depicted as a feature model. Drawing from selected publications, we illustrated each feature with examples. Our model offers a comprehensive benchmarking reference for circularity and will be a valuable tool for managers in the transition toward circularity. Supply chains seeking to benchmark their transition to circularity can apply the reference model to ensure that their benchmarking strategy is consistent with state-of-the-art knowledge. By providing a generic circularity benchmarking approach that is valid for diverse economic sectors, our findings contribute to theoretical efforts to address the lack of generic frameworks for CE.

Intelligent System/Equipment for Quality Deterioration Detection of Fresh Food: Recent Advances and Application.

The quality of fresh foods tends to deteriorate rapidly during harvesting, storage, and transportation. Intelligent detection equipment is designed to monitor and ensure product quality in the supply chain, measure appropriate food quality parameters in real time, and thus minimize quality degradation and potential financial losses. Through various available tracking devices, consumers can obtain actionable information about fresh food products. This paper reviews the recent progress in intelligent detection equipment for sensing the quality deterioration of fresh foods, including computer vision equipment, electronic nose, smart colorimetric films, hyperspectral imaging (HSI), near-infrared spectroscopy (NIR), nuclear magnetic resonance (NMR), ultrasonic non-destructive testing, and intelligent tracing equipment. These devices offer the advantages of high speed, non-destructive operation, precision, and high sensitivity.

Z-number based fuzzy MCDM models for analyzing non-traditional security threats to finance supply chains: A case study from Vietnam.

Non-traditional security (NTS) threats have a vast and profound impact on many aspects of economic, political, social, and many other areas, especially supply chain finance (SCF), particularly in countries like Vietnam, which potentially affects the economic efficiency of businesses' supply chain financial, thereby affecting the general economy of the country and the world. In order to prevent and minimize the negative impacts caused by NTS threats to SCF, this study was conducted to identify NTS threats affecting SCF in Vietnam, at the same time calculate the weight of the impact level and find out the cause and effect relationship between them. Solution strategies are also proposed and ranked, thereby serving as a reference basis for relevant parties to choose appropriate response solutions. Due to the multi-criteria nature of NTS threats, the multiple criteria decision-making (MCDM) method is used in combination with the Z-number concept and Fuzzy set theory to approach the problem of certainty and increase the accuracy of study. The NTS threats are first identified through a literature review and then validated for suitability using the DELPHI technique (DELPHI). Suitable threats will be determined by relationship, weighted by Decision Making Trial And Evaluation Laboratory (DEMATEL) method. Proposed strategies are ranked using the Technique for Order of Preference by Similarity to Ideal Solution (TOPSIS) method. The results indicate that there are 19 NTS factors affecting SCF in Vietnam, and the global economic downturn, pandemic and health crisis, financial crisis and cybersecurity risk are the four root cause factors with the most decisive influence. Businesses and concerns need to prioritize addressing these four threats because they not only have a strong impact but also entail many other threats. The two strategies considered to be the most effective are a sustainable practice and a risk-hedging strategy. Businesses, governments, and stakeholders also should pay attention to the macroeconomic environment, technology, and environment and build sustainable businesses, regularly monitoring economic fluctuations and creating plans to prevent risks.

Confirmation of a measurement model for hospital supply chain resilience.

Background: The hospital supply chain has revealed increasing vulnerabilities and disruptions in the wake of the COVID-19 pandemic, threatening the healthcare services and patient safety. The resilience of hospital supply chains has emerged as a paramount concern within the healthcare system. However, there is a lack of systematic research to develop an instrument tailored to the healthcare industry that is both valid and reliable for measuring hospital supply chain resilience. Therefore, this study aims to construct and validate a comprehensive scale for assessing hospital supply chain resilience, based on dynamic capability theory. Methods: This study followed rigorous scale development steps, starting with a literature review and 15 semi-structured interviews to generate initial items. These items were then refined through expert panel feedback and three rounds of Delphi studies. Using data from 387 hospitals in Province S, mainland China, the scale underwent rigorous testing and validation using structural equation modeling. To ensure the most effective model, five alternative models were examined to determine the most suitable parsimonious model. Results: The study produced a 26-item scale that captures five dimensions of resilience in line with dynamic capability theory: anticipation, adaptation, response, recovery, and learning, all showing satisfactory consistency, reliability and validity. Conclusion: The multi-dimensional scale offers hospital managers a valuable tool to identify areas needing attention and improvement, benchmark resilience against their counterparts, and ultimately strengthen their supply chains against unexpected risks.

Role of supply chain intermediaries in steering hospital product choice: Group Purchasing Organizations and biosimilars.

Over 95% of hospitals in the United States use pooling alliances, known as Group Purchasing Organizations (GPOs), to purchase medications, devices, and supplies. While GPOs create savings for hospitals through lowered prices and reduced administrative burden, critics allege that these supply chain intermediaries reduce competition, particularly if GPOs concentrate purchasing from larger, dominant manufacturers. Using a mixed-methods design, we studied whether GPOs influence hospital purchasing behavior and explored the contracting mechanisms used by GPOs. Focusing on 4 high-cost biologic molecules that face competition from generic-like biosimilars between 2015 and 2019, we found that biosimilar uptake was 16%-23% higher among Traditional Medicare patients in hospitals associated with 2 of the 3 top GPOs as compared with smaller GPOs. The increase in biosimilar use was driven by single biosimilar brands that varied by GPO. Based on qualitative interviews, these 2 GPOs used more aggressive contracting strategies to steer member hospitals to specific biosimilar brands. To date, the use of GPOs and these aggressive contracting strategies appear to have increased biosimilar use, suggesting savings for payers and patients. However, single-source GPO contracting could inhibit competition or create shortages in the long term. Transparency on GPO practices and pricing strategies is needed for further GPO evaluations.

Expanding community case management of malaria to all ages can improve universal access to malaria diagnosis and treatment: results from a cluster randomized trial in Madagascar.

BACKGROUND: Global progress on malaria control has stalled recently, partly due to challenges in universal access to malaria diagnosis and treatment. Community health workers (CHWs) can play a key role in improving access to malaria care for children under 5 years (CU5), but national policies rarely permit them to treat older individuals. We conducted a two-arm cluster randomized trial in rural Madagascar to assess the impact of expanding malaria community case management (mCCM) to all ages on health care access and use. METHODS: Thirty health centers and their associated CHWs in Farafangana District were randomized 1:1 to mCCM for all ages (intervention) or mCCM for CU5 only (control). Both arms were supported with CHW trainings on malaria case management, community sensitization on free malaria care, monthly supervision of CHWs, and reinforcement of the malaria supply chain. Cross-sectional household surveys in approximately 1600 households were conducted at baseline (Nov-Dec 2019) and endline (Nov-Dec 2021). Monthly data were collected from health center and CHW registers for 36 months (2019-2021). Intervention impact was assessed via difference-in-differences analyses for survey data and interrupted time-series analyses for health system data. RESULTS: Rates of care-seeking for fever and malaria diagnosis nearly tripled in both arms (from less than 25% to over 60%), driven mostly by increases in CHW care. Age-expanded mCCM yielded additional improvements for individuals over 5 years in the intervention arm (rate ratio for RDTs done in 6-13-year-olds, RRRDT6-13 years = 1.65; 95% CIs 1.45-1.87), but increases were significant only in health system data analyses. Age-expanded mCCM was associated with larger increases for populations living further from health centers (RRRDT6-13 years = 1.21 per km; 95% CIs 1.19-1.23). CONCLUSIONS: Expanding mCCM to all ages can improve universal access to malaria diagnosis and treatment. In addition, strengthening supply chain systems can achieve significant improvements even in the absence of age-expanded mCCM. TRIAL REGISTRATION: The trial was registered at the Pan-African Clinical Trials Registry (#PACTR202001907367187).

Does reusable mean green? Comparison of the environmental impact of reusable operating room bed covers and lift sheets versus single-use.

INTRODUCTION: As hospitals strive to reduce their environmental footprint, there is an ongoing debate over the environmental implications of reusable versus disposable linens in operating rooms (ORs). This research aimed to compare the environmental impact of reusable versus single-use OR bed covers and lift sheets using life cycle assessment (LCA) methodology. METHODS: LCA is an established tool with rigorous methodology that uses science-based processes to measure environmental impact. This study compared the impacts of three independent system scenarios at a single large academic hospital: reusable bed covers with 50 laundry cycles and subsequent landfill disposal (System 1), single-use bed covers with waste landfill disposal (System 2), and single-use bed covers with waste disposal using incineration (System 3). RESULTS: The total carbon footprint of System 1 for 50 uses was 19.83 â€‹kg carbon dioxide equivalents (CO2-eq). System 2 generated 64.99 â€‹kg CO2-eq. For System 3, the total carbon footprint was 108.98 â€‹kg CO2-eq. The raw material extraction for all the material to produce an equivalent 50 single-use OR bed cover kits was tenfold more carbon-intensive than the reusable bed cover. Laundering one reusable OR bed cover 50 times was more carbon intensive (12.12 â€‹kg CO2-eq) than landfill disposal of 50 single-use OR bed covers (2.52 â€‹kg CO2-eq). DISCUSSION: Our analysis demonstrates that one reusable fabric-based OR bed cover laundered 50 times, despite the carbon and water-intensive laundering process, exhibits a markedly lower carbon footprint than its single-use counterparts. The net difference is 45.16 â€‹kg CO2-eq, equivalent to driving 115 miles in an average gasoline-powered passenger vehicle. This stark contrast underscores the efficacy of adopting reusable solutions to mitigate environmental impact within healthcare facilities.

HCSRL: hyperledger composer system for reducing logistics losses in the pharmaceutical product supply chain using a blockchain-based approach.

Blockchain technology uses a secure and decentralised framework for transaction management and data sharing within supply chains. This is particularly crucial in the pharmaceutical industry, where product authenticity and traceability are paramount. Blockchain plays a pivotal role in preventing product loss and counterfeiting, while simultaneously enhancing transparency and efficiency throughout the supply chain. The research introduces a step-by-step approach to implementing a proof-of-concept (PoC) for Supply Chain Risk Management (SCRM) through blockchain technology. This PoC involves simulating a supply chain process to assess feasibility and measure key performance indicators. Engaging stakeholders and gathering feedback is integral to refining the blockchain-based SCRM system. The study rigorously evaluates the performance of the SCRM blockchain across various test scenarios, featuring differing numbers of organizations and clients. Multiple fabric networks are employed to assess the system's scalability and performance under diverse conditions. The results of these comprehensive tests inform practical deployment decisions and highlight areas for potential optimization and further development. So this research provides valuable insights into the application of blockchain in pharmaceutical supply chains, offering a roadmap for implementation and improving supply chain security, efficiency, and transparency.

Prevalence of Listeria monocytogenes in Milk and Dairy Product Supply Chains: A Global Systematic Review and Meta-analysis.

Listeria monocytogenes, one of the main foodborne pathogens, is commonly found in milk and dairy products. This study aimed to estimate the presence of L. monocytogenes in milk and dairy product supply chains using a meta-analysis based on PubMed, Embase, Web of Science, and Scopus databases. A total of 173 studies were included in this meta-analysis. The pooled prevalence in the supply chain environment was 8.69% (95% confidence interval [CI]: 5.30%-12.78%), which was higher than that in dairy products (4.60%, 95% CI: 1.72%-8.60%) and milk products (2.93%, 95% CI: 2.14%-3.82%). Subgroup analysis showed that L. monocytogenes prevalence in raw milk (3.44%, 95% CI: 2.61%-4.28%) was significantly higher than in pasteurized milk (0.60%, 95% CI: 0.00%-2.06%). The highest prevalence of L. monocytogenes in milk and dairy products was observed in North America (5.27%, 95% CI: 2.19%-8.35%) and South America (13.54%, 95% CI: 3.71%-23.37%). In addition, studies using culture and molecular methods (5.17%, 95% CI: 2.29%-8.06%) had higher prevalence than other detection methods. Serogroup 1/2a and 3a (45.34%, 95% CI: 28.74%-62.37%), serogroup 1/2b and 3b (14.23%, 95% CI: 6.05%-24.24%), and serogroup 4b/4e (13.71%, 95% CI: 6.18%-22.83%) were dominant in these studies. The results of this study provide a better understanding of the prevalence of L. monocytogenes in milk and dairy product supply chains and suggest a potential foodborne pathogen burden.

Research and Technologies to Reduce Grain Postharvest Losses: A Review.

Reducing postharvest losses offers a significant opportunity to enhance food availability without requiring extra production resources. A substantial portion of cereal grain goes to waste annually due to a lack of science-based knowledge, unconscious handling practices, suboptimal technical efficiency, and inadequate infrastructure. This article extensively reviews losses occurring during postharvest operations across various crops, examining diverse postharvest operations in different countries. Recent advancements in postharvest technology research are thoroughly discussed. The primary obstacles and challenges hindering the adoption and implementation of postharvest technologies are also explored. The appropriate postharvest technology relies on specific factors, including the kind of crops, production locales, seasons, and existing environmental and socioeconomic conditions.

Multi-Criteria Decision Analysis (MCDA) for sustainability assessment in food sector. A systematic literature review on methods, indicators and tools.

In the last decades, several studies have highlighted the significant impacts of the food sector. Therefore, enhancing sustainability within this sector has become of paramount importance. A crucial step towards achieving this goal involves the definition and implementation of effective sustainability metric and measurements. In this regard, the adoption of multi-criteria decision analysis (MCDA) methods can be seen as one of the most suitable and promising approach to comprehensively capture the complex and broad-ranging effects of agricultural practices and food supply chains. In such context, a systematic review of the scientific literature on multi-criteria approaches and tools for measuring the sustainability of food supply chains (harvest and post-harvest stages) has been carried out, resulting in the selection and analysis of 42 articles. To delve into the selected articles, three main areas of focus have been identified. The first about MCDA methods and their features, revealing the most adopted methods for sustainability assessments of food supply chains. The second, focusing on the participatory approach, led to the definition of a stakeholder's engagement map, highlighting the typology of stakeholders involved, the reasons of their involvement and engagement methods. Lastly, the third focus is related to the analysis and classification of indicators adopted in each study and the sustainability dimensions to which they refer to. The results of the present review study provide a comprehensive overview of the essential aspects to be considered when developing a MCDA for sustainability assessment in the food sector, serving as a valuable resource for both scholars and practitioners.

Evaluating Sustainable Practices for Managing Residue Derived from Wheat Straw.

Farm leftovers, particularly crop residues, are a key source of renewable energy in Canada. The nation's robust agricultural industry provides ample biomass, derived from forestry and agriculture resources, for energy generation. Crop residues, such as straws and husks, play a crucial role in this biomass reservoir, contributing to biofuel production and greenhouse gas mitigation efforts. Focusing on supply chains, waste management, and emission reduction, this study evaluates the sustainability of wheat straw, an agricultural biomass by-product. The environmental issues of various approaches to managing agricultural biomass were explored. Following an evaluation of biomass features, conversion methods, and economic and environmental advantages, the results show anaerobic digestion to be the most sustainable approach. Four metrics were examined in relation to social elements, and numerous aspects were considered as inputs in the evaluation of transportation costs. The use of electric trucks versus fuel-based trucks resulted in an 18% reduction in total operating costs and a 58% reduction in consumption costs. This study examined CO2 emissions over four different transportation distances. The data indicate that a significant reduction of 36% in kg CO2 equivalent emissions occurred when the distance was lowered from 100 km to 25 km. These findings offer insights for creating practical plans that should increase the sustainability of agricultural biomass leftovers.

Use of dairy industry side-stream lactose for tablet manufacturing - proof of concept study.

During recent years there have been shortages of certain drugs due to problems in raw material supply. These are often related to active ingredients but could also affect excipients. Lactose is one of the most used excipients in tableting and comes in two anomeric and several solid-state forms. The aim of this study was to utilize lactose from a dairy side-stream and compare it against a commercial reference in direct compression. This would be a sustainable option and would secure domestic availability during crises. Two types of lactose, spray-dried and freeze-dried, were evaluated. Lactose was mixed with microcrystalline cellulose in different ratios together with lubricant and glidant, and flowability and tabletability of the formulations was characterized. The fully amorphous and small particle-sized spray-dried lactose flowed inadequately but exhibited good tabletability. The larger particle-sized, freeze-dried lactose exhibited sufficient flow and better tabletability than the commercial reference. However, disintegration and drug release were slower when using the investigational lactose formulations. This was most likely due to remaining milk proteins, especially caseins, in the lactose. Overall, the investigational lactose provides promise for the use of such a side-stream product during crisis situations but enhancing their properties and/or purity would be needed.

Assessing the Disruption Impact on Healthcare Delivery.

Health emergency outbreaks such as the COVID-19 pandemic make it challenging for healthcare systems to ration medical resources and patient care. Such disastrous events have been increasing over the past years and are becoming inevitable, necessitating the need for healthcare to be well-prepared and resilient to unpredictable rises in demand. Quantitative and qualitative based decision support systems increase the effectiveness of planning, alleviating uncertainties associated with the crisis. This study aims to understand how the COVID-19 pandemic has affected the performance of healthcare systems in different areas and to address the associated disruption. A cross-sectional online survey was conducted in the Kingdom of Saudi Arabia and the United Arab Emirates among healthcare workers who worked during the pandemic. The pandemic-related disruption and its psychometric properties were assessed using Structural Equations Modeling (SEM) with 5 latent factors: Staff Mental Health, Communication Level, Planning and Readiness, Healthcare Supply Chain, and Telehealth. Responses from highly qualified participants with many years of experience in hospital settings were collected and analyzed. Results show that the model satisfactorily fits the data with a CLI of 0.91 and TLI of 0.88. The model indicates that enhancing supply chain management, planning, telehealth usage, and communication level across the healthcare system can mitigate the disruption. However, the lack of mental health management for healthcare workers can significantly disrupt the quality of delivered care. Staff mental health and healthcare supply chain, respectively, are the highest contributors to varying degrees of disruption in healthcare delivery. This study provides a direction for more research focusing on determinants of healthcare efficiency. It also provides decision-makers insights into the main factors leading to disruptions in healthcare systems, allowing them to shape their outbreak response and better prepare for future health emergencies.