This paper investigates the application of Graph Neural Networks (GNNs) in solving the facility location decision problem. By adapting the learning objectives and structure of GNNs, this research bridges the gap between traditional optimization approaches and modern machine learning techniques. The proposed method demonstrates improved decision-making capabilities, providing promising results for facility location optimization. Additionally, potential future research directions are outlined, highlighting areas where GNNs can further enhance decision-making processes in complex supply chain networks. Hybrid GNN and Mixed Integer Programming solutions have been proposed.

This study introduces numerical advancements in an alternative design for the SPS Beam Dump Facility (BDF) at CERN. The design envisions a high-power operation target made of flowing liquid lead. The BDF is a proposed versatile facility at CERN, intended for both beam-dump-like and fixed-target experiments. The target behavior is assessed, assuming a proton beam with a momentum of 400 GeV/c, a pulse frequency of 1/7.2 Hz, and an average beam power of 355 kW. An evaluation is conducted using various Computational Fluid Dynamics (CFD) codes to analyze the behavior of liquid lead and to predict the thermal stress on the target vessel induced by the pulsed heat source generated by the charged particle beam. The comparison increases the reliability of the results, investigating the dependencies on the CFD modeling approach. The beam is modeled as a volumetric heat source with data coming from beam-lead interaction simulations provided by CERN and obtained with the Monte-Carlo code FLUKA. The velocity field and stress profiles are utilized to enhance the design of the lead loop and verify its viability and safety when operated with a liquid metal target.

Background: Immunization prevents over 4-6 million deaths each year worldwide. Ensuring mother satisfaction is an important means of preventing the death of children caused by communicable diseases. However, in Ethiopia, there is paucity of evidence on maternal satisfaction with immunization services. Thus, this study is aimed at assessing the level of maternal satisfaction with childhood immunization services and associated factors among children’s caregivers. Methods: A facility-based cross-sectional study was conducted among 556 systematically selected children’s caregivers in public health facilities at Gondar Town from May through June, 2022. Data were collected using a pretested structured questionnaire. P≤ 0.25 during the bivariate binary logistic regression analysis was included in the multivariate analysis. From the multivariable analysis, variables with p ≤ 0.05 were declared statistically significant. Results: The prevalence of maternal satisfaction towards childhood immunization services was 69.3%(95%CI: 65.5, 73.1%). Of mothers, 45.3% had adequate knowledge, while 43.9% had favorable attitude. Mothers 19-24 years old [AOR = 5.29; 95%CI:2.58,10.86], mothers who waited less than one hour [AOR = 3.03; 95%CI: 1.92,4.77], mothers less than thirty minutes waiting in health facility[AOR=1.98;95%CI:1.24,3.15], mother feel happy during service[ AOR=4.00; 95%CI: 2.53,6.34], mothers adequate knowledge [AOR=2.91; 95%CI: 1.79, 4.73] and had favorable attitude [AOR=3.64; 95%CI: 2.25, 5.91] were significantly associated with maternal satisfaction during childhood immunization services.Conclusions: The overall level of mothers’ satisfaction with childhood immunization services was considerably lower as compared with other studies. Thus, the town health office and concerned stakeholders need more efforts to improve mothers’ satisfaction with childhood immunization services.

Glaucoma is a blinding disease largely caused by increased resistance to drainage of fluid from the eye’s anterior chamber, resulting in elevated intraocular pressure (IOP). A major site of fluid outflow regulation and pathology is the trabecular meshwork (TM) at the entrance of the eye’s drainage system. We aimed to characterize the structural and functional properties of a newly developed tissue-engineered anterior segment eye culture model. We hypothesized that repopulation of a decellularized TM with non-native TM cells could restore aspects of normal TM. The decellularization protocol removed all cells and debris while preserving the ECM. Seeded cells localized to the TM region and progressively infiltrated the meshwork ECM. Cells reached a distribution comparable to control TM after four days of perfusion culture. After a perfusion rate increase challenge, tissue-engineered cultures reestablished normal IOPs (reseeded = 13.7±0.4 mmHg, decellularized = 35.2±2.2 mmHg, p < 0.0001). eGFP expressing CrFK control cells caused a high and unstable IOP (27.0±6.2 mmHg). In conclusion, we describe a readily available, storable, and biocompatible scaffold for anterior segment perfusion culture of non-native cells. Tissue-engineered organs demonstrated similarities to native tissues and may reduce the need for scarce donor globes in outflow research.

COVID-19, caused by SARS-CoV-2, was first identified in China in 2019. The exact origin of the disease remains uncertain, with theories suggesting it may have emerged from animals or accidentally leaked from a research laboratory. If the hypothesis that COVID-19 originated from a research laboratory is accurate, it is crucial to investigate potential pathways for pathogens to escape from biocontainment research animal facilities (BRAFs). We examine key biosafety issues associated with BRAFs, including inadequate decontamination procedures for water and experimental samples, handling high biosafety level pathogens in lower level laboratories, risks of animal bites and sharps injuries, contamination of bedding and enrichment materials, and improper management and transportation of biohazard samples. Additionally, we discuss the role of veterinarians in African research animal facilities and the challenges they encounter in maintaining biocontainment standards. We emphasize the importance of routine monitoring of effluent water to detect possible disease outbreaks. We recommend a thorough investigation of the COVID-19 pandemic to identify potential sources of pathogen release from BRAFs, which could serve as hotspots for future disease outbreaks. Findings from such investigations will inform the development of policies aimed at safeguarding human populations from future pandemics and preventing BRAFs from becoming sources of infectious disease outbreaks.

For women giving birth, every moment of delay in receiving skilled care significantly increases the risks of stillbirth, neonatal and maternal death. More than half of all births in developing countries including South Africa, take place outside a health facility and without skilled birth attendants. This has therefore, made it difficult to achieve the Sustainable Development Goals of global reduction in maternal mortality, which is a key health challenge globally, especially in developing countries and sub-Saharan Africa in particular. The aim of this study was to explore and describe the views of pregnant women regarding facility-based delivery. Focus group discussions were used to gather information from the pregnant women. Information was collected from six groups of pregnant women who had delivered babies at the antenatal care facilities in the past years. Results showed several factors associated with the failure to use institutional delivery service, such as long distance from the health care facility, lack of transport, lack of transport fare, shortages of skilled staff, failure to disclose pregnancy, cultural and religious beliefs, and staff attitudes.

Recent advances in microscopy imaging and image analysis motivate more and more institutes world-wide to establish dedicated core-facilities for bio-image analysis. To maximize the benefits research groups at these institutes gain from their core-facilities, they should be established to fit well into their respective environment. In this article, we introduce common collaborator requests and corresponding potential services core-facilities can offer. We also discuss potential conflicts of interests between the targeted missions and implementations of services to guide decision makers and core-facility founders to circumvent common pitfalls.

Purpose: To investigate the extent of anterior chamber angle circumference needed to maintain a physiological outflow facility (C). Methods: Twenty anterior segments of porcine eyes were assigned to 5 groups, each with a different degree of cyanoacrylate-mediated angle closure: 90° (n = 4), 180° (n = 4), 270° (n = 4), 360° (n = 4) and four unoccluded control eyes. The outflow facility was measured at baseline, 3, 12, 24, and 36 hours after angle closure. Outflow patterns were evaluated with canalograms and the histomorphology was compared. Results: Baseline outflow facilities of the five groups were similar (F = 0.922, P = 0.477). Complete, circumferential occlusion over 360° induced a significant decrease in facility from baseline at all time-points (P ≤ 0.023 at 3, 12, 24 and 36 hours). However, no difference from baseline was found in any of the partially-occluded (0–270°) groups (F ≥ 0.067, P ≥ 0.296 at 3, 12, 24 and 36 hours). The canalograms confirmed the extent of occlusion with flow through the unblocked regions. Histology revealed no adverse effects of blockage on the TM or aqueous plexus in the unoccluded angle portions. The unoccluded TM appeared normal. Conclusion: Cyanoacrylate-mediated angle occlusion created a reproducible angle closure model. 90° of unoccluded anterior chamber angle circumference was sufficient to maintain physiological outflow. This model may help understand how outflow can be regulated in healthy, nonglaucomatous TM.

China’s greenhouse industry has thousands of years of development history, although the development of modern greenhouses has come late. After decades of development of China, its greenhouse industry is in the forefront of the world. China’s greenhouse industry is experiencing rapid development, transformation and upgrading. China ranks first in the world in terms of greenhouse area, used mainly for vegetable cultivation and plays an important role in the utilization of agricultural resources and food production. In 2023, the cumulative area of new greenhouses nationwide was 1835.87 million ha. In this paper we present the latest developments in the greenhouse sector. More specifically, we present a greenhouse market development overview, the greenhouse production, the greenhouse industry, and technology development. Current problems are underpinned, development opportunities and prospects are analyzed, and measures and specific proposals are detailed for the technological development of the greenhouse sector both for increasing product quantity and quality.

Facility Management (FM) has increasingly focused on using Building Information Modeling (BIM) in large-scale development projects. To successfully integrate BIM in the FM sector, cooperation among different participants involved in various project stages must be improved. The objective of this digital revolution in FM is to enhance the efficacy of planning, constructing, and managing assets, benefiting all parties involved. However, the utilization of BIM in FM is limited due to factors such as incomplete owner understanding, insufficient data accessibility, and stakeholders' unfamiliarity with BIM procedures and standardization. Although the FM industry acknowledges BIM's significance, achieving successful implementation remains challenging. Facility managers lack a clear understanding of BIM's benefits in expediting operations and cost efficiency and the necessary skills for efficient utilization. To address this constraint, it is essential to develop an Employee’s Information Requirement (EIR) at the outset of a project, serving as a strategic plan and providing a comprehensive vision for all parties involved, particularly large-scale projects. Two essential technologies that facilitate the transition towards building operations are BIM and the Internet of Things (IoT). Incorporating these technologies is crucial to reducing time, expenses, and operational challenges throughout any project. The aim of this research is to create a Digital-Trio workflow, as a new expression, by providing a methodology for using facility management with BIM through the integration of EIR and IoT, maximizes the benefit of stakeholders strategically and operationally. It also explores how the preparation of the EIR by communicating with all parties will definitely improve the design process, sustainability, efficiency, cost, and time for any project, especially megaprojects.

A comprehensive Energy Audit of a Maintenance facility was performed to assess its energy performance and identify scope for improvement. The facility’s Energy Use Intensity (EUI) for 2022 was 404 kWh/m2 — more than double the Benchmark EUI for Maintenance facilities (151 kWh/m2) recommended by EnergyStar. Furthermore, the Load Factor for 2022 was 0.22, which is lower than the recommended minimum of 0.75 for an efficient building. The audit encompassed an in-depth evaluation of the building's structural and operational characteristics, comprising HVAC systems, lighting, building envelope, and energy-intensive machinery. An energy model of the building was developed to emulate the baseline building energy performance for 2022. Following the energy model's development and validation, an analysis was conducted to identify energy-intensive areas and opportunities for optimization. Energy Efficiency Measures were then formulated, focusing on improving energy efficiency while focusing on energy consumption reduction and GHG emission reduction. Results demonstrated the potential of Energy Audits and Modeling to enable significant reductions in energy consumption and promote sustainable building practices. Among the Energy Efficiency Measures considered, re-sizing and decarbonizing HVAC equipment contributed the most to energy savings, with a 100% decrease in natural gas and 37% decrease in electricity use annually.

Upon declaration of poliovirus (PV) type 2 eradication in 2015, the World Health Organization (WHO) published PV containment requirements in the Global Action Plan III (GAPIII) for mitigating risks of a facility-associated release post-eradication. In 2018, the 71st World Health Assembly resolution urged Member States retaining PV to appoint a National Authority for Containment (NAC), reduce the number of PV facilities, and submit applications for containment certification. The United States (US) NAC was established in 2018 for containment oversight, and two paths to WHO GAPIII containment certification were developed. Facilities retaining PV were identified through national poliovirus containment surveys. US NAC conducted 27 site visits at 18 facilities (20 laboratories: A/BSL-2 (65%), A/BSL-3 (20%), and storage-only (15%)) to verify implementation of US NAC’s preliminary containment measures. NAC identified areas for improvement in seven categories: primary containment, decontamination, hand hygiene, security, emergency response, training, and immunization practices. Sixteen facility applications were endorsed to pursue poliovirus-essential facility (PEF) certification whereas four facilities opted to withdraw during the containment certification process. The US made noteworthy progress in PV containment to enhance biosafety and biosecurity practices at US PV facilities to safeguard the polio eradication effort.

This article deals with the queueing-inventory system, composed of c junior servers, a senior server, two finite waiting halls, and an infinite orbit. On occasion, junior servers encounter challenges during customer service. In these instances, they approach the senior server for guidance in resolving the issue. Suppose the senior server is engaged with another junior server. The approaching junior servers await their turn in a finite waiting area with a capacity of c for consultation. Concerning this, we study the performance of junior servers approaching the senior server in the retrial queueing-inventory model with the two finite waiting halls dedicated to the primary customers and the junior servers for consultation. We formulate a level-dependent QBD process and solve its steady-state probability vector using Neuts and Rao’s truncation method. The stability condition of the system is derived, and the R matrix is computed. Optimum total cost has been obtained, and sensitivity analyses, which include expected total cost, waiting time of customers in waiting hall and orbit, number of busy servers, and fraction of successful retrial rate of the model, are done numerically.

Purpose: We hypothesized that a recently introduced epibulbar micro-shunt (PRESERFLO, P) produces nycthemeral (24h) intraocular pressure (IOP) profiles different from ab-interno trabeculectomy (Trabectome, T). P is a flow restrictor that drains fluid into the sub-tenon space. In contrast, T increases conventional outflow, which is limited by episcleral venous pressure. Methods: In this prospective cohort, we analyzed 68 patients (34 P and 34 T) who presented for 24-h IOP monitoring 6 to 12 months after surgery. IOP and tonographic outflow facility were measured in the habitual position using a pneumatonometer. The IOP variation was considered the primary outcome measure. Glaucoma medications were also compared. Results: P had a higher baseline IOP than T (24.8±10.0 vs. 17.3±7.9 mmHg, p=0.001). Postoperatively, P and T had similar nycthemeral IOP profiles, but IOP in P was significantly lower than in T, except at 4 pm. P had a lower absolute IOP variation than T (5.8±2.6 vs. 7.1±2.7 mmHg, p=0.049). The relative IOP variation was similar in both (34.8±13.2 vs. 37.2±13.1, p=0.45) as was the tonographic outflow facility (0.35±0.23 vs. 0.26±0.18 µl/min/mmHg, p=0.097). Conclusion: Nycthemeral IOP profiles of P and T were similar, but P had lower IOPs and less variation than T. This could reflect how T, unlike P, is more impacted by habitual, positional factors, especially at night.

This research contributes to the detailed discussion about the approach to secure, hygienic water and cleanliness in Uganda and its pastoral regions. The relationship between the sanitation and clean water access with destitution is also discussed. Although this document is not leading towards the policy recommendation but it is an overall idea of how Uganda progressed because of the provisions adopted by the government, local and international organizations, and NGOs, and how the country lacked before these steps taken. Most of the data mentioned is taken from the house surveys of a decade 2002-2013 alongside the qualitative data. Literature review is also considered and is divided in two sections: first included researches related to water accessibility and usage, while the second section included researches related to work done and progress for diarrheal diseases and sanitation. Afterwards, methodologies were discussed where, firstly, trends and then the limitations in access to the basic necessities of life that is clean water and hygiene are mentioned. At last, the implementations and how they affected the rural Ugandans was discussed.

This research project focuses on the optimization of the hybrid energy system together with the assistance of thin-film coatings aiming to achieve self-sustainable food and crop storage facilities which will run effectively with its own generated energy. An infrastructure will be designed and constructed that will comprise a hybrid power generation system accompanied by thin-film coated semitransparent and non-transparent construction materials for energy saving. Thin-film low emissivity (Low-E) type coatings will assist the transparent or semitransparent construction materials to reflect most of the infrared (IR-mostly heat) and UV spectra of sunlight without interrupting the visible spectrum and will lead to saving energy consumption by reducing the heat and lighting during day time

Purpose: To investigate whether microsurgical excision of trabecular meshwork (TM) in an ex vivo pigmentary glaucoma model can normalize the hypertensive phenotype. Methods: Eight eyes of a porcine pigmentary glaucoma model underwent 90° of microsurgical TM excision with an aspirating dual-blade (Goniotome (G)). 24 hours later, an additional 90° of TM were removed. Anterior segments with sham surgeries served as the control (C). Outflow facility and intraocular pressure (IOP) were analyzed. Histology with hematoxylin and eosin (H&E) was obtained. Results: After the first 90° TM excision, IOP was significantly lower in G (10.23±2.39 mmHg, n=7) than C (20.04±1.97mmHg, n=8, P<0.01). Outflow facility in G (0.38±0.07 µl/min/mmHg) was higher than C (0.16±0.02 µl/min/mmHg, P<0.01). After the second 90° TM excision, IOP in G (6.46±0.81 mmHg, n=7) was significantly lower than C (20.25±1.66 mmHg, n=8, P<0.001), while the outflow facility in G (0.50±0.05 µl/min/mmHg, n=7) was higher than C (0.16±0.01 µl/min/mmHg, n=8, P<0.001). Compared to the first excision, excision of an additional 90° did not change of IOP (P=0.20) or outflow facility (P=0.17) further. Conclusion: Excision of 90° of TM in a pigmentary glaucoma model using an aspirating dual-blade decreased IOP and increased outflow facility. Translational Relevance: Microsurgical TM excision over 90° can effectively restore outflow in pigmentary glaucoma.

In an effort to upgrade and provide a unified and improved instrument control and data acquisition system for the ORNL SANS instrument suite (Bio-SANS, EQ-SANS, GP-SANS), beamline scientists and developers teamed up and worked closely together to design and develop a new system. We began with an in-depth analysis of user needs and requirements, covering all perspectives of control and data acquisition based on previous usage data and user feedback. Our design and implementation were guided by the principles from the latest user experience and design research and based on effective practices from our previous projects. In this article, we share details of our design process as well as prominent features of the new instrument control and data acquisition system. The new system provides a sophisticated Q-Range Planner to help scientists and users plan and execute instrument configurations easily and efficiently. The system also provides different user operation interfaces, such as wizard-type tool Panel Scan, a Scripting Tool based on Python Language, and Table Scan, all of which are tailored to different user needs. The new system further captures all the metadata to enable post-experiment data reduction and possibly automatic reduction and provides users with enhanced live displays and additional feedback at the run time. We hope our results will serve as a good example for developing a user-friendly instrument control and data acquisition system at large user facilities.

Purpose: To evaluate three different microincisional ab interno trabeculectomy procedures in a porcine eye perfusion model. Methods: In perfused porcine anterior segments, 90 degrees of trabecular meshwork (TM) were ablated using the Trabectome (T; n = 8), Goniotome (G; n = 8), or Kahook device (K; n = 8). After 24 hours, additional 90 degrees of TM were removed. Intraocular pressure (IOP) and outflow facility were measured at 5 µL/min and 10 µL/min perfusion to simulate an elevated IOP. Structure and function were assessed with canalograms and histology. Results: At 5 µL/min infusion rate, T resulted in a greater IOP reduction than G or K from baseline (76.12% decrease versus 48.19% and 47.96%, P = 0.013). IOP reduction between G and K was similar (P = 0.420). Removing another 90 degrees of TM caused an additional IOP reduction only in T and G but not in K. Similarly, T resulted in the largest increase in outflow facility at 5 µL/min compared with G and K (first ablation: 3.41 times increase versus 1.95 and 1.87; second ablation: 4.60 versus 2.50 and 1.74) with similar results at 10 µL/min (first ablation: 3.28 versus 2.29 and 1.90 (P = 0.001); second ablation: 4.10 versus 3.01 and 2.01 (P = 0.001)). Canalograms indicated circumferential flow beyond the ablation endpoints. Conclusions: T, G and K significantly increased the outflow facility. In this model, T had a larger effect than G and K.

The benefits of cycling as a sustainable transportation mode are widely recognized. Cycling to work offers numerous advantages for individuals, employers, the environment, and society, ranging from improved physical health, wellbeing, and productivity to enhanced public health and reduced carbon emissions. Many governments around the world have implemented various policy measures, interventions, and initiatives to promote cycling. Some cities and towns have encouraged workplaces to provide bike-friendly amenities, such as secure bike parking/storage and shower and changing facility (referred to as end-of-trip facilities), to accommodate cyclists and motivate more employees to embrace sustainable transportation options. However, the presence or absence of such amenities has been found to both positively influence cycling behavior or deter some individuals from cycling to work. Despite the desirability of these amenities, the number of office buildings equipped with bike storage and shower/changing facility remains small, and their economic value is not well understood. In this paper, we aim to investigate whether the presence of cycling-supportive facilities could add value to office buildings. Specifically, we conduct a study using data from office buildings across England as of the end of 2021. We employ hedonic techniques to examine whether office buildings with bike storage and/or shower facility command a rent premium and whether the existence of a rent premium for bike storage and/or shower facility vary by location and across regions in England, independently from any premium associated with BREEM certification. We find that the buildings with bike storage and shower facility secure rent premiums respectively. The level of rent premiums varies with location and regions. The variations of premium are driven by the shortage of the supply of these facilities.

Insecticide testing facilities that evaluate a variety of vector control products may generate large amount of hazardous wastes from routine operations. These wastes originate from degraded technical grade materials, sprayed substrates, redundant stock or working insecticidal solutions. The washing of Long-Lasting Insecticidal Nets (LLINs) during preparation for laboratory and experimental hut trials also contribute to waste water with insecticide content. Human and environmental exposure to insecticidal waste can occur during transport, categorization, storage and disposal in resulting in environmental pollution and potential health effects. Various national and international guidelines have been devised for safe disposal and should be strictly followed to avoid adverse effects on humans or environment. The current paper describes a case study from insecticide test facility in north-eastern Tanzania in management of insecticidal waste.

The current global COVID-19 pandemic is compounding on populations susceptible to tropical illnesses like dengue in different developing countries like Bangladesh. The growing concern is that Bangladesh is a dengue-endemic zone and the peak transmission occurs in the monsoon season (June to October). In the most recent monsoon, a total of 354 dengue cases have been confirmed until 27^th July 2020, data-driven from only 41 hospitals alone. A fifty-three-year-old male patient was found to be co-infected with COVID-19 and dengue fever. Concerns arise as hospitals are increasingly denying to admit the patients. Moreover, reports of the false-positive results in dengue screening tests recorded in different countries further exacerbate the issue. These conditions could postpone the early diagnosis of COVID-19 cases and aggravate the situation. In addition, the overwhelming wave of the dengue cases would be a challenge for the vulnerable health care system of the country which is already under strain due to the COVID-19 pandemic. Failure to establish and implement proper policies might lead to the dengue outbreak with the burdens of the concurrent COVID pandemic, resulting in the collapse of the health and social system, as well as the economic growth of the country.

The aim of this study is (a) to develop, test, and employ a combined method of unsupervised machine learning to objectively assess the condition of sports facility in primary schools (PSSFC) and (b) examine the examine the geographical and typological association with PSSFC. Based on the Sixth National Sports Facility Census (NSFC), six PSSFC indicators (indoor and outdoor facility included) were selected as the measurements and decomposed by using the t-stochastic neighbor embedding (t-SNE). Thereafter, the Fuzzy C-mean (FCM) algorithm was used to cluster the same type of PSSFC with selecting the optimum numbers of evaluation level. Overall 845 primary schools in Shanghai, China were recruited and tested by this combined approach of unsupervised machine learning. In addition, the two-way analysis of covariance was used to examine the location and types of school associated with PSSFC variables in each level. The combined method was found to have acceptable reliability and good interpretability, differentiating PSSFC into five gradient levels. The characteristics of PSSFC differ by the location and school type of individual school. Our findings are conducive to the regionalized and personalized intervention and promotion on the children’s physical activity (PA) upon the practical situation of particular schools.

One of the main challenges associated with spatial entities affected by potentially irreversible adverse development processes (depopulation and related changes in the population structure, economic difficulties, declining accessibility and quality of services, etc.) is coping with their consequences – taking a planned approach (as opposed to passive observation of spontaneous developments) towards mitigating adverse effects on the quality of life of the local population. Public services (healthcare, education, culture, etc.), as a fundamental human need in modern society, but also a warranty of a certain level of living quality, are particularly important in such areas. Apparently, it is necessary to accept the closing of a number of facilities as a reality, and to take a planned approach seeking to mitigate the negative effects on the life of the local population. This is a context of our research, where these services are taken as a universal human right and striving for their equitable availability as a goal of national spatial development policies. The starting point in our analysis of this issue observed through the lens of the Serbian national legal and planning framework is the spatial plan of a local self-government unit as the basic platform for defining and operationalising spatial development policies at the local level. It has been examined whether it would be possible to use the mathematical modelling of optimal spatial solutions as support in making decisions that would minimise the negative effects of the closure of a number of public service facilities. The results for the selected research area and the network of primary healthcare facilities show that it is possible to stabilise the accessibility of these facilities by modelling the spatial organisation of primary healthcare despite the expected closure of as much as one-third of the facilities, while any other solution would give more or less unfavourable results.

The emergence of digital twins (DTs) represents a recent advancement in technological processes that support the planning, construction, and oversight of constructed assets. A DT is essentially a digital model that facilitates simulations and two-way information exchange with its real-world counterpart (a physical twin), creating opportunities for data-driven decision-making. Despite the promising prospects of DTs, both the technology and the methodologies for developing them, as well as their potential applications, remain not fully understood in both academic and industrial contexts. This research explores the applications of DTs for the management of existing assets within the AEC/FM industry. The study presents the results of a comprehensive literature review that explores existing knowledge in this domain. The findings reveal that procedures for creating DTs are still in their early stages, emphasizing potential applications in asset management throughout their lifespan, facilitating sustainability upgrades, and supporting the maintenance and restoration of heritage assets. The review concludes by providing recommendations for future research in this evolving field.

Amid the deepening imbalance in the supply and demand of allogeneic organs, xenotransplanta-tion can be a practical alternative because it makes an unlimited supply of organs possible. How-ever, to perform xenotransplantation on patients, the source animals to be used must be free from infectious agents. This requires breeding of animals using assisted reproductive techniques, such as somatic cell nuclear transfer, embryo transfer, and cesarean-section, without colostrum de-rived in designated pathogen-free (DPF) facilities. Most infectious agents can be removed from animals produced by these methods, but several viruses known to pass through the placenta are not easy to remove, even with these methods. Therefore, in this review, we look at the characteris-tics of several viruses known to cross the placenta and determine how they can be detected. This review is intended to help maintain DPF facilities by preventing animals infected with the virus from entering DPF facilities and to help select pigs suitable for xenotransplantation.

Due to an urgent need for reducing the fast progressing climate changes, a rapid, standardized and replicable solution for the infrastructure restructuring of heat demand coverage of buildings at district and city level must be developed. As more and more communities in Europe, especially in Germany, are obligated to have plans for coverage of heat demand, city planners, energy agencies seek a tool, which will help them to design the first drafts of heating network routes, which can supply whole districts and cities with renewable energy. ArcGIS Pro Tools like Least-Cost-Path-Analysis (LCPA) and Closest Facility (CF) allow to find the shortest and “cheapest” way between the heat source and heat consumers in the analyzed areas. Starting from the community level, through the district, county, voivodeship and whole country levels, the replication of the methods for generating district heating (DH) network infrastructure can be achieved. The proposed LCPA and CF based methods help to design the most suitable and efficient DH networks in the analyzed areas. As only few open-source data input, like street networks and building footprints are needed, the methods can be implemented in all communities of the country of Poland. In this paper one example of one community of Wroclaw county, called Siechnice and surroundings is presented.

The state of BIM adoption and implementation in facility management in Africa has been regarded as a developmental discourse gradually gaining grounds. While several studies have focused on manual review of the intellectual progression of BIM research, this confined review however understates the evolution of BIM in facility management. This approach therefore is not always representative of the picture of BIM in facility management at its formative stage. This paper aims to present a scientometric review of BIM in facility management exploring the intellectual progress made so far by authors. The state of the art of BIM in facility management research and practice and the challenges debilitating against BIM in facility management research. The review revealed a considerable amount of research endeavours limited by inadequate collaboration acorss organizations and institutions. The study also revealed the low degree of awareness amongst researchers in the AEC sector. While North America and China were leading countries due to the activity of few universities, Africa wasn’t as visible in research endeavours. The study recommended an increase in awareness drive across countries and increased government effort, joint funding for research to include gaps in practice issues.

A novel approach to the remote-control system for the compact multi-crystal energy-dispersive spectrometer for x-ray emission spectroscopy (XES) applications has been developed. This new approach is based on asynchronous communication between software components and on reactive design principles. In this paper, we identify the challenges we have faced, our solution to them as well as the implementation and future development prospects. The main motivation of this work was the development of a new holistic communication protocol that can be implemented to control various hardware components.

With the outbreak of coronavirus disease 2019 (COVID-19), there is a need for efficient management of patients with mild or no symptoms, which account for the majority. The aim of this study is to introduce the structure and operation protocol of a living and treatment support centre (LTSC) operated by Seoul National University Hospital in South Korea. The existing accommodation facility was converted into a 'patient centre' where patients was isolated. A few Medical staff here performed medical tests and responded to emergencies. Another part of the LTSC was 'remote monitoring centre'. In this center, patients’ self-measured vital signs and symptoms were monitored twice a day, and the medical staff staying here provided video-consultation via a smartphone. During the 3 weeks from March 5 to March 26, 2020, 113 patients were admitted and treated. LTSC could be an efficient alternative to hospital admission in pandemic situation like COVID-19.

A community food environment plays an essential role in explaining the healthy life-style patterns of its community members. However, there is a lack of compelling quantitative approaches to evaluate these environments. This study introduces and validates a new tool named the Facility List Coder (FLC), whose purpose is to assess food environments based on data sources and classification algorithms. Using the case of Mataró (Spain), we randomly selected 301 grids areas (100 m2) where we conducted street audits in order to physically identify all the facilities by name, address and type. Then, audit-identified facilities were matched with those automatically-identified and were classified using the FLC in order to determine its quality. Our results suggest that automatically-identified and audit-identified food environments have a high level of agreement. The ICC estimates and their respective 95% confidence intervals for the overall sample, yield the result “excellent” (ICC ≥ 0.9) for the level of reliability of the FLC.

Long-term care (LTC) settings are increasingly used for palliative care in Japan. This study aimed to assess the proportion of LTC settings that provide palliative care services for older clients with advanced dementia in Japan and the trends across the types of settings. A nationwide questionnaire survey was conducted between November 2022 and January 2023, targeting 1,000 geriatric hospitals (GHs), 1,000 geriatric health services facilities (GHSFs), and 1,000 home nursing care stations (HNCSs). The palliative care practices for older patients with advanced dementia and their families in the agencies were assessed. Less than half of the GHs supported family participation or the spiritual needs of their older clients with dementia, while many had access to pain and symptom assessments and analgesic prescriptions by physicians. Less than half the GHSFs used pain assessment tools, assessed and supported family caregivers' pain and distress, and supported family participation in palliative care. More than 80% of the HNCSs practiced most of the listed palliative care. Current palliative care practices for older adults with dementia vary among GHs, GHSFs, and HNCSs. This emphasizes the need for targeted approaches to improve the provision of palliative care for patients with dementia across LTC settings in Japan.

Building Information Modelling (BIM) is increasingly adopted in supporting Facility Management (FM). However, in the future perspective of efficiently encouraging the management of building estates, e.g. owned by public authorities or institutions, providing an effective integration between Building Information Models and Geographic Information Systems (GIS) becomes also essential. This contribution is therefore aimed at presenting a methodological framework integrating BIM and GIS environments by mainly taking advantage of open-source tools (e.g. QGIS and Dynamo) and non-proprietary data exchange formats like the COBie (Construction-Operations Building Information Exchange) international standard. Unlike what has been mainly proposed in the literature concerning BIM-GIS integration so far, the methodology presented in this paper does not provide for an integral transfer of BIM data to the GIS platform. The work led instead to the development of an effective bidirectional integration between the two informative systems, by properly relating them and allowing for an easy switch from one system database to the other. This integrated framework is intended to enable facility managers to easily visualize in the GIS platform, through queryable 2D and 3D maps, some relevant information from BIM to efficiently manage workspaces. At the same time, this hybrid informative system allows BIM practitioners to access and manage more detailed information stored in Building Information Models. The findings of experimental applications of the proposed methodological approach to the ex-Macciotta pediatric hospital, a healthcare building owned by the University of Cagliari, are finally presented and discussed.

This commentary is focused on radioactive contaminations in the Urals, where the consequences were more severe in the long term than those after the Chernobyl accident. The difference is that the latter was a technogenic catastrophe, but the former - a radioactive contamination tolerated since 70 years with several accidents in between. In earlier publications of Russian researchers no cancer frequency elevation was reported after exposures below 0.5 Sv or generally in the populations exposed to low doses. Later on, the same scientists started to claim similar relative risks for cancer and other diseases among exposed people in the Urals and in atomic bomb survivors from Hiroshima and Nagasaki. Apparently, an unofficial directive has been behind this ideological shift noticed around the year 2005. Trimming of statistics has been not unusual in the former Soviet Union. Potential motives included fostering radiophobia, stirring anti-nuclear protests in other countries and strangulation of nuclear energy aimed at the boosting of fossil fuel prices. Recent publications claiming cardiovascular risks after low-dose low-rate exposures and recommending more stringent standards of radiological protection are discussed here in some detail. Such recommendations for dose rates compatible with the natural radiation background are obviously nonsensical.

The paper is based on the scientific outcome of a PhD Thesis. It introduces the generic, model-based, reusable, and extensible conceptual framework to incorporate Facility Management data based within the three-dimensional model-based design and construction of an asset to enable smart applications, which are introduced. The conceptual framework is composed of empirical data from expert interviews, questionnaires, and factual analysis from 13 projects of varied sizes of public and private clients. It shows which phases need which data, who needs them, and which added value can be generated if intelligent data structuring is used at the beginning of the construction project and bridges the gap between requirement and practice. The term “smart application” is introduced.

An effective method to inspect inaccessible nuclear power facility by interface wave which propagate along the shrink fit boundary of reactor head is proposed in this study. Reactor head is relatively thick to inspect from the outside of reactor by conventional ultrasonic testing. The proposed interface wave can propagate a long distance from the fixed transducer position. The inside of nuclear reactor is limited to access due to the high radiation, so transducers are located at outside of nuclear facility and interface wave propagates into the nuclear reactor for defect detection. The numerical simulation and experiments were carried out to validate the effectiveness of the proposed interface wave inspection method. Various defect cases simulating field failures are also presented with satisfactory detectability by the proposed technique with the features for defect classification.

Many measles endemic countries with suboptimal coverage levels still rely on vaccination campaigns to fill immunity gaps and boost control efforts. Depending on local epidemiological patterns, national or targeted campaigns are implemented, following which post-campaign coverage surveys (PCCSs) are conducted to evaluate their performance, particularly in terms of reaching previously unvaccinated children. Due to limited resources, PCCS surveys are designed to be representative at coarse spatial scales, often masking important heterogeneities in coverage that could enhance the identification of areas of poor performance for follow up via routine immunization strategies. Here, we undertake geospatial analyses of the 2021 measles PCCS in Nigeria to map indicators of coverage measuring the individual and combined performance of the campaign and routine immunization (RI) at 1x1 km resolution and the ward and district levels in 13 states. Using additional geospatial data sets, we also produced estimates of numbers of unvaccinated children during the campaign and numbers of measles-containing vaccine (MCV) zero-dose children before and after the campaign at these levels and within health facility catchment areas. Our study revealed that although the campaign reduced the numbers of MCV zero-dose children in all the districts, areas of suboptimal campaign and RI performance with considerable numbers of zero-dose children remained. Our analyses further identified wards and health facility catchment areas with higher numbers of unvaccinated children within these areas. Our outputs provide a robust evidence base to plan and implement follow-up RI strategies and to guide future campaigns at flexible and operationally relevant spatial scales.

The burden of bacterial bloodstream infections (BSIs) is rapidly increasing in Africa including Rwanda. This is a retrospective study investigates the diversity, distribution, and antimicrobial susceptibility profiles of BSIs bacteria in three tertiary referral hospitals in Rwanda between 2020 and 2022. A total of 1,532 blood culture tests were performed for visiting patients. Overall, the proportions of Gram-negative and Gram-positive bacteria were 48.2% and 51.8, respectively. Staphylococcus aureus was the predominant species accounting for 25% of all Gram-positive BSIs species and Klebsiella species representing 41% of all Gram-negative BSIs species. Antimicrobial susceptibility testing revealed that Amikacin exhibited the highest activity against Enterobacter spp., Serratia spp. and Escherichia coli in &gt;92% of cases and Klebsiella spp. in 75.7%. Meropenem and Imipenem were highly efficacious to Salmonella spp. (100% susceptibility), Enterobacter spp. (96.2% and 91.7%, respectively), and Escherichia coli (94.7% and 95.5%, respectively). The susceptibility of Enterococcus spp., S. aureus, and Streptococcus spp. to Vancomycin was 100%, 99.5% and 97.1%, respectively. Klebsiella spp. was highly sensitive to Colistin (98.7%), Polymyxin B (85.6%), Imipenem (84.9%), and Meropenem (78.5%). We recommend strengthening the implementation of integrated transdisciplinary and multisectoral One Health including AMR-stewardship for the surveillance, prevention, and control of AMR in Rwanda.

AbstractBackground: Maternal health service (MHS) use is a key strategy to reduce maternal mortality. However, the existing evidence is scarce to design efficient intervention strategies in Ethiopia. Thus, we aimed to explore community members and health care providers' perceptions of MHS, and barriers, and facilitators of MHS use in southern Ethiopia. Methods: A phenomenological qualitative study was conducted from November 14-30, 2022, in the northern zone of the Sidama region. Sixteen in-depth interviews, nine focus group discussions, and 15 key informant interviews were done with 112 study participants. A maximum variance sampling method was used to select study participants. Data coding and analysis were done using MAXQAD 2020 software and presented in narratives. Results: Communities have positive perceptions and good practices of skilled antenatal care (ANC) and health facility delivery (HFD), but lack awareness of postnatal care (PNC) services and schedules. Some have experienced negative interactions with health care providers, health facilities, and ambulance drivers. The main identified barriers to ANC use were lack of awareness of ANC benefits, distance from a health facility, costs associated with ANC use, long waiting time, lack of access to road, and women being busy with different household chores. Distance from health facility, costs associated with HFD use, unpredicted labour, lack of an ANC visit, lack of a birth preparedness plan, and non-dignified care were the main barriers to HFD. The major identified barriers to PNC use were home delivery, lack of awareness of PNC service and schedule, and socio-cultural beliefs. The main identified facilitators of MHS use were previous experience and fear of obstetric complications, health extension workers and women’s development teams, and pregnant women's forum.Conclusions: Rural women still encounter several challenges when using MHS, even though communities have positive perceptions and good practices of skilled MHS. Bad experiences mothers faced in health facilities, challenges associated with the costs of MHS use, poor awareness of service, and unpredictable labour continued to be basic barriers to MHS use. Intervention approaches should consider inter-sectoral collaboration to address barriers at the community and health facility levels. The programs must emphasize the transportation arrangements during unpredictable labour, the needs of poor mothers, and women who have poor awareness of MHS at the community level.

Abstract: Background: Bangladesh has achieved remarkable progress in reducing maternal mortality, yet postpartum deaths remain a significant issue. Emphasis on quality postnatal care (qPNC) is crucial, as increased coverage alone has not sufficiently reduced maternal morbidity and mortality. Methods: This study included data from the Bangladesh Maternal Mortality Survey of 32,106 mothers who delivered within three years prior to the survey. Descriptive statistics were used to report coverage and components of postnatal care stratified by covariates. Log-linear regression models were used to assess the determinants of quality postnatal care among facility and home births. Results: From 2010 to 2016, postnatal care coverage within 48 hours of delivery by a qualified provider rose from 23% to 47%. 94% of facility births received timely PNC, contrasted with only 6% for home births. Despite the increased coverage, quality of care remained as low as 1% for home births and 13% for facility births. Key factors affecting qPNC utilization included socio-demographic factors, pregnancy complications, delivery method, financial readiness, and mobile ownership. Conclusion: Importantly, deliveries assisted by skilled birth attendants correlated with higher quality postnatal care. The study reveals a significant gap between the coverage and quality of postnatal care in rural Bangladesh, especially for home births. It underscores the need for targeted interventions to enhance qPNC.

The adipose-derived mesenchymal stem cells are becoming the tool of choice for many clinical applications and nowadays, nearly 200 clinical trials are running worldwide to prove the efficacy of this cell type for many diseases and pathological conditions. To reach the goal of cell therapies and produce ATMPs as drugs for regenerative medicine, it is necessary to properly standardize the GMP processes and thus collection methods, transportation strategies, extraction protocols and characterization procedures without forgetting that all the tissues of the human body are characterized by a wide inter-individual variability genetically determined and acquired during life. Here we compare 302 samples processed under GMP rules to exclude the influence of the operator and of the anatomical site of collection. Variability in the age of patients, gender and laboratory parameters like total cell number, cell viability, stem cell number and other stromal vascular fraction cell sub-populations have been compared to each other. Results show that, when the laboratory protocol is standardized, the variability in quantifiable cell parameters is widely statistically non-significant, meaning that we can make a further step toward standardized advanced cell therapy products.

Virtual reality (VR) describes a family of technologies which immerse users in sensorily-stimulating virtual environments. Such technologies have increasingly found applications in the treatment of neurological and mental health disorders. Depression, anxiety, and other mood abnormalities are of concern in the growing elderly population – especially those who reside in long-term care facilities (LTCFs). The transition from the familiar home environment to the foreign LTCF introduces a number of stressors that can precipitate depression. However, recent studies reveal that VR therapy (VRT) can promote positive emotionality and improve cognitive abilities in the elderly, both at home and in LTCFs. VR thus holds potential in allowing elderly individuals to gradually adapt to their new environments – thereby mitigating the detrimental effects of place attachment and social exclusion. Nevertheless, while the current psychological literature is promising, the implementation of VR in LTCFs faces many challenges. LTCF residents must gain trust in VR technologies, care providers require training to maximize the positive effects of VRT, and decision makers must evaluate both the opportunities and obstacles in adopting VR. Here, we concisely review the implications of depression related to place attachment in LTCFs, and explore the potential therapeutic applications of VR.

Background: Globally, infections are the third leading cause of neonatal mortality. Predominant risk factors for facility-born newborns are poor hygiene practices that span both the facility and home environments. Current improvement interventions focus on only one environment and tar-get limited caregivers, primarily birth attendants and mothers. To inform the design of a hand hygiene behaviour change intervention in rural Cambodia, a formative mixed-methods research study was conducted to investigate the context specific behaviours and determinants of hand-washing among healthcare workers, maternal and non-maternal caregivers along the early new-born care continuum. Methods: Direct observations of hygiene practices of all individuals providing care to 46 newborns across eight facilities and associated communities were completed and hand hygiene compliance assessed in analysis. Semi structured interactive interviews were subsequently conducted with 35 midwives and household members to explore the corresponding cognitive, emotional, and environmental factors influencing the observed key hand hygiene behaviours. Results: Hand hygiene opportunities during newborn care were frequent in both set-tings (n = 1319) and predominantly performed by mothers, fathers and non-parental caregivers. Compliance to hand hygiene protocol across all caregivers, including midwives, was inadequate (0%). Practices were influenced by the lack of accessible physical infrastructure, time, increased workload, low infection risk perception, nurture-related motives, norms and inadequate knowledge. Conclusion: Our findings indicate that an effective intervention in this context should be multi-modal to address the different key behaviour determinants and target a wide range of caregivers.

With Unmanned Aerial Vehicles (UAV), a swift response to urgent needs like search \& rescue missions or medical deliveries can be realized. Simultaneously, the legislator is establishing so-called geographical zones, which restrict UAV operations to mitigate the air and ground risk to third parties. These geographical zones serve a particular safety interest, but they may also hinder the efficient usage of UAVs on time-critical missions with a range-limiting battery capacity. In this study, we address a facility location problem for up to two UAV hangars with a robust optimization model considering demand hotspots, geographical zones as restricted areas, a standard mission to satisfy battery capacity constraints, and the impact of wind scenarios. To this end, water rescue missions are used exemplary, for which positive and negative location factors for UAV hangars and areas of increased drowning risk as demand points are derived from open-source georeferenced data. Optimal UAV mission trajectories are computed with an A* algorithm considering five different restriction scenarios. As this pathfinding is very time-consuming, binary occupancy grids and image processing algorithms accelerate the computation by identifying either entirely inaccessible or restriction-free connections beforehand. For the optimal UAV hangar locations, we maximize accessibility while minimizing the service time to the hotspots, resulting in a decrease from the average service time of 570.4 s for all facility candidates to 351.1 s for one and 287.2 s for two optimal UAV hangar locations.

A cross-flow ultrafiltration harvesting system of a pre-concentrated microalgae culture was tested in an innovative anaerobic-based WRRF. The microalgae culture was cultivated in a membrane photobioreactor fed with the effluent from an anaerobic membrane bioreactor treating sewage. These harvested microalgae biomass was then anaerobically co-digested with primary and secondary sludge from the water line. Depending on the needs of this anaerobic co-digestion, the filtration harvesting process was evaluated intermittently over a period of 212 days for different operating conditions, mainly the total amount of microalgae biomass harvested and the desired final total solids concentration (up to 15.9 g·L1 with an average of 9.7 g·L1). Concentration ratios of 15-27 were obtained with average transmembrane fluxes ranged from 5 to 28 L·m2·h1. Regarding membrane cleaning, both backflushing and chemical cleaning resulted in transmembrane flux recoveries that were, on average, 21% higher than those achieved with backflushing alone. The carbon footprint assessment shows promising results as the GHG emissions associated with the cross-flow ultrafiltration harvesting process could be less than the emissions savings associated with the energy recovered from the biogas production from the anaerobic valorisation of the harvested microalgae.

The concept of Digital Twins has been in the field for a long time, constantly challenging the specification, modeling, design, implementation, and exploitation of complex cyber-physical systems. Despite the various foundations, standards, and platforms in Systems Engineering, there are ongoing challenges with Verification and Validation methodology. This study aims to establish a generic framework that addresses the various aspects of Digital Twinning. The multifaceted nature of the problem requires raising the abstraction level in both the Real (Actual) and Virtual domains, effective dissemination of information resources, and a design inspired by verification and validation. The proposed framework combines the Quintuple Helix model with the Problem and Operational Domains of a Real (Actual) Twin, the Solution and Implementation Domains of a Virtual Twin, and the Execution Domain as the bridge that links them. Verification and Validation dimensions follow the Meta Object Facility abstraction layers (Instance, Model, Meta-model, and Meta-meta-model) mapping over five Helices. Embedding the complexity reduction mechanisms in the proposed framework builds a suite for extendible and verifiable digital twinning in simulation and real-time scenarios.

This study provides a methodology for optimizing oil production and CO2 sequestration using an integrated asset model of the Farnsworth Unit field, incorporating extensive geological, geophysical, and engineering data. Sensitivity analysis identified critical parameters impacting oil recovery and CO2 storage, leading to the construction of a proxy model using polynomial regression and radial basis function neural networks, with the latter proving more effective for "What-if" analysis. The sensitivity analysis indicated that the Corey parameters impact cumulative oil produced the most. Comprehensive history matching validated the model against historical production data, ensuring reliability for forecasting and optimization. Two scenarios, "Do-Nothing" and development strategy, were forecasted over 15 years (2020-2035). The "Do-Nothing" scenario resulted in 9.57 MMSTB of oil recovery and 2,822.70 MMlbs of CO2 storage. The development strategy case improved outcomes with 13.95 MMSTB of oil recovery and 5,061.68 MMlbs of CO2 stored, and was selected for optimization using particle swarm optimization. The optimized strategy achieved 14,043,372 STB of cumulative oil and 4,832.18 MMlbs of CO2 stored, and increased the field NPV by 25.84% to $114,871,730. This study underscores the significance of integrated asset modeling in enhancing oil recovery and optimizing CO2-EOR processes, providing valuable insights into operational conditions and constraints.

In the context of healthcare technology management (HTM) in Saudi Arabia and the Gulf region, this study addresses a significant gap by exploring both external and internal risk factors affecting HTM performance. Previous research has primarily focused on modeling or predicting failures in medical devices, mostly examining internal (endogenous) factors that impact device performance and the development of optimal service strategies. However, a comprehensive investigation of external (exogenous) factors has been notably absent. This research introduces a novel hierarchical risk management framework, designed to accommodate the broad array of healthcare technologies, not limited to medical devices. It significantly advances the field by thoroughly investigating and validating a comprehensive set of 53 risk factors and assessing their influence on HTM. Additionally, this study embraces the perspective of enterprise risk management (ERM) and expands it to identify and incorporate a wider range of risk factors, offering a more holistic and strategic approach to risk assessment in healthcare technology management. The findings reveal that several external and internal factors previously underexplored significantly impact HTM performance. Notably, the Fuzzy AHP survey identified “design risk” under facility and environmental risks as the highest risk for HTM in the region. Furthermore, the study reveals that three out of the top ten risks are related to “facility and internal environmental” factors, six are related to technological endogenous factors, and only one is related to managerial factors. This distribution underscores the critical areas for intervention and the need for robust facility and technology management strategies. In conclusion, this research not only fills a critical void by providing a robust framework for healthcare technology risk assessment but also broadens the scope of risk analysis to include a wider array of technologies, thereby enhancing the efficacy and safety of healthcare interventions in the region. Additionally, the proposed hierarchy provides insights into the underlying risk factors for healthcare technology management, with potential applications extending beyond the regional context to a global scale. Moreover, the equation we propose offers a novel perspective on the key risk factors involved in healthcare technology management, presenting insights with far-reaching implications applicable not only regionally but also on a global level. This framework also supports sustainability goals by encouraging the efficient and responsible utilization and management of healthcare technologies, essential for ensuring the long-term economic and environmental sustainability of medical technology use.