Global Health Strategies (United States)

Invasive non-typhoidal Salmonella (iNTS) disease is a global health concern, particularly for sub-Saharan Africa. Despite high case fatality risks, there is no vaccine available against the disease. An obstacle to vaccine development is a lack of data on the economic burden of iNTS disease in many parts of the world. The main aim of the current study is to estimate the economic burden of iNTS disease in 123 countries. Several multivariate regression models were parameterised with the data obtained from an existing systematic literature review on the economic burden of iNTS disease and all forms of NTS disease. Various model diagnostics were performed to validate the statistical significance of each model outcome, and the most suitable model was selected to predict costs in countries where no data points were available. A generalised linear model with gamma distribution with log link was chosen based on model diagnostics. While the average economic burden per iNTS disease episode ranged from US$341 in Africa to US$2194 in Europe, the total economic burden of iNTS disease was the highest in Africa due to the high burden of the disease in the region. The current study indicates that the economic burden of iNTS disease is substantial. Given the scarcity of field-based iNTS disease economic burden estimates, cost extrapolation through an econometric framework can be helpful for understanding the associated cost implications in a resource-limited setting and for informing the cost-effectiveness of public health interventions including future vaccination strategies.

PIANC EnviCom Working Group 227 is developing a decision-making guide associated with the application of environmental windows for dredging and marine navigation infrastructure construction. Dredging and construction works are often restricted during certain periods to reduce potential impacts on environmental receptors. Times when the potential environmental impacts of the project are thought or perceived to be unacceptable—and, consequently, works are not allowed—are commonly defined as seasonal restrictions. Conversely, environmental windows are the periods when works are allowed. Limiting projects to fixed environmental windows complicates contracting schedules by constricting them, adds challenges with respect to the availability of construction equipment, and extends project timelines. These limitations can also impact the safety of works and inflate their cost. The objective of this guide is to provide a risk-based decision-making process that can be applied in cases where restrictions on dredging and navigation infrastructure work may be considered. Case studies are included.

In February 2023, various waterfront structures along the Gulf of Iskenderun coastline experienced ground motions from a magnitude 7.8 (Pazarcık) earthquake, a magnitude 7.6 (Elbistan) earthquake, and subsequent aftershocks. The American Society of Civil Engineers/Coasts, Oceans, Ports and Rivers Institute (ASCE/COPRI) deployed a team in May 2023 to observe the impact of these earthquakes on ports and marine infrastructure. The team visited a total of 15 public and private facilities, including coastal structures, ferry terminals, bulk handling terminals, and container terminals, within the Gulf of Iskenderun. Infrastructure included pile-supported piers and wharves, floating docks, gravity quay walls, and sheet pile quay walls. This paper is one of a three-paper series presenting the observations and findings from the field reconnaissance effort. It highlights the post-event emergency response and recovery efforts undertaken at the ports based on field reconnaissance observations and interviews with facility operators and the port community. Several facilities encountered accessibility issues due to differential settlements. Even structures with minimal or no structural damage encountered operational setbacks and unexpected downtime due to damage to conveyor systems, critical firewater lines, and rail cranes. The availability of materials and equipment impacted repair and recovery times. Further, the ports played an essential role in emergency response, community support, and local recovery. This paper summarizes important lessons learned about post-earthquake emergency response and recovery, with key takeaways for port authorities to consider in emergency planning.

The quality of most coastal or ocean laboratory experiment depends on the accuracy, uniformity and stability of the generated waves. Generation of waves in the laboratory seems simple, but it should consider the spatio-temporal variability of the wave profile. As they propagate, waves interact with the boundaries, i.e. changes in water depth, lateral walls, test specimens, instrument supporting structures, passive absorbers, etc., as well as with varying hydrodynamic conditions (wave-induced currents, wave-wave interactions, or nonlinear energy transfer, among others). Reflected, scattered and radiated waves may propagate back to the wave generator and reflect back. Re-reflections from the wave generator may be a non-realistic representation of the intended wave field, to the extent that the total energy content in the testing facility may increase significantly and uncontrollably. Theoretically, for weakly nonlinear unidirectional waves propagating over a relatively small number of wavelengths, and as long as the still water depth and facility width does not change, the wave properties should remain constant in space and time, which can be identified as the uniformity and stability of the waves. Under these conditions, nonuniform or unsteady wave properties can be associated to an inadequate selection of the wave theory (Airy, Stokes n-order, Cnoidal, Stream Function, etc., e.g. Fenton 1999), the approximation of the wave generation technique (first or second order, nonlinear - see e.g. Mohtat et al., 2020), formation of wave instabilities (e.g. Benjamin-Feir, 1967), wave reflection, scattering or radiation, and the performance of the active wave absorption system. It can be said that the performance of the active wave absorption control system is one of the responsible factors that can affect directly the quality of the generated waves. Many laboratories have implemented different passive and active wave absorption systems, but the performance on the uniformity and stability of the generated waves, as well as the performance of the active wave absorption system used, have not been assessed in a systematic way, and related published data and information is quite scarce, with few interesting exceptions, e.g. (Lykke-Andersen, 2016; Spinneken 2010; Schäffer and Skourup 1996). However, a direct comparison among the different available active wave absorption control systems is still missing. This paper presents a thorough experimental study on the performance assessment of two different active wave absorption control systems (MTS and Awasys7) as a means to establish the quality of the experiment in terms of the uniformity (space) and stability (time) of generated wave parameters (descriptors) in the laboratory.

<p>This project originates from the need to provide seismic resilient solution for water supply to Wellington and Porirua. With other factors influencing the design, the pipeline crossing must withstand seismic loads including the rupture event of the Wellington Fault with movement of +/-6.5 m parallel to the river stream</p><p>The option study for the pipeline crossing concluded on using a bridge structure spanning the river and the geological Fault. This network arch bridge structure selected is provided with enough movement capacity to withstand the effects of the fault rupture movement without failure.</p><p>The length of the bridge structure is defined so to match the differential rotations between the supports to the allowable limits for the pipeline flex joints. To resist these seismic effects, the structure is provided with seismic restrainers that, at the same time as supporting the seismic load, provide enough rotation capability to accommodate movements on the foundations due to the Fault’s ruptureevent.</p>

Unruptured intracranial aneurysm repair is the most commonly performed procedure for the prevention of hemorrhagic stroke. Despite efforts to regionalize care in high-volume centers, overall results have improved little. This study aims to determine the effectiveness in improving outcomes of previous efforts to regionalize unruptured intracranial aneurysm repair to high-volume centers and to recommend future steps toward that goal. Using data obtained via the New York Statewide Planning and Research Cooperative System, this study included all patients admitted to any of the 10 highest volume centers in New York state between 2005 and 2010 with a principal diagnosis of unruptured intracranial aneurysm who were treated either by microsurgical or endovascular repair. Mixed-effects logistic regression was used to determine the degree to which hospital-level and patient-level variables contributed to observed variation in good outcome, defined as discharge to home, between hospitals. Of 3499 patients treated during the study period, 2692 (76.9%) were treated at the 10 highest volume centers, with 2198 (81.6%) experiencing a good outcome. Good outcomes varied widely between centers, with 44.6% to 91.1% of clipped patients and 75.4% to 92.1% of coiled patients discharged home. Mixed-effects logistic regression revealed that procedural volume accounts for 85.8% of the between-hospital variation in outcome. There is notable interhospital heterogeneity in outcomes among even the largest volume unruptured intracranial aneurysm referral centers. Although further regionalization may be needed, mandatory participation in prospective, adjudicated registries will be necessary to reliably identify factors associated with superior outcomes.

The World Health Organization (WHO) has recently recommended new technologies for the diagnosis of tuberculosis. The WHO recommendations include the development of a strategic plan for bringing the network up to grade; investment in supervision and quality control; and implementation of a system of laboratory environmental management. Without those measures having been taken, no new technology can be effectively incorporated. We surveyed the tuberculosis laboratory network in Brazil in order to identify possible bottlenecks for the incorporation of new technologies. We identified a lack of resources allocated to supervision and quality control; a low number of requests for cultures; a lack of effective laboratory information systems; and a lack of awareness regarding the future infrastructure needs of the laboratory network at the municipal level.