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Background: Lack of or use of suboptimal cold chain equipment (CCE) is a major barrier to optimal immunization coverage and equity. Gavi established the CCE optimization platform (CCEOP) in 2015 to help eligible countries modernize their cold chain systems. However, there are limited data on CCE deployment at country level. We present lessons learnt from deploying CCE from the Gavi CCEOP in Cameroon., Methods: This cross-sectional study collected data on the number of days items of CCE spent at each point on their trajectory from the entry port to 62 randomly selected health facilities in Cameroon., Results: Once equipment arrived at the entry port, it took 10 d for customs clearance, 2 d from customs clearance to warehousing and 257 d (>9 mo) from the warehouse to facilities. Upon arrival at the facilities, it took a median of 53 (range 0-395) d from installation to final commissioning: most of the days (median=210) were spent between installation and final commissioning. The major causes of delays included insufficient coordination and communication across all levels, poor documentation and final commissioning., Conclusion: Early engagement on customs clearance, strengthening coordination and communication, ensuring proper documentation, as well as eliminating final commissioning, could significantly improve implementation of the program., (© The Author(s) 2024. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene.)

Objective: To determine the efficacy of refrigerated gel packs in achieving and maintaining target temperature in neonates receiving therapeutic hypothermia (TH) for hypoxic ischaemic encephalopathy during neonatal retrieval., Design: Retrospective cohort study., Setting: Paediatric Infant Perinatal Emergency Retrieval, Victoria, Australia., Patients: 200 neonates treated with TH during retrieval between 1 January 2015 and 31 December 2020., Interventions: Active cooling with refrigerated gel packs or passive cooling., Main Outcome Measures: The primary outcomes were the proportion of neonates who achieved therapeutic cooling rectal temperature (33-34°C) within 6 hours of birth and maintained target temperature range once TH was achieved. Secondary outcomes included need for respiratory support, inotropes, anticonvulsant therapy, sedation and survival at 7 days of life., Results: 200 neonates received TH. Median gestational age was 39 weeks and median birth weight 3300 g. 120 (60%) were actively cooled with refrigerated gel packs and the remainder passively cooled. 121 neonates (61%) reached target temperature within 6 hours and 14 (7%) after 6 hours of birth. Of those who achieved target temperature, 38% were maintained in therapeutic cooling range for the remainder of the retrieval., Conclusions: Achieving and maintaining TH during neonatal retrieval with gel packs is challenging. Target temperature was not maintained in most neonates in this study. These findings support existing evidence favouring the use of servo-controlled cooling devices to optimise TH in the retrieval setting., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2025. No commercial re-use. See rights and permissions. Published by BMJ Group.)

Modified atmosphere packaging (MAP) is widely used to preserve fresh fruits. In the case of exporting products in bulk formats (2-5 kg), perforated MAP can help extend shelf life if appropriately configured to reach suitable gas levels. This study evaluated the configuration of a perforated MAP system for purple passion (Passiflora edulis Sims) fruits based on modeling and simulation of changes in gas levels within the package headspace and experimental data on the respiration and transpiration of the fruits. For this evaluation, perforation-mediated multilayer bags made of polyamide and low-density polyethylene were adjusted to preserve 2 kg of purple passion fruits. The number of perforations made in the bags was predefined by performing predictive calculations to reach favorable gas levels in the packaging headspace. Subsequently, storage tests were conducted at the laboratory level (6 and 17 ± 1°C) and then at the pilot level (6 ± 2 and 17 ± 3°C), obtaining steady molar fractions of O 2 of 0.122-0.128 and CO 2 of 0.098-0.100 and shelf life of 36 days for the fruits packaged at 6°C. Additionally, the accumulated weight loss of the fruits was monitored, obtaining values close to those previously modeled. The pre-configuration of the perforations resulted in suitable O 2 and CO 2 levels in the MAP, achieving up to 36 days of shelf life at 6°C and 24 days at 17°C. Likewise, moisture permeation through the bags resulted in low condensation with fruit weight losses of 4.8% at 6°C after 55 days in the pilot test. PRACTICAL APPLICATION: This study evaluated using perforated PA/LDPE multilayer bulk bags (2 kg) to preserve purple passion fruits. The package was preconfigured (with a predefined number of perforations necessary to achieve favorable levels of O 2 , CO 2 , and humidity) and was compared against a commercial factory-made perforated package. By performing predictive calculations to define a suitable number of perforations, it was possible to regulate the respiration and transpiration of the packaged fruit to increase its shelf life under controlled and real conditions. This approach can be extended to any bulk-packaged fruit, and it can help select, design, and develop breathable packages that prevent decay., (© 2024 Institute of Food Technologists.)

Time-temperature data for queso fresco (QF) cheese varieties stored in a residential refrigerator operating at 5°C and a predictive microbiology secondary model for Listeria monocytogenes in QF were used to estimate a refrigerator performance indicator (RPI) of microbial preservation. RPI values were used to assess how compressor technology (single [SS] and variable speed [VS]), ambient temperature (21.1°C [LT] and 32.2°C [HT]), and refrigerator load (22.5 kg regular load and 39 kg higher load) affected preservation performance. All deterministic and probabilistic RPI estimations slightly exceeded the desirable 1.0 value, i.e., the variable temperatures for the QF kept in the refrigerator were worse than keeping it constantly at the temperature recommended by food safety agencies for QF. Furthermore, the mean comparison of estimates of the time-temperature equivalent indicator previously developed by French researchers showed similar behavior to those observed for RPI. Finally, statistical analysis showed that T ambient was the factor with the highest impact on refrigerator performance because of its impact on the sample temperature increase during door openings and when exposed to ambient temperature during product use. This highlights the need to reduce the time for product temperature recovery by improving the compressor operation logic. Also important are consumer behavior changes such as a reduction in product exposure to ambient temperature and in the door opening duration and frequency. PRACTICAL APPLICATION: This study demonstrated how a quantitative tool (RPI) can assess refrigerator preservation performance. Although the findings presented can be applied to any cold chain segment, the data used was collected for its weakest link, the domestic refrigerator. Surveys show that 77% of them operate above the recommended 4°C. The RPI methodology is ready for use by refrigerator designers to assess performance improvements possible by modifications of the compressor operation logic. Moreover, it can be integrated into smart-hubs monitoring the frequency and duration of refrigerator door openings to inform consumers when their habits are compromising the preservation performance of the refrigerator., (© 2024 Institute of Food Technologists.)

The increasing public demand for fresh products has catalyzed the requirement for cold chain logistics distribution systems. However, challenges such as temperature control and delivery delays have led a significant product loss and increased costs. To improve the current situation, a novel approach to optimize cold chain logistics distribution for fresh products will be presented in the paper, utilizing a hybrid Tabu-Grey wolf optimizer (TGWO) algorithm. The proposed hybrid approach combines Tabu search (TS) and Grey wolf optimizer (GWO), employing TS for exploration and GWO for exploitation, aiming to minimize distribution costs in total and establish efficient vehicle scheduling schemes considering various constraints. The effectiveness of the TGWO algorithm is demonstrated through experiments and case studies compared to other heuristic algorithms. Comparative analysis against traditional optimization methods, including Particle swarm optimization (PSO), Whale optimization algorithm (WOA), and original GWO, highlights its superior efficiency and solution quality. This study contributes theories by demonstrating the efficacy of hybrid optimization techniques in complex supply chain networks and dynamic market environments. The practical implication lies in the implementation of TGWO to bolster distribution efficiency, cost reduction, and product quality maintenance throughout the logistics process, offering valuable insights for operational and strategic improvements by decision-makers. However, the study has limitations in generalizability and assumptions, suggesting future research areas including exploring new search operators, applying additional parameters, and using the algorithm in diverse real-life scenarios to improve its effectiveness and applicability., Competing Interests: The authors declare that there are no Competitive financial benefits and no conflict of interest., (Copyright: © 2024 Zhang et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Introduction: The United States Army has shifted doctrine to focus on large-scale combat operations against peer to near-peer adversaries. Future conflicts could result in a limited supply chain, leaving medical providers with only expired blood products for treatment of hemorrhagic shock. This study evaluated quality, function, and safety metrics of whole blood stored for 1 week past regulated expiration (i.e., 35 days, in CPDA-1)., Materials and Methods: Whole blood units (n = 6) were collected in citrate phosphate dextrose adenine-1 (CPDA-1) anticoagulant and stored refrigerated for up to 42 days. Units were sampled on days 35, 37, 39, and 42 of storage and evaluated for the following: complete blood count, blood metabolism and chemistries, clotting dynamics, and presence of bacteria., Results: The majority of evaluated parameters fell outside of normal clinical ranges beginning at day 35 of storage. At 42 days, blood pH was 6.58 ± 0.038, hemolysis was significantly increased (P = .037 vs day 35), and bacterial contamination was not evident. Glucose levels continuously dropped during extended storage. K+ was significantly increased at day 42 compared to day 35 (P = .010). A significant reduction in clot strength, factor V activity, and factor VIII activity was evident beginning at day 39 of storage., Conclusions: Storage of whole blood out to 42 days results in a continuous decline in function, but further in vivo safety studies should be performed to determine if the benefits of expired blood outweigh the risks. Other methods to safely extend storage of whole blood that maintain hemostatic function and preserve safety should be investigated, with emphasis placed on methods that reduce potassium leak and/or hemolysis., (Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2024. This work is written by (a) US Government employee(s) and is in the public domain in the US.)

Home preservation depends on the food matrix, refrigerator design/technology, consumer actions, and ambient temperature. Storing different food matrices in product-relevant refrigerator locations generating different temperature histories can be used to develop an indicator of how refrigerator technology, consumer habits, and environment conditions impact the refrigerator food preservation performance. In this study, poultry, particularly prone to spoilage reflecting its pH, nutrient availability, and high aw, was used to evaluate refrigerator preservation performance as affected by compressor technology (single [SS] and variable speed [VS]), ambient temperature (21.1°C [LT] and 32.2°C [HT]), and refrigerator load (22.5 kg [RL] and 39 kg [HL]). Time-temperature values collected for chicken breast stored in a drawer independently controlled at 0°C in a refrigerator set 5°C, and a Pseudomonas predictive microbiology model, were used to estimate a normalized refrigerator performance indicator (RPI). Values <1, ∼1, and >1 described excellent, good, or poor performance, respectively. A first analysis revealed that up to 54% of chicken breast temperatures were above its recommended refrigerated storage value. When ignoring variability sources, SS technology yielded RPI values ranging 0.61-0.70, whereas the more energy efficient VS compressor yielded values ranging 0.86-1.14. The higher and wider VS RPI range reflects a compressor control logic optimized for energy efficiency compliance while disregarding effects on food preservation. When considering the variability of model parameters and temperature measurements through one-sided 95% confidence intervals yielded RPI reaching 1.16. Although the independently controlled drawer preservation performance was near optimal, it can improve by considering energy use and preservation impact when optimizing the compressor speed control protocol. PRACTICAL APPLICATION: Worldwide poultry meat consumption has reached 15 kg per person. Refrigeration is widely used for its safety and quality preservation. Efficiency regulations decreased the energy use of residential refrigerators by nearly tenfold even though their size increased by 50% in the last half century. In this study, we provide quantitative evidence that their preservation performance must be improved. This is particularly true for upper end units typically equipped with quieter and more energy-efficient variable speed compressors. The same methodology can be used to evaluate the preservation performance of the storage units, trucks, and display cases used for refrigerated products., (© 2023 Institute of Food Technologists.)

European Union regulations stipulate that household refrigeration systems must operate with fluid refrigerants that possess low global warming potential (GWPs). In this work, theoretical performance of six binary and one ternary mixture (which consists of R13I1, R290, R161, R32, R1234yf, and R1234ze(E)) was investigated. The performance parameters such as coefficient of performance (COP), refrigeration effect (RE), volumetric cooling capacity (VCC), discharge temperature, pressure ratio, and specific power consumption of all considered refrigerant mixtures is studied with respect to the evaporator temperature range of -18 to 18 0 C and the condenser temperature range of 40 to 55 0 C. The properties corresponding to different operating conditions for the refrigerants considered in this study are estimated using REFPROP 10. The findings demonstrated that, when compared to R134a, all the investigated refrigerants exhibited very low specific power consumption (apart from M9, M10, and M14-M16), and high volumetric cooling capacity (VCC) (apart from M11 and M13) under the operating conditions of evaporator temperature -18 0 C and condenser temperature 40 0 C. M1-M3 and M11-M13 gave similar and within 10% deviation in coefficient of performance, while M3 and M11-M13 refrigerant mixtures offer significantly low discharge temperatures when compared to R134a. Refrigerant mixtures M2 and M11 consistently exhibited a better performance in comparison to R134a in the aspect of majority of the performance parameters considered in this study. Finally, it is understood that M2 and M11 are two possible alternative refrigerants to conventional refrigerants used in small refrigeration units (R134a and R22). Further, it is also identified that these mixtures are non-flammable, possess zero ODP and low GWP values., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

The changes in microbiological, physiochemical, and textural properties in fresh cheeses made from either cow or goat milk were observed under hyperbaric storage (HS, 50-100 MPa) at room temperature (RT) and compared with refrigerated storage under normal atmospheric pressure for 60 days. An initial microbial growth inhibition was observed for both cheese types, as well as a considerable inactivation of all endogenous microbiota under HS/RT (75-100 MPa/RT). This contributed to a higher stability of pH and color values, especially at the higher pressure at room temperature (100 MPa/RT) throughout 60 days storage. A compression effect occurred during HS/RT, resulting in higher whey loss, reduction in moisture content, and textural changes. Such changes tended to decrease over time, to values closer to the initial ones, with hardness values at the 60th day of storage at 75/RT similar to those observed for refrigeration on the 7th day and 1.4-fold higher than those observed at 100/RT. Overall, HS/RT reduced the microbial populations load during storage (≥5 log units in some cases), with minimal effects on most of the evaluated quality parameters. These results point to a considerable shelf-life extension of HS fresh cheeses, without temperature control, pinpointing HS as a more sustainable preservation strategy than refrigeration, with great potential for industrial application. PRACTICAL APPLICATION: The results presented in this study point to increased microbial stability of fresh cheeses when stored under hyperbaric storage without temperature control, leading possibly to an increased shelf-life, of up to 60 days. This kind of new food preservation strategy may be suitable for longer transportation of foods, where energy may not be handily and widely available, while additionally contributing to increased shelf-life and safety. Also, hyperbaric storage could be applied throughout the food storage, improving shelf-life with a lower carbon footprint than refrigeration., (© 2022 Institute of Food Technologists.)

High pressure pasteurised (HPP) milk was stored by hyperbaric storage at room temperature (HS/RT) (50-100 MPa at 20 °C) and compared with refrigeration (RF), to assess the effect on two pathogens surrogates and a pathogenic, up to 120 days, and on fatty acids, volatile organic compounds (VOCs) and secondary lipid oxidation over 60 days. HS/RT (75-100 MPa) was able to inactivate at least 6.68/6.31/6.03 log CFU/mL of Escherichia coli/Listeria innocua/Salmonella Senftenberg (to below the detection limit), while RF resulted only in minor changes. Overall, fatty acids profile remained stable under HS/RT, although secondary lipid oxidation showed slightly higher values. In addition, both HS/RT and RF showed stable and similar VOCs profiles and off-flavour indicative compounds were not detected, except for the lowest pressure (50 MPa) after 40 days. HS/RT preserved HPP milk with enhanced microbial safety, shelf-life and quality compared to RF, being in addition quasi-energetically costless and more sustainable than RF., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

The effect of extended refrigerated storage of 14 serum and plasma specimens on 5 syphilis serologic tests was evaluated for 16 weeks. Higher stability of nontreponemal and treponemal antibodies in serum was recorded compared to plasma. Described work may provide insights on refrigerated specimens' stability and suitability for syphilis tests., (Published by Elsevier Inc.)

Commercially harvested cull dairy cow carcasses (n = 64) from the two lowest-valued marketing classes (MC: Lean, LE; Light, LI) were conventionally chilled (CN) or vascularly rinsed with a chilled isotonic substrate solution (Rinse & Chill®; RC). Longissimus lumborum (LL) and Triceps brachii (TB) muscles were processed (steaks, ground). Early postmortem (first 24 h), RC resulted in a lower pH at each time measured. RC steaks had longer sarcomeres and lower shear force than CN. RC produced greater redness associated with blooming and display times. RC LE beef resulted in greater oxymyoglobin during display times. RC ground TB had greater moisture fat-free than CN. RC Lean LL had less purge loss compared to CN LE. RC had greater total pigments than CN. RC ground TB had greater oxygen consumption and lower thiobarbituric acid reactive substances compared to CN. RC has the potential to improve tenderness and color as well as limit lipid oxidation with similar benefits across the two marketing classes., (Copyright © 2021 Elsevier Ltd. All rights reserved.)