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.

DTR-SHIELD: Mutual Synchronization for Protecting against DoS Attacks on the SHIELD Protocol with AES-CTR Mode.

To enhance security in the semiconductor industry's globalized production, the Defense Advanced Research Projects Agency (DARPA) proposed an authentication protocol under the Supply Chain Hardware Integrity for Electronics Defense (SHIELD) program. This protocol integrates a secure hardware root-of-trust, known as a dielet, into integrated circuits (ICs). The SHIELD protocol, combined with the Advanced Encryption Standard (AES) in counter mode, named CTR-SHIELD, targets try-and-check attacks. However, CTR-SHIELD is vulnerable to desynchronization attacks on its counter blocks. To counteract this, we introduce the DTR-SHIELD protocol, where DTR stands for double counters. DTR-SHIELD addresses the desynchronization issue by altering the counter incrementation process, which previously solely relied on truncated serial IDs. Our protocol adds a new AES encryption step and requires the dielet to transmit an additional 100 bits, ensuring more robust security through active server involvement and message verification.

Exploring Opioid Prescription Patterns and Overdose Rates in South Carolina (2017-2021): Insights into Rising Deaths in High-Risk Areas.

With opioid overdose rates on the rise, we aimed to develop a county-level risk stratification that specifically focused on access to medications for opioid use disorder (MOUDs) and high overdose rates. We examined over 15 million records from the South Carolina Prescription Tracking System (SCRIPTS) across 46 counties. Additionally, we incorporated data from opioid treatment programs, healthcare professionals prescribing naltrexone, clinicians with buprenorphine waivers, and county-level overdose fatality statistics. To assess the risk of opioid misuse, we classified counties into high-risk and low-risk categories based on their prescription rates, overdose fatalities, and treatment service availability. Statistical methods employed included the two-sample t-test and linear regression. The t-test assessed the differences in per capita prescription rates between high-risk and low-risk counties. Linear regression was used to analyze the trends over time. Our study showed that between 2017 and 2021, opioid prescriptions decreased from 64,223 to 41,214 per 100,000 residents, while fentanyl-related overdose deaths increased by 312%. High-risk counties had significantly higher rates of fentanyl prescriptions and relied more on out-of-state doctors. They also exhibited higher instances of doctor shopping and had fewer medical doctors per capita, with limited access to MOUDs. To effectively combat the opioid crisis, we advocate for improved local healthcare infrastructure, broader treatment access, stricter management of out-of-state prescriptions, and vigilant tracking of prescription patterns. Tailored local strategies are essential for mitigating the opioid epidemic in these communities.

Can sharing auditors with customers improve suppliers digital transformation?

Introduction: Promoting enterprises' digital transformation is fundamental to implementing the digital China strategy and realizing high-quality development. Methods: Taking China's A-share listed companies from 2007 to 2021 as a research sample, this study examines the impact of sharing auditors with customers on the digital transformation of suppliers. Results: The results show that sharing auditors with customers can promote suppliers' digital transformation, and this promotion effect is stronger among suppliers with weaker bargaining power, lower media attention, and higher auditor industry expertise. In terms of the mechanism of action, sharing auditors with customers can help strengthen the supplier's supervision, alleviate suppliers' financing constraints, and thus facilitate their digital transformation. Further research finds that when suppliers share auditors with their customers, suppliers' digital transformation helps promote innovation. Discussion: The research conclusion provides effective empirical evidence for alleviating the dilemma of digital transformation of enterprises.

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.

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.

Blockchain-enabled architecture for lead acid battery circularity.

Widespread use of lead acid batteries (LABs) is resulting in the generation of million tons of battery waste, globally. LAB waste contains critical and hazardous materials, which have detrimental effects on the environment and human health. In recent times, recycling of the LABs has become efficient but the collection of batteries in developing countries is not efficient, which led to the non-professional treatment and recycling of these batteries in the informal sector. This paper proposes a blockchain-enabled architecture for LAB circularity, which ensures authentic, traceable and transparent system for collection and treatment of batteries. The stakeholders-battery manufacturers, distributors, retailers, users, and validators (governments, domain experts, third party experts, etc.)-are integrated in the circular loop through a blockchain network. A mobile application user interface is provided to all the stakeholders for the ease of adoption. The batteries manufactured and supplied in a geographical region as well as the recycled materials at the battery end-of-life are traced authentically. This architecture is expected to be useful for the battery manufacturers to improve their extended producer responsibility and support responsible consumption and production.

Sustainability of new energy vehicles from a battery recycling perspective: A bibliometric analysis.

In recent years, new energy vehicles (NEVs) have taken the world by storm. A large number of NEV batteries have been scrapped, and research on NEV battery recycling is important for promoting the sustainable development of NEVs. Battery recycling is an important aspect of the sustainable development of NEVs. In this study, we conducted an in-depth analysis of the current status of research on NEV battery recycling from a new perspective using bibliometric methods and visualization software. This study shows that research targeting the recycling of NEV batteries is growing rapidly, and collaborative networks exist among researchers from different countries, institutions, and fields. The focus of research has shifted from lead-acid batteries to lithium batteries, and the supply chain and circular economy related to NEV battery recycling is an emerging research hotspot. Based on our analysis, we propose that the government should establish policies to improve the recycling networks at the collection stage and provide subsidies to attract consumers. Enterprises should develop low-cobalt and cobalt-free technologies, utilize green solvents, and develop new battery swap modes. The establishment of an information platform is conducive to the further development of collaborative networks.

Design of a sustainable supply chain network of biomass renewable energy in the case of disruption.

Non-renewable energy sources, including fossil fuels, are a type of energy whose consumption rate far exceeds its natural production rate. Therefore, non-renewable resources will be exhausted if alternative energy is not fully developed, leading to an energy crisis in the near future. In this paper, a mathematical model has been proposed for the design of the biomass supply chain of field residues that includes several fields where residue is transferred to hubs after collecting the residue in the hub, the residue is transferred to reactors. In reactors, the residue is converted into gas, which is transferred to condenser and transformers, converted into electricity and sent to demand points through the network. In this paper, the criteria of stability and disturbance were considered, which have been less discussed in related research, and the purpose of the proposed model was to maximize the profit from the sale of energy, including the selling price minus the costs. Genetic algorithm (GA) and simulated annealing (SA) algorithm have been used to solve the model. Then, to prove the complexity of the problem, different and random examples have been presented in different dimensions of the problem. Also, the efficiency of the algorithm in small and large dimensions was proved by comparing GA and SA due to the low deviation of the solutions and the methods used have provided acceptable results suitable for all decision-makers. Also, the effectiveness of the algorithm in small and large dimensions is proven by comparing the genetic algorithm and simulated annealing, and the genetic algorithm's values are better, considering the deviation of 2.9%.and have provided solution methods suitable for all decision makers.

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.

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.

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).

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.

Energy and emissions: Comparing short and long fruit cold chains.

This paper evaluates GHG emissions and energy usage in "short" and "long" cold chains for oranges, table grapes, and apples transported from South Africa to a retail store in Scotland. Novel formulae assess energy usage and emissions based on cold chain duration. "Short" chains show carbon footprints between 0.87 and 1.28 kg CO2e/kg of saleable fruit, contrasting starkly with extended cold chains. Extending storage durations increases emissions; a one-month extension results in 24-27 % emissions for oranges and grapes and 16 % for apples. Six months of CA storage of apples increases emissions by 96 % compared to "short" cold chains. Energy consumption follows a similar trend as emissions. This research informs policymakers and consumers, emphasising the need for sustainable and "short" cold chains. This is also the first paper that comprehensively assesses both the energy requirements and emissions outputs in a fruit supply chain based on the combined transport and storage duration of the cold chain from tree to retail markets.