The originality of this paper lies in the presentation of a new, innovative method for manufacturing medical screws with a cylindrical head of 316 LVM. This method is unique on a global scale, and its assumptions have been granted patent protection. The paper presents selected results of theoretical and experimental research on the developed process of forming of medical screws based on new technology. In the first part of the study a review of the types of screws used in the medical industry is made and the previous methods of their manufacture are described. The second part of the paper presents the assumptions and analysis of the elaborated process of metal forming of medical screws with a cylindrical head and ring thread made of 316 LVM austenitic steel. The theoretical analysis of the new process of forming a screw selected for testing was performed on the basis of numerical simulations. The experimental verification of the proposed theoretical solutions was carried out on the basis of laboratory tests, industrial research and qualitative research. The positive results obtained from computer simulations and experiments confirmed the effectiveness of the developed technology and the validity of its use in future in industrial practice. Austenitic steel of type 316 LVM X2CrNiMo18-15-3) is characterised by high metallurgical purity and is dedicated to medical applications for implants . In orde-15-3 is Austenitic stainless steel obtains significantly higher mechanical properties after cold forming, where the appropriate degree of crushing allows to control the increase in mechanical properties with a decrease in forming properties ,13. The In medical applications 316 LVM steel is used for implantation into orthopaedic connecting wires, pins, skinning nails, bone nails, femoral heads, vertebrae, acetabulum bones, hip joints, knee joints, bones and nail plates, catheters, internal fastening devices, dental implants or staples ,15,16,17At present, medical screws are produced mainly by machining, additive processing and injection moulding methods .The application of machining for the production of medical screws is described in the article ,24. The Among the methods of manufacturing medical screws, one can distinguish the additive processing described in the article ,26. In cOne of the ways of producing medical screws is also the injection moulding method developed by researchers from the Fraunhofer IFAM Institute for Production Engineering and Research of Applied Materials in Bremen. This technology involves the production of biodegradable medical screws made from polylactic acid, hydroxyapatite and medical stainless steel by injection moulding. Depending on the chemical composition of the screws, they can be biodegradable within 24 months. These screws can be manufactured precisely using conventional injection moulding methods, which means that there is no need for additional cavity processing. The resulting medical screws have similar properties to real bone. Their compressive strength is greater than 130 MPa, while a real bone can withstand 130–180 MPa.Despite the existence of these technologies, new solutions are still being sought. Particularly noteworthy are the metal forming processes, which allow forming products with better mechanical and functional properties. Replacing the previously used technologies of medical screws production with the new methods of metal forming processing would allow forming products with better quality and at the same time reduce their manufacturing costs .It should be mentioned that the research subject matter undertaken is a response of the scientific world to the needs reported by medical producers for the development of an effective technology for the production of medical screws made of austenitic steel in terms of obtaining products of the highest quality. Therefore, the Lublin University of Technology has undertaken to develop a new method of forming medical screws using metal forming processes. This method is unique on a global scale, and its assumptions have been granted patent protection ,28. ThisThe material used for the test was 316 LVM  austenitic steel in the annealed condition with the chemical composition and properties shown in Experimental verification of the assumed process was performed in laboratory conditions in the laboratory of the Department of Computer Modelling and Metal Forming Technology at the Lublin University of Technology and in industrial conditions in the Eurowkret Production Company on industrial machines. In laboratory tests, a specially designed and manufactured thread rolling device a and setExperimental verifications under industrial conditions at Eurowkret Production Company  were carried out on industrial machines i.e.,-forging of screw heads was performed on a machine produced by the Zabierzów Machinery Factory’s  model Pazm 6 using a set of dies shown in -thread rolling of the screw forgings was carried out on the Chun Zu CPR6S  cross-wedge rolling machine using the dies shown in -Making cuts on abrasive disc cutting machines and water cooling;-Embedding preparations in the resin;-Grinding on abrasive discs with grits 80, 220 with water cooling;-Three-step polishing using a diamond suspension of 9 µm, 3 µm and colloidal silica 0.05 µm; and-Electrolytic etching in a 10% oxalic acid solution, at 3V.In order to analyse the correctness of the deformation process and to verify the simulation results, macro and microstructural tests were carried out, including a quantitative analysis of the microstructure of the products. Additionally, in order to check the degree of strengthening in selected areas, micro hardness tests were carried out using the Vickers method. Macro and microstructural analysis was performed for screw forgings and raw material with the use of optical microscopy   and the observations were made in a bright field. The metallographic specimens  for micrIn selected areas of the samples where microstructures were analysed, microhardness tests were also performed using the Vickers method in accordance with PN-EN ISO 6507-1:2006. The tests were performed on the HV 0.5 scale using the Futuretech FM 800 microhardness meter . Additionally, in selected areas, grain size analysis was carried out in accordance with the ASTM E112 standard.The results of the simulation confirmed the possibility of metal forming of medical screw forgings according to the proposed technology. The On the basis of the simulation, more important information was obtained about the analysed process of forming of the forging of medical screw, including the distribution of the intensity of strains, stresses, or the criterion of destruction and forming forces. The results of the laboratory experiment and in real conditions in the Eurowkret Production Company confirmed the correctness of the modelled process of forming medical screw forgings. During the research, the forces needed to form the screw head and roll the screw thread were determined. A comparison of forces measured experimentally and simulated is shown in The microstructure of the drawn wire used to produce the screw  consistsOn the basis of macrostructural observations of etching metallographic specimen , areas 1The microstructures of formed screws shown in The microstructure of the analysed screw is characterised by considerable heterogeneity due to differences in plastic deformation values for individual areas. The structural changes are mainly related to the appearance of a significant number of twins, grains cut by the slip bands and deformations in the direction of the material flow.It is therefore necessary to consider the use of appropriately selected post-rolled heat treatment processes in order to homogenise mechanical properties and ensure proper corrosion resistance.The hardness measurements obtained in -Increasing the efficiency of product manufacturing;-Reduction of production costs. This advantage results from lower material, time, labour and energy consumption of the new process. It is possible to reduce process waste by up to 45% compared to machining. A screw produced by machining takes several minutes to several tens of minutes to produce, depending on the shape. In the case of metal forming processes for producing screws: forging the screw head takes a few seconds and rolling the screw thread also takes a few seconds. Due to the reduction of the manufacturing time of the screws according to the new technology, this will result in a reduction of the labour and energy intensity of the process;-Increase in product quality. Higher product quality is associated with a more favourable structure and high surface smoothness as a consequence of the application of plastic working processes, which results in better strength and service properties;-Pro-environmentality. The new process’s environmental friendliness results from production that is less harmful to the environment, i.e., low waste by reducing material losses.This paper presents new possibilities of manufacturing medical screws using metal forming processes. On the basis of theoretical and experimental research, it has been found that in the assumed forming process it is possible to obtain forgings of medical screws with cylindrical head and ring threads of the correct shape. The advantage of the developed technology of metal forming screws over the hitherto applied machining lies in the following:The advantage of the new technology is its versatility. This method can be used to form screws from various metal biomaterials.The numerical analyses carried out confirm the advantages of using computer simulations when developing new technologies . Thanks The laboratory and industrial tests carried out made it possible to determine the optimum technological parameters for the correct implementation of the process of metal forming of screw forgings and to produce technology demonstrators with qualitative tests. It should be mentioned that due to the adopted scheme of the process, the microstructure of the obtained screw forgings is characterized by heterogeneity related to the occurrence of different deformation values in individual areas of the product. The quantification of structural change expressed by increase in hardness as a result of hardening and the change in the average grain diameter confirm the results of numerical analyses in terms of the expected deformations in individual areas. It is, therefore, necessary to consider the application of appropriately selected heat treatment processes after the screw thread rolling operation in order to homogenize the structure and mechanical properties and ensure proper corrosion resistance.


Most molecular maturity parameters of the oil samples suggest a maturity level equivalent to the onset of the peak of the oil generative window.The organic geochemistry of six oil samples from the offshore Block 17  was studied by a combination of classical biomarker and extended diamondoid analyses to elucidate source rock facies, the extent of biodegradation, and thermal maturity. Based on molecular data, oils are interpreted as depicting a mixture of two pulses of hydrocarbon generation probably from the Bucomazi and Malembo formations. Geochemical results also gave evidence of mixing of a lacustrine siliciclastic-sourced oil charge and a second more terrestrially derived oil type in the samples analyzed. A single genetic oil family was identified through hierarchical cluster analysis; however, two groups of oils were identified on the basis of their biodegradation levels using the Peters/Moldowan scale. Lower and upper Malembo oils have a slight depletion and a notable absence of  Angola is one of the largest crude oil producers in Sub-Saharan Africa. The country produces about 1.8 million barrels per day after a boom from 2002 to 2008 as its deepwater fields began to take off. Currently, crude oil production comes almost entirely from offshore fields off the coast of Cabinda and deepwater fields in the Lower Congo Basin (LCB). Angola began producing oil in 1956, when the company Petrofina discovered the first accumulation near Benfica in the Kwanza Basin, and has estimated crude oil reserves of 13 billion barrels. Most of the proved reserves are located in the offshore parts of the Lower Congo and Kwanza basins, which developed during the Late Jurassic and Neocomian times on the conjugated margins of Africa and Brazil. The study area is located within the sedimentary LCB a, that i2 and is located around 230 km northwest of Luanda  and ceased around the late Barremian and early Aptian 127–117 Ma) )Analyzed oil samples from six fields in the Angolan Block 17 originated from the same source rocks  consist of a mixture of two generation pulses of hydrocarbons. Biomarker data indicate that the first pulse originated from the Bucomazi Formation lacustrine facies, whilst the second one was generated from the more terrestrially derived facies of the Malembo unit. All the study oils belong to the same genetic type. Differences in the PM levels of biodegradation within the study oils could be explained by factors such as reservoir temperature and/or microbial communities.


The emergence of antibiotic-resistant bacteria presents a major challenge in terms of increased morbidity, mortality, and healthcare costs. The World Health Organization (WHO) states that antibiotic resistance is one of the biggest threats to global health, food security, and development. One promising alternative to treat infections caused by antibiotic-resistant bacteria is phage therapy, where bacteriophages (phages) are used to combat the pathogens. Phage therapy has a 100 years history, but it has been largely ignored in Western countries after the commercialization of antibiotics. Now, as antibiotic-resistant bacteria are becoming more common, a renewed interest in phage therapy is emerging.This Special Issue “Phage Therapy: A Biological Approach to Treatment of Bacterial Infections” covers different aspects of phage therapy. The issue altogether includes nine papers, four out of which are research papers, four are reviews, and one is a case study.Acinetobacter baumannii, which were isolated earlier in hospital wastewater in Thailand. They show that each of the analyzed five phages can infect 22–28% of 150 multiresistant A. baumannii strains and that one of the phages clearly reduces the cytotoxic effect of A. baumannii on human cells in vitro [Two of the published articles concentrate on the isolation and characterization of phages and on setting up a phage depository. Styles et al., describe the analysis of phages infecting Flavobacterium columnare becomes phage resistant in a one-month co-culture of the phage and the bacterium in lake water and describe the isolation and analysis of an evolved phage that can overcome the phage resistance in some of the bacterial mutants resistant to the original phage [Interestingly, three articles in the Special Issue concern phage therapy in aquaculture. A review article by Zaczek et al., discusses different aspects of phage application in aquaculture niches from both theoretical and practical points of view. They handle topics such as microbial spoilage of seafood, phage abundance in aquatic systems, and therapeutic application of phages in the fish industry in practice . The twoal phage .Escherichia coli [There are three review articles in the Special Issue that cover human phage therapy from different perspectives. The article by Steven Abedon gives a thorough summary of published information about the combination therapy of phages and antibiotics  and Zalehia coli . The arthia coli . The last article of the Special Issue is a case report by Rubalskii et al., describing the phage therapy of eight patients having severe bacterial infections related to cardiothoracic surgery. The authors report the eradication of the pathogenic bacteria in seven out of eight patients for whom antibiotic treatments had earlier failed .This Special Issue represents a multifaceted collection of research and review articles that together cover several aspects of phage therapy: setting up a phage collection and the isolation and analysis of phages, the application of phages in the food industry (as represented by aquaculture), and the treatment of different types of human infections. We hope that the articles in this Special Issue will reach a wide audience and provide new information for professionals working on different aspects of phage research.


The performance of copper selenide and effectiveness of chemical catalytic reactors are dependent on an inclined magnetic field, the nature of the chemical reaction, introduction of space heat source, changes in both distributions of temperature and concentration of nanofluids. This report presents the significance of increasing radius of nanoparticles, energy flux due to the concentration gradient, and mass flux due to the temperature gradient in the dynamics of the fluid subject to inclined magnetic strength is presented. The non-dimensionalization and parameterization of the dimensional governing equation were obtained by introducing suitable similarity variables. Thereafter, the numerical solutions were obtained through shooting techniques together with 4th order Runge–Kutta Scheme and MATLAB in-built bvp4c package. It was concluded that at all the levels of energy flux due to concentration gradient, reduction in the viscosity of water-based nanofluid due to a higher radius of copper nanoparticles causes an enhancement of the velocity. The emergence of both energy flux and mass flux due to gradients in concentration and temperature affect the distribution of temperature and concentration at the free stream. Conservation of energy is capable to unravel the nature of outward flux of energy. Meanwhile, Hort et al.8 once remarked that concentration currents and heat are two driven forces of fluctuations in temperature as in the case of conservation of energy. The effect of energy flux due to concentration gradient on six different gases (9. It was remarked that kinetic theory is useful to determine the Dufour coefficient of each gas and temperature difference within the domain 10). Dynamics of peristaltic flow through a channel of width 2a subject to energy flux due to concentration gradient and mass flux due to energy gradient was closely examined by Hayat et al.11. It was shown that temperature distribution is an increasing property of both Dufour and Soret effects. Although, the increase in the temperature distribution is more enhanced near the surface. The reverse is the observed effects of Dufour and Soret phenomena on the concentration as both properties decreases.The roles of energy and mass fluxes due to temperature and concentration gradients play major roles in electrochemical processes, dynamics of gases, chemical catalytic reactors, production of copper selenide sequel to the pioneering work by Louis Dufour12 led to a conclusion that a larger Dufour number was recommended for gaseous mixtures in which energy flux due to concentration gradient is significant. Following the suggestion by Partha et al.15, Lewis number is more appropriate than Schmidt number in characterizing heat and mass transfer due to the significance of energy flux due to concentration gradient and mass flux due to temperature gradient. This led to a robust analysis of the interconnectedness of Lewis number, Dufour number, and Soret number. The results show that when 13 as the most important source of heat conduction within the region where magnetic fields do not exist or even weak. The further associated increase in effective thermal conductivity to growth in Dufour effect. The major reason why temperature increases due to higher magnetic strength were associated with the fact that heat conduction in the perpendicular direction diminishes whenever magnetic field is intensified. The conclusions mentioned above are not affected in the correction published as Ref.14.Further examination of energy and mass fluxes by Linz16, Narayanan and Rakesh17, Lin and Yang18. Intrinsic magnetic related properties of magnetite vary as to its diameter changes (i.e. higher ratio of surface to volume). As the size of nanoparticles becoming smaller, the superparamagnetic nature of magnetic nano-sized particles even changes19. Ashraf et al.20 remarked that changes in the radius of nanoparticles affect the characteristics of both interphase and nanoparticles. According to Yapici et al.21, the outcome of comparative analysis of ethylene glycol conveying SiO22 noted that the viscosity of nanofluid can be greatly influenced by particle size, the nature of energy transfer between fluid’s layer and the surface of the particles. There exist significant changes in the melting point of nanoparticles due to rises in the radius. This conclusion was based on the fact that the melting temperature was seen to be a decreasing property of higher particle size with a significant decreasing rate between spherical and nanoparticles; see Antoniammal and Arivuoli23.Enhancement in the transfer of heat across fluid flow has made experts in thermal engineering embrace the efficiency of nanofluids. The earlier mentioned advancement is based on the nature of the base fluid and nanoparticles. Nanoparticle concentration and temperature effects on the ratio of mass to density and viscosity are some of the physical properties. However, thermal conductivity and specific heat capacity at different levels of concentration of nanoparticles, nanoparticles’ size, and temperature are some of the thermal properties. The concentration of nanoparticles, pressure drop, friction factor, nanoparticles radius are also some of the outlined characteristics of nanofluids as pointed out by Mohamoud Jama24 indicates that increasing the diameter of silicon dioxide nanoparticles in ethylene glycol and water corresponds to a decrease in the nanofluid’s viscosity. It is worth remarking that the observed decrease in fluid’s viscosity is more significant when the nanofluid is cold (negative temperature). At a larger temperature, the decrease in viscosity with particle size disappears. In the case of a nanofluid parallel to a moving stretchable sheet, platelet shape of molybdenum disulfide (MoS2) nanoparticles was found by Hamid et al.25 to produce a unique heat transfer. In another study, Sheikholeslami et al.26 illustrated the movement of multiple wall carbon nanotube and Iron(iii)oxide nanoparticles in a typical water based nanofluid through a porous medium when Lorentz force is predominant. The dynamics of water conveying alumina and copper nanoparticles over a split lid-driven square cavity was examined by Khan et al.27 and it was shown that higher Nusselt number proportional to the heat transfer rate is attained at the point when both lids meet. In another related report by Khan et al.28, carbon nanotubes and heating of the wall are two factors capable to boost the local Nusselt number in the case of water-based carbon nanotubes over a right-angle trapezoidal cavity. Meanwhile, the local Nusselt numbers are increasing property of solid volume fraction of carbon nanoparticles; Hamid et al.29. The analysis of seven different hybrid nanofluids by Nehad et al.30 shows that optimal Nusselt number is achievable when suction and stretching are significantly large but less dense nanoparticles like silicon dioxide and multiple wall CNT.The analysis of Namburu et al.when energy flux due to concentration gradient and mass flux due to temperature gradient are negligible, what is the significance of increasing radius of nanoparticles on the local skin friction coefficients, heat transfer rate, and mass transfer rate?Cu-water nanofluids?At various levels of energy flux and mass flux due to gradients in concentration and temperature respectively, how does increasing radius of copper nanoparticles influences the transport phenomena of What is the variation in Sequel to the aforementioned reviews of related literatures, in the presence of Joule heating and space-dependent heating, it is noteworthy to examine the significance of increasing nanoparticle radius and inclined magnetic field on the dynamics of chemical reactive water conveying copper nanoparticles through a porous medium. The outcome of such study would be very helpful to experts dealing with the performance of copper selenide and effectiveness of chemical catalytic reactors. This study was designed to provide answers to the following related research questions: 39, the governing equation suitable to investigate the aforementioned transport phenomenon is31 and Gosukonda et al.32 for the ratio of dynamic viscosity of the nanofluid to the dynamic viscosity of base fluid defined ash was adopted. The effective nanofluid properties are given by33 on the thermal conductivity of nanofluids, the model proposed by Maxwell34 was adopted to incorporate the enhancement in the thermal conductivity of Cu-Water nanofluid. Next is to introduce the following variablesM, and porosity parameter P, heat source/sink parameter S are defined as35, Saidi & Karimi36, Khoshvaght-Aliabadi & Hormozi37, Wan et al.38, and Bachok et al.39. The dimensionless local skin friction, heat transfer rate, and mass transfer rate areWhen energy flux due to concentration gradient and mass flux due to temperature gradient are significant, the dynamics of water conveying copper nanoparticles over a horizontal surface subject to magnetic field of strength 40) was used to obtain the system of first order IVP for Eqs. . Th. Th40) w24 corresponds to a decrease in the nanofluid’s viscosity. Not only that, the outcome of an examination of (i) ethylene glycol and alumina nanoparticles mixture (ii) water and CuO nanoparticles mixture by Pastoriza-Gallego et al.49 shows that higher viscosity is bound to occur as particle size diminishes. It is worth deducing from Figs. When at all the levels of energy flux due to concentration gradient, reduction in the viscosity of water-based nanofluid due to a higher radius of copper nanoparticles causes an enhancement of the velocity.significance decrease in distribution of temperature across the domain due to increasing radius of copper nanoparticles is achievable when energy flux due to concentration gradient is sufficiently large in magnitude.when mass flux due to temperature gradient is highly negligible, optimal temperature is also observable when energy flux due to concentration gradient is sufficiently large. Reverse is the case when mass flux due to temperature gradient is sufficiently large as optimal temperature is ascertained at all levels of energy flux due to concentration gradient.reduction in the mass transfer rate the emergence of both energy flux and mass flux due to gradients in concentration and temperature affect the distribution of temperature and concentration at the free stream.Attempt had been made to examine the significance of increasing radius of nanoparticles, energy flux due to concentration gradient, and mass flux due to temperature gradient in the dynamics of chemically reactive fluid subject to suction and inclined magnetic strength. Based on the analysis, it is worth concluding that


Policy dialogue for health policies has started to gain importance in recent years, especially for complex issues such as health financing. Moroccan health financing has faced several challenges during the last years. This study aims to document the Moroccan experience in developing a consolidated health financing strategy according to the policy dialogue approach. It especially considers the importance of conceptualising this process in the Moroccan context.We documented the process of developing a health financing strategy in Morocco. It concerned four steps, as follows: (1) summarising health financing evidence in preparation of the policy dialogue; (2) organising the health policy dialogue process with 250 participants ; (3) a technical workshop to formulate the strategy actions; and (4) an ultimate workshop for validation with decision-makers. The process lasted 1 year from March 2019 to February 2020. We have reviewed all documents related to the four steps of the process through our active participation in the policy debate and the documentation of two technical workshops to produce the strategy document.The policy dialogue approach showed its usefulness in creating convergence among all health actors to define a national shared vision on health financing in Morocco. There was a high political commitment in the process and all actors officially adopted recommendations on health financing actions. A strategy document produced within a collaborative approach was the final output. This experience also marked a shift from previous top-down approaches in designing health policies for more participation and inclusion. The evidence synthesis played a crucial role in facilitating the debate. The collaborative approach seems to work in favouring national consensus on practical health financing actions.The policy dialogue process adopted for health financing in Morocco helped to create collective ownership of health financing actions. Despite the positive results in terms of national mobilisation around the health financing vision in Morocco, there is a need to institutionalise the policy dialogue with a more decentralised approach to consider subnational specificities. Policy dialogue approaches legitimise the adoption of a health financing strategy.Participation in designing health financing strategies is important for a shared vision on health financing.Policy dialogue for health financing strategies needs to be institutionalised and cover sub-national levels.Universal Health Coverage (UHC) is an opportunity to strengthen health systems and promote equity . CountriBy definition, UHC is the capacity to provide all people with access to health services of sufficient quality, while also ensuring that the use of these services does not expose the user to financial hardship . For UHCHealth financing is one of the six blocks of the health system . There a… part and parcel of policy and decision-making processes, where they are intended to contribute to developing or implementing policy change following a round of evidence-based discussions/workshops/consultations on a particular subject” ubject” , the institutionalisation of dialogue is crucial for the continuity and maintenance of institutional intelligence , 23.Régime d’Assistance Médicale or RAMED) has contributed to improving the coverage rate to reach 62%, according to the latest figures; and the scheme for self-employed, whose law was passed by the parliament on June 23, 2017. The latter is the most challenging in terms of implementation as it concerns the informal sector and highly heterogeneous categories of the population with less capacities to contribute.The path to universality in Morocco was designed around three components, as follows: a compulsory health insurance scheme for formal employees of both private and public sectors (it covers 34% of the population); the scheme for the poor and vulnerable  financing presents fewer challenges [Different studies highlighted the challenges of health financing in Morocco. Whilst the compulsory health insurance scheme , the need to extend the coverage, the need to link the benefits package definition to health financing capacity, and the fragmentation of pooling. To deal with these challenges, Morocco decided to formulate a consolidated health financing strategy using a national dialogue approach.This paper documents the conceptualisation and application of the policy dialogue on health financing in Morocco. The Global Action Plan initiative for Healthy Lives and Well-being for All  and the The main data sources for this documentation are (1) mission reports and presentations of the first scoping mission on health financing organised by WHO, (2) the detailed reports of each workshop prepared by the teams of rapporteurs during the national conference as well as the reports of both follow-up workshops, (3) the presentations that were made by national and international experts, decision-makers from other countries (ministers and experts), (4) the final report of the policy dialogue recommendations, (5) notes from our observation as participants and organisers, and (6) health financing documentation review prepared as the background of the policy dialogue.All reports and documents were centralised and categorised according to each step of the process . The analysis was performed in such a way as to extract details about the whole process of the policy dialogue from evidence gathering to the strategy draft finalisation. Based on the detailed reports of sessions and workshops, data were charted using a grid that follows the different phases of the policy dialogue.We then used a coding system to chart the data in a way to reconstruct each step of the process. This qualitative coding allowed structuring of the information and its analysis according to the specificity of each phase. As most of the policy dialogue steps were documented, the quality of findings was checked by sharing and cross-checking the results among the researchers, who themselves contributed and participated in the whole process. When missing parts are identified, we went back to the source documents and completed the analysis.A stepwise approach was used to structure the process of developing national recommendations for a health financing strategy in Morocco. The stepwise approach allowed understanding of the current status of health financing in Morocco and the consensus of national stakeholders on future visions and directions. This stepwise approach is described in Fig. Participation in the different steps of the policy dialogue was organised based on criteria related to the involvement in health issues, either directly or indirectly, through actions on health determinants. An inclusive list was established within the organisation committee  and from other non-governmental departments).Prime minister, other ministers, former ministers and government representativesParliament representatives of the social commissionNational observatories, Ministry of PlanningTechnical and financial partners, international experts and foreign ministers of health National professional councils, national experts from research centres and national institutes and representatives of medical schoolsRepresentatives of the private sector associationsTrade union representativesCivil society organisations with an active role in healthRepresentatives of the health insurance agency and health insurance fundsRepresentatives of hospitals, including teaching hospitalsProfessional associationsMedia and analysts in the social fieldsThe policy dialogue involved the following participants:The first follow-up workshop involved 22 experts from national departments concerned with health financing to translate the outputs of the policy dialogue into feasible actions. The second follow-up workshop involved decision-makers in the field of health financing , including technical and financial partners  as a commitment to support the implementation phase of the strategy.The authors of this paper participated and contributed to the whole process . All preparatory meeting minutes, documents and workshop reports were analysed to redesign the framework of the policy dialogue for further learning. Each step of the health financing debate in Morocco was structured and organised to ensure the participation and inclusion of all actors.During the preparatory phase of the policy dialogue, technical staff from the MoH and WHO reviewed and summarised essential documents on health financing to facilitate the debate. These were research studies and consultant reports produced in Morocco between 2013 and 2018. The objective of this review was to provide access to available evidence on health financing in Morocco to all stakeholders involved in the policy dialogue process.Before the conference, a series of discussions with the main actors in the Moroccan health system allowed the mapping of the challenges around which the national debate would be organised. During these discussions, additional documents were also identified for the review. The preparatory phase was also an opportunity to identify the main actors to be invited to the national forum.The policy dialogue benefited from the collaboration between WHO, the European Union delegation in Morocco, the African Development Bank and the World Bank. Each of these organisations had, in recent years, produced evidence and provided technical assistance on different components of health financing in Morocco  The collaboration allowed sharing of the evidence and technical expertise and the mobilising of experts and representatives from different countries to share country experiences and best practices during the dialogue process.The MoH steered the entire dialogue process, including the collaboration of partners and the selection, synthesis and dissemination of available information.The national conference on health financing was held on June 18–19, 2019, in Rabat; around 250 participants contributed to this event. The participation covered all actors concerned by the health system (see above). Different ex-ministers from other countries and international experts in the field of health financing shared their experiences. Two plenary sessions focused on sharing national and international expertise on health financing and health financing governance. Three parallel workshops were held to deepen the dialogue on health financing functions . The parallel workshops were designed to give more time for debate and participation. The organisation committee designated a general rapporteur who was responsible for consolidating the overall proceedings of the conference as well as rapporteur teams and moderators for each session. Templates were used for rapporteurs to document each step of the national event, including guiding questions for facilitators. Box 1 gives an example of the guiding questions for the resource mobilisation workshop.As a follow-up to the national conference, two workshops were organised to translate the health financing recommendations adopted during the debate into vision, strategic directions and feasible actions. Members of the research team participated in these workshops and documented the discussions. These two workshops were held by WHO to identify the main challenges and explore all current and future windows of opportunity to define concrete actions for implementation. The first workshop was technical, with the participation of professional staff and managers representing all departments involved in health financing. The second workshop was aimed at decision-makers’ validation of the health financing actions and to discuss how partners could support the implementation phase.Box 1 Guiding questions for the resource mobilisation workshopWhat is the situation in Morocco in terms of resource mobilisation for health? How does Morocco compare to other countries?• What are the existing constraints for an optimised resource mobilisation process for health?• What opportunities exist in terms of fiscal space for mobilising resources for health?• How can civil society organisations and parliamentarians contribute to the debate and enrich the discussion towards a national consensus on a vision on resource mobilisation for health?• What are the existing possibilities for additional mobilisation of resources for health, in particular, innovative financing, partnership, etc.?• What recommendations can each stakeholder make in this regard? What is the point of view of experts in relation to the proposals for the case of Morocco?• What concrete actions can be taken for the short-, medium- and long-term vision in terms of mobilising resources for health?The results of this paper are structured around key components of the policy dialogue process, namely a summary of existing evidence on the current situation in Morocco, political commitment, participation, and exchange of experiences, the health financing functions and their governance. The following sections present the findings following each step of the policy dialogue.A summary of existing evidence on the current situation in Morocco was shared with participants. This summary was organised into three groups. The first synthesis provided an overview of the Moroccan health system using the latest data and health indicators. The health system overview also presented the organisational aspects and main challenges that Morocco is experiencing . The second synthesis was about the health financing analysis and indicators as well as its main challenges based on national health accounts and recent studies produced at the national level. In this synthesis, the financing of UHC schemes was examined by stressing areas of success but also pitfalls. Recent studies on the fragmentation and payment mechanisms were summarised, emphasising the difficulties that the purchasing function is facing. The third synthesis was about studies on the benefits package and access to health services, especially for the vulnerable population and former strategies and reforms. These syntheses covered financial access barriers and the quality of care and its link to health financing. International experiences were summarised and covered health financing strategies in general and, more specifically, areas of strategic purchasing in different countries . These international experiences contributed to enrich the debate by stressing the implementation challenges for each strategy. These syntheses were presented at the beginning of each workshop to give participants insights on what worked well in other settings, including a summary of technical recommendations for health financing.The health financing dialogue organised in June 2019 benefited from the support of His Majesty, the King, through the Royal patronage. The Head of Government (the Prime Minister) as well as other ministers from the government supported the national debate through their active participation. The importance of the dialogue was reflected in massive national media attention . The debFormer ministers of health of other countries that achieved excellent results in terms of health financing came to present their successes during the national conference but also stressed the challenges faced in implementation and equity . Other examples included France and Ghana and emphasised strategic aspects in the area of health financing. International examples focused on the importance of promoting primary healthcare through incentives from health financing and the convergences of UHC schemes to ensure more equity in the health system. The presentation of countries’ path to UHC gave different perspectives for Moroccan participants to think of the diversity of approaches of a health financing strategy. The discussions also covered the roles, commitment of actors, central place of the benefits package and how they link to health financing. The financial protection and all measures adopted in each country were essential in the sharing of these experiences. International experts and resource persons also addressed the role of the private sector in the path to UHC and strategic purchasing as a leverage to improve the overall health system performance through health financing payment mechanisms. Former ministers of health discussed the complexity of the policy design and implementation and shared their specific approaches with Moroccan policy-makers. The Moroccan health system and its main challenges and achievements were presented during this session to give a background for international experts.The resource mobilisation workshop tackled the main challenges in Morocco and debated the following elements: (1) the situation regarding the resource mobilisation function for health in Morocco; (2) the mobilisation of extra-budgetary financial resources for the health sector; (3) main successful mechanisms to expand fiscal space for health; (4) taxation as an innovative source of financing in the health sector, and (5) practical recommendations to improve the mobilisation of resources for health. Participants acknowledged the effort of the state in terms of mobilising resources for health . ThThe dialogue around the pooling of resources in Morocco focused on reducing fragmentation between existing schemes. National experts presented the Moroccan experience and discussed its details with participants. Multiple insurance schemes cover portions of the population in Morocco, including private-sector employees, civil servants, students, self-employed workers, internal plans for some large companies, and the RAMED subsidies . These mThe workshop related to the Purchasing function raised the issue of the benefits package and the difficulties in quantifying its services. In Morocco, the benefits package is defined in broad terms and mainly through a description of activities . The anaIt was highly recommended to consider the needs of vulnerable groups in the design of the benefits package but also through contracting mechanisms. The objective is to ensure that no one is left behind and the Purchasing function enables the implementation of incentives that support operationalising this value in the health system. Box 4 presents the strategic recommendations for the Purchasing function.Agence Nationale de l’Assurance Maladie) and the inter-ministerial committee that should be strengthened. The role of evidence for improving governance was also discussed to recommend improving the UHC information system. The autonomy of regions and empowering them with regional policy dialogues was mentioned as a determinant for better governance. Another element concerned the creation of spaces and channels for dialogue and participation of stakeholders, including the population, to develop recommendations for decision-makers. These spaces of discussion should be inclusive of all actors involved in health . To foster a long-term vision on health financing, participants and experts recommended the development of a national charter on health financing. Box 5 presents the strategic recommendations for the governance function.The plenary session devoted to health financing governance started by confronting the Moroccan experience with other countries’ and the analysis of experts from WHO and the European Union. Discussions revolved around the importance of working on the unification of all health insurance schemes, mainly through the same reimbursement rates and benefits package, as well as the creation of an independent fund for the management of RAMED resources. Creating regional committees for decisions on health financing was highlighted as a requirement to improve the governance function. The separation of functions  was stressed as a strategic requirement for UHC in general and particularly for RAMED to sustain in the future. An essential part of the debate focused on governance entities and their roles like the National Agency of Health Insurance , the moderator launches the general questions, and opens the debate. Moderators were given instructions to allocate more time for discussions and allow participants to express their views. However, the presence of health financing experts provided arbitration that reduced political divergence, especially when feasibility was analysed based on real international experiences. Despite that, disagreements concerning specific points  were avoided by adjusting the recommendation through adopting a progressive merging in the long term rather than an immediate unification of funds. Another example is related to the fact that some actors suggested increasing reimbursement rates for health insurance schemes. The political sensitivity of this recommendation was mitigated by suggesting a revision of rates based on health technology assessment analysis so the increase could be objective. In this way, the purchasing system is strategic. The role of moderators was crucial to move from suggestions to adopted recommendations by confronting the expert point of view and invited resource persons from other countries. Facilitators were given the guidance to try to give the floor to all categories of participants and ensure the inclusion of all ideas.To continue the coproduction process started before, within and after the national conference, the MoH, with the support of WHO, organised two workshops to identify concrete actions. The starting point was the conference recommendations. The participation of all technical departments in the coproduction process gave strength to the proposed measures. The objectives of the follow-up workshops were to sustain stakeholder involvement and increase the ownership of proposed actions, beyond the recommendations of the conference.The draft strategy was developed along the following axes: (1) actions related to resources mobilisation, 2) the pooling of resources, (3) improving the purchasing function, (4) improving equity and ensuring the financial protection for vulnerable groups, (5) improving health financing governance, and (6) multisectoral actions related to health financing such as benefits package definition and health in all policies. Figure  the poolBox 2 Main strategic recommendations for resources mobilisation in Morocco• Adopt and implement new financing mechanisms • Mobilise and prioritise resources for primary healthcare• Accelerate the implementation of health insurance for self-employed workers with stable funding• Increase fiscal space for health by strengthening tax revenue dedicated to health and strengthening the budget of the Ministry of HealthBox 3 Strategic recommendations for the Pooling function• Gradually work for the unification of compulsory health insurance schemes• Ensure equity in funding by adopting the same contribution rate for all insureds and the same benefit package for a harmonisation of schemes and their convergence and fight against the fragmentation• Encourage the pooling of risks, promote prepayment in order to reduce direct payments• Establish a system of solidarity between schemesBox 4 Strategic recommendations for the Purchasing function• Redefine a benefit package to be made available to the entire population, according to the needs of the population and evaluate feasibility, including funding, to deliver it to the whole population• Define a body in charge of updating the benefits package and its mechanism based on priority-setting and health technology assessment tools• Strengthen partnerships for processes of strategic purchasing• Develop hospital autonomy by strengthening their management according to performance and self-financing• Implement separation of financing and service provision functions• Strengthen and set up an information system for monitoring the performance of healthcare structures • Develop strategic purchasing methods based on performance contracting• Orient the purchasing function to develop family medicine• Develop the partnership to mobilise resources for health and encourage private investment in health• Encourage the private sector to invest according to the need for health• Strengthen the targeting system to allow financial protection of target and vulnerable groups• Ensure that the service package and funding integrate the needs of vulnerable groupsBox 5 Strategic recommendations for the Governance functionAgence Nationale de l’Assurance Maladie) as the UHC regulatory authority• Strengthen the governance missions of the National Agency of Health Insurance • Establish a national health charter• Create governance bodies: inter-ministerial committee and regional health committees and institutional spaces for dialogue through the high Health Council• Create regional and national dialogue forumsThe objective of this article was to stress the central role of policy dialogue for developing a health financing strategy in Morocco and share this experience as a learning opportunity for other countries. In the past years, the development process of health strategies in Morocco adopted mostly a top-down approach with less involvement of all concerned actors. Former strategies on health financing were not implemented because of the lack of participation in their process and design and, thus, the lack of political legitimacy and technical ownership. In 2015, a strategy on health financing was developed by experts with suggestions of actions. This strategy could not find its way to becoming a formulated policy. The lack of involvement of parliamentarians, civil society, and the Ministry of Finance and the lack of high-level endorsement weakened the strategy adoption. Since 2011, the Arab spring social movement introduced a culture of participation as a way of legitimising policy decisions  but alsoThe importance of dialogue in policy design appears to show its added value in other contexts, including LMICs. A case study from Liberia showed the role of policy dialogue to mobilise all stakeholders in supporting health policy design . The autThe literature on the benefits package definition shows the importance of involving stakeholders through debate and dialogue to set national priorities in terms of designing its content and the process to perform further adaptation . Althougconférences régionales de santé) [The draft strategy proposed institutionalised dialogues at national but also at regional levels. For instance, existing examples of policy dialogue at the subnational level have proven effective in France (e santé) . Anothere santé) . In the This policy dialogue was the first experience in the area of health financing and is far from being perfect. It provides a first attempt to document this complex process and prepare the field for a more in-depth qualitative analysis of policy dialogues. The management of parallel sessions was a challenge because of the difficulty to simultaneously ensure freedom to participants to choose the sessions while keeping a representativity level in each session. Fortunately, the number of participants was more than expected (250 instead of 200), which allowed guaranteeing a good level of participation in each workshop. Maybe a prior pre-registration in workshops that respects an acceptable level of distribution and representativeness could solve the problem in the future.The complexity of the process did not allow us to perform individual interviews to analyse the contextual determinants of the policy debate. It might have been interesting to explore the psychological influence of this experience on health actors and to what extent they are willing to support the implementation of the strategy in the long-term.With this article, we tried to provide a structured analysis of a fruitful policy dialogue on health financing. The paper presents an approach of crafting health strategies with more legitimacy through participation. Although implemented in other countries, this approach is fairly new in Morocco. We hope that further qualitative research will explore policy commitments for health financing and draw a picture of its determinants. The documentation of policy processes, especially those involving a participatory approach, will enhance the overall learning for UHC in Morocco and internationally.


Agricultural waste mapping is an indispensable tool for the development and adoption of sustainable waste management practises in the agricultural sector. Current practices of agricultural plastic waste (APW) management in countries with large agricultural areas and thus high generation volumes of APW include uncontrollable disposal in fields or near water sources, or uncontrolled burning of the waste. These practices lead to irreversible deterioration of the natural environment through land and soil contamination, contamination of freshwater resources, air pollution and also pose public health issues. Given these negative effects on the environment, spatial prediction of APW generation becomes significant in sustainable agriculture. This dataset consists of the coordinates of the agricultural plots identified in the Republic of Cyprus and the area in square meters covered by agricultural greenhouses. The dataset has been used to perform APW generation mapping and predict the national generation quantities of waste low- density polyethylene (LDPE). The collection of the data is included in sixteen tables separated per geographical area-cluster. The agricultural plastic waste (APW) generation mapping was conducted with the use of up-to-date statistics from Cyprus Agricultural Payments Organization (CAPO), geographic information system (GIS) and satellite imagery. The agr21.greenhouses of more than 3 m height2.greenhouses of average height 2 – 3 m3.tunnels of more than 3 m height4.tunnels of less than 2 m heightThe mapping of the greenhouse APW in Cyprus was conducted using primary data and information obtained from the records of CAPO on the latest statistics of recent years. In particular, the records of CAPO specify which agricultural plots enclose greenhouses and tunnels; the most recent records are for the year 2016. Accordingly, the number of plots enclosing greenhouses, their specific geographic locations and size are information that was deduced from the records. Given the exact coordinates of the agricultural plots, the plots have been located with the use of ArcGIS The validation of the dataset and the characterization of the robustness of data has been implemented through the conduction of a comparative assessment with previous findings of research initiatives on quantities of agricultural plastics. Among the tasks under the research project ‘Design of a common agrochemical plastic packaging waste management scheme to protect natural resources in synergy with agricultural plastic waste valorisation – AgroChePack’, the area of greenhouses and plastic generated in the districts of Cyprus have been determined. The findings of the AgroChePack indicate to a total mass of 985,656 tonnes of generated plastics; a value which in comparison to the total mass of APW calculated in this work – 919,707 tonnes - is found among the acceptable limits of ± 10%.The geographic locations of greenhouses in Cyprus distinguished into the defined clusters and were investigated in terms of this work are illustrated in No ethical issues are associated with this work.The authors declare that they have no known competing financial interests or personal relationships which have, or could be perceived to have, influenced the work reported in this article.


The GSA Public Policy Advisor will facilitate a discussion about the 2020 reauthorization of the Older Americans Act with key stakeholders from Washington, DC. Also, the presentation will include perspective on GSA's active role in policy development and the legislative process.


Understanding the mechanisms that regulate atherosclerotic plaque formation and evolution is a crucial step for developing treatment strategies that will prevent plaque progression and reduce cardiovascular events. Advances in signal processing and the miniaturization of medical devices have enabled the design of multimodality intravascular imaging catheters that allow complete and detailed assessment of plaque morphology and biology. However, a significant limitation of these novel imaging catheters is that they provide two-dimensional (2D) visualization of the lumen and vessel wall and thus they cannot portray vessel geometry and 3D lesion architecture. To address this limitation computer-based methodologies and user-friendly software have been developed. These are able to off-line process and fuse intravascular imaging data with X-ray or computed tomography coronary angiography (CTCA) to reconstruct coronary artery anatomy. The aim of this review article is to summarize the evolution in the field of coronary artery modeling; we thus present the first methodologies that were developed to model vessel geometry, highlight the modifications introduced in revised methods to overcome the limitations of the first approaches and discuss the challenges that need to be addressed, so these techniques can have broad application in clinical practice and research. Invasive coronary angiography is the reference standard for assessing the extent and severity of coronary artery disease (CAD) which is a leading cause of death in the developed and developing world . This moOver the last few decades intravascular imaging catheters have been designed which can be advanced into the coronary arteries to obtain high-resolution cross-sectional images of the vessels. This enables comprehensive visualization of the lumen and plaque pathology. Intravascular ultrasound (IVUS) and optical coherence tomography (OCT) were the first invasive imaging techniques that were used to study plaque pathobiology and provided unique insights about the mechanisms that regulate plaque evolution. Validation studies using histology as the gold standard have demonstrated the advantages but also the limitations of IVUS and OCT in assessing plaque characteristics and led research toward the development of novel invasive imaging modalities that were able to overcome the drawbacks of the first techniques –11. NearRoelandt et al. were the first that attempted to reconstruct coronary artery anatomy from IVUS imaging data . They asA similar approach was also introduced to reconstruct coronary artery anatomy from OCT data . The obtDespite the undoubted role of these reconstruction methodologies in the clinical arena, they have significant limitations as they are unable to portray coronary artery geometry, evaluate the distribution of the plaque onto the vessel and accurately quantify plaque volume especially in the case of increased curvature where neglecting vessel curvature can lead to an underestimation of the plaque volume by 5% .In 1992 Klein et al. for the first time suggested fusion of IVUS and X-ray angiography for a more reliable assessment of vessel architecture . The proIn vivo validation of the developed methodology using X-ray angiography as the gold standard demonstrated that it provides accurate coronary modeling; however the time consuming protocol and increased radiation required for coronary reconstruction did not allow this method to have applications in the clinical arena -OCT and X-ray angiography was proposed by Athanasiou et al.  and valiribution . Over thribution , 50, assribution , 52, andribution –55.P < 0.0001). Although this approach appears superior to others, previously reported in the literature, it does have limitations as it makes two assumptions; more specifically: (1) it implements an interpolation technique to place on the lumen centreline the OCT frames between those portraying side branches; this assumption cannot correct the error caused by the longitudinal motion of the OCT catheter that is increased at the beginning of the systole, and (2) it uses the origin of the side branches, which cannot be always accurately assessed in two angiographic projections, to estimate the rotational orientation of the OCT contours.The above OCT-based reconstruction methodology may have significant applications in the research arena but it also has two significant limitations: (1) it is not able to correct the geometrical error caused by the longitudinal movement of the OCT catheter within the vessel during the cardiac cycle , 56 and Moreover, this approach has not been thoroughly validated and therefore it is unclear what is the effect of the above limitations on vessel reconstruction and ESS computation.The methodologies developed to reconstruct the coronary artery anatomy from X-ray angiography and intravascular imaging data rely on the extraction of the lumen centerline or the catheter path from two angiographic projections. The angle difference between the two projections as well as the presence of vessel foreshortening in these projections can affect the efficacy of these approaches in assessing vessel geometry. Moreover, as it was stated above, the origin of the side branches is likely to not be well visible in the projections used for coronary artery reconstruction and this can affect the accurate estimation of the absolute orientation of the intravascular images on the 3D model. These limitations can be overcome by the use of CTCA which provide 3D images of the coronary artery tree.In 2010 van der Giessen et al. were the first to propose the fusion of CTCA and IVUS imaging to reconstruct the coronary arteries . This apThis approach has been used to evaluate the role of ESS on vessel wall healing following bioresorbable scaffold implantation and investigate the role of multidirectional ESS on the development of advanced atherosclerotic plaques in pig models , 60. TheTo enhance the research applicability of the 3D reconstruction methodologies mentioned above, user—friendly systems have been developed that operate in a user-friendly environment and expedite coronary reconstruction . The firANGIOCARE  was the IVUSAngio tool is the only freely available software for the fusion of IVUS and angiographic imaging data . The sofUniversity of Leiden and Medis Medical Imaging Systems BV have recently developed a novel software for coronary reconstruction . The sofFusion of intravascular imaging data and X-ray angiography or CTCA imaging has enabled accurate reconstruction of coronary artery geometry and the generation of 3D models that can be processed with CFD techniques to evaluate vessel flow patterns and examine the effect of the hemodynamic forces on plaque evolution. These models have been enriched our understanding about the mechanisms that regulate atherosclerotic disease progression enabling more accurate prediction of lesions that are likely to progress and cause events , 37, 38.The PREDICTION study which was the first prospective clinical study that used at scale fusion of intravascular imaging and X-ray angiography to assess the ESS distribution and highlighted the prognostic value of ESS in predicting plaque progression, thereby creating hope that an invasive assessment of plaque morphology combined with CFD analysis could enable accurate detection of vulnerable plaques . The finThe developed user-friendly software that included established data fusion algorithms are expected to facilitate research in the field and allow more complex simulations and complete assessment of vessel physiology. Cumulative data have highlighted the role of PSS on plaque destabilization and its value in predicting vulnerable lesions –72. The Recent reports have highlighted the need to refine the methodologies for the reconstruction of vessel architecture especially in stented segments –77. AdvaFusion of intravascular imaging and angiographic or CTCA imaging data allows generation of 3D models that accurately portray the vessel geometry and enable evaluation of plaque composition. These approaches have been extensively used to examine the implications of flow patterns on atherosclerotic disease progression and stent/scaffold thrombosis. Further advances in intravascular imaging, catheter design and the development of methodologies that will allow estimation of the distribution of different plaque components on the 3D plaque, and accurate reconstruction of stent architecture are expected to provide a complete and detailed evaluation of luminal geometry and coronary artery pathology. They are also expected to permit more precise quantification of the local hemodynamic forces, better prediction of plaque evolution, and optimization of focal therapies developed for the treatment of culprit or vulnerable lesions.All authors listed have made a substantial, direct and intellectual contribution to the work, and approved it for publication.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The reviewer, AK, declared a past co-authorship with one of the authors, CB, to the handling editor.


An accurate assessment of the adequacy of prenatal care utilization is critical to inform the relationship between prenatal care and pregnancy outcomes. This systematic review critically appraises the evidence on measurement properties of prenatal care utilization indices and provides recommendations about which index is the most useful for this purpose.MEDLINE, EMBASE, CINAHL, and Web of Science were systematically searched from database inception to October 2018 using keywords related to indices of prenatal care utilization. No language restrictions were imposed. Studies were included if they evaluated the reliability, validity, or responsiveness of at least one index of adequacy of prenatal care utilization. We used the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist. We conducted an evidence synthesis using predefined criteria to appraise the measurement properties of the indices.From 2664 studies initially screened, 13 unique studies evaluated the measurement properties of at least one index of prenatal care utilization. Most of the indices of adequacy of prenatal care currently used in research and clinical practice have been evaluated for at least some form of reliability and/or validity. Evidence about the responsiveness to change of these indices is absent from these evaluations. The Adequacy Perinatal Care Utilization Index (APNCUI) and the Kessner Index are supported by moderate evidence regarding their reliability, predictive and concurrent validity.The scientific literature has not comprehensively reported the measurement properties of commonly used indices of prenatal care utilization, and there is insufficient research to inform the choice of the best index. Lack of strong evidence about which index is the best to measure prenatal care utilization has important implications for tracking health care utilization and for formulating prenatal care recommendations. Routine prenatal care is a series of regular contacts between a health care provider and a pregnant woman at scheduled intervals that occur between the confirmation of pregnancy and the initiation of labour. The primary goal of these encounters is to deliver effective screening, preventive (education), and treatment interventions that seek to improve health outcomes for both the mother and the newborn. Prenatal care also aims to address behavioural risk factors, support women’s medical, social and psychological needs, and coordinate actions for labour and delivery .The American College of Obstetrics and Gynecology (ACOG) recommends visiting every 4 weeks for the first 28 weeks of pregnancy followed by bi-weekly visits up to 36 weeks. After 36 weeks, weekly visits are advised –7. EvideA variety of methods have been used in past research to determine adequacy of prenatal care in low-risk pregnancies. Over the last two decades, several scoring systems for prenatal care utilization have been developed, each employing different algorithms: the Kessner Index , the KotThe comparability of the different prenatal care utilization indices for low-risk pregnancies has not been completely explored. To date, no systematic review has incorporated a comprehensive analysis of the methods by which prenatal care utilization indices have been developed, nor appraised their relative value. A systematic evaluation of the measurement properties of these indices, their relative strengths and weaknesses, and the quality of the evidence that support their use is an essential step to inform the selection of these indices for research and clinical practice. To fill these knowledge gaps, we completed a systematic review of the scientific literature to assess and compare the measurement properties  of prenatal care utilization indices.CRD42017067110). Comprehensive electronic searches of MEDLINE, EMBASE, CINAHL, and Web of Science were conducted from database inception to October 2018 for studies evaluating the measurement properties of prenatal care utilization indices. An information specialist designed and executed the search strategy using selected subject headings and keywords related to prenatal care utilization indices and measurement properties. The MEDLINE search strategy is available in Additional File The systematic review was conducted and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement . The rev. There were no restrictions on the study design; however, book chapters, editorials, letters, and in vitro or animal studies were excluded.Indices evaluating prenatal care utilization were defined as quantitative tools that evaluated both the initiation of prenatal care and the frequency at which a pregnant woman attends prenatal care services  in low-rThe search strategy generated a list of articles that two reviewers  screened independently for relevance. Titles and abstracts that were identified as relevant or those that provided insufficient information were pursued for further assessment. The full text of considered articles was again independently reviewed for inclusion , with disagreements resolved through consensus. The final reason for the exclusion of an article was documented in the PRISMA flow chart Fig. .Fig. 1PTwo reviewers [SR and MO or IM and MO] independently evaluated the methodological quality of studies assessing the measurement properties of indices of adequacy of prenatal care utilization using the COnsensus-based Standards for the Selection of health Measurement INstruments (COSMIN) checklist . DisagreThe COSMIN checklist is frequently used in systematic reviews of indices and measurement instruments, and it is currently the only validated and standardized tool available for this purpose . For theor in one study of excellent methodological quality); moderate ; limited ; conflicting ; and unknown .For each index of prenatal care utilization, the overall levels of evidence on each measurement property were synthesized using the data on measurement properties reported in the included studies. If several studies informed the measurement properties of one index, findings were combined based on their number and methodological quality, and the consistency of the results. The level of evidence for the measurement properties of each index was classified according to the following criteria : strong Information on authors, publication year, study design, population characteristics, data sources, and measurement properties evaluated in individual studies were first extracted by one reviewer  and verified for accuracy and completeness by a second reviewer [MO]. Discrepancies between data extraction and verification were sorted through consensus.The search strategy identified 2664 citations of which 712 duplicates were removed. Titles and abstracts of the remaining 1952 citations were screened for relevance, yielding to 308 articles judged as potentially relevant for the review. After applying the eligibility criteria to the full text of these and examining redundant publications, 13 unique studies were included in the review  whiReliability was evaluated for eight indices: the APNCUI , 25, thePredictive validity was evaluated for the APNCUI , 26, 27,Concurrent validity based on head-to-head comparisons across indices was evaluated for the APNCUI , 22–25, This systematic review identified 13 studies that reported on the measurement properties of 12 indices of prenatal care utilization. The APNCUI and the Kessner Index were described the most while others were evaluated in only one or two articles per index, which weakens the level of evidence for the results. We used the COSMIN checklist to evaluate their methodological quality and the level of evidence informing their uptake. The scientific literature has not comprehensively reported the measurement properties of commonly used indices of prenatal care utilization, and there is insufficient research to inform the choice of the best index. Most of the indices of prenatal care utilization currently used in research and clinical practice have been evaluated for at least some form of reliability and/or validity. Evidence about the responsiveness to change of these indices is absent from these evaluations. The indices of prenatal care utilization supported by the strongest evidence regarding their measurement properties were the APNCUI and the Kessner Index followed by the PHS/EPPC and the GINDEX. Moderate evidence informs the reliability, predictive and concurrent validity properties of the APNCUI and the Kessner Index. Decisions about their use should be supported on recommendations promoted by local prenatal care clinical practice guidelines (CPG). Both APNCUI and the Kessner Index have similar criteria for optimal timing of initiation of prenatal care  and number of prenatal care visits during pregnancy  and seem to align with current CPG recommendations made by ACOG. However, they have different category responses of prenatal care adequacy, with the APNCUI having an extra category of “Intensive” care during pregnancy that the Kessner Index does not consider. The discrepancy within the literature prevents a consensus being formed about the strongest index to measure the adequacy of prenatal care.The most important strength of this systematic review is the use of the COSMIN taxonomy to evaluate the measurement properties of the proposed indices of prenatal care utilization based on the methodological qualities of the individual studies and the strength of the body of evidence that informs the use of each index. The use of COSMIN by two independent reviewers provided a consistent approach to assess the measurement properties of all indices.One limitation of this review is that we did not include indirect evidence from studies in which the indices were actually applied either to measure prenatal care utilization as a predictor of pregnancy or birth outcomes, or as an outcome of any other risk factor. One important use of the indices of prenatal care utilization has been to evaluate policy or public interventions seeking to improve the organization and evaluation of prenatal care services. In such situations, the indices can be used to evaluate the changes in levels of prenatal care utilization of such interventions. It is yet to be determined if the utilization of prenatal care services translates into improvements in birth outcomes for the mother and child however, a number of these indices may be useful in examining population utilization levels.Despite lingering uncertainty of the effectiveness of prenatal care and what adequacy entails, prenatal care has been proposed as a vital strategy to reduce the risk of adverse outcomes at delivery/birth . SeveralAdditionally, the indices are typically based on visit recommendations for average or low risk pregnancies and do not establish a recommended visit pattern for high risk women or for women with specific medical conditions. This may result in underestimating the prenatal care needs of high risk women and overestimating adequate utilization of prenatal care in the total population . BroaderPrenatal care utilization indices included in this review focus on quantifying the timing and amount of care used and therefore, they do not assess the quality or content of the prenatal services delivered . BecauseDifferences remain in the scientific literature and in CPG  regarding recommendations about the timing and the frequency of prenatal care , 2. HoweMost commonly used indices of prenatal care utilization have moderate to limited evidence informing their validity and reliability. Current choices of a preferred index to measure prenatal care utilization can differ depending on the measurement properties that have priority to the users of the index. Important measurement properties such as criterion and predictive validity and responsiveness to change should be further evaluated for all the indices using sound research methodology.Additional file 1. MEDLINE Search Strategy.


Eimeria. Coccidiosis is the most prevalent disease in broilers with worldwide economic losses estimated to be up to US$ 3 billion per year. Understanding the relationship between nutrition and Eimeria infection is an important component of the growth and sustainability of poultry worldwide. Recognizing the role of nutrition in coccidial infections as part of new technologies to control disease pathogenesis should be a component of future control strategies. The papers presented in this collection address these findings and other new research in the control of coccidiosis.Poultry coccidiosis is a parasitic intestinal infection, caused by several species of Eimeria relationships during the initial steps of infection. López-Osorio et al. presented new data describing the development of pathogenicity and immune response triggered by the early stages of the Eimeria life cycle .The first step in discovering new control measures against coccidiosis is understanding the host:Eimeria challenge are of primary importance. The I See Inside (ISI) methodology was recently developed and described by Sanches et al. to evaluate basal and infectious enteritis in chickens. The results showed the feasibility of ISI as an in-situ method that describes the pathogenic mechanisms of inflammation associated with losses in performance during subclinical Eimeria and necrotic enteritidis infections.More accurate methods to measure the different parameters involved in the performance of the birds under Eimeria infections. However, ionophores are classified as antibiotics and current political and societal pressure has resulted in the reduction and/or the banning of the use of these molecules in livestock production. Therefore, the use of dietary nutrients and feed additives as a means of controlling Eimeria infection and improving the broiler gut health were discussed and focused on answering some essential questions in the field. Exploring this area, Bortoluzzi et al. focused on how micro-minerals and their absorption by the gastrointestinal tract (GIT) could have an important role in the modulation of the intestinal physiology, immunity, and microbiology of broiler chickens during Eimeria infection. They showed the beneficial effects, increased performance and attenuated the inflammatory response when feeding Zn to broilers infected with coccidia and Clostridium perfringens. Additionally, Zn modulates the ileal microbiota thus improving the gut health of broilers. Further, Cu and Mn provided as feed additives during Eimeria infection were also shown to improve feed conversion and modulate the immune response during the infection.Administration of ionophores has long been employed as the best effective method to control Kiarie et al. focused on reviewing the role of feed enzymes and yeast derivatives in modulating coccidial infection. The authors discussed the use of these additives as an alternative and/or complementary strategy for the control of the infection. They cited several papers in which the use of whole yeast or its derivatives as nucleotides or cell wall-associated with feed enzymes enhanced cellular and humoral immunity which would be of utmost importance for increasing the effectiveness of coccidial vaccines.Similarly, Stefanello et al. discussed the use of a blend of protected organic acids and essential oils to improve the health of broilers challenged with Eimeria spp. and with Clostridium perfringens. The blend of protected organic acids and essential oils improved growth performance, nutrient digestibility, and intestinal health in the treated animals better than growth promoter (AGP) and could be an excellent alternative in AGP-free programs. Similarly, Calik et al. showed the improvement in the immune response followed by a modification in the intestinal morphology and increase in the performance of broiler chickens challenged with coccidiosis when fed with direct feed microbial (DFM) dietary additive. Chickens treated with the additive showed an increase in body weight gain and a reduction in the lesions at the duodenum and jejunum and an increment of the ileal villus area. An increase in the expression of IFN-γ and IL-1β were also observed in the ileum, showing that the feed with microorganisms could be a promisor technique to improve the health of broilers.Two original research papers about feed additives were also published here. Soutter et al.. Further, the development of standard protocols to evaluate vaccine efficacy and the improvement of performance and nutrient utilization by birds is required. Gautier et al., describing the timing and magnitude of coccidiosis vaccination and its influence of growth performance and nutrient utilization during the various stages of Eimeria cycling. Coccidial vaccination impaired the feed conversion ratio (FCR) but did not change the body weight gain (BWG) and the feed intake (FI).Vaccination as the preferred method to prevent the infection was also discussed in a review of Taken together the papers published in this Research Topic showed several important results that could be used for the avian industry and highlight the importance of new studies in the exciting area of poultry coccidiosis.All authors listed have made a substantial, direct and intellectual contribution to the work, and approved it for publication.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


The problem of transmission of intestinal microorganisms to tissues occurs when intestinal epithelial cells do not adhere tightly (tight junction), which is caused by improper nutrition, usually associated with poor mucosal status. The impact on maintaining its proper condition in the case of animals also depends on the proper preparation and fragmentation of the ingredients of the feed. Intestinal microbiota disorders are increasingly indicated as one of the causes of many autoimmune, neurodevelopmental and metabolic diseases. However, there are no studies indicating damage to the intestinal barrier of animals resulting in the penetration of microorganisms from the gastrointestinal tract directly into the bloodstream which may result in the development of chronic inflammation.Neovison vison) farm with a foundation stock of 4,000 females, abscesses were observed in the head, followed by progressive deaths. Antibiotic treatment with amoxicillin and clavulanic acid added to the animals’ feed was not successful. Macroscopic and microscopic changes indicated local suppurative inflammation of the skin and subcutaneous tissue with the presence of purulent fistulas. Microbiological analysis showed a significant increase in Escherichia coli in all samples taken from the abscesses. The results indicate the migration of intestinal bacteria through disturbance of the permeability of the intestinal barrier and their transfer to the blood. Symptoms were alleviated in all animals following changes in the feed components and in feed particle size.On a mink (It is necessary to take into account the possibility of transmission of intestinal bacteria in the etiology of inflammatory diseases in animals. Conducting more research in this field will improve the understanding of the relationship between intestinal microbes and the health of the body as a whole. Enterobacteriaceae (e.g. Escherichia coli) are the cause of intestinal infections when the body’s immune defences are weakened [The diet of animals is the most important factor affecting their productivity. In the case of carnivorous fur animals, this means obtaining optimal reproduction rates and skins with high quality parameters. The energy value of the feed rations should be adapted to the feeding period, and the feed should be preserved to protect it against the development of pathogenic microorganisms. Incorrect feeding of mink can lead to metabolic disorders, which are often imperceptible in the short production cycle of these animals. When selecting feed components, especially of animal origin, care should be taken about their microbiological status, freshness, high biological value and degree of homogenization , 2. In aweakened .Neovison vison).The aim of the study is to present the problem of the occurrence of purulent skin lesions on the head and neck of farmed American mink  and by special methods: periodic acid-Schiff (PAS), Gomori methenamine-silver (GMS) and Ziehl-Neelsen acid-fast (ZN) staining. Before the organ samples were taken, the lesions in the head of the animals were cut and samples were taken for microbiological testing. The material was plated on an agar medium with 5% sheep blood, MacConkey agar, and Sabouraud agar with chloramphenicol, and then incubated for 24 hours at 37 °C. The resulting colonies were identified using bioMerieux API biochemical assays.2 to about 12 cm2, covered with yellow-brown crusts, were observed on the scalp and dorsal surface of the neck .Escherichia coli in all samples taken from the abscess material. The results indicate the migration of intestinal bacteria through disturbance of the permeability of the intestinal barrier and their transfer to the blood. The interview with the breeder indicated that the feed ration was correctly balanced in terms of energy. Attention was drawn to the introduction of a feed component in the form of a 30% share of ground turkey bones, which coincided with the onset of disease among the animals and could have caused mechanical damage to the intestinal barrier.The microbiological analysis showed a very large increase in E. coli strains in the colonic mucosa of dogs with granulomatous colitis [Disturbances of intestinal permeability have been demonstrated to play a role in the pathogenesis not only of gastrointestinal diseases, but also of nervous, immune and reproductive disorders . Translo colitis –14.To alleviate the symptoms in all animals and prevent remission of the disease, it was recommended that the ground turkey bones should be eliminated from the diet, as they were believed to have caused the damage to the intestinal mucosa. For economic reasons and in order to maintain the proper structure and energy value of the feed, the breeder chose to replace the turkey bones with poultry breast bones, but ground much more finely. This resulted in a significant reduction in the incidence of new cases of disease. Complete remission of the lesions was observed in the animals a few weeks after the formula and means of preparing the feed had been changed.Maintaining the proper state of intestinal epithelium depends on many factors, including the proper preparation of animal feed. Intestinal microorganisms that can enter the blood and tissue of animals through the intestinal epithelium should be considered in the etiological differentiation of disease lesions. A thorough understanding of bacterial translocation mechanisms will allow effective therapy of the source of infection without re-emission of inflammatory processes.