Search Results (157)

Cervical cancer remains a significant global public health challenge, with human papillomavirus (HPV) as its primary cause. In response, the World Health Organization (WHO) launched a global strategy to eliminate cervical cancer by 2030 and, in its 2022 position paper, recommended a single-dose vaccination schedule. The objective of this review is to critically examine the current HPV vaccination landscape in China, including vaccination policies, immunization schedules, supply–demand dynamics, and the feasibility of transitioning to a single-dose regimen. By synthesizing recent developments in HPV virology, epidemiology, vaccine types, and immunization strategies, we identify both opportunities and barriers unique to the Chinese context. Results indicate that China primarily adheres to a three-dose vaccination schedule, with an optional two-dose schedule for girls aged 9–14, leaving a notable gap compared to the most recent WHO recommendation. The high prevalence of HPV types 52 and 58 contributes to a distinct regional infection pattern, underscoring the specific need for nine-valent vaccines tailored to China’s epidemiological profile. Despite the growing demand, vaccine supply remains inadequate, with an estimated annual shortfall of more than 15 million doses. This issue is further complicated by strong public preference for the nine-valent vaccine and the relatively high cost of vaccination. Emerging evidence supports the comparable efficacy and durable protection of a single-dose schedule, which could substantially reduce financial and logistical burdens while expanding coverage. This review advocates for the adoption of a simplified single-dose regimen, supported by catch-up strategies for older cohorts and the integration of HPV vaccination into China’s National Immunization Program (NIP). Sustained investment in domestic vaccine development and centralized procurement of imported vaccines may also possibly alleviate supply shortage. These coordinated efforts are critical for strengthening HPV-related disease prevention and accelerating China’s progress toward the WHO’s cervical cancer elimination targets. Full article

Rural road programs are essential for enhancing connectivity in remote areas, yet they frequently encounter schedule delays and budget overruns. This study explores the extent to which specific project characteristics influence these deviations in Colombian rural road contracts. A dataset comprising 229 projects was extracted from the national SECOP open-procurement platform and processed using the CRISP-DM protocol. Following the cleaning and coding of 14 project-level variables, statistical analyses were conducted using Spearman correlations, Kruskal–Wallis tests, and post-hoc Wilcoxon comparisons to identify significant bivariate relations I confirm I confirm I confirm hips. A Random Forest model was subsequently applied to determine the most influential multivariate predictors of cost and time deviations. In parallel, a directed content analysis of contract addenda reclassified 22 recorded deviation descriptors into ten internationally recognized categories of causality, enabling an integrated interpretation of both statistical and documentary evidence. The findings indicate that contract value, geographical region, and contractor configuration are significant determinants of cost and time performance. Additionally, project intensity and discrepancies between awarded and bid values emerged as key contributors to cost escalation. Scope changes and adverse weather conditions together accounted for 76% of all documented deviation triggers, underscoring the relevance of robust front-end planning and climate-risk considerations in rural infrastructure delivery. The findings provide information for stakeholders, policymakers, and professionals who aim to manage the risk of schedule and budget deviations in public infrastructure projects. Full article

Introduction: The escalating scarcity of skilled healthcare professionals is particularly pronounced within surgical specialties, where the prospect of attracting prospective medical practitioners poses formidable challenges. Throughout their academic journey, students exhibit diminishing enthusiasm and motivation to pursue careers in surgery, including trauma surgery. It is postulated that the caliber of teaching plays a pivotal role in influencing students’ subsequent specialization choices. Methods: This prospective observational study was conducted among a cohort of third-year medical students at the German University Medicine Greifswald. The methodology encompassed the utilization of a self-administered questionnaire to procure data. Results: The study encompassed 177 participants, of whom 34.7% expressed an inclination toward a career in surgery (22.7% in trauma surgery). Participants who reported a favorable impact from the examination course displayed a significantly heightened interest in clinical clerkships within trauma surgery (p < 0.001), and even expressed a contemplation of specializing in orthopedics and trauma surgery (p = 0.001). Logistic regression analysis highlighted that the convergence of practical training and positive role modeling emerged as the most influential factors augmenting the allure of trauma surgery. Conclusions: Evidently, students who gleaned substantial benefits from high-quality practical instruction in trauma surgery exhibited a significantly heightened likelihood of pursuing this domain in their future endeavors. Surgical academic institutions stand to leverage this insight in their strategic planning for attracting and retaining potential residents. Cultivating a positive affinity for trauma surgery should be instilled early in the curriculum, subsequently sustained through ongoing immersive engagement that encompasses professional as well as interpersonal dimensions. Full article

With the global maritime industry accelerating toward carbon neutrality, the adoption of alternative marine fuels has emerged as a pivotal pathway for achieving net-zero emissions. To identify the most promising fuel transition solution for multi-purpose heavy-lift vessels (MPHLVs), which are widely used for transporting large and complex industrial equipment and have specialized structural requirements, this study conducted a comprehensive techno-economic analysis based on a fleet of 12 MPHLVs. An eight-dimensional technical adaptability framework was established, and six types of marine fuel were evaluated. Concurrently, a total cost assessment model was developed using 2024 operational data of the fleet, incorporating the fuel procurement, the carbon allowances under the EU ETS, the FuelEU Maritime compliance costs, and the IMO Net-Zero penalties. The results show that methanol as an alternative fuel is the most compatible decarbonization pathway for this specialized vessel type. A case study of a 38,000 DWT methanol-fueled MPHLV further demonstrates engineering feasibility with minimal impact on cargo capacity, and validates methanol’s potential as a technically viable and strategically transitional fuel for MPHLVs, particularly in the context of stricter international decarbonization regulations. The proposed evaluation framework and engineering application offer practical guidance for fuel selection, ship design, and retrofit planning, supporting the broader goal of accelerating low-carbon development in heavy-lift shipping sector. Full article

With the rapid advancement in artificial intelligence, autonomous driving has emerged as a prominent research frontier. Autonomous vehicles rely on high-precision high-definition map data, necessitating timely map updates by map companies to accurately reflect road conditions. This paper proposes an efficient and fair map-data-sharing mechanism for vehicular networks. To encourage vehicles to share data, we introduce a reputation unit to resolve the cold-start issue for new vehicles, effectively distinguishing legitimate new vehicles from malicious attackers. Considering both the budget constraints of map companies and heterogeneous data collection capabilities of vehicles, we design a fair incentive mechanism based on the proposed reputation unit and a reverse auction algorithm, achieving an optimal balance between data quality and procurement costs. Furthermore, the scheme has been developed to facilitate mutual authentication between vehicles and Roadside Unit(RSU), thereby ensuring the security of shared data. In order to address the issue of redundant authentication in overlapping RSU coverage areas, we construct a Merkle hash tree structure using a set of anonymous certificates, enabling single-round identity verification to enhance authentication efficiency. A security analysis demonstrates the robustness of the scheme, while performance evaluations and the experimental results validate its effectiveness and practicality. Full article

Background: Economic logistics in fire and rescue services is a critical determinant of operational readiness, fiscal sustainability, and resilience to large-scale emergencies. Despite its strategic importance, logistics remains under-researched in Central and Eastern European contexts, where legacy governance structures and EU-funded modernization coexist with systemic inefficiencies. This study focuses on the Slovak Fire and Rescue Service (HaZZ) as a case to explore how economic logistics systems can be restructured for greater performance and value. Objective: The objective of this paper was to evaluate the structure, performance, and reform potential of the logistics system supporting HaZZ, with a focus on procurement efficiency, lifecycle costing, digital integration, and alignment with EU civil protection standards. Methods: A mixed-methods design was applied, comprising the following: (1) Institutional analysis of governance, budgeting, and legal mandates based on semi-structured expert interviews with HaZZ and the Ministry of Interior officers (n = 12); (2) comparative benchmarking with Germany, Austria, the Czech Republic, and the Netherlands; (3) financial analysis of national logistics expenditures (2019–2023) using Total Cost of Ownership (TCO) principles, completed with the visualization of cost trends and procurement price variance through original heat maps and time-series graphs. Results: The key findings are as follows: (1) HaZZ operates a formally centralized but practically fragmented logistics model across 51 district units, lacking national coordination mechanisms and digital infrastructure; (2) Maintenance costs have risen by 42% between 2019 and 2023 despite increasing capital investment due to insufficient lifecycle planning and asset heterogeneity; (3) Price variance for identical equipment categories across regions exceeds 30%, highlighting the inefficiencies in decentralized procurement; (4) Slovakia lacks a national Logistics Information System (LIS), unlike peer countries which have deployed integrated digital platforms (e.g., CELIS in the Czech Republic); (5) Benchmarking reveals high-impact practices in centralized procurement, lifecycle-based contracting, regional logistics hubs, and performance accountability—particularly in Austria and the Netherlands. Impacts: Four high-impact, feasible reforms were proposed: (1) Establishment of a centralized procurement framework; (2) national LIS deployment to unify inventory and asset tracking; (3) adoption of lifecycle-based and performance-based contracting models; (4) development of regional logistics hubs using underutilized infrastructure. This study is among the first to provide an integrated economic and institutional analysis of the Fire and Rescue Service logistics in a post-socialist EU member state. It offers a structured, transferable reform roadmap grounded in comparative evidence and adapted to Slovakia’s hybrid governance model. The research bridges gaps between modernization policy, procurement law, and digital public administration in the context of emergency services. Full article

Background: The COVID-19 pandemic necessitated immediate regulatory vaccine approvals to facilitate timely global access. The prevailing differences in economies and resources and the varying maturity of the regulatory systems worldwide resulted in different levels of capacity to ensure vaccine quality, safety, and efficacy. In addition to the Emergency Use Authorization or equivalent by some advanced regulatory agencies, the WHO issued Emergency Use Listings (EULs), among other tools, to streamline and expedite regulatory approvals globally. This study aimed to assess the regulatory strategies and best practices adopted during the COVID-19 vaccine approvals and gather lessons for future emergency preparedness. Methods: A mixed-method approach employing qualitative desk reviews and a cross-sectional study collected data from 194 national regulatory authorities (NRAs) across all WHO regions. Results: Three main approval processes were identified: procurement-driven, reliance-based, and independent evaluations. Wealthier countries with more mature regulatory systems were found to spend a longer time issuing approvals, primarily due to being the initial assessors of the vaccines’ quality, safety, and efficacy. Furthermore, various regulatory flexibilities and best practices centered around regulatory reliance, rolling reviews, fast-tracking reviews, and employing digital tools were identified. Notably, the WHO’s EULs were essential in facilitating the timely approval of vaccines globally, including in low- and middle-income countries. Conclusions: The findings suggest a significant turn in vaccine regulation theories and practice, emphasizing balancing speed with scientific validity. This necessitates the creation of thorough provisions for emergency preparedness, regulatory reliance, and administrative flexibility in regulatory practices worldwide. Full article

Expensive medical devices, especially in the areas of orthopedics, and cardiology, have a significant impact on hospital costs and the delivery of high-quality services. These medical supplies are known as physician preference items (PPIs), as they act as “surrogate buyers”—impacting the selection and sourcing of products. There is a gap between the purchasing strategy and the adoption of tactical activities for these complex medical supplies. In the context of the healthcare exceptionalism thesis, this research investigates how healthcare organizations can successfully adopt suitable sourcing levers aiming to achieve different purchasing results. This research conducts a multi-case study in 15 healthcare organizations in nine countries. Three new sourcing levers specific to the healthcare sector emerged, based on the healthcare exceptionalism thesis. It was possible to identify five main sourcing levers clusters. The fit between strategy and tactical level can be allowed by the implementation of suitable sourcing levers—facilitating the achievement of the desired objectives. Healthcare procurement practitioners should assess the fit between strategy and the tactical level by employing suitable sourcing levers. Organizations wishing to move towards a value-based procurement approach should adopt a set of supporting sourcing levers to enable this transition. Full article

The growing frequency and complexity of both natural and man- made crises like pandemics have highlighted the need for robust emergency logistics strategies during the last decade. Procurement is one of the critical areas impacting any emergency supply chain. Dealing with disruptions usually involves multi-sourcing, option contracts, and back-up suppliers as resilient strategies. The proposed review classifies emergency procurement strategies into three capacities following the capacity resilience framework: absorptive, adaptive, and restorative. Also, quantitative resilience metrics, modelling methods, and objectives for practical scenarios are discussed. Conclusions are extracted, and future research agendas outlined. Full article

Background and Objective: Innovation is a key enabler of patient-centered care in cardiology, with new medical devices and digital health technologies offering the potential to improve outcomes and efficiency. However, the evaluation of these innovations poses challenges for clinicians, regulators, and procurement stakeholders, particularly within the complex European healthcare landscape. This review aims to explore the current state of health technology assessment (HTA) for cardiology-related medical devices in Europe, offering a clinical perspective. Material and Methods: Three independent scoping reviews were conducted following the PRISMA-ScR guidelines. Keywords included “innovation”, “health technology assessment”, and “cardiology”. The search was supplemented by the relevant literature on European HTA policies, regulatory directives, and emerging technologies. Results: The review identified three central themes: (1) the evolving role of clinicians in HTA processes, (2) the integration of innovative technologies such as digital tools and artificial intelligence within HTA frameworks, and (3) the considerable variation in HTA practices and policies across EU member states. Conclusions: HTA in Europe is undergoing a transformation, with increasing emphasis on interdisciplinary collaboration and frameworks that support innovation. While the goal of harmonization across the EU remains a work in progress, new regulatory efforts, such as the HTA Regulation (HTAR), offer promising avenues for aligning clinical practice with evidence-based assessment and reimbursement decisions. Full article

Zaire Ebolavirus (EBOV) is one type of filovirus that causes the deadly EBOV disease, with an average fatality rate of around 50%. EBOV outbreaks are devastating and unpredictable and may emerge as the next global pandemic. As a BSL-4 pathogen, EBOV is inaccessible to regular biological laboratories. Therefore, EBOV virus-like particles (EBOV-VLPs) and EBOV pseudoviruses (EBOV-PVs) are utilized in the initial development of many potential therapies, for safety reasons and ease of procurement, as opposed to using infectious viruses. To investigate the host cell entry of EBOV and develop viral entry blockers, the EBOV model virions must accurately represent the morphological and mechanical properties of infectious EBOV virions. Due to the nanometer scale and irregular shape of EBOVs, these properties are challenging to characterize. In this research, state-of-the-art nanoscale characterization techniques are employed to examine the mechanical and structural elements of a selection of commonly used EBOV-approximating model virions. This study comprehensively determines the accuracy of EBOV approximation with a variety of model virions and the uniformity of mechanical and structural traits across different model virion types and preparation methods. This provides important implications for developing therapeutic treatments against EBOV using these model virions. Full article

Increasing environmental pollution has reinforced the necessity of implementing circular economy (CE) as a sustainable approach to reducing resource consumption, waste generation, and carbon emissions. Despite the construction industry’s significant environmental impact in terms of global carbon emissions, water consumption, and biodiversity loss, only 12% of its materials exhibit circular characteristics, necessitating improvements in terms of circularity in construction projects. This study develops a CE-based decision-making model for contractor selection, focusing on off-site construction (OSC), which offers greater circularity potential than conventional construction methods. The decision-making model, established through literature analysis and expert discussions, utilizes the fuzzy analytic hierarchy process (AHP) to evaluate CE criteria and employ the fuzzy Technique for Order Preference by Similarity to Ideal Solution (TOPSIS) to determine contractor suitability. The findings indicate that Material Circularity, Energy Circularity, and Product Circularity are the most influential criteria, with green procurement emerging as the highest-priority factor. The model was validated through a hypothetical case study involving four contractors experienced in sustainable construction. The results demonstrate the model’s capacity to produce sensitive outcomes in terms of decision-making. Full article

Dental fear and anxiety are frequently identified as major contributing factors to non-compliance, uncooperativeness, and difficulties during dental procedures in pediatric patients. These issues can lead to avoidance of dental treatment, resulting in long-term negative consequences for oral health and overall well-being. The assessment and quantification of psychological functioning (i.e., dental fear, anxiety, and self-perceived stress) has traditionally relied on self-reported questionnaires validated for the pediatric population. While this approach is cost-effective and non-invasive, it relies on subjective self-reported data, oftentimes influenced by parental or guardian interaction, especially in young children. Salivary diagnostics has recently emerged as an objective method for the procurement of biological molecules that serve as biomarkers for a variety of oral and systemic conditions. This literature review aims to comprehensively summarize the available literature on the correlation between psychological and salivary physiological measurements assessing dental fear, dental anxiety, and self-perceived stress in pediatric dental patients, highlighting the advantages and disadvantages of each method of assessment. Four databases (PubMed^®, PsycInfo, Dentistry & Oral Sciences Source, and Web of Science) were searched for published articles, in the English language, assessing the correlation between psychological and physiological distress in children undergoing dental procedures. Studies on pediatric patients reveal positive correlations between salivary cortisol and dental fear, stress, and anxiety, especially in returning patients. Conversely, findings on salivary alpha-amylase and secretory immunoglobulin A were inconsistent, with some studies suggesting correlations with dental fear and prior dental experiences. Full article

The operational condition of fire water supply aims to ensure the continuous and reliable supply of high-pressure water in emergency situations. Assuming a fire breaks out in a mountain village located far from the city center, due to the significantly higher flow rate and velocity of the water supply pipeline compared to normal operating conditions, any malfunction or shutdown of the pump caused by improper operation could result in catastrophic damage to the pipeline system. In response to the call for sustainable development, addressing this urgent academic challenge means finding a way to safely and economically maintain a continuous water supply to the target water demand point, even under extreme accident conditions. In this paper, drawing on engineering examples, we considered air tanks with varying process parameters installed at multiple locations within a water conveyance system to prevent water hammer and ensure water supply safety. To ensure that air tanks are of high quality and cost-effective after procurement and use, a multi-objective optimization design model comprising fitting, optimization, and evaluation plates was constructed, aimed at selecting certain process parameters. In the multi-objective optimization design model, Latin hypercube sampling improved by simulated annealing (LHS-SA), stepwise regression analysis (SRA), the Multi-Objective Whale Optimization Algorithm (MOWOA), and the Multi-Criteria Decision Analysis (MCDA) method with various weight biases are used to ensure the rationality of the optimization process. By comparing the optimization results obtained using these different MCDA methods, it is evident that the results output after AHP-EWM evaluation tend to be economic indicators, whereas the results output after FN-MABAC evaluation tend to be safety indicators. In addition, according to the sensitivity analysis of weight distribution, it can be inferred that the changes in maximum transient pressure head caused by water hammer have the most significant impact on final decision-making. Full article

Background: Donation after circulatory death (DCD) has emerged as a potential source of transplantable organs. To date, there have been no reports of face procurement in AD, and “face first” with ex situ perfusion has become the gold standard technique for obtaining facial allografts in most centres. Objectives: We report a case of successful total face and kidney transplantation from a 47-year-old male AD donor. Methods: Immediately after confirmation of death, the “rapid recovery” technique was performed and a cannula was placed in the ascending aorta for in situ perfusion of the facial allograft simultaneously with the abdominal team. Results: The total ischaemic time from donor cardiac death to face reperfusion in the recipient was 5.5 h. Excellent renal and facial allograft function was reported. Full article