Royal Tropical Institute

Multi-Core Processors (MCPs) are ubiquitous in modern electronic devices. However, their exploitation within the high criticality domains, specifically that of aerospace, introduces challenges. The European Union Aviation Safety Agency (EASA) and the Federal Aviation Administration (FAA) recently released harmonised guidance in the form of Acceptable Means of Compliance (AMC) 20-193, which details what is required, from a certification perspective, to enable the use of MCPs for satisfying airworthiness requirements. Although regulatory authorities have withdrawn Job Aids for standards such as DO-178 and DO-254, they are an effective method of showing compliance to standards and widely used by assessors. Understanding MCPs is, however, non-trivial and requires significant expertise not only of the device itself, but also how software will be architected and executed, along with how system level safety considerations are to be employed, all to ensure safe application of this technology. Thus, within this paper the authors, through the provision of an assessment of the what detailed in AMC 20-193, give an in-depth analysis into the intent behind the 10 objectives set out in this new AMC. The aim of the paper is to provide a foundation upon which Subject Matter Experts (SMEs) might construct their own Job Aid. Through its discussions, it is the authors intention that this paper enables a common understanding against which an applicant, assessor, and authority can interpret the how when looking to achieve the what set out in AMC 20-193. • This paper provides understanding toward Multi-Core Processor (MCP) assurance against civil aerospace standards. • In-depth analysis into the 10 objectives of AMC 20-193 is provided. • From this, we enable a common understanding against which stakeholders may interpret AMC 20-193. • Additionally, a foundation for Subject Matter Experts to construct a Job Aid is realised.

Aquaculture has surpassed capture fisheries in terms of production and is among the fastest growing food sectors. It has great potential to contribute to food security and nutrition, poverty reduction, jobs, and environmental sustainability. Fish seed is increasingly considered to be a major driver and disabler of aquaculture development. However, little is known about how fish seed systems operate, their challenges and opportunities, or entry points for strengthening them. This study analyzes primary data on the challenges and opportunities faced by various actors along the fish seed chain, documents the lessons from a fish seed project (Ghana Tilapia Seed Project, 2019–2022), and provides an analysis of entry points for strengthening fish seed systems. Using an analytical framework that tracks germplasm base, seed production and quality, seed availability and distribution, and the information flow along the fish seed value chain, we analyze the case of Ghana, the top producer of farmed tilapia in sub-Saharan Africa. The study uses a mixed-methods approach, including value chain analysis, action-oriented research methods, and statistical analysis of survey data. Findings indicate that the initial rapid growth in tilapia production in Ghana was partly due to an improved local strain released in 2004; however, the recent stagnation is largely caused by seed-related issues (poor maintenance and improvement of germplasm base, seed quality and availability, lack of information and coordination, and lack of enforcement of regulations). This study highlights the successes and lessons learned from the Ghana Tilapia Seed Project on broodstock distribution, training on fingerling production, establishment of nurseries, and training of fish farmers. The lessons highlight the need for policy changes and capacity building related to strain development and broodstock management. These findings fill the large gap in evidence on the functioning of fish seed systems and how to strengthen them. They can directly inform ongoing country-level efforts and programs aiming to develop aquaculture. • Initial rapid growth in tilapia production in Ghana is partly due to improved strain. • Recent stagnation is largely due to challenges with low seed quality and availability. • New broodstock, hatchery training, and new nurseries increased seed supply and demand. • Training and digital tools led to more farmer's knowledge, productivity, and income. • Seed policy change and capacity to evaluate and manage multiple strains are needed.

This study introduces FOWCUS, a novel dataset detailing the composition of about 280 food commodities, categorized into various groups including vegetables, fruits, nuts, eggs, livestock, seafood, cereals, sugar, vegetable oils, stimulants, pulses, and root vegetables. Unlike previous works focusing on the chemical composition of food products, this dataset extends to quantitatively capture the amounts of products and by-products that could potentially contribute to the generation of avoidable, potentially avoidable, and unavoidable food waste across the food supply chain. By providing a detailed breakdown of the different components of food products, this dataset aids in identifying potential revalorization opportunities for unavoidable food waste via, for instance, feedstocks for biochemical, biomaterial, and bioenergy applications. It also supports the quantification of food waste generation across the food supply chain, which is crucial for food waste studies and the monitoring of food waste reduction targets at the national and international levels. Indexed according to the FAOSTAT commodity typology, it serves as a valuable resource for researchers and policymakers in managing food waste and valorizing by-products.

Well-functioning pharmaceutical systems are crucial for ensuring universal access to medicines and their appropriate use. While existing frameworks for analysing pharmaceutical systems generally focus on the national level, in many countries, the core functions are often managed locally within a broader national framework. Despite this local focus, there has been no effort to conceptualize a ‘local pharmaceutical system’ as a distinct entity with its own goals, functions and operational components. A method for analysing and comparing the performance of local pharmaceutical systems (LOPHAS) within a country is still lacking. We aim to develop an analytical approach and framework to assess the performance of LOPHAS and guide improvements in access to essential medicines. We conducted an integrative literature review and consulted with purposively selected experts. We systematically searched for existing approaches for conceptualizing or assessing pharmaceutical systems and empirical studies in which these were applied and combined this with insights from 23 reviews and guidebooks suggested by experts to develop the LOPHAS approach and framework. We identified 13 existing frameworks and 16 studies that had applied these frameworks to analyse pharmaceutical systems. Building on these findings, we propose that a LOPHAS has six core functions: (1) local governance, (2) managing product supply, (3) financing, (4) developing human and physical resources, (5) appropriate dispensing and use of medicines and (6) monitoring performance. For each function, we defined operational components and indicators. The primary outcomes of a LOPHAS are access to medicine and appropriate use of medicine. The LOPHAS framework provides a practical tool for assessing and comparing the performance of LOPHAS. By identifying areas for improvement, it can guide policymakers, healthcare providers and local administrators in strengthening systems to ensure that essential medicines are accessible and used appropriately, supporting broader health goals.

IntroductionThe Dutch Medical Doctor-Global Health (MD-GH) prepares to work in low-resource settings (LRS) by completing a hybrid postgraduate training program of 2 years and 9 months, with clinical and public health exposure in the Netherlands and a Global Health residency in LRS. The objectives of the program include acquiring clinical skills to work as a physician in a setting with different (often more severe) pathology and limited resources. In public health teaching, emphasis is given, among other, to adapting to a culturally different environment. After graduation, MD-GH work in a wide variety of countries and settings for variable time. As part of a curriculum review, this study examines MD-GHs' perception of the quality of the training program and provides recommendations for improvement.MethodsA qualitative study was performed. Thematic analysis was applied to semi-structured interviews with 23 MD-GH who graduated between 2017 and 2021.ResultsMD-GHs predominantly worked as clinicians; several were (also) involved in management or capacity building. The clinical training program adequately addressed general skills, but did not sufficiently prepare for locally encountered, often severe, pathology. During the training, adequate supervision with clear learning goals was found pivotal to a positive learning experience. Gaps included clinical training in Internal Medicine (particularly infectious diseases and non-communicable diseases) and Paediatrics. Public Health teaching as well as cultural awareness should be intensified and introduced earlier in the program. The Global Health residency was considered important, but tasks and learning outcomes varied. Teaching, supervision, and capacity building were considered increasingly important key elements of working in LRS. Consensus favoured the current duration of the training program without extension.DiscussionWhile the generalist nature of the MD-GH training was appreciated, the program would benefit from additional clinical training in infectious diseases, non-communicable diseases, and Paediatrics. Moving forward, emphasis should be placed on structured mentorship, enhanced public health teaching, and standardized residency programs with clearly delineated objectives to better equip MD-GH professionals for their multifaceted roles in LRS. Moreover, future revisions of the training program should incorporate the perspectives of host institutes in LRS and tailor the training needs.

BackgroundUniversal health coverage (UHC) is a key component of Afghanistan’s health plan, but the country faces challenges due to decades of conflict and instability. Concurrently, healthcare successes have been achieved despite significant shortages in the health workforce. A fit-for-purpose health workforce is crucial for achieving UHC, and requires decision-making by policy-makers driven by sufficient evidence. This study presents a comprehensive situational analysis of Afghanistan’s health workforce in 2023, focusing on distribution by geography, gender, facility type, as well as trends in health worker production.MethodsA multi-stage assessment of the active health workforce was conducted through a national census-style count using active registries and facility-level verification through sampled facilities visits. Health worker production was estimated through an analysis of enrollment and graduation figures from public and private institutions from 2019 to 2023.FindingsWe estimated 63,632 health workers in Afghanistan in 2023, with 73% in the public sector and 27% in the private sector. Key health workers (physicians, nurses and midwives) total 10.3 per 10,000 population, falling significantly short of the aspirational UHC threshold (44.5 key health workers per 10,000). Substantial geographic disparity exists between provinces, with remote provinces reporting far fewer key health workers compared to the national average and Kabul representing approximately 50% of the country’s specialized physicians. Significant gender imbalances exist as only 18% of specialized physicians and 29% of nurses are female. Health workforce production is largely dependent on the private sector, and has declined for certain cadres due to restrictions on female education, which are increasing in severity. Majority female cadres, such as Obstetrics/Gynecology, are anticipating significant declines in active staff, jeopardizing aspirations of UHC.InterpretationAfghanistan faces critical health workforce challenges, including shortages, gender imbalances and unequal geographic distribution. These findings provide essential insights for policymakers to guide human resources policies aimed at achieving UHC.

BackgroundA better understanding of adverse health and underlying risk factors in the context of military and law enforcement is essential to developing future preventative strategies. We conducted an umbrella review to provide an overview of the current literature regarding risk factors for adverse health in military and law enforcement populations.MethodsWe systematically searched the literature for systematic reviews and meta-analyses regarding risk factors for adverse health in military or law enforcement populations. We critically appraised the studies that matched our inclusion criteria, extracted the adverse health outcomes and underlying risk factors, and narratively synthesised the findings.ResultsThis umbrella review included 34 systematic reviews that covered data from 43 countries. We identified twenty-six adverse health outcomes and 220 underlying risk factors. The adverse health outcomes covered in the included systematic reviews were one infectious disease (Heliobacter pylori infection); two endocrine, nutritional, or metabolic diseases (metabolic syndrome and obesity); seven mental, behavioural, or neurodevelopmental disorders (adjustment disorder, alcohol misuse, anxiety, depression, poor mental health, PTSD, and stress); two diseases of the nervous system (insomnia and sleep-disordered breathing); one disease of the ear or mastoid process (noise-induced hearing loss); eight diseases of the musculoskeletal system and connective tissue (cervical spine injuries, injuries, lower extremity injuries, musculoskeletal injuries, neck pain, rhabdomyolysis, and stress fractures); one symptom, signs and abnormal clinical and laboratory findings, not elsewhere classified (suicidal ideation); three injuries, poisonings, or other consequences of external causes (concussion, heat illness, and suicide); and one factor influencing health status and contact with health services (burnout). Of the 220 identified risk factors, 136 were modifiable, and the most frequently reported were female sex, older age, lower functional movement screen scores, maladaptive coping, lack of social support, and neuroticism.ConclusionThis umbrella review identified twenty-six adverse health outcomes and their underlying risk factors in military and law enforcement populations. Hereby, this study provides potential starting points for preventing adverse health in these populations. It also identifies a broad lack of systematic reviews investigating mental, behavioural, or neurodevelopmental disorders in military populations and diseases of the musculoskeletal system and connective tissue in law enforcement populations.Prospero Registration NumberCRD42022378123.

Health insurance is a key instrument for a health system on its path to achieving universal health coverage (UHC) and protects individuals from catastrophic health expenditures, especially in health emergencies. However, there are other dimensions to care access beyond financial accessibility. In this study, we assess the geographical accessibility of comprehensive emergency obstetric care (CEmOC) within the Lagos State Health Insurance Scheme. We geocoded functional public and private CEmOC facilities, established facilities registered on the insurance panel as of December 2022, and assembled population distribution for women of childbearing age. We used Google Maps Platform's internal directions application programming interface to obtain driving times to facilities. State- and local government area (LGA)-level median travel time (MTT) and a number of CEmOC facilities reachable within 30 min were obtained for peak travel hours. Across Lagos State, MTT to the nearest public CEmOC was 25 min, reduced to 17 min with private facilities added to the insurance panel. MTT to the nearest public facility in LGAs ranged from 9 min (Lagos Island) to 51 min (Ojo) (median = 25 min). With private facilities added, MTT ranged from 5 min (Agege and Ajeromi-Ifelodun) to 36 min (Ibeju-Lekki) (median = 13 min). On average, no public CEmOC facility was reachable within 30 min of driving for women living in 6 of 20 LGAs. With private facilities included in the scheme, reachable facilities within 30 min remained zero in one LGA (Ibeju-Lekki). Our innovative approach offers policy-relevant evidence to optimise insurance coverage, support efforts in advancing UHC, ensure coverage for CEmOC, and improve health system performance.

BackgroundCurrent Universal Health Coverage (UHC) considerations confirm the need for strong governance in improving health sector performance. However, empirical evidence on the effects of decentralized health system governance remains limited in Low-and-middle-income countries (LMICs). This paper assesses the de facto health governance policies and practices of the decentralized health system of Ghana and its implications, for better policy formulation and implementation. Material and methodsThe study employed a cross-sectional design, comprising of systematic literature review (SLR) and in-depth interviews on health governance components. The literature review (n=103) was performed to document the factors that affect health governance management and policy uptake. A total of 32 purposively sampled key health system actors were individually interviewed face-to-face between January and February, 2018. Thematic content analyses of literature and interviews were done. ResultsTension regarding power relationships exists between the policies governing the health sector of Ghana, which has rendered the decentralization reform effort in health governance policies and practices uncoordinated, incoherent and sometimes contradictory. Implication of the de facto decentralized health governance policies and practice include: limited involvement of sub-national level in policy development; weak interaction between policy formulators and implementers; and political interference in policy implementations compromising evidence-based policy formulation. Originality/valueDrawing on diverse literatures and opinions of key health actors, this paper contributes to knowledge on health governance practices in a decentralized and resource constrained health system, and offers practical accounts of the implications of the de facto health governance system of Ghana for health policy formulation and implementation.

Aims: The prevalence of self-medication worldwide has been on the increase especially with the outbreak of the COVID-19 pandemic. Even though self-medication can reduce pressure on the healthcare, the seeming downsides is overwhelming especially with the lockdown in the COVID-19 era. This study is thus set to understand the prevalence and nature of self-medication against COVID-19 among Individuals in Nsukka Town. Methods: A cross-sectional survey based on descriptive non-experimental research designed to investigate the prevalence and practices of self-medication against COVID-19 was conducted within the Nsukka town of Enugu state, Nigeria. A 20-item structured, self-administered questionnaire was administered to a population consisting of Health workers, Road Transport workers and market women. Microsoft Excel 2016 and SPSS version 21.0 were used to analyze the data. Descriptive and inferential statistics were used to summarize the data. Results: A total of 840 responses were received. Participants aged 35-44 (262, 29.6%) and males (592, 67%) were the highest in the study. A 38.0% of the respondents have a tertiary education certificate while a 36.5% are traders. Nearly half (45.5%) of the participants were married. Participants indulgence in general self-medication (439, 49.7%) was higher than indulged in self-medication to prevent COVID-19 (415, 46.9%). Most self-medication was done largely to prevent COVID-19 infection. Among the drugs commonly self-medicated are dexamethasone (6.2%) and vitamin C (6%) closely followed prednisolone (3.8%). A few of the participants had “no trust in doctor” (1.8%) while an equal number “have medicines of family members” (1.8%). Conclusion: Approximately half of the respondents reported to have self-medicated to prevent COVID-19. Dexamethasone and Vitamin C were most commonly used drugs. The only factor associated with COVID-19 self-medication was gender where being a female was associated with self-medicating against COVID-19. Concerted efforts are needed to educate the public on the dangers of self-medication and the need to access medical attention and information from healthcare professionals during pandemics.