Quality-adjusted life years and surgical waiting list:Systematic review of the literature

BACKGROUND The quality-adjusted life year(QALY)is a metric that is increasingly used today in the field of health economics to evaluate the value of different medical treatments and procedures.Surgical waiting lists(SWLs)represent a pressing problem in public healthcare.The QALY measure has rarely been used in the context of surgery.It would be interesting to know how many QALYs are lost by patients on SWLs.AIM To investigate the relationship between QALYs and SWLs in a systematic review of the scientific literature.METHODS The study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement.An unlimited search was carried out in PubMed,updated on January 19,2024.Data on the following variables were investigated and analyzed:Specialty,country of study,procedure under study,scale used to measure QALYs,the use of a theoretical or real-life model,objectives of the study and items measured,the economic value assigned to the QALY in the country in question,and the results and conclusions published.RESULTS Forty-eight articles were selected for the study.No data were found regarding QALYs lost on SWLs.The specialties in which QALYs were studied the most in relation to the waiting list were urology and general surgery,with 15 articles each.The country in which the most studies of QALYs were carried out was the United States(n=21),followed by the United Kingdom(n=9)and Canada(n=7).The most studied procedure was organ transplantation(n=39),including 15 kidney,14 liver,5 heart,4 lung,and 1 intestinal.Arthroplasty(n=4),cataract surgery(n=2),bariatric surgery(n=1),mosaicplasty(n=1),and septoplasty(n=1)completed the surgical interventions included.Thirty-nine of the models used were theoretical(the most frequently applied being the Markov model,n=34),and nine were real-life.The survey used to measure quality of life in 11 articles was the European Quality of Life-5 dimensions,but in 32 articles the survey was not specified.The willingness-to-pay per QALY gained ranged from$100000 in the United States to€20000 in Spain.CONCLUSION The relationship between QALYs and SWLs has only rarely been studied in the literature.The rate of QALYs lost on SWLs has not been determined.Future research is warranted to address this issue.

Construction and Application of a Quality Evaluation System for Group Elderly Care Services Based on the Internet of Things

With the continuous intensification of global aging,the issue of elderly care has become an increasingly prominent social problem.The Internet of Things(IoT)technology,as an emerging field,holds broad application prospects.This article focuses on the application of IoT technology in group elderly care services and constructs a quality evaluation system for these services based on IoT technology.Through the analysis of practical application cases,the advantages and challenges of IoT technology in group elderly care services have been examined,confirming the feasibility and effectiveness of the evaluation system.

Mitochondrial dysfunction and quality control lie at the heart of subarachnoid hemorrhage

The dramatic increase in intracranial pressure after subarachnoid hemorrhage leads to a decrease in cerebral perfusion pressure and a reduction in cerebral blood flow.Mitochondria are directly affected by direct factors such as ischemia,hypoxia,excitotoxicity,and toxicity of free hemoglobin and its degradation products,which trigger mitochondrial dysfunction.Dysfunctional mitochondria release large amounts of reactive oxygen species,inflammatory mediators,and apoptotic proteins that activate apoptotic pathways,further damaging cells.In response to this array of damage,cells have adopted multiple mitochondrial quality control mechanisms through evolution,including mitochondrial protein quality control,mitochondrial dynamics,mitophagy,mitochondrial biogenesis,and intercellular mitochondrial transfer,to maintain mitochondrial homeostasis under pathological conditions.Specific interventions targeting mitochondrial quality control mechanisms have emerged as promising therapeutic strategies for subarachnoid hemorrhage.This review provides an overview of recent research advances in mitochondrial pathophysiological processes after subarachnoid hemorrhage,particularly mitochondrial quality control mechanisms.It also presents potential therapeutic strategies to target mitochondrial quality control in subarachnoid hemorrhage.

Advances in the Research of Quality Management System of Dairy Enterprises

As the global economy enters a new stage,Chinese dairy enterprises are gradually moving towards the road of internationalization.In this paper,the internationally common quality management system,food safety system and quality traceability system were analyzed and studied to promote the comprehensive transformation and upgrading of dairy industry and broaden the development road with the help of systematic construction.

Contract Mechanism of Water Environment Regulation for Small and Medium Sized Enterprises Based on Optimal Control Theory

The small and scattered enterprise pattern in the county economy has formed numerous sporadic pollution sources, hindering the centralized treatment of the water environment, increasing the cost and difficulty of treatment. How enterprises can make reasonable decisions on their water environment behavior based on the external environment and their own factors is of great significance for scientifically and effectively designing water environment regulation mechanisms. Based on optimal control theory, this study investigates the design of contractual mechanisms for water environmental regulation for small and medium-sized enterprises. The enterprise is regarded as an independent economic entity that can adopt optimal control strategies to maximize its own interests. Based on the participation of multiple subjects including the government, enterprises, and the public, an optimal control strategy model for enterprises under contractual water environmental regulation is constructed using optimal control theory, and a method for calculating the amount of unit pollutant penalties is derived. The water pollutant treatment cost data of a paper company is selected to conduct empirical numerical analysis on the model. The results show that the increase in the probability of government regulation and public participation, as well as the decrease in local government protection for enterprises, can achieve the same regulatory effect while reducing the number of administrative penalties per unit. Finally, the implementation process of contractual water environmental regulation for small and medium-sized enterprises is designed.

Investigation of Groundwater Quality with Borehole Depth in the Basin Granitoids of the Ashanti Region of Ghana

The dependence of groundwater quality on borehole depth is usually debatable in groundwater studies, especially in complex geological formations where aquifer characteristics vary spatially with depth. This study therefore seeks to investigate the relationship between borehole depth and groundwater quality across the granitoid aquifers within the Birimian Supergroup in the Ashanti Region. Physicochemical analysis records of groundwater quality data were collected from 23 boreholes of public and private institutions in the Ashanti Region of Ghana, and the parametric values of iron, fluoride, total hardness, pH, nitrate, and nitrite were used to study the groundwater quality-depth relationship. The results showed that the depth-to-groundwater quality indicated a marginal increase in water quality in the range of 30 to 50 m, which is mathematically represented by the low-value correlation coefficient (r2 = 0.026). A relatively significant increase occurs in the depth range of 50 to 80 m, which is given by a correlation coefficient of r2 = 0.298. The mean percent parameter compatibility was 74%, 82%, 89%, and 97% at 50, 60, 70, and 80 m depths, respectively. The variations in groundwater quality per depth ratio ranged from 1.48, 1.37, 1.27, and 1.21 for 50, 60, 70, and 80 m depth, respectively. The recommended minimum borehole depth for excellent groundwater quality is suggested with a compatibility per meter depth ratio of 1.37. This results in a range between 50 and 70 m as the most desirable drilling depth for excellent groundwater quality within the granitoids of the Birimian Supergroup of the Ashanti Region in Ghana.

The Use of Secondary Grape Biomass in Beef Cattle Nutrition on Carcass Characteristics, Quality and Shelf Life of Meat

We determined whether the inclusion of 100 g/kg dry matter of grape pomace silage (GPS) and grape pomace bran (GPB) as substitutes for other traditional fiber sources in the diet of steers (Charolais x Nellore) would improve carcass characteristics, meat quality and composition, and shelf life. Twenty-four animals (248 ± 19.32 kg of initial body weight) were fed a high concentrate diet for 121 days. Carcass characteristics were measured, and the longissimus dorsi muscle was analyzed for fatty acid (FA) profile and composition. The meat was sliced and stored in air-permeable packages for 10 days. On each sampling day (d 1, 3, 7, and 10), oxidative stability, bacterial load, lipid and protein oxidation, and staining were analyzed. The experimental diets influenced the pH of cold carcasses only. The GPS group had a higher pH than the control. The GPS and GPB groups showed improved oxidant status (i.e., lower lipid peroxidation and concentrations of reactive oxygen species were in the meat of both groups than in control). On the first day of storage, the antioxidant enzyme glutathione S-transferase activity was more significant in the meat of the GPS and GPB groups than in the control. The bacterial loads in the meat were attenuated by GPS inclusion;there were lower total coliform counts and a trend toward lower counts for enterobacteria in the control group. The diets altered the FA profile of the meat;i.e., the GPB diet allowed for a more significant amount of the n-6 omegas in the meat, while the GPS diet showed a tendency for a more significant amount of n-6 and 9 omegas. Both diets (GPS and GPB) increased the amounts of long-chain FAs. The GPS diet decreased saturated FA levels. We conclude that the dietary treatments GPS and GPB are a promising alternative to maintain meat quality standards throughout in real-world retail conditions. These treatments gave rise to an improvement in the nutritional value of the meat due to the more significant amounts of FAs that improve human health.

Research on Pathways of How Digital Transformation Affects the Business Performance of MEEC Enterprises in Chengdu

This paper aims to examine the impact of digital transformations on the business performance of the meetings,expositions,events,and conventions(MEEC)industry in Chengdu by conducting an empirical analysis of 68 MEEC enterprises in the city.The study employed the fuzzy-set qualitative comparative analysis(fsQCA)method to explore the pathways and factors involved.Drawing on the theory of synergetics,nine condition variables were carefully selected from four dimensions:digital technologies,digital strategy,digital infrastructure,and digital innovation.The findings revealed that digital transformations were an intricate systematic process,whereby a single factor alone did not serve as a necessary condition for MEEC enterprises to achieve high business performance.The analysis identified five distinct pathways that would lead to high performance,which can be categorized into three distinct models:the“organization-human resources”dominated model,the“human resources-infrastructure”driven model,and the multi-factor coordination model.The analysis also identified two pathways that would result in low performance,categorized as the“basic condition absent”model.Notably,there was substantial heterogeneity observed in the configurational pathways in terms of the magnitude of the impact of digital transformation on business performance across MEEC enterprises of different sizes.This paper suggests that the government should assume the role of a platform,providing policy and financial support to MEEC enterprises to help guide them through the process of digital transformation and that MEEC enterprises themselves should seize the opportunities arising from digital transformation to strengthen their digital infrastructure construction,human resources development,and innovation in brand building.This study presents empirical evidence that contributes to the understanding of the transformation process of MEEC enterprises within the digital economy era,as well as valuable insights into understanding the channels and internal conditions involved in digital transformations.

Demography and Socio-Economic Aspects on Irrigated Smallholder Agricultural Enterprises and Their Association with the Cultivation of Maize (Zea mays L.) as a Selected Field Crop

The purpose of this study is to correlate demography and socio-economic aspects at Irrigated Smallholder Agricultural Enterprises and their association with the Cultivation of Maize in order to determine its positive impacts at irrigated smallholders’ agricultural entrepreneurs’ household. Chi-square test was used as descriptive analysis method. The Fischer Exact tests were employed to test demography (gender, age, education, and income) in winter and summer production season of irrigated smallholder agricultural enterprises and their association with the cultivation of selected field crop (i.e. maize). The results show that gender results were not being statistically significant, as measured by the Phi measure of effect size, φ = 0.149, p = 0.011, and φ = 0.05, p = 0.392 in summer. As far as age is concern, it appears to be a statistically significant association between cultivating maize and age in winter, φ = 0.046, p = 0.730 in winter and φ = 0.172, p = 0.013. Education winter result not being statistically significant, the effect size showed a weak association, as measured by the Phi measure of effect size, φ = 0.112, p = 0.305 and φ = 0.035, p = 0.948 in summer. Income result not being statistically significant, as measured by the Phi measure of effect size, φ = 0.049, p = 0.399 and φ = 0.081, p = 0.166 in summer. In conclusion, the study shows that the development of best management practices must be based on a comprehensive analysis of the livelihoods and irrigated smallholder agricultural enterprise farming styles of participating irrigated smallholder agricultural entrepreneurs.

Remote sensing of quality traits in cereal and arable production systems:A review

Cereal is an essential source of calories and protein for the global population.Accurately predicting cereal quality before harvest is highly desirable in order to optimise management for farmers,grading harvest and categorised storage for enterprises,future trading prices,and policy planning.The use of remote sensing data with extensive spatial coverage demonstrates some potential in predicting crop quality traits.Many studies have also proposed models and methods for predicting such traits based on multiplatform remote sensing data.In this paper,the key quality traits that are of interest to producers and consumers are introduced.The literature related to grain quality prediction was analyzed in detail,and a review was conducted on remote sensing platforms,commonly used methods,potential gaps,and future trends in crop quality prediction.This review recommends new research directions that go beyond the traditional methods and discusses grain quality retrieval and the associated challenges from the perspective of remote sensing data.

Reservoir Quality Controlling Factor of the Asmari Reservoir in an Oil Field in Dezful Embayment, SW Iran

The Asmari Formation Oligo-Miocene in age is one of the most important reservoir rocks in SW Iran and Zagros basin and composed of carbonate rocks and locally sandstones and evaporates. In this research, reservoir quality controlling factors have been investigated in a well in one of the oil fields in Dezful Embayment, SW Iran. Based on this research, depositional environment, diagenesis and fracturing have been affected on reservoir quality. 3 distinct depositional settings can be recognized in the studied interval including tidal flat, lagoon, and shoal. Among these depositional setting, shoal environment with ooid grainstone microfacies along with interparticle porosity shows good reservoir characteristics. Diagenetic processes also play an important role on reservoir quality;dolomitization and dissolution have positive effects on porosity and enhances reservoir quality, while cementation, anhydritization and compaction have negative effect on it. Fracturing is another important factor affected on the carbonate reservoirs especially in the Asmari Formation.

A Problem Not to Be Ignored: The Influencing Factors of Mobile Phone Addiction and Its Influence on Sleep Quality

Background and Objective: With the popularity and widespread use of mobile phones, the effects of mobile phone dependence and addiction on individuals’ physical and mental health have attracted more and more attention. The present study aims to analyze the current state of mobile phone addiction and its impact on sleep quality within the population, while also exploring the influence of related factors on sleep quality. Ultimately, this research will provide a scientific foundation for targeted intervention measures and strategies. Methods: A total of 253 permanent residents in Nanjing were randomly selected as study subjects. The Mobile Phone Addiction Index (MPAI) and Pittsburgh Sleep Quality Index (PSQI) were used to evaluate the degree of smartphone addiction and sleep quality of the study subjects. Body mass index (BMI) was measured according to standardized procedures. Independent sample t-test, Chi-square test, rank sum test and multiple linear regression were used to analyze the correlation between mobile phone addiction and sleep quality, and P Results: 117 people (46.2%) were addicted to mobile phones. Chi-square test showed that the rate of mobile phone addiction in drinking group was significantly higher than that in non-drinking group (P P P P P P P P P P Conclusion: Mobile phone addiction may lead to shorter sleep duration and reduce sleep efficiency. The withdrawal of mobile phone addiction may have a negative impact on sleep quality. According to the characteristics of the population, appropriate comprehensive intervention measures should be taken to build an effective evaluation system, so as to reduce the impact of mobile phone addiction and withdrawal problems on sleep and improve sleep quality.

Deep learning models semi-automatic training system for quality control of transthoracic echocardiography

Objective To explore the value of deep learning(DL)models semi-automatic training system for automatic optimization of clinical image quality control of transthoracic echocardiography(TTE).Methods Totally 1250 TTE videos from 402 patients were retrospectively collected,including 490 apical four chamber(A4C),310 parasternal long axis view of left ventricle(PLAX)and 450 parasternal short axis view of great vessel(PSAX GV).The videos were divided into development set(245 A4C,155 PLAX,225 PSAX GV),semi-automated training set(98 A4C,62 PLAX,90 PSAX GV)and test set(147 A4C,93 PLAX,135 PSAX GV)at the ratio of 5∶2∶3.Based on development set and semi-automatic training set,DL model of quality control was semi-automatically iteratively optimized,and a semi-automatic training system was constructed,then the efficacy of DL models for recognizing TTE views and assessing imaging quality of TTE were verified in test set.Results After optimization,the overall accuracy,precision,recall,and F1 score of DL models for recognizing TTE views in test set improved from 97.33%,97.26%,97.26%and 97.26%to 99.73%,99.65%,99.77%and 99.71%,respectively,while the overall accuracy for assessing A4C,PLAX and PSAX GV TTE as standard views in test set improved from 89.12%,83.87%and 90.37%to 93.20%,90.32%and 93.33%,respectively.Conclusion The developed DL models semi-automatic training system could improve the efficiency of clinical imaging quality control of TTE and increase iteration speed.

Diagenetic evolution and reservoir quality of the Oligocene sandstones in the Baiyun Sag, Pearl River Mouth Basin, South China Sea

The Oligocene Zhuhai sandstones are significant reservoirs for hydrocarbons in the Baiyun Sag, South China Sea.For effective appraisal, exploration and exploitation of such a deep-water hydrocarbon sandstone, samples of five wells from depths of 850 m to 3 000 m were studied. A series of comprehensive petrographic and geochemical analyses were performed to unravel the diagenetic features and their impact on the reservoir quality.Petrographically, the sandstones are dominated by feldspathic litharenites and lithic arenites with fine to medium grain sizes and moderate to good sorting. The reservoir quality varies greatly with a range of porosity from 0.2% to 36.1% and permeability from 0.016 ×10~(–3) μm~2 to 4 301 ×10~(–3) μm~2, which is attributed to complex diagenetic evolution related to sedimentary facies;these include compaction, cementation of calcite, dolomite, siderite and framboidal pyrite in eogenetic stage;further compaction, feldspar dissolution, precipitation of ferrocalcite and ankerite, quartz cements, formation of kaolinite and its illitization, precipitation of albite and nodular pyrite, as well as hydrocarbon charge in mesogenetic stage. The dissolution of feldspar and illitization of kaolinite provide internal sources for the precipitation of quartz cement, while carbonate cements are derived from external sources related to interbedded mudstones and deep fluid. Compaction is the predominant factor in reducing the total porosity, followed by carbonate cementation that leads to strong heterogeneity. Feldspar dissolution and concomitant quartz and clay cementation barely changes the porosity but significantly reduces the permeability.The high-quality reservoirs can be concluded as medium-grained sandstones lying in the central parts of thick underwater distributary channel sandbodies(>2 m) with a high content of detrital quartz but low cement.

Research on the Collaborative Governance of Social Responsibility in Online Audiovisual Enterprises

This paper aims to analyze the present conditions of the social responsibility ecosystem in online audiovisual enterprises in the digital age. It focuses on the governance of social responsibility in these enterprises and conducts an in-depth analysis of the problems and influencing factors related to the social responsibility aberrations of online audiovisual enterprises. Drawing upon social responsibility theory and collaborative governance theory, this research constructs a social responsibility guidance and governance system guided by the public, supported by the voluntary fulfillment of responsibilities by online audiovisual enterprises, and based on the collaborative participation of diverse stakeholders. It explores and optimizes the implementation pathways of this system, providing theoretical support and practical guidance for promoting the sustainable development of online audiovisual enterprises. Furthermore, it aims to contribute to the creation of a harmonious Internet ecosystem.

Assessment of the Drafting Quality of Request Forms Submitted to the Malaria and Parasitology Units at the Institut Pasteur de Cote d’Ivoire

Biological tests provide information on the medical analysis requested by both the patient and the prescriber. It is a communication link between the prescriber and the laboratory staff. The lack of some information on request forms not only affects the drafting quality of the test and patient care, but could also make thousands of data produced by healthcare centers unusable. The aim of this study was to assess the drafting quality of request forms submitted to the Malaria and Parasitology Units at the Institut Pasteur de Côte d’Ivoire. Methods: It was a descriptive cross-sectional study to assess the drafting quality of request forms of various prescribers received at the Institut Pasteur de Côte d’Ivoire. This study was conducted at the Malaria and Parasitology Units, department of Parasitology and Mycology (Institut Pasteur de Côte d’Ivoire), from 6th December 2020 to 6th December 2021. The information on each request forms was recorded on a data collection form designed for this purpose. Each data collection form corresponds to a request forms and each test to a patient. Results: Out of a total of 1990 request forms received, the patient’s age and sex were missing on 18% and 26.8% of the tests respectively. More than half (51.80%) of request forms did not indicate the patient’s place of residence. Clinical information was not provided on 45.90% of the tests. Prescribers omitting their signatures were 51%, stamps were 50.3% and contacts were 71.2%. Only 5.4% of request forms were of good drafting quality. Providing all the required information on the forms could facilitate the use and analysis of data and samples.

Correlation and Pathway Analysis of the Carbon,Nitrogen,and Phosphorus in Soil-Microorganism-Plant with Main Quality Components of Tea(Camellia sinensis)

The contents of carbon(C),nitrogen(N),and phosphorus(P)in soil-microorganisms-plant significantly affect tea quality by altering the main quality components of tea,such as tea polyphenols,amino acids,and caffeine.However,few studies have quantified the effects of these factors on the main quality components of tea.The study aimed to explore the interactions of C,N,and P in soil-microorganisms-plants and the effects of these factors on the main quality components of tea by using the path analysis method.The results indicated that(1)The contents of C,N,and P in soil,microorganisms,and tea plants were highly correlated and collinear,and showed significant correlations with the main quality components of tea.(2)Optimal regression equations were established to esti-mate tea polyphenol,amino acid,catechin,caffeine,and water extract content based on C,N,and P contents in soil,microorganisms,and tea plants(R^(2)=0.923,0.726,0.954,0.848,and 0.883,respectively).(3)Pathway analysis showed that microbial biomass phosphorus(MBP),root phosphorus,branch nitrogen,and microbial biomass carbon(MBC)were the largest direct impact factors on tea polyphenol,catechin,water extracts,amino acid,and caffeine content,respectively.Leaf carbon,root phosphorus,and leaf nitrogen were the largest indirect impact factors on tea polyphenol,catechin,and water extract content,respectively.Leaf carbon indirectly affected tea polyphenol content mainly by altering MBP content.Root phosphorus indirectly affected catechin content mainly by altering soil organic carbon content.Leaf nitrogen indirectly affected water extract content mainly by altering branch nitrogen content.The research results provide the scientific basis for reasonable fertilization in tea gardens and tea quality improvement.

Exploring the relationship between ambient sulfur dioxide and semen quality parameters:A systematic review and meta-analysis

Objective:To investigate the relationship between ambient sulfur dioxide(SO2)exposure and semen quality parameters.Methods:A systematic literature search was conducted to identify relevant studies investigating the association between SO2 exposure and semen quality parameters.This search encompassed the timeframe from January 2000 to May 2023 and included electronic databases such as Web of Science,Google Scholar,PubMed,Cochrane,and Scopus.Pooled effect estimates with 95%confidence intervals(CI)were calculated using percent changes(PC).The meta-analysis included seven studies with 6711 participants and 15087 semen samples.Results:The results revealed a significant negative association between ambient SO2 exposure and certain semen quality parameters.In particular,SO2 exposure was associated with a significant decrease in progressive motility(PC=0.032;95%CI:-0.063 to-0.001;P=0.044)and sperm concentration(PC=-0.020;95%CI:-0.036 to-0.005;P=0.012).However,no statistically significant associations were observed for total sperm count(PC=-0.038;95%CI:-0.079 to 0.003;P=0.070),seminal fluid volume(PC=-0.009;95%CI:-0.048 to-0.030;P=0.662)and sperm motility(PC=-0.17;95%CI:-0.363 to 0.022;P=0.830).In addition,the results of the subgroup analysis revealed specific variables that were associated with the decrease in relevant sperm parameters.Conclusions:This systematic review and meta-analysis provides compelling evidence supporting a consistent negative association between exposure to ambient SO2 and semen quality parameters.

Enhancing Private Healthcare Effectiveness in Lagos State, Nigeria: An Overview of the Effect of Quality Improvement Initiatives and Implications for Sustainable Healthcare Delivery

Background: Nigeria, a nation grappling with rapid population growth, economic intricacies, and complex healthcare challenges, particularly in Lagos State, the economic hub and most populous state, faces the challenge of ensuring quality healthcare access. The overview of the effect of quality improvement initiatives in this paper focuses on private healthcare providers in Lagos State, Nigeria. The study assesses the impact of donor-funded quality improvement projects on these private healthcare facilities. It explores the level of participation, perceived support, and tangible effects of the initiatives on healthcare delivery within private healthcare facilities. It also examines how these initiatives influence patient inflow and facility ratings, and bring about additional benefits and improvements, provides insights into the challenges faced by private healthcare providers in implementing quality improvement projects and elicits recommendations for improving the effectiveness of such initiatives. Methods: Qualitative research design was employed for in-depth exploration, utilizing semi-structured interviews. Private healthcare providers in Lagos involved in the SP4FP Quality Improvement Project were purposively sampled for diversity. Face-to-face interviews elicited insights into participation, perceived support, and project effects. Questions covered participation levels, support perception, changes observed, challenges faced, and recommendations. Thematic analysis identified recurring themes from interview transcripts. Adherence to ethical guidelines ensured participant confidentiality and informed consent. Results: Respondents affirmed active involvement in the SP4FP Quality Improvement Project, echoing literature emphasizing private-sector collaboration with the public sector. While acknowledging positive influences on facility ratings, respondents highlighted challenges within the broader Nigerian healthcare landscape affecting patient numbers. Respondents cited tangible improvements, particularly in staff management and patient care processes, validating the positive influence of quality improvement projects. Financial constraints emerged as a significant challenge, aligning with existing literature emphasizing the pragmatic difficulties faced by private healthcare providers. Conclusions: This study illuminates the complex landscape of private healthcare provision in Lagos State, emphasizing the positive impact of donor-funded quality improvement projects. The findings provide nuanced insights, guiding policymakers, healthcare managers, and practitioners toward collaborative, sustainable improvements. As Nigeria progresses, these lessons will be crucial in shaping healthcare policies prioritizing population well-being.

The Effects of Age and Ejaculatory Abstinence on Semen Quality and Reproductive Hormones in Africa and the Middle East

The aim of this study was to retrospectively evaluate the effects of male age and ejaculatory abstinence on semen parameters and reproductive hormones among men residing in Africa and the Middle East. A total of 70,142 semen analysis results were analysed and grouped according to the age intervals (16 - 20, 21 - 30, 31 - 40, 41 - 50, 51 - 60, >60) and ejaculatory abstinence (<2 days, 2 - 5 days and >5 days). Semen parameters i.e. volume, concentration, progressive motility, total progressively motile count, morphology, total normal sperm count, DNA fragmentation, viability, sORP, normed sORP were specifically evaluated. Additionally, for each age interval, reproductive hormones i.e. estradiol, luteinizing hormone, follicle stimulating hormone, testosterone and prolactin were evaluated. Semen volume, total progressively motile count, sperm morphology and total normal sperm count constantly decrease significantly after the age of 30 years. Sperm concentration started declining significantly after the age of 50 years. There was a constant age- related increase in number of spermatozoa with damaged DNA. sORP constantly increased up to 60 years. Furthermore, constantage-related decreases in FSH, serum testosterone and prolact in were observed from patients aged between 16 years and 60 years. Semen volume, sperm concentration, progressive motility and normal morphology were significantly higher in patients having > 5 days of abstinence. Patients having > 5 days of abstinence had the lowest normed sORP. Male age significantly affects sperm parameters and reproductive hormones in fertile and infertile men residing in Africa and the Middle East. Prolonged abstinence days provides better semen quality.