IPVS STATEMENT on HPV vaccination: No longer supply constraints: Towards achieving WHO vaccine targets.

The global supply of human papillomavirus (HPV) prophylactic vaccines has been constrained since 2020.Vaccine manufacturers have increased capacity and new HPV vaccines are now available. Vaccine supply is now able to meet the full HPV vaccine demand which has been achieved earlier than predicted.

Segmental vitiligo distribution follows the underlying arterial blood supply territory: a hypothesis based on anatomo-clinical, pathological and physio-pathological studies.

Background: Segmental vitiligo (SV) is a subset of vitiligo typically characterized by its unilateral distribution. The pathogenesis of SV remains unclear, and until now the two main patterns proposed for SV have lacked biological support. This calls for a new approach. Objectives: Use data obtained from anatomo-clinical, pathological, and physio-pathological studies to formulate a new hypothesis on segmental vitiligo distribution and its pathogenesis. Methods: Using transparent templates of local arterial blood supply, we evaluated anatomical correspondence (AC) in 140 SV lesions according to the number of SV lesions that fit within the corresponding arterial blood-supply areas. SV lesions were graded as 1 (moderate: AC < 50%), 2 (good: AC > 50%), or 3 (excellent: AC of all lesions). To support this anatomical investigation, we searched for complementary assessments according to the activity of SV lesions. Arterial and periarterial network impairment and inflammatory infiltration were histologically studied using nerve growth factor (NGF) and CD4 and CD8 monoclonal antibodies. Increased blood flow of the underlying arteries was also investigated using thermography and ultrasonography. Results: We recruited 140 patients with a sex ratio of 0.8 and mean age 26.13 years. Localizations: head and neck 84.28%; trunk 6.42%; upper limb 5%; genital areas 2.14%; lower limb 1.42%. The AC of each SV lesion with the underlying artery blood supply territory was rated as 72% excellent; 16% good; and 12% moderate. Histologically (40 patients), we found some periarterial network impairments. Thermal asymmetry was significantly associated with active SV (p < 0.001). Conclusion: We hypothesized that SV distribution corresponds to the underlying artery blood-supply territory.

Safer supply and political interference in medical practice: Alberta's Narcotics Transition Services.

Across much of Canada, opioid poisoning deaths have been increasing due to a toxic, contaminated, and unpredictable drug supply. Multiple prescribed safer supply pilot projects are being implemented and evaluated in an attempt to save lives. In the province of Alberta, however, new regulations introduced in 2022 significantly constrain safer supply prescribing by banning the prescription, dispensing, and administration of safer supply outside of a very limited number of clinics. In this commentary, we review prescribed safer supply programs in Canada and outline how the Alberta Government's change in regulations conflict with emerging evidence and efforts by other jurisdictions to address the rising opioid poisoning deaths. We examine the development of these regulations and analyze how the Alberta government shaped and justified this restrictive policy. We conclude by identifying important lessons learned from the experience in Alberta for researchers, healthcare providers, and decisionmakers in other jurisdictions.

The effect of enterosgel on the activity of energy supply processes in rats at the same time affected by malathion and tetrachlormethane.

OBJECTIVE: Aim: The aim of the study was to investigate the activity of bioenergetic processes in rats under conditions of simultaneous exposure to malathion and carbon tetrachloride and after the use of enterosgel. PATIENTS AND METHODS: Materials and Methods: Experiments were conducted on rats. The rats were divided into nine groups.Malathion was administered daily (for 30 days) at a dose of 20 mg / kg body weight of the animal. Tetrachloromethane was administered twice (every other day) as a 50% oil solution at a dose of 1.0 ml / kg body weight. The intensity of energy supply processes was assessed by the activity of succinate dehydrogenase and cytochrome oxidase, impaired carbohydrate metabolism in terms of glucose and glycogen. RESULTS: Results: It was noted that succinate dehydrogenase activity in the liver decreased 2 times, in the myocardium - 1.6 times. On the thirty and seventh day of administration of toxicants after enterosorbent use, succinate dehydrogenase activity increased in the liver by 20%, cytochrome oxidase by 27%, in the myocardium - by 31% and 23%, respectively. The content of glucose in the serum after exposure to toxicants increased maximally (2.4 times) at the end of the study. In contrast, the glycogen content in the liver decreased by 48%, in the myocardium by 13%. The use of enterosgel resulted in a decrease in serum glucose. CONCLUSION: Conclusions: The use of enterosgel leads to the restoration of energy processes in the body of affected rats, which is confirmed by increased activity of mitochondrial enzymes, lowering glucose and increasing glycogen in the studied organs.

An integrated blockchain-enabled multi-channel vaccine supply chain network under hybrid uncertainties.

The recent pandemic caused by COVID-19 is considered an unparalleled disaster in history. Developing a vaccine distribution network can provide valuable support to supply chain managers. Prioritizing the assigned available vaccines is crucial due to the limited supply at the final stage of the vaccine supply chain. In addition, parameter uncertainty is a common occurrence in a real supply chain, and it is essential to address this uncertainty in planning models. On the other hand, blockchain technology, being at the forefront of technological advancements, has the potential to enhance transparency within supply chains. Hence, in this study, we develop a new mathematical model for designing a COVID-19 vaccine supply chain network. In this regard, a multi-channel network model is designed to minimize total cost and maximize transparency with blockchain technology consideration. This addresses the uncertainty in supply, and a scenario-based multi-stage stochastic programming method is presented to handle the inherent uncertainty in multi-period planning horizons. In addition, fuzzy programming is used to face the uncertain price and quality of vaccines. Vaccine assignment is based on two main policies including age and population-based priority. The proposed model and method are validated and tested using a real-world case study of Iran. The optimum design of the COVID-19 vaccine supply chain is determined, and some comprehensive sensitivity analyses are conducted on the proposed model. Generally, results demonstrate that the multi-stage stochastic programming model meaningfully reduces the objective function value compared to the competitor model. Also, the results show that one of the efficient factors in increasing satisfied demand and decreasing shortage is the price of each type of vaccine and its agreement.

The influence of storage conditions on hygiene condition and eicosapentaenoic acid oxidation in Nannochloropsis algae for sustainable food supply.

BACKGROUND: Nannochloropsis algae contain approximately 20% polyunsaturated fatty acids (PUFA) and hold significant potential for high-quality eicosapentaenoic acid (EPA) food industrialization. However, EPA in Nannochloropsis sp. is prone to oxidation, and microbial growth is a critical factor affecting the shelf life of fresh food. Storage composition and temperature are primary factors influencing microbial growth, yet these aspects are not fully understood. This study investigates the effects of temperature and encapsulation on EPA content in nano-products over time. Nano-powder and nanobeads derived from Nannochloropsis sp. served as raw materials. Additionally, changes in aerobic plate counts and coliform groups were monitored. RESULTS: The results indicated that nanobeads, due to their more complex processing and less mature packaging, were more susceptible to coliform contamination compared to nano-powder. In terms of EPA stability, nanobeads exhibited a longer storage life than nano-powder. The oxidation rate of both nano-powder and nanobeads was faster at 37 °C than at 25 °C. CONCLUSION: These findings can inform general shelf life estimation, rapid detection of total lipid content in nano-products and macro extraction of nano-oil. Moreover, they have significant implications for delaying EPA oxidation in nano-products and improving hygienic quality control for microbial detection. © 2024 Society of Chemical Industry.

A review of the emerging technologies and systems to mitigate food fraud in supply chains.

Food fraud has serious consequences including reputational damage to businesses, health and safety risks and lack of consumer confidence. New technologies targeted at ensuring food authenticity has emerged and however, the penetration and diffusion of sophisticated analytical technologies are faced with challenges in the industry. This review is focused on investigating the emerging technologies and strategies for mitigating food fraud and exploring the key barriers to their application. The review discusses three key areas of focus for food fraud mitigation that include systematic approaches, analytical techniques and package-level anti-counterfeiting technologies. A notable gap exists in converting laboratory based sophisticated technologies and tools in high-paced, live industrial applications. New frontiers such as handheld laser-induced breakdown spectroscopy (LIBS) and smart-phone spectroscopy have emerged for rapid food authentication. Multifunctional devices with hyphenating sensing mechanisms together with deep learning strategies to compare food fingerprints can be a great leap forward in the industry. Combination of different technologies such as spectroscopy and separation techniques will also be superior where quantification of adulterants are preferred. With the advancement of automation these technologies will be able to be deployed as in-line scanning devices in industrial settings to detect food fraud across multiple points in food supply chains.

Influenza vaccine allocation in tropical settings under constrained resources.

Influenza virus seasonality, synchronicity, and vaccine supply differ substantially between temperate and tropical settings, and optimal vaccination strategy may differ on this basis. Many national vaccine recommendations focus on high-risk groups, elderly populations, and healthcare workers despite previous analyses demonstrating broad benefits to vaccinating younger high-contact age groups. In this study, we parameterized an age-structured nonseasonal asynchronous epidemiological model of influenza virus transmission for a tropical low-income setting. We evaluated timing and age allocation of vaccines across vaccine supplies ranging from 10 to 90% using decade-based age groups. Year-round vaccination was beneficial when compared with more concentrated annual vaccine distribution. When targeting a single age group for vaccine prioritization, maximum vaccine allocation to the 10-19 high-contact age group minimized annual influenza mortality for all but one vaccine supply. When evaluating across all possible age allocations, optimal strategies always allocated a plurality of vaccines to school-age children (10-19). The converse, however, was not true as not all strategies allocating a plurality to children aged 10-19 minimized mortality. Allocating a high proportion of vaccine supply to the 10-19 age group is necessary but not sufficient to minimize annual mortality as distribution of remaining vaccine doses to other age groups also needs to be optimized. Strategies focusing on indirect benefits (vaccinating children) showed higher variance in mortality outcomes than strategies focusing on direct benefits (vaccinating the elderly). However, the indirect benefit approaches showed a lower mean mortality and a lower minimum mortality than vaccination focused on the elderly.

Social interactions are impacted by food availability and group size.

Social interactions are important for how societies function, conferring robustness and resilience to environmental changes. The structure of social interactions can shape the dynamics of information and goods transmission. In addition, the availability and type of resources that are transferred might impact the structure of interaction networks. For example, storable resources might reduce the required speed of distribution and altering interaction structure can facilitate such change. Here we use ants as a model system to examine how social interactions are impacted by group size, food availability, and food type. We compare global- and individual-level network measures across experiments in which groups of different sizes received limited or unlimited food that is either favorable and cannot be stored (carbohydrates), or unfavorable but with a potential of being stored (protein). We found that in larger groups, individuals interacted with more social partners and connected more individuals, and interaction networks became more compartmentalized. Furthermore, the number of individuals ants interacted with and the distance they traveled both increased when food was limited compared to when it was unlimited. Our findings highlight how biological systems can adjust their interaction networks in ways that relate to their function. The study of such biological flexibility can inspire novel and important solutions to the design of robust and resilient supply chains.

A novel two-stage network data envelopment analysis model for kidney allocation problem under medical and logistical uncertainty: a real case study.

Organ transplantation is one of the most complicated and challenging treatments in healthcare systems. Despite the significant medical advancements, many patients die while waiting for organ transplants because of the noticeable differences between organ supply and demand. In the organ transplantation supply chain, organ allocation is the most significant decision during the organ transplantation procedure, and kidney is the most widely transplanted organ. This research presents a novel method for assessing the efficiency and ranking of qualified organ-patient pairs as decision-making units (DMUs) for kidney allocation problem in the existence of COVID-19 pandemic and uncertain medical and logistical data. To achieve this goal, two-stage network data envelopment analysis (DEA) and credibility-based chance constraint programming (CCP) are utilized to develop a novel two-stage fuzzy network data envelopment analysis (TSFNDEA) method. The main benefits of the developed method can be summarized as follows: considering internal structures in kidney allocation system, investigating both medical and logistical aspects of the problem, the capability of expanding to other network structures, and unique efficiency decomposition under uncertainty. Moreover, in order to evaluate the validity and applicability of the proposed approach, a validation algorithm utilizing a real case study and different confidence levels is used. Finally, the numerical results indicate that the developed approach outperforms the existing kidney allocation system.

Private sector led multi-stakeholder platforms positively influence certified common bean seed supply in Malawi.

Common bean yields in Malawi remain low, primarily due to the use of low-yielding, recycled local seeds by most smallholder farmers. The low uptake of certified bean seed is attributed to limited incentives from the private sector. This study hypothesizes that the sustainable adoption of market-preferred varieties can be achieved by synchronizing and linking seed production to the grain market through committed value chain actors in a private sector-led multi-stakeholder platform. This paper examines the role of private sector-led multi-stakeholder platforms in the supply of certified common bean seed in Malawi. The research draws on both qualitative and quantitative primary data collected through a semi-structured questionnaire and interviews with key informants. Data were analyzed using an Ordinary Least Squares (OLS) regression model. The results indicate that several variables representing membership in multi-stakeholder platforms (MSPs) significantly affect the supply of certified common bean seed. Participation in MSPs, contractual arrangements, market structure, extension services, and seed demonstrations positively influenced seed supply. The findings underscore the need for a well-coordinated multi-stakeholder platform to enhance the supply of certified common bean seed, supported by effective policies and incentives from policymakers.

Effective Supply Chain Strategies in Addressing Demand and Supply Uncertainty: A Case Study of Ethiopian Pharmaceutical Supply Services.

BACKGROUND: Ensuring the consistent availability of essential medicines is crucial for effective healthcare systems. However, Ethiopian public health facilities have faced frequent stockouts of crucial medications, highlighting systemic challenges such as inadequate forecasting, prolonged procurement processes, a disjointed distribution system, suboptimal data quality, and a shortage of trained professionals. This study focuses on the Ethiopian Pharmaceutical Supply Services (EPSS), known for its highly unstable and volatile supply chain, aiming to identify risks and mitigation strategies. METHODS: Using a mixed-method approach involving surveys and interviews, the research investigates successful and less successful strategies, key success factors, and barriers related to pharmaceutical shortages. RESULTS: Proactive measures such as communication, stock assessment, supervision, and streamlined procurement are emphasized as vital in mitigating disruptions, while reactive strategies like safety stock may lack long-term efficacy. The study highlights the importance of aligning supply chain strategies with product uncertainties, fostering collaboration, and employing flexible designs for resilience. Managerial implications stress the need for responsive structures that integrate data quality, technology, and visibility. CONCLUSIONS: This study contributes by exploring proactive and reactive strategies, elucidating key success factors for overcoming shortages in countries with unstable supply chains, and offering actionable steps for enhancing supply chain resilience. Embracing uncertainty and implementing proactive measures can help navigate volatile environments, thereby enhancing competitiveness and sustainability.

Design and optimization of dynamic reliability-driven order allocation and inventory management decision model.

Efficient order allocation and inventory management are essential for the success of supply chain operations in today's dynamic and competitive business environment. This research introduces an innovative decision-making model incorporating dependability factors into redesigning and optimizing order allocation and inventory management systems. The proposed model aims to enhance the overall reliability of supply chain operations by integrating stochastic factors such as demand fluctuations, lead time uncertainty, and variable supplier performance. The system, named Dynamic Reliability-Driven Order Allocation and Inventory Management (DROAIM), combines stochastic models, reliability-based supplier evaluation, dynamic algorithms, and real-time analytics to create a robust and flexible framework for supply chain operations. It evaluates the dependability of suppliers, transportation networks, and internal procedures, offering a comprehensive approach to managing supply chain operations. A case study and simulations were conducted to assess the efficacy of the proposed approach. The findings demonstrate significant improvements in the overall reliability of supply chain operations, reduced stockout occurrences, and optimized inventory levels. Additionally, the model shows adaptability to various industry-specific challenges, making it a versatile tool for practitioners aiming to enhance their supply chain resilience. Ultimately, this research contributes to existing knowledge by providing a thorough decision-making framework incorporating dependability factors into order allocation and inventory management processes. Practitioners and experts can implement this framework to address uncertainties in their operations.

Obstetric Emergency Supply Chain Dynamics and Information Flow Among Obstetric Emergency Supply Chain Employees: Key Informant Interview Study.

BACKGROUND: For the past several decades, the Ethiopian Ministry of Health has worked to decrease the maternal mortality ratio (MMR)-the number of pregnant women dying per 100,000 live births. However, with the most recently reported MMR of 267, Ethiopia still ranks high in the MMR globally and needs additional interventions to lower the MMR to achieve the sustainable development goal of 70. One factor contributing to the current MMR is the frequent stockouts of critical medications and supplies needed to treat obstetric emergencies. OBJECTIVE: This study describes the obstetric emergency supply chain (OESC) dynamics and information flow in Amhara, Ethiopia, as a crucial first step in closing stockouts and gaps in supply availability. METHODS: Applying qualitative descriptive methodology, the research team performed 17 semistructured interviews with employees of the OESC at the federal, regional, and facility level to describe and gain an understanding of the system in the region, communication flow, and current barriers and facilitators to consistent emergency supply availability. The team performed inductive and deductive analysis and used the "Sociotechnical Model for Studying Health Information Technology in Complex Adaptive Healthcare Systems" to guide the deductive portion. RESULTS: The interviews identified several locations within the OESC where barriers could be addressed to improve overall facility-level readiness, such as gaps in communication about supply needs and availability in health care facilities and regional supply hubs and a lack of data transparency at the facility level. Ordering supplies through the integrated pharmaceutical logistics system was a well-established process and a frequently noted strength. Furthermore, having inventory data in one place was a benefit to pharmacists and supply managers who would need to use the data to determine their historic consumption. The greatest concern related to the workflow and communication of the OESC was an inability to accurately forecast future supply needs. This is a critical issue because inaccurate forecasting can lead to undersupplying and stockouts or oversupplying and waste of medication due to expiration. CONCLUSIONS: As a result of these interviews, we gained a nuanced understanding of the information needs for various levels of the health system to maintain a consistent supply of obstetric emergency resources and ultimately increase maternal survival. This study's findings will inform future work to create customized strategies that increase supply availability in facilities and the region overall, specifically the development of electronic dashboards to increase data availability at the regional and facility levels. Without comprehensive and timely data about the OESC, facilities will continue to remain in the dark about their true readiness to manage basic obstetric emergencies, and the central Ethiopian Pharmaceutical Supply Service and regional hubs will not have the necessary information to provide essential emergency supplies prospectively before stockouts and maternal deaths occur.

Exploring health inequities through the actor-network theory lens.

Social theory plays an important role in the nursing discipline and nursing inquiry as it helps conceptually embed nursing in the larger picture of the social world. For example, a broad category of critical theory provides a unique lens for uncovering social conditions of inequity and oppression. Among the sociological theories, actor-network theory (ANT) is an approach to research and analysis that has recently gained interest among nurse philosophers and researchers. Studies guided by ANT seek to understand phenomena of interest as constituted within the relationships between human and nonhuman actors to understand how care practices are co-created/enacted and how they can be made more humane. In this paper, we describe the benefits of ANT for examining healthcare access for incarcerated individuals with life-limiting illnesses accessing palliative care and for people using illicit drugs. We argue that attention to the materiality of care practices can contribute to efforts of advancing health equity for these groups.

Applications of blockchain technology in peer-to-peer energy markets and green hydrogen supply chains: a topical review.

Countries all over the world are shifting from conventional and fossil fuel-based energy systems to more sustainable energy systems (renewable energy-based systems). To effectively integrate renewable sources of energy, multi-directional power flow and control are required, and to facilitate this multi-directional power flow, peer-to-peer (P2P) trading is employed. For a safe, secure, and reliable P2P trading system, a secure communication gateway and a cryptographically secure data storage mechanism are required. This paper explores the uses of blockchain (BC) in renewable energy (RE) integration into the grid. We shed light on four primary areas: P2P energy trading, the green hydrogen supply chain, demand response (DR) programmes, and the tracking of RE certificates (RECs). In addition, we investigate how BC can address the existing challenges in these domains and overcome these hurdles to realise a decentralised energy ecosystem. The main purpose of this paper is to provide an understanding of how BC technology can act as a catalyst for a multi-directional energy flow, ultimately revolutionising the way energy is generated, managed, and consumed.

Minimum Space When Transporting Pigs: Where Is the "Good" Law?

This paper focuses on the problem of numeracy when writing regulations, specifically how to describe a threshold for crowding of pigs during transport, considering transported pigs range in body mass from 5 to 500 kg. When scientific findings provide the basis for regulation in the public interest, those findings must be communicated in a consistent way to regulators and policymaking bodies. Numeracy is the ability to understand, reason with, and apply appropriate numerical concepts to real-world questions. Scientific understanding is almost always based on rational understanding of numerical information, numeracy. The threshold of administrative offenses is often a numerical description. Commercial livestock transporters have an interest in loading livestock compartments to the maximum to achieve the largest payload allowed by axle weight laws, as is the case in all bulk commodity transport. Maximizing payload minimizes costs and environmental hazards of fuel exhaust and can benefit the public with lower pork prices, but has a serious animal welfare risk. Livestock production academics, veterinarians, and animal welfare activists have been working for decades to determine the level of livestock crowding in transport containers that would be appropriate for regulatory enforcement. The scientific discourse has been plagued by a lack of numerical standardization when describing results of trials and forming recommendations. Exceeding specific numerical thresholds is the core to implementing enforcement actions. This paper examines the communication and other barriers that have prevented emergence of a consensus on this question and provides a direction toward resolution. Further confirmation of effects of crowding livestock in transit is needed. This paper suggests that articulating an enforceable standard in pig transport is possible. In inspection for compliance, discovering the LP50 (lethal pressure-50) for slaughter-weight pigs is an initial global benchmark goal. The LP50 is the loading floor pressure in a commercial transport compartment, under field conditions, that would result in the death of at least one pig in the group 50% of the time.

A systematic review of antibiotic drug shortages and the strategies employed for managing these shortages.

BACKGROUND: There is a need to examine the impact of increasingly prevalent antibiotic shortages on patient outcomes and on the emergence and spread of antimicrobial resistance (AMR). OBJECTIVES: To: 1) assess patterns and causes of shortages, 2) investigate the effect of shortages on health systems and patient outcomes, and 3) identify strategies for forecasting and managing shortages. DATA SOURCES: PubMed/MEDLINE, EMBASE, Scopus, and Web of Science. STUDY ELIGIBILITY CRITERIA: Studies published in English during January 2000-July 2023. PARTICIPANTS: Healthcare, policy and strategic teams managing and responding to shortages. Patient populations (adult and children) affected by shortages. INTERVENTIONS: Strategies, policies, and mitigation options for managing and responding to antibiotic drug shortages. RISK OF BIAS: Methodological quality of included studies was reviewed using the most appropriate tool from Joanna Briggs Institute critical appraisal tool for each study design. METHODS: Data synthesis was qualitative and quantitative using descriptive statistics. RESULTS: The final analysis included 74 studies (61/74, 82.4% high-income countries). Shortages were most reported for piperacillin-tazobactam (21/74, 28.4%) with most of the reported antibiotics being in the WHO Watch category (27/54, 51%). Frequent cause of shortages was disruption in manufacturing including supply of active pharmaceutical ingredient and raw materials. Clinical implications of shortages included increased length of hospital stay, treatment failure after using inferior alternative agents and negative impact on antimicrobial stewardship programmes (AMS). Robust economic impact analysis of shortages is unavailable. Successfully reported mitigation strategies were driven by AMS and infectious diseases teams in hospitals. CONCLUSIONS: Antibiotic shortages are directly or indirectly driven by economic viability and reliance on single source ingredients. The limited data on clinical outcomes indicates mixed effect with some infections becoming more difficult to treat, though there is no robust data on the impact of shortages on AMR. The mitigation strategies to manage shortages rely heavily on AMS teams.

Exposure of Cattle Breeding Herds to Naturally Co-Contaminated Zearalenone and Deoxynivalenol: The Relevance of a Urinary Mycotoxin Monitoring System for Herd Health and Food Safety.

The widespread presence of Fusarium mycotoxins in animal feed is a global issue, not only for the health of livestock but also for ensure the safety of food as an end product. High concentrations of zearalenone (ZEN) and deoxynivalenol (DON) have been detected in the diets of Japanese Black (JB) and Holstein Friesian (HF) breeding herds. Consequently, we monitored serum biochemical parameters over a long time in both herds, focusing on anti-Müllerian hormone (AMH) levels and acute-phase inflammation. Additionally, urinary 8-hydroxy-2'-deoxyguanosine (8-OHdG) and progesterone levels were measured in the HF herd. The JB herd, a ZEN-dominant model with low DON contamination, demonstrated ZEN levels that exceeded the Japanese limit in the purchased total mixed rations (TMR). Conversely, the HF herd, which primary consumes DON-dominant feed with low ZEN contamination, had high DON levels in the dent corn silage. Specifically, the JB herd's TMR contained 1.79 mg/kg ZEN and 0.58 mg/kg DON, whereas the HF herd's silage had 15.3 mg/kg DON (dried sample) and 0.1 mg/kg ZEN. Enzyme-linked immunoassay were used to measure urinary ZEN-DON levels following confirmation through liquid chromatography-tandem mass spectrometry. Urinary ZEN-DON levels measured were significantly correlated (p < 0.05, r > 0.6) in both herds. In the HF herd, AMH levels increased (p = 0.01) and serum amyloid A (SAA) levels decreased (p = 0.02) when contaminated and at the end of the monitoring period. Additionally, urinary ZEN and DON levels were significantly correlated with SAA levels (ZEN: p = 0.00, r = 0.46; DON: p = 0.03, r = 0.33), with an increase in ZEN and DON levels resulting in higher SAA levels. The JB herd showed no significant differences. Additionally, in the HF herd, 8-OHdG/Cre levels increased significantly during major contamination periods (p < 0.05). Clinical data from the HF herd indicated an increase in mastitis cases and treatment rates during periods of major contamination. Abortion rates in the HF herd decreased from 22.9% (before monitoring) to 8.9% (during the high contamination period) and finally to 1% (at the end of the monitoring period), with corresponding increases in progesterone levels. ZEN-DON contamination adversely affects breeding cattle's productivity, reproductive performance, and health. Therefore, monitoring urinary ZEN-DON is valuable for detecting contaminants and ensuring the safety of food products.

Challenges Experienced by Health Care Workers During Service Delivery in the Geographically Challenging Terrains of North-East India: Study Involving a Thematic Analysis.

BACKGROUND: The public health landscape in North-East India is marked by the foundational principle of equitable health care provision, a critical endeavor considering the region's intricate geography and proximity to international borders. Health care workers grapple with challenges, such as treacherous routes, limited infrastructure, and diverse cultural nuances, when delivering essential medical services. Despite improvements since the National Rural Health Mission in 2005, challenges persist, prompting a study to identify health care workers' challenges and alternative strategies in Manipur and Nagaland. OBJECTIVE: This study aims to document the challenges experienced by health care workers during service delivery in the geographically challenging terrains of North-East India. METHODS: This study is part of the i-DRONE (Indian Council of Medical Research's Drone Response and Outreach for North East) project, which aims to assess the feasibility of drone-mediated vaccine and medical delivery. This study addresses the secondary objective of the i-DRONE project. In-depth interviews of 29 health care workers were conducted using semistructured questionnaires in 5 districts (Mokokchung and Tuensang in Nagaland, and Imphal West, Bishnupur, and Churachandpur in Manipur). Nineteen health facilities, including primary health care centers, community health centers, and district hospitals, were selected. The study considered all levels of health care professionals who were in active employment for the past 6 months without a significant vacation and those who were engaged in ground-level implementation, policy, and maintenance activities. Data were recorded, transcribed, and translated, and subsequently, codes, themes, and subthemes were developed using NVivo 14 (QSR International) for thematic analysis. RESULTS: Five themes were generated from the data: (1) general challenges (challenges due to being an international borderline district, human resource constraints, logistical challenges for medical supply, infrastructural issues, and transportation challenges); (2) challenges during the COVID-19 pandemic (increased workload, lack of diagnostic centers, mental health challenges and family issues, routine health care facilities affected, stigma and fear of infection, and vaccine hesitancy and misinformation); (3) perception and awareness regarding COVID-19 vaccination; (4) alternative actions or strategies adopted by health care workers to address the challenges; and (5) suggestions provided by health care workers. Health care workers demonstrated adaptability by overcoming these challenges and provided suggestions for addressing these challenges in the future. CONCLUSIONS: Health care workers in Manipur and Nagaland have shown remarkable resilience in the face of numerous challenges exacerbated by the pandemic. Despite infrastructural limitations, communication barriers, and inadequate medical supply distribution in remote areas, they have demonstrated adaptability through innovative solutions like efficient data management, vaccination awareness campaigns, and leveraging technology for improved care delivery. The findings are pertinent for not only health care practitioners and policymakers but also the broader scientific and public health communities. However, the findings may have limited generalizability beyond Manipur and Nagaland.