It is common practice to use objects to bridge disciplines and develop shared understanding across knowledge boundaries. Objects for knowledge mediation provide a point of reference which allows for the translation of abstract concepts into more externalized representations. This study reports from an intervention that introduced an unfamiliar resilience perspective in healthcare, through the use of a resilience in healthcare (RiH) learning tool. The aim of this paper is to explore how a RiH learning tool may be used as an object for introduction and translation of a new perspective across different healthcare settings.This study is based on empirical observational data, collected throughout an intervention to test a RiH learning tool, developed as part of the Resilience in Healthcare (RiH) program. The intervention took place between September 2022 and January 2023. The intervention was tested in 20 different healthcare units, including hospitals, nursing homes and home care services. A total of 15 workshops were carried out, including 39-41 participants in each workshop round. Throughout the intervention, data was gathered in all 15 workshops at the different organizational sites. Observation notes from each workshop make up the data set for this study. The data was analyzed using an inductive thematic analysis approach.The RiH learning tool served as different forms of objects during the introduction of the unfamiliar resilience perspective for healthcare professionals. It provided a means to develop shared reflection, understanding, focus, and language for the different disciplines and settings involved. The resilience tool acted as a boundary object for the development of shared understanding and language, as an epistemic object for the development of shared focus and as an activity object within the shared reflection sessions. Enabling factors for the internalization of the unfamiliar resilience perspective were to provide active facilitation of the workshops, repeated explanation of unfamiliar concepts, provide relatedness to own context, and promote psychological safety in the workshops. Overall, observations from the testing of the RiH learning tool showed how these different objects were crucial in making tacit knowledge explicit, which is key to improve service quality and promote learning processes in healthcare. It is common practice to use objects to bridge disciplines and develop shared understanding across knowledge boundaries . ResearcBoundary objects have been found valuable for mediating knowledge in the implementation of quality improvement interventions in healthcare . A boundwhy people collaborate (motivation to collaborate)  . Activitaborate) , 12, 13.Despite the recognized value of mediating objects for collaborations, benefits gained by the objects cannot be determined beforehand due to the context specific nature of mediating objects. Objects are not magical solutions, and even thoughtfully developed objects may fail to provide mediating value , 6, 14, Interventions designed to improve healthcare quality introduce changes, either in the form of new ways of acting or through new ways of thinking. The adoption of new practices and perspectives is challenging as it questions our cultural and contextual knowledge , 16. The“the capacity to adapt to challenges and changes at different system levels to maintain high quality care,” and as such focus is directed toward adaptive capacity, learning from what goes right, and to provide understanding of everyday practices  research program , 23, whiractices , p. 6. Tractices . The resIn the Norwegian setting, resilience in healthcare is perceived as a new and unfamiliar perspective on healthcare quality. The traditional way of thinking about quality and patient safety largely entails learning from mistakes, adverse events, and near misses. The introduction to practice of a RiH tool, which promotes the aim of learning from success, therefore requires translation into practice, alongside the development of a shared understanding and learning of a new way of thinking. This article reports findings from the initial testing of a tool developed to translate resilience into practice and investigates how we can understand the role of objects in this process.The development process of the RiH learning tool was based on the approach of ‘perspective taking’, where new knowledge is to be “exchanged, evaluated, and integrated with that of the others in the organization” as a way to introduce a new perspective , p. 358.The aim of this paper is to explore how a RiH learning tool may be used as an object to introduce and translate a new quality and safety perspective into practice across different healthcare settings.The research questions are:How does a RiH learning tool act as a mediating object for the translation of resilience in healthcare?What contributions does a RiH learning tool make to the introduction of a novel perspective of quality improvement in healthcare?We report and discuss findings from the test phase of the RiH project , 23, wheThe RiH learning tool is designed to assist diverse healthcare units, such as teams, wards, or organizations, to understand the resilience perspective, what resilience capacities are, and to enable identification of patterns of own resilient performance through collaborative assessment and discussion of everyday practice. The tool is made up of three different elements to allow for flexible use within dynamic healthcare settings; Element 1 (Mapping tool), Element 2 (Learning scenarios) and Element 3 (Reflection tool). Each element can be used separately or as part of a step-by-step process moving from one element to the next. The development of the RiH learning tool elements in terms of technological features, aim, content, and approach is described in Facilitation to understand the resilience perspective was in this tool constructed by including three e-learning videos; one introductory video, one as part of the Mapping tool (Element 1) and one as part of the Learning scenarios tool (Element 2), as well as through descriptions of the 10 resilience capacities as part of the Mapping tool (Element 1) and the Reflection tool (Element 3), see The study findings are based on empirical observational data. The intervention to test the tool took place from September 2022 to January 2023. The intervention entailed three, sequential researcher-led workshops where representatives from each unit received training in how to use the different elements of the RiH learning tool. In between each researcher-led workshop the unit representatives were instructed to undertake specific self-directed activities in their respective unit, before returning to the next researcher-led workshop. The topics of the three workshops (WS) were: WS1; Mapping, WS2; Learning scenarios, and WS3; Resilience reflection. See Throughout the intervention, data was gathered through observations conducted at each of the three workshops at all the intervention sites. Observations were only undertaken at the researcher-led workshops, and not during the self-directed learning activities. The intervention program was run as one intervention at each site, meaning that all units at the same site participated in the same set of three workshops. This was intentionally set up to facilitate learning between units from the same organization. A total of 15 workshops were carried out, at five sites including hospitals, nursing homes and home care services see . These fPairs of researchers were responsible for carrying out interviews, observations, training, documentation of observations, and providing feedback at each of the five sites. Some of the researchers were involved at several sites, while other researchers were only involved at one site.Observation notes from all 15 workshops make up the data set for this study, based on approximately 30 h of observation. All observation notes were written up after the workshops in accordance with a predefined observation template, which included the following main themes and subthemes: introduction of participants, experiences from the self-directed activities with the tool in their own organization, usability and functionality of the tool, training of new procedures, interaction between participants, reflection over resilience concepts, and the researchers’ own post-workshop reflections. All researchers took part in workshops, observations, and the writing up of observation notes.Data were analyzed by way of a thematic analysis approach inspired by Braun and Clarke , and folFindings from this intervention to test a RiH learning tool in diverse clinical settings show that resilience as a perspective for understanding work-as-done, quality of care and patient safety was a highly unfamiliar approach among workshop participants. Participants have been used to the traditional emphasis within the Norwegian healthcare system on learning from adverse events . Outcomes from the introduction of a new quality and safety perspective in clinical practice will be presented below, focusing on how the RiH learning tool functions as a mediating object to translate novel ideas into practice.The RiH learning tool acted as a mediating object through the provision of shared reflection and shared understanding, categorized as cognitive elements, for the different actors. Furthermore, the RiH learning tool contributed to a shared language and shared focus for the involved participants in terms of elements related to practice. The overall contribution of the RiH learning tool as a mediating object for different healthcare disciplines and roles was in its facilitation of learning, motivation, awareness, and concretization. Results from the inductive analysis are depicted in the model in Having an arena to engage in reflection over what works well in their practice was appreciated by all participants. Due to the unfamiliarity of the resilience perspective, explaining resilience and the associated resilience capacities was needed as a starting point to allow for subsequent shared reflection. Once concepts had been clarified, participants engaged eagerly in the reflection rounds, to the extent that these had to be paused at points to move forward. The engagement in reflection was not found to be restricted to the workshop, as we observed prolonged reflection after the workshops ended which also became evident at the next workshop. The resilience perspective and the resilience capacities were found easily translatable to participants’ work practices and settings, although it did demand an initial familiarization with the concepts.learn from each other during the reflections. Usually, finding time for knowledge transfer during their daily hectic work schedules was difficult but their engagement with the RiH learning tool supported knowledge exchange processes.Some sites reported that having a combination of newly hired personnel together with experienced personnel as very rewarding during the reflection. They reported that new staff members more easily could discover and value what worked well in their setting. Furthermore, participants experienced that both experienced and new personnel could concretization in participants’ reflections improved in proportion with their shared understanding of the concepts. Thus, the explanatory text included on the website and within the different elements of the tool, as well as the time set aside for clarification of concepts in every workshop, provided a shared understanding of the resilience perspective which again improved reflection. Some participants reported surprise at the high level of consensus, across organizational levels , happening in the reflections. Others stressed the value of reflecting and negotiating with people who have a different perspective than your own. Due to the practice-near nature of the RiH learning tool, the different participants related the resilience perspective to different aspects of their situated work. As such, the participants brought different operationalizations of resilience in practice to the discussion. However, as the resilience capacities are of a quite generic nature, these differences were not found to hamper the development of a shared understanding. Since the tool elements were designed in such a way that the participants need to reach a consensus before reporting a joint response, the tool prompts the need for participants to agree upon a shared understanding during reflections. For the participants in this intervention, this was sometimes a straightforward process, while at other times it relied on converging reflections within a group of colleagues. However, these discussions were found to provide valuable reflections in the group work due to their differing work-related operationalizations. The practice-near foundation of the RiH learning tool meant that some aspects of the scenarios were found to be more easily relatable for healthcare professionals working directly with patients, as opposed to those in managerial and administrative positions.We observed that the tool provided a shared understanding of important elements of resilience, quality of care and patient safety. The level of The resilience perspective was found to be unfamiliar to all participants. This unfamiliarity introduced a challenge for the researchers in terms of keeping workshop reflections and discussions within the resilience perspective.motivation, which was highly needed in the post-covid healthcare context. The new focus on positive experiences was therefore highly welcomed by the participants. Reflections on what they are good at and what works well in their everyday clinical work provided a shared focus leading to the development of shared goals. However, a change of focus to an unfamiliar methodology required structured efforts from facilitators, repeated explanations and clarifications, and a willingness to embrace new ways of thinking. To keep a shared focus over time, several sites decided to do the work with the self-directed activities as part of already planned meetings in their units. By doing so they worked on small parts of the tool over a longer time period. An example was where one unit incorporated reflection on one or two statements from the first element of the tool during their routine morning meeting over the course of several days.When reflections centered around a shared focus on resilience and what works well, participants reported this shift in focus to provide awareness of which of the capacities that contributed to well-functioning work practices. We observed a marked improvement in how they described their work from the first to the third workshop. For example, they went from saying “we interact well with family members of patients” which only provides general knowledge, to saying “we have good structures in place for the involvement of next-of-kin, like monthly updates via phone calls,” which provides concretization of what works well to facilitate involvement. Concretization allows for best practices to be transferred to other teams and organizations, thereby encouraging broad learning from success.Working with the different elements of the tool allowed for rich reflections across disciplines, roles, and organizational boundaries. A highly important outcome of these reflections was the development of a shared language to concretize what works well. Through the shared language provided by the tool, participants got an The rewards gained by translating the resilience perspective to practice is not as straight forward as just giving healthcare providers a resilience tool. The translation of the resilience perspective to practice was found in this study to rely on several enabling factors. Enabling factors observed in the workshops were facilitation of reflections, to establish psychological safety, to explain unfamiliar concepts, and to provide relatedness to a specific context. See The RiH learning tool intervention relies on a ‘train-the-trainer’ methodology. The workshop participants were therefore expected to go back to their own unit/organization to facilitate several self-directed activities together with their colleagues. It became apparent that achieving fruitful reflections, where all participants contribute and have the same focus, need targeted facilitation (both in the workshops and in self-directed activities). As the researchers listened in on the reflections taking place during the researcher-led workshops, there was a noticeable tendency for participants to drop back into a familiar quality and safety perspective with discussions of areas in need of improvement. Facilitators, therefore, had to interact with and guide participants to keep reflections within the resilience perspective, thereby encouraging them to focus on positive outcomes when discussing everyday practice within their own units.Another enabling factor to encourage good reflections was to establish an atmosphere characterized by psychological safety. This was achieved by researchers engaging in informal conversation and small talk with the participants, asking questions about their work and daily life, and by complimenting and encouraging their contributions to the conversation. The facilitators also supported the participants whenever they expressed difficulties in focusing on positive, rather than negative outcomes, thereby attempting to take the stress out of dealing with learning a new approach to quality and safety work. The participants reported the workshops to be informal, respectful, and welcoming.Introducing an unfamiliar perspective on healthcare quality and safety posed a need for facilitators to explain concepts and the background and rationale for using a resilience approach in the participants’ more familiar disciplinary language. To do so the facilitators needed some knowledge and understanding of the participants’ contextual settings, to provide them with practice-based examples and terms. In doing so, the facilitators took on the role as boundary spanners  . DespiteThe need for participants to relate the resilience perspective to their own context and practice was found crucial for operationalization and concretization. As such, the facilitator continuously requested practical examples from participants during the reflection sessions. A marked intention was to ensure that the participants kept discussing work-as-done by asking questions like “how do you do this in your team/organization?,” instead of reflections of work as imagined, with participants talking about what they ought to be doing or wish they could be doing, for example “we wish we had meeting arenas to talk about these things.” Keeping the focus on work as actually done in the real and explicit context of participants was thus an issue in need of continuous attention from the facilitators of the workshops.In this study we have explored the role of objects in a novel effort to translate resilience into practice when implementing a RiH learning tool in Norwegian nursing homes, homecare, and hospital units. In response to the call for specificity in the way objects act in collaborations , the folThe RiH learning tool acted as a boundary object in providing shared understanding and a shared language across disciplines and diverse healthcare settings. Unfamiliarity with the resilience perspective made it necessary for participants to have objects for the translation of unfamiliar concepts and perspectives to their situated practice . For theActions of knowledge conveyance and convergence need to be repeated in a cyclic manner . This isThe RiH learning tool acted as an epistemic object in providing motivation and engagement for the participants through the development of shared goals. Nicolini, Mengis  exemplifFurthermore, the RiH learning tool elements acted as activity objects. The main objective of the RiH learning tool is to ensure reflection sessions for the understanding, ownership, and operationalization of the resilience perspective in diverse healthcare settings. Activity objects are described as “incomplete, emergent, and expansive which gives them their performative character” , p. 624.Both epistemic objects and activity objects are found to support motivation. Michie, Van Stralen  describeFindings from this study provide both theoretical and practical implications for similar interventions aimed at introducing new theoretical perspectives to the healthcare setting.This study extends the resilience in healthcare literature by providing an empirical understanding of how to translate the resilience perspective into practice. Furthermore, this study also extends the object literature through the provision of an empirical understanding on how a RiH learning tool acted as different forms of objects throughout an intervention to introduce a new quality and safety perspective across different healthcare settings. Calls have been made to provide clarification of different types of objects , and thiThis study reports from the introductory phase of a resilience intervention, where a new resilience perspective was introduced for healthcare professionals in clinical practice. As both resilience and objects are not possessable stable phenomena, but instead dynamic aspects that change over time, the findings in this study cannot determine whether resilient performance was subsequently achieved or adopted at the involved study sites, nor can they determine whether the learning tool would act as an object at later phases of resilience adoption. The understanding contributed by this study is based on the introductory phase only, where a learning tool was found to act as different mediating objects for introducing the resilience perspective to the practice field.This study also contributes with implications for practice. Firstly, the learning tool was found helpful to aid the introduction and translation of a new perspective like resilience in healthcare to practice by encouraging the development of shared focus, understanding, language and reflection. The initial participants reported a lack of meeting arenas where they could engage in reflection within their organizations. Healthcare providers and leaders should therefore consider providing their staff with reflexive spaces to promote this learning and practice improvements. This was highly appreciated by the participants in our study, which is in line with suggestions from the literature on how to leverage resilience into practice .Learning new work practices and perspectives requires time, openness and interest on the part of the learners. The RiH learning tool described here acted as an object that can bring people together with a common purpose. This is of utmost importance in improvement activities. In addition, the built-in flexibility in how to use the tool in diverse healthcare settings was found to be important and implies that future efforts to support resilience in practice need to take this into account. Using tools for knowledge translation and to learn new perspectives requires bringing people together , it requires a tool with a solid theoretical foundation, and it needs structured activities and support as part of its introduction into workplaces.However, setting aside time and resources for engaging in interventions relies on interventions to be anchored in leadership , 35. ImpDespite the current digitalization trend, findings from this study illustrate the utility of face-to-face facilitation and physical meetings. The study participants needed guidance and repeated explanations to understand the new perspective, as well as active facilitation during reflections. They stressed the value of facilitators being physically present and questioned if they would be able to succeed to the same degree if the intervention workshops had been provided only digitally. The physical presence aspect of facilitation is thus something that needs to be considered when designing future resilience interventions for the healthcare setting.Some of the workshops reported in this study included participants from several teams and wards within the same organization. An intra-organizational approach was found to be valuable to support learning and the sharing of best practices across differing teams and wards and was appreciated by the participants. Using a cross-organizational approach requires efforts to develop psychological safety within the workshops. Psychological safety was addressed in this study by making time for small talk during the introduction to each of the three workshops. Further studies should research the role of psychological safety  in resilFor interventions seeking to improve healthcare quality, objects prove to be valuable instruments for translating and transforming knowledge into practice and to promote reflection, motivation, the bridging of hierarchies and collaborative learning , 21. TheIn sum, observations from the test phase of the RiH learning tool showed how these different objects were crucial in making tacit knowledge explicit which is key to improving healthcare quality and promote learning processes across healthcare services.The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.HL, CH-D, and SW advanced the initial idea for the article. CH-D, VG, ER, HD, BF, HW, and HL contributed to the facilitation of workshops and in the data collection. HL drafted the manuscript with significant contributions from CH-D, VG, ER, HD, BF, HW, and SW. HL led the analysis process while all authors contributed to the analysis process at different stages. All authors have read and approved the final manuscript.This study was funded by the Norwegian research council, as a sub study under the overall Resilience in healthcare project (RiH) project number 275367. The Resilience in Healthcare Research Program has received funding from the Research Council of Norway from the FRIPRO TOPPFORSK program, grant agreement no. 275367. The University of Stavanger, Norway; NTNU Gjøvik, Norway; and The Norwegian Air Ambulance support the study with in-kind funding.The author SW is a member of the editorial board (Associate Editor).The remaining 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.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


The present study aimed to investigate the influence mechanism of carboxymethyl cellulose (CMC) on the flotation of fine chlorite. To this end, a series of flotation tests, sedimentation tests, and microscope analyses were conducted. Flotation tests revealed an inverse relationship between particle size and the recovery of chlorite, indicating that finer particles exhibited higher recovery rates. Moreover, it was observed that the recovery of fine chlorite was significantly associated with the water recovery  and a variety of frother types. Based on these findings, it can be inferred that froth entrainment may constitute a crucial component of the recovery mechanism underlying fine chlorite. Thus, reducing froth entrainment  is the key to depress chlorite flotation. Flotation tests indicate that fine chlorite recovered into froth products can be depressed effectively by CMC with a high molecular weight. The results of sedimentation tests and microscope analyses in the presence of CMC prove that CMC with a high molecular weight generates flocculation on fine chlorite particles while that with a low molecular weight does not. It is suggested that the depression of chlorite flotation may be attributed to the reduction in the entrainment resulting from the flocculation induced by CMC. As a prevalent magnesium silicate gangue mineral, chlorite is frequently associated with sulfides, such as copper-nickel sulfide ,2. Due tBased on the above, the deleterious effect of magnesium silicate gangue minerals on the flotation of sulfide ores is mainly attributed to the “slime coating” of magnesium silicate gangue minerals on sulfide surfaces and the import of magnesium silicate gangue minerals into the concentrate. Numerous additives have been explored to mitigate the adverse impact of magnesium silicate gangue minerals. Sodium hexametaphosphate has been found to be effective in inhibiting magnesium silicate gangue minerals; however, its excessive use can generate phosphorus wastewater and result in environmental concerns . In addiIt has been reported that the primary recovery mechanism of fine magnesium silicate gangue mineral particles , including chlorite, is primarily attributed to the entrainment facilitated by water recovery. In addition, the entrainment of minerals may be correlated with particle size . HoweverIt is reported that the depression of silicate minerals from sulfide ore, especially when the entrainment of silicate minerals is serious, can be achieved with some polymers ,14,15. CMany possible interaction mechanisms involving the possible contributions of electrostatic, chemical, hydrogen, and hydrophobic bonding between CMC and the surface of the magnesia-bearing mineral have been proposed ,20. BecaCMC is known to be effective in reducing the floatability of minerals and its applications are diverse, with numerous systematic investigations having been conducted. However, the understanding of the various ways in which CMC influences chlorite with different particle sizes is currently inadequate, thereby impeding the broader application of CMC. Furthermore, it remains unclear whether the depressive effects of CMC are predominantly attributable to flocculation/dispersion . Thus, tThe chlorite utilized in the entire experiment was sourced from Haicheng, Liaoning Province, China. The XRD analysis  and chemCMC used for all tests was purchased from Aladdin Industrial Corporation, Shanghai, China. The molecular weight of the CMC we used in this work was 90,000, 250,000, 700,000, respectively. All three kinds of CMC were with the same degree of substitution, with 0.7. Terpilenol, MIBC (methyl isobutyl carbinol), and hexanol used as frothers, and were all obtained from Tianjin Guangfu Fine Chemical Research Institute, Tianjin, China. Hydrochloric acid (HCl) and sodium hydroxide (NaOH) were employed as pH modifiers and were procured from Tianjin Kermil Chemical Reagents Development Centre, Tianjin, China. All the chemicals were of analytical grade quality.Stock solutions of CMC were prepared by dispersing a predetermined amount of solid into 100 mL of vigorously stirred cold distilled water and the stirring was continued for about 30 min until the CMC powders were dissolved completely. The solutions were freshly prepared each day. The HCl stock solution was prepared by adding a portion of known-weight HCl solution with a concentration of 36% to the appropriate amount of cold distilled water and stirring. NaOH stock solution was prepared by adding a portion of known-weight NaOH solid into the appropriate amount of cold distilled water and stirring until the NaOH powders were dissolved completely. Deionized double distilled water was used for all experiments.Flotation tests were performed using an XFG-type mechanical agitation flotation machine made by the Changchun Prospecting Machine Factory. In a typical single mineral flotation test, 2.0 g of mineral were added to 40.0 mL of distilled water, followed by conditioning. The pH of the mineral suspension was adjusted to the desired value using HCl or NaOH stock solution. Afterwards, CMC (if necessary) stock solution and a frother were added into the pulp and conditioned for 5 min and 1 min, respectively. Flotation was conducted for a duration of 4 min. Both the floated and sink products were collected, filtered, and subsequently dried before being weighed to facilitate the calculation of recovery. Each experiment was conducted in triplicate, and the average value was considered as the final result.Flocculation/dispersion of the chlorite was assessed via settling tests launched using a graduated cylinder. An amount of 0.1 g of chlorite powder was conditioned in a 100 mL beaker at the desired pH for 5 min, following which CMC stock solution was added and gentle stirring was carried out for an additional 5 min using a magnetic stirrer. The suspension was then transferred to a 100 mL cylinder and the water level was adjusted to 100 mL using distilled water. The cylinder was stoppered, inverted twenty times, and then allowed to remain in an upright position for a fixed duration of 10 min. The suspension in the upper 25 mL of the cylinder was siphoned out and measured using a WGZ-3(3A) type Scattering Turbidimeter fabricated by the Shanghai Xinrui Instrument Company. The degree of flocculation/dispersion of the suspension was assessed based on the turbidity of the supernatant liquor. Lower turbidity values were indicative of superior flocculation. Each test was repeated thrice, and the average value was considered as the final outcome.Visual examination of the flocculation/dispersion state of fine chlorite was performed using a polarized optical microscope Leica DM4800. The procedure for the preparation of the slurry was identical to that mentioned in the sedimentation tests. A drop of slurry was dispensed onto a glass slide by pipette during the stirring of the slurry, following which the sample was examined using a microscope, which was fitted with a video camera.Rg is the recovery of hydrophilic gangue caused by froth entrainment, %; e is the entrainment factor of hydrophilic gangue; and Rw is the water recovery of the floated concentrate, %.In the flotation process, fine-grained minerals and hydrophilic minerals may be entrained into the concentrate by foam water. It is well known that the froth entrainment is closely linked to the water recovery  during flotation. That is, the recovery of fine chlorite is directly proportional to the water recovery due to the froth entrainment of flotation.The water recovery in flotation is determined by the froth’s behaviors which are bound up with the properties of frothers and frothers almost do not change the hydrophobicity of mineral. Thus, in order to verify the froth entrainment, the flotation of −38 μm chlorite were carried out with three types of frothers. No collector was used in the flotation tests. The results are presented in From The findings from the flotation tests conducted on chlorite with different particle sizes in the presence of CMC are illustrated in It has been mentioned above that the flotation recovery of the fine chlorite (−38 μm) in the presence of three types of CMC with the molecular weight of 90,000, 250,000, 700,000, respectively, are drastically different . In addiIt is well known that the recovery due to froth entrainment is also closely linked with fine particles. To investigate the influence of CMC molecular weights on the flotation of fine chlorite, a series of settling tests were carried out. The results are presented in These results reveal that the CMC with a low molecular weight almost does not affect the settling behavior of the fine chlorite and is not an effective depressant for its failure in reducing froth entrainment in flotation, despite the fact that it can render the fine chlorite particles hydrophilic. On the other hand, the CMC with a high molecular weight, which generates flocculation on the fine chlorite particles, gives a low flotation recovery of the fine chlorite because of the reduction of froth entrainment. Thus, the conclusion can be drawn that froth entrainment is an important factor for the difference between the low molecular weight CMC and the high molecular weight CMC in the depression of fine chlorite. In addition, the flocculation caused by the high molecular weight CMC is significant in reducing the froth entrainment of fine chlorite particles, which is consistent with the findings suggested by Liu et al. .This study systematically investigated the influence of CMC with different molecular weights on the flotation of chlorite. Flotation results indicate that the recovery of fine chlorite increases with particle size reduction due to the entrainment through water recovery. However, a high molecular weight CMC is found to be more effective in depressing the flotation of fine chlorite than a low molecular weight one. Sedimentation tests and microscope analysis show that the flocculation/dispersion state plays an important role in the depression effect of CMC on the flotation of fine chlorite. A high molecular weight CMC can flocculate fine chlorite particles to reduce froth entrainment as well as hydrophily, while a low molecular weight CMC fails. It is suggested that the reduction of entrainment because of flocculation caused by CMC is key to realizing the depression of fine chlorite flotation, which also provides a reference for the flotation of other fine minerals.


When the correct technique is applied, forceps and vacuum extractors have low rates of complications.For the fetus with signs of hypoxia in the expulsive phase, operative vaginal delivery has the potential to reduce exposure to intrapartum factors that promote hypoxic-ischemic encephalopathy.Medium and/or rotational forceps are appropriate options in selected circumstances and require skill and experience.Even though forceps are more effective than vacuum extraction for operative vaginal delivery, they are more associated with severe perineal lacerations.Cephalohematoma is more likely to occur with increasing duration of vacuum extraction.Flexible vacuum cups have higher failure rates, but lower incidences of trauma to the newborn’s scalp.Operative vaginal delivery is contraindicated if the fetal head is not engaged, delivery presentation is unknown, or if the fetus has suspected or diagnosed bone demineralization or bleeding disorders.Ultrasound evaluation prior to instrumentation of labor is recommended when there is doubt in the clinical assessment of delivery presentation.Routine episiotomy is not recommended in operative vaginal delivery because of poor healing and discomfort associated with mediolateral episiotomy, and the risk of injury to the anal sphincter and rectum with midline episiotomy. When individually indicated, it should be mediolateral and performed only after a successful traction test.In the prolonged pelvic period of fetuses estimated to weigh more than 4,500 grams, intrapartum cesarean section for prevention of shoulder dystocia is preferable to low operative vaginal delivery or outlet delivery. Similarly, operative vaginal delivery with the fetal head in the mid pelvis should be avoided in fetuses estimated to weigh more than 4,000 grams, and intrapartum cesarean section is indicated. In these situations, instrumental delivery should only be considered in the presence of experienced operators, through individual assessment of fetal position and size, history of previous deliveries and maternal habits.The attempt to use forceps must be interrupted if there is no progression of the cephalic pole after three tractions performed with correct grip by an experienced operator.Vacuum extraction should be avoided before 32 weeks and caution should be exercised between 32 and 36 weeks, as the lower safe limit for gestational age has not been established yet.Vacuum extraction should be stopped when there is no evidence of progressive descent of the fetal head or when the cup detaches on three occasions.Sequential use of vacuum extraction and forceps is associated with increased neonatal complications and should not be routinely performed. After a failed vacuum extraction attempt, the risks and benefits of a sequential attempt to use a forceps or cesarean section should be evaluated.Neonatologists must be informed about the technique used in operative vaginal delivery.Operative vaginal delivery is used to provide a safe birth via the vaginal route based on maternal and fetal indications. Its greater benefits are the prevention of a cesarean section and its associated morbidities, as well as neonatal complications arising from intrapartum hypoxia.Although the forceps has been presented as the resource with the greatest potential for saving lives in the history of medicine, its current replacement by cesarean section is a result of the lack of preparation of the new generation of obstetricians, the inability of professors to teach its practice and the growing medical judicialization of obstetrics. The forceps instrument currently holds stigma and social prejudice arising from maternal and neonatal trauma caused by misuse. Vacuum extractors are more contemporary instruments, and although less effective than forceps, they are easier to use and have advantages that have made them instruments of choice in several countries.In recent decades, an increase in the rates of cesarean sections performed in the second stage of labor has been observed with a concomitant reduction in operative vaginal delivery. Difficult fetal extraction in cesarean section is an event associated with failure or lack of attempt at operative vaginal delivery, potentially aggravating maternal and neonatal morbidity. Therefore, the acquisition of skills and competences related to the use of forceps and vacuum extractors has become essential in the current process of training obstetricians.For the fetus with signs of hypoxia in the expulsive phase, operative vaginal delivery has the potential to reduce exposure to intrapartum factors that promote hypoxic-ischemic encephalopathy.Because it causes less maternal trauma than the forceps, the vacuum extractor is an excellent alternative for operative vaginal delivery, especially for outlet delivery. Its indications are similar to those of the forceps. However, as the vacuum extractor requires more time for fetal extraction, it should not be the preferred method in emergency situations. The main advantages of vacuum extraction include a reduction in application errors, greater ease of learning, the possibility of self-direction and autorotation, less use of force on the fetal head, less need for analgesia and episiotomy and the reduction of birth canal lacerations. Vacuum-extractors with flexible cups cause less severe trauma to the fetal scalp than those with rigid cups, and should be preferred in simple vaginal deliveries.Operative vaginal delivery is contraindicated if the fetal head is not engaged or the delivery presentation is unknown. The following are absolute contraindications to operative vaginal delivery: cephalopelvic disproportion, total or partial placenta previa and anomalous presentations such as transverse, second-degree deflected cephalic (forehead) and third-degree deflected cephalic (face) with a variety of posterior chin positions. It is also relatively contraindicated if the fetus has suspected or diagnosed bone demineralization (osteogenesis imperfecta) or bleeding disorders . Operative vaginal delivery in fetuses weighing more than 4,000 grams must be judicious when choosing either forceps or the vacuum extractor. With regard to fetuses with an estimated weight of less than 2,000 grams, forceps are the safest instrument and can be used in fetuses as small as 1,000 grams.In the prolonged pelvic period of fetuses estimated to weigh more than 4,500 grams, intrapartum cesarean section to prevent shoulder dystocia is preferable to low operative vaginal delivery or outlet delivery. Similarly, operative vaginal delivery with the fetal head in the mid pelvis (De Lee station 0 and + 1) should be avoided in fetuses weighing more than 4,000 grams, and intrapartum cesarean section is indicated. In these situations, instrumental delivery should only be considered in the presence of experienced operators, through individual assessment of fetal position and size, history of previous deliveries and maternal habits.Vacuum extraction is not risk free , and is also contraindicated in prematurity . Between 32 and 36 weeks, the vacuum extractor must be used with great caution, as the lower safety limit for gestational age has not been established yet. As the fetal extraction time with the vacuum extractor is prolonged, the instrument should also not be used if there are signs of fetal hypoxia. Vacuum extractors are also not indicated for pelvic vaginal delivery (breech baby) nor for face presentation, and should be replaced by forceps in these situations. Contraindications to vacuum extraction, although relative, also include: previous collection of blood or trauma to the fetal scalp, fetal death, anomalies of the cephalic pole , macrosomia and negative test traction in a previous attempt to use forceps.Forceps and vacuum extractors are the main instruments recommended for extracting the fetus from the birth canal, performed by grasping and pulling the fetal cephalic pole. The choice of instrument is related to the operator’s preference and experience, and to maternal and fetal conditions.Forceps are instruments with two broad branches, each with four components: blade , shank , joint and handle. The best known models nowadays are Simpson, Kielland, Piper and Marelli.Although forceps are more effective than vacuum extractors, they are more associated with severe perineal lacerations. Simpson’s forceps are the most widespread worldwide. It features crossed branches, English (by fitting) fixed lock, handle with finger grips and fins (finger support) and fenestrated blades. The cephalic  and pelvic  curvatures of the blades are prominent, and this specificity is advantageous for the grip and traction of the cephalic pole. It has three sizes, with shank lengths of 30, 33 and 35 cm.Kielland’s forceps have crossed branches, but the articulation is performed by sliding, allowing the asymmetrical application of the blades in the vagina and the correction of asynclitism. It is 39cm long, handles are smooth with fin and identification buttons (knobs) on the front side. In the articulated instrument, the shanks are superimposed with the right above the left. Blades are fenestrated with smooth and rounded edges, and have very discreet cephalic and pelvic curvatures, which makes it an specific instrument for wide rotations .9The Piper’s forceps are specific instruments for extracting the head (breech baby) in pelvic delivery. It has long (44cm long) crossed branches, English lock and handle without finger grips and fins. Blades are fenestrated with very prominent cephalic and pelvic curvatures. A third curvature, the perineal, is present on the underside of the handles, close to the blades .9Marelli’s forceps are specific for fetal extraction in cesarean sections. It has crossed branches, English lock and smooth handle without fins. Its blades are fenestrated without a pelvic curvature (“bayonet” shaped blade), since fetal extractions with this instrument are performed through the abdomen .59Vacuum extractors are instruments that have a cup, a connecting tube and a suction pump. By means of negative pressure, the cup, applied to the scalp, pulls the fetal head. Cups can be rigid , semi-rigid or flexible and have a bell or mushroom shape . FlexibSpatulas and the Odon device are less widespread instruments. Spatulas are instruments with two independent and symmetrical branches that do not articulate. Each branch has a stem, handle and solid, wide blade. The branches act as independent levers and the fetal head is not pinched between the blades. The action of the spatulas is similar to that of the shoe presser, whose function is to help slide. Thierry, Velasco and Teissier spatulas are described.The Odon device is a film-type polyethylene instrument that creates an air envelope around the fetal head, allowing extraction by means of traction .1213Classifications of operations in operative vaginal delivery are based on pelvic planes and delivery mechanisms. The application performed before the engagement of the cephalic pole (“high forceps”) is contraindicated. The American College of Gynecology and Obstetrics 2015), endorsed by the Royal College of Obstetricians and Gynecologists (2020) has the most current classification .45, endorseThe main prerequisites for operative vaginal delivery include information and agreement on the benefits and risks of the procedure, adequate maternal pelvis, fetal weight estimate performed , engagement of the cephalic pole, complete cervical dilation and effacement, ruptured membranes, previous bladder emptying, knowledge of the presentation and variety of position, and satisfactory anesthesia .The application of the forceps must be preceded by a urinary catheter and satisfactory maternal anesthesia. Low spinal anesthesia (“saddle”) is preferred, especially in emergency situations and in mid and rotational forceps. It has the advantages of quick installation, providing anesthetic blockade of the sacral fibers and perineal relaxation without interfering in uterine contractility, abdominal press and quality of pushing. In situations where the parturient is already under analgesia by epidural block, with a catheter installed, the infusion of higher doses of anesthetics will be necessary and the time for achieving satisfactory analgesia will be longer.The operative times are sequentially: presentation of the instrument in front of the vulva, introduction and application, gripping of the cephalic pole, assessment of grip, traction test and definitive traction (with or without rotation).The first stage involves presenting the instrument to the vulva, simulating the way it will look after being applied to the fetal head . The grThe biparietal-mentonian is the ideal grip. Three fundamental diagnostic criteria (Laufe’s criteria) are used to check the correct grip: the small fontanel must be a transverse finger width from the plane of the handles (“in the center of the figure”); the sagittal suture must be placed perpendicularly and equidistant from the plane of the handles; the blade fenestrae should not be perceived by more than a finger pad between the grasped head and the forceps on either side . After The traction must be simultaneous to the contractions and performed axially, that is, in the axis of the birth canal, perpendicularly to the presentation stop plane. The operator should be seated at an adequate height with the chest at the same level as the birth canal and the arms flexed just below the table. The force must be exerted only with the arms. To obtain axial traction, the dominant hand positioned on the handles exerts force directed at the operator’s chest. Simultaneously, the other hand positioned on the rods applies downward force against the maternal perineum (Saxtorph-Pajot maneuver) by providing a 45° vector and effective axial traction .45Rotation is performed in the oblique and transverse varieties simultaneously with traction. Rotation with Simpson’s forceps should be performed with a wide movement of the handles in an arc (circumduction). With the Kielland’s forceps, the movement of the handles is performed in a “key through the keyhole” movement and the rotation can be completed before traction . Note tThe removal of forceps branches must precede the complete exit of the fetal head and must be performed as soon as the mandible is accessible. The branches are removed in reverse order of their application . DetachPudendal nerve block may be preferable to neuraxial anesthesia when choosing vacuum extraction. Local anesthetic infiltration is performed bilaterally below the sciatic spines. Unlike forceps blades, vacuum extractor cups do not come into significant contact with the vaginal walls and do not increase the diameter of the cephalic pole.A good grasp should be checked before traction, confirming the absence of maternal tissue between the cup and the fetal head. The manometer should be calibrated to a maximum of 500 mmHg (between 350 and 500 mmHg) during contractions with a reduction to 100 mmHg during uterine relaxation.The operator, seated in front of the delivery table with the chest at the level of the birth canal, must pull perpendicularly to the cup plane until the occiput is positioned below the pubic symphysis. Traction performed during uterine contraction should follow the pelvic curvature (Pajot’s manuver), keeping the traction shank always straight at a 90° angle with the cup. Thus, the pulling hand exerts a perpendicular force to the planes of the cup and the fetal cephalic pole, towards the operator’s chest. Efficient traction is obtained by the imbalance between the hand that pulls and the hand that keeps the cup attached to the fetal cephalic pole, similar to a “tug of war”. This force is opposite and slightly stronger than the force exerted by the hand that keeps the cup attached to the fetal cephalic pole. The cup is kept attached to the fetal cephalic pole by means of a force that is also perpendicular and exerted in a superior direction, in the opposite direction to the traction force with a slightly weaker intensity than this, sufficient to prevent the cup from detaching during the entire action of traction. The superior steering force is exerted by the thumb positioned in the center of the cup. Simultaneously, index and middle fingers are positioned directly on the cephalic pole, thereby contributing to maintain the cup attached to the fetal scalp and17.As soon as the occiput reaches the pubic symphysis, the suction pump and the connecting tube of the vacuum extractor are elevated and the need for episiotomy is assessed. After vulvar exteriorization of the fetal mandible, the cup is removed by pressing the pressure relief valve (vacuum). The extraction of the fetal cephalic pole is completed with the modified Ritgen maneuver.Medium and/or rotational forceps are appropriate options in selected circumstances and require operator skill and experience.In forceps in posterior oblique varieties (ROP and LOP), there are three technical options related to the model, forceps availability, and operator skill and preference. Although rotation to OP requires more skill, it should be preferred whenever possible, avoiding detachment of the cephalic pole in OA. In all application possibilities, the posterior branch must be introduced first. Subsequently, the second (anterior) branch is introduced through the Lachapelle’s maneuver.One option is to rotate 45° in the posterior direction for OA. In this situation, the branches of the forceps are applied with the pelvic curvature of the blades in an anterior direction. Although rotation is not wide, detachment of the cephalic pole occurs in the posterior variety (OA), which requires more vigorous traction and indicates Simpson’s forceps as the preferred instrument. The rotation must be performed in a wide movement of circumduction of the handles.A second strategy for applications in posterior varieties, which has the advantage of avoiding detachment of the occiput against the perineal musculature, is to perform a wide 135° anterior rotation for the OP, followed by a single-grip extraction. This technique requires operator experience and the use of a Kielland’s forceps. Here, the slight pelvic curvature of this forceps allows the blades to be directed downwards at the time of application. Once the 135° of rotation is completed (“key through the keyhole”), the pelvic curvature of the forceps is positioned in the same direction as the maternal pelvic curvature and the cephalic detachment occurs in the OP variety, with no need for a second grip.A third technical option for the posterior varieties, which also has the advantage of cephalic detachment in the OP variety, is to perform the 135° rotation by means of Scanzoni’s maneuver (double grasp) using a Simpson’s forceps. The technique is useful when Kielland’s forceps are not available and/or when there is an operator with dexterity and appreciation of the procedure. The first application is performed with the pelvic curvature of the forceps directed upwards, towards the fetal bregma. After a 135° rotation performed with a wide circumduction movement of the handles, the pelvic curvature of the forceps is directed downwards and the cephalic pole in the OP variety. As Simpson’s forceps blades have a wide pelvic curvature, the instrument must be removed for a second application, and extraction of the cephalic pole with the pelvic curvature of the blades facing downwards is prohibited. The second grip follows the principles for application and detachment of the fully rotated cephalic pole.Among these three techniques in posterior presentations, the 135° rotation with Kielland’s forceps in a single grip is undoubtedly the most advantageous as it promotes detachment in the OP variety, with a reduction in vaginal manipulation and use of force.Kielland’s forceps are the most indicated for application in transverse varieties (right occiput transverse [ROT] and left occiput transverse [LOT]). The option of applying the anterior branch first is advantageous, as it requires a wide Lachapelle maneuver, which can be hampered when one chooses to apply the first branch posteriorly in the pelvis. As this displaces the cephalic pole anteriorly, insertion of the anterior branch by means of the triple spiral movement is made difficult. Thus, the first branch is applied anteriorly, through movements of translation, lowering and twisting of the handle (Lachapelle maneuver - itinerant technique) . The seBecause it has larger branches and ample perineal curvature, Piper’s forceps are the most indicated for impaction of the head (breech baby) . In theIn the later varieties, the branches are introduced over the fetal body and the application takes place in the OA. Traction is exerted forward, with the mandible and fetal neck resting on the superior border of the pubic symphysis. The fetal trunk is then elevated towards the maternal abdomen.The sequential use of forceps and vacuum is associated with increased rates of cerebral, subdural, and subarachnoid hemorrhage in newborns, as well as facial nerve and brachial plexus injuries. Severe perineal lacerations are also more common.Ultrasonography can be used to confirm the diagnosis of the variety of position and height of the cephalic pole, helping to assess the probabilities of success and the risks of operative vaginal delivery. It has also been described in the objective monitoring of rotational applications. The parameters evaluated when determining the position and variety of position are the cerebellum, orbits and midline falx. Ultrasonographic measurements of head circumference, the distance between the perineum and the fetal skull, and the angle of progression are predictive of difficult operative vaginal deliveries. Studies reveal that ultrasound increases the diagnostic accuracy of positional variety with no differences in maternal or neonatal outcomes.Operative vaginal delivery is one of the indications for episiotomy, which must be selective. Current recommendations do not advocate routine episiotomy in operative vaginal delivery given the poor healing and discomfort associated with mediolateral episiotomy, and the risk of injury to the anal sphincter and rectum with median episiotomy.When used in the correct technique, forceps and vacuum extractors have low rates of maternal and neonatal complications.Postpartum analgesia with non-steroidal anti-inflammatory drugs and paracetamol should be routinely performed after assisted birth with forceps or a vacuum extractor.In the evolution of childbirth care, forceps are the resource with the greatest potential to save lives. Although vacuum extractors are more recent, they are also effective devices for assisted birth and offer the advantage of simplifying the operative technique. With adequate knowledge and skill, the cost-effectiveness and safety of instrumental vaginal delivery are favorable and endorse current guideline recommendations for operative vaginal delivery. Despite the obvious advantages, the potential of operative vaginal delivery is currently limited both by ignorance and misuse. The progressive replacement of forceps and vacuum extractors by cesarean section motivated by the lack of preparation of the new generation of obstetricians seems to introduce a real possibility of the disappearance of these instruments from the medical practice of childbirth care. The emergence of new instruments that although less effective, require less technical skill from the operator seems to be a reflection of the current inabilities of obstetricians for operative vaginal delivery. Therefore, training in these important skills must be urgently reconsidered, before this art is lost forever.National Specialized Commission on Obstetric Emergencies of the Brazilian Federation of Gynecology and Obstetrics AssociationsPresident:Álvaro Luiz Lage AlvesMembers:Gabriel Costa OsananSamira El Maerrawi Tebecherane HaddadAdriana Amorim FranciscoAlexandre Massao NozakiBrena Carvalho Pinto de MeloBreno José Acauan FilhoCarla Betina Andreucci PolidoEduardo CordioliFrederico José Amedée PeretGilberto NagahamaLaíses Braga VieiraLucas Barbosa da SilvaMarcelo Guimarães RodriguesRodrigo Dias NunesRoxana Knobel


In recent years, BCT has garnered significant attention from researchers worldwide. The technology in question is a distributed database system characterised by its decentralised nature and lack of reliability. BCT has been widely adopted by numerous governments and scholars across various sectors for a number of years. Blockchain technology also involves highly innovative and advanced concepts. Given the increasing interest among scholars in the academic community regarding the agrifood supply chain, the objective of this study was to investigate BCT and its potential for application in the fields of food and agriculture. This research paper presents a bibliometric analysis of articles on the utilisation of BCT in the fields of food and agriculture. This study discusses scholarly articles that have been published in esteemed academic journals and conferences. Through our bibliometric analysis, we aimed to discern the recurring trends and themes within the research on BCT in relation to agrifood systems. Furthermore, this study examines a diverse array of research domains, prominent scholarly publications, leading publishing platforms, prominent funding institutions, and the prospective trajectory of future research. This study also presents the prominent patterns and themes within this field through an analysis of the most influential scholarly articles, authors, countries, and keywords found in the existing literature. Hence, this research employed various analytical techniques, including analyzing the co-occurrence of author keywords, bibliographic coupling analysis, network view map analysis, and co-citation analysis. This study holds promise as a valuable learning resource for aspiring researchers seeking to acquire compelling and pertinent information about research outcomes from studies on the utilisation of BCT in the field of smart agriculture. With each and every day, managing food supply for the world’s ever-increasing population becomes more and more difficult. Climate change, pests, floods, desertification, droughts, loss of biodiversity, and disease are the primary challenges regarding agricultural food managment. Some of these issues can only be addressed by making improvements to the agricultural processes we already use, which will make farming more appealing to smallholder farmers and hence more lucrative for them .Many of the Sustainable Development Goals (SDGs) may be achieved with the use of information and communication technologies (ICTs). Some of agriculture’s greatest issues have been alleviated by the rapid rise of information and communication technology (ICT). The Internet of Things (IoT), increase access to mobile broadband devices, smart networks, drones, large data processing and analysis tools, and artificial intelligence are just a few of the recent developments that have given those in the agricultural field new tools and technologies to help them improve their production and marketing processes.One of the most appealing use cases for blockchain is in agriculture, where it can help streamline the process of growing and distribuing food. Many current processes may be re-engineered using BCT, including facilitating transactions, identifying food origins, and establishing new interesting markets. In the agricultural value chain, BCT may minimize inefficiencies and save time and energy ,3. ThereThis paper aims to provide a bibliometric analysis of the evolution of state-of-the-art BCT in the agrifood sector from 2014 to 2022. Bibliometric analysis is a quantitative method used to analyze the scholarly literature on a particular topic, including the publication output, citation impact, research themes, and collaboration patterns.This paper seeks to answer the following research questions: What is the current state of research on the development of BCT in the agrifood sector? What are the primary research themes and topics related to the application of BCT in the industry? What are the use cases for BCT in agriculture? What are the challenges and limitations of the blockchain-based applications? What are the open research issues and the areas for future research? What are the field’s most influential publications, authors, journals, and institutions?Overall, this study adds to the body of research on BCT’s use in the agricultural and food industries by conducting a thorough bibliometric analysis of the most recent studies on the issue. The study sheds light on the state of the field, the leading publications, authors, journals, and organizations, and the possible advantages and disadvantages of BCT in the business world. The study’s results may help direct future work on the subject and provide policymakers and industry stakeholders with insight into the potential benefits and drawbacks of incorporating BCT into the agrifood sector.The present research article pertains to the domain of smart agriculture, wherein sensors are deemed to be instrumental in propelling advancements in this field. Precision agriculture, commonly referred to as smart agriculture, is a farming methodology that leverages cutting-edge technology and data-driven strategies to enhance agricultural operations and improve productivity. Sensors play a crucial role in smart agriculture systems by facilitating the acquisition of real-time data pertaining to crop growth, soil conditions, environmental factors, and livestock monitoring.The remainder of this paper is structured as follows: In Finance, healthcare, supply chain management, and the energy sector are just a few of the areas that have been transformed by the rise of BCT. Researchers, decision-makers, and business leaders have all given this distributed ledger technology a lot of attention because of its potential to increase efficiency, security, and transparency across a range of industries. The use of BCT in the agrifood sector has grown in popularity in recent years as academics and industry professionals have come to realise its potential for solving significant problems frequently experienced in the field.The agrifood supply chain must be transparent and traceable in order to guarantee the safety, quality, and authenticity of food products. Tracking the production, processing, and distribution of food items is challenging due to the old centralised systems’ frequent limits regarding the provision of real-time information. Additionally, the current procedures can be vulnerable to dishonest practises such as fraud or the use of false labels, which might jeopardise customer safety.A decentralised, immutable ledger made possible by blockchain technology allows for the safe, open recording of transactions and data. BCT offers a tamper-resistant and auditable record of all operations throughout the supply chain by using cryptographic methods and consensus procedures. Any and all activity, including the transfer of commodities, changes in ownership, and quality control checks, is documented in a block, resulting in an unbreakable chain of data.The potential advantages of using BCT in the agrifood industry have been noted in a number of studies. For instance,  performeFurthermore, Ref.  examinedAlthough the potential advantages of BCT in the agrifood industry are encouraging, it is crucial to have a thorough awareness of the current research environment. A biblimetic analysis may assist in identifying the unresolved questions, themes, and problems associated with BCT’s use in agriculture. This study intends to add to the existing body of research in the literature by offering insights into the development of BCT research in the agrifood industry from 2014 to 2022 by presenting a bibliometric analysis.Crop management, supply chain traceability, quality assurance, and sustainability are a few of the well-known study areas that were considered in our analysis. In this study, the worldwide cooperation and information diffusion in this field is highlighted through the identification of significant academic publications, authors, and nations. The study also presents the publications that are mentioned the most and highlights the significant contributions that have influenced the growth of BCT applications in agriculture and future research directions.This study will inform readers about the present status of BCT in the agrifood industry by synthesising the available literature and identifying research trends. The results will be helpful for academics, decision-makers, and business professionals who want to use BCT to solve difficult problems in the agrifood sector.Firstly, a search was conducted across bibliographic databases that use search terms or keywords. Throughout the course of our investigation, we consulted a number of different scientific databases. These included ACM, IEEE Xplore, PubMed, the Web of Science, and Scopus. Due to the fact that this research topic is still relatively novel, the literature search was carried out without taking time constraints into consideration. As a consequence of this, every piece of information that was found in this field was considered relevant to our investigation, irrespective of the amount of time it took to find.The articles that had been retrieved from the databases in line with our search strategy were subsequently subjected to a filtering process to determine whether or not they were pertinent to the topic at hand. The very first stage of this processing procedure consisted of examining the titles of the papers to determine whether or not they were relevant to our analysis. Any articles that had been retrieved but whose titles made it abundantly clear that they were not pertinent to our study were dismissed. Some of the articles that our search protocol found did not have anything to do with the use of BCT in the agricultural industry; hence, we did not consider such articles to be relevant to our analysis and removed them from consideration. In cases where the relevance of an article could not be determined based on its title, the article was moved on to the subsequent phase for further screening. The second stage of the screening procedure consisted of reviewing the abstracts of the papers that had successfully passed the first stage of the screening process. When determining whether or not a paper met our criteria for exclusion, it was sometimes necessary to read not only the beginning but also the end of the paper.The following publications were not considered: (1) papers that have not been subjected to a peer review process, such as interview sessions and media news releases; (2) articles wherein the complete text has not been made wholly accessibile; (3) documents not mainly focusing on the use of BCT in agribusiness; (4) redundant documents; (5) articles not published in English; and (6) articles that have been withdrawn from publication. Papers that did not meet these exclusion criteria were considered mostly focused on the application of BCT in agriculture and moved on to the subsequent stage of the screening process.This step organized relevant material into logical groupings. The process involves collecting keywords and concepts from article abstracts that reflect the publications’ area contributions. Keywords grouped the papers. Each document was checked to determine whether it belonged to a different category after categorizing them. The categories were changed if the document was deemed more suitable for a different category. When a paper did not match any existing category, a new one was created. Consequently, related articles were mapped into many categories.This section presents the results of our bibliometric analysis. Our search strategy extracted 465 scientific database documents. After the title screening, 192 items were eliminated. A total of 273 articles required further screening. Our search protocol uncovered publications that mentioned agriculture as a non-financial use case of blockchain technology. Combining the 273 Mendeley articles removed duplicates, reducing the selected papers to 173. We subsequently reviewed the abstracts, introductions, and conclusions of the selected articles to evaluate whether they met the aforementioned criteria for further screening. Hence, 130 articles were considered. Twelve additional non-agricultural articles were deleted after reading all of the selected items. These papers only partially mentioned the potential application of BCT in agriculture and did not provide any new ideas or concepts. After filtering, we were left with a total of 118 articles.Although our search methodology did not include a time constraint, all of the articles selected were published after the year 2018. As shown in In addition, the journals of the articles that were evaluated are shown in Researchers who have restricted access to research funds, such as those working at less well-funded institutions, those living in developing countries, and less-experienced academics, are encouraged to begin new studies with the help of a research fund. There are several agencies and organizations all over the world that provide financial support for research. It is possible to describe scientific cooperation as the connection that occurs within a social context among two or more scientists to allow for the exchange of ideas and the completing tasks to achieve a mutually agreed-upon aim. Examining co-authorship in scientific and technology partnerships can elucidate the patterns of collaboration between people and organizations. A formal declaration of the participation of two or more authors or organizations in a technical document is made when a technical document is co-authored. Despite the ongoing controversy about the meaning and interpretation of co-authorship analysis, it is still commonly employed to investigate and evaluate patterns of scientific cooperation in the field of a given research topic. Co-authorship networks are nodes that represent authors, organizations, or nations that are linked together because they are co-authors responsible for the creation of a single publication. n = 19) is selected as a starting point. The size of a node is determined by the number of times a keyword appears. With co-occurrences represented by lines connecting nodes, the distance between nodes shows how closely the terms are connected to one another.Using direct citation and co-citation analyses, citation analysis may be displayed as a network analysis to investigate the link between publications in a given time period. This can help to discover prolific publications and assist in analyzing the effect of an article. Various citation analysis software packages such as HistCite, Pajek, Gephi, and VOS viewer are available for download. Apart from Pajek, which is limited to “Net” format output, HistCite is only compatible with Web of Science output, and Gephi necessitates the use of a third-party programme for file preparation. As a result, we chose to utilize VOS viewer since it does not need any preparation and has been extensively used in network research for many years. For our analysis, we used of the lens.org dataset.Direct citation analysis is a statistical study that indicates how many times an article has been mentioned in other papers. In addition to “documents”, “author”, and “source”, VOS viewer includes a variety of other units of analysis. In order to facilitate citation network analysis, we chose “documents” from the database as a unit of analysis. It is clear from One of the oldest citation analysis approaches for document similarity measurement is known as ‘Bibliographic Coupling’. M.M. Kessler of the Massachusetts Institute of Technology was the first to propose this notion in 1963. When two papers contain similar references, they are considered bibliographically connected. In other words, bibliographic coupling occurs when mutually cited references can be identified in their bibliographies. The coupling intensity is considered to be stronger when the two-referencing works have more citations in common than not. This connection also impacts the degree to which the two works are comparable in terms of subject matter. Bibliographic coupling is equally beneficial since it assists researchers in locating previous research that is relevant to their current research. VOS Viewer tool is widely used to analyze bibliographic coupling networks. It is capable of supporting three different kinds of bibliographic coupling networks, the first of which uses “documents” as the unit of analysis, the second uses “sources” as the unit of analysis, and the third uses “author” as the unit of analysis. Our analysis of the aforementioned bibliographic connection network is shown in As each article addresses one or more blockchain use cases in agriculture, we decided to categorize them by use case. In today’s world, technology can help revolutionize and create new perspectives on farm management. Various state-of-the-art technologies can be used to create smart and intelligent farms. Sensor-based techniques can be used in combination with IoT devices to forecast weather conditions among other things . Storing agricultural data digitally using sensors, offers stakeholders and farmers convenient access to information for various purposes. By implementing blockchain technology, sensor networks can be managed more efficiently and effectively ,10. AddiLand registration is a process of defining a system in which the respective ownership, value, use, and all rights related to that property are explained in a proper way. Currently, the system used for land registry has lots of restrictions. It is impossible to completely authenticate and verify transactions between the land owner and a person or organization ,12. All Food safety is an important factor in managing the quality of food. Obviously, food is a vital resource and is crucial to human health. Therefore, we should concentrate on the environment used to manage and store food products. Additionally, food contamination can cause illnesses. Blockchain technology could become help in providing solutions to these issues. With the help of blockchain technology, improved food traceability could be achieved ,16,17. BA supply chain describes the network in which the movement of products from farm to consumer is managed. In the current system, the product keeps moving down the chain for a long time, and it is not easy to track the supply chain. However, with the implementation of blockchain technology, this problem can be solved, and consumers can trace the quality of the products ,19. ThisBasically, food security can be defined as ensuring that every individual has social, physical, and convenient access to healthy food at any time. This includes maintaining the nutritional value of the food and monitoring pesticide levels in crops. Blockchain technology offers a solution to address these challenges ,22. By uWhat is the current state of research on the development of BCT in the agrifood industry?Increased interest in BCT and an improved understanding of its potential applications the agrifood sector can be seen in the existing literature. Researchers and industry professionals have explored the use of BCT in a number of business-related areas, including supply chain management, traceability, quality control, and smart contracts. As previously stated in the present study, BCT has the ability to improve security, efficiency, and transparency in the agrifood industry by tackling problems regarding food fraud, supply chain opacity, and consumer trust issues.2.What are the use cases for Blockchain in agriculture?This study found a variety of applications for blockchain in agriculture. Some noteworthy use cases include the following:1. Supply chain transparency and traceability: Blockchain technology may be utilised to increase transparency and traceability across the agricultural supply chain. Stakeholders may confirm the source, procedures of production, quality, and management of agricultural products by documenting all transactions and the movement of items on the blockchain. 2. Certification and authentication: Using blockchain, it is possible to produce tamper-proof records of certifications and authentications pertaining to sustainable development, fair trade, organic agricultural practises, and other quality requirements. 3. Smart contracts for fair trade: Automated, secure, and transparent agreements between farmers and buyers can be made possible by blockchain-based smart contracts. These agreements may guarantee honest pricing, fast payments, and effective trade transactions, therefore lowering reliance on middlemen and enhancing farmers’ quality of life.4. Land and crop ownership: A decentralised, immutable ledger for tracking land ownership and crop management rights may be provided via blockchain. This may assist in preventing land conflicts, enabling open business dealings, and improving farmers’ access to loans and insurance.5. Agricultural insurance: By automating verification claims and safely preserving policy information, blockchain technology can help expedite the agricultural insurance process. Blockchain’s decentralised structure guarantees transparency, lowers fraud, and expedites the claim settlement process.6. Decentralised marketplaces: By cutting out middlemen and reducing expenses, blockchain-based marketplaces may link farmers with customers directly. These markets promote fair trade and give farmers more control by enabling transparent pricing, direct feedback, and safe transactions.7. Data management and sharing: Agricultural data, such as weather patterns, soil quality, and crop yields, may be safely stored and shared using blockchain technology. This facilitates data-based decision making, improves research cooperation, and encourages agricultural innovation.3.What are the primary research themes and topics related to the application of BCT in the agrifood industry?The primary research themes and areas of study surrounding the use of BCT in the agricultural and food sectors are as follows: A key theme is supply chain traceability. Much of the research we found concentrated on using BCT to enhance the traceability of agricultural goods, allowing for the precise monitoring of a product’s origin, manufacturing methods, and distribution. This subject seeks to increase accountability and decrease fraud in supply chains. Another key theme is quality control and certification. BCT has been proposed as a way to enhance the agrifood sector’s quality control procedures. Researchers want to use BCT to create an unchangeable record of certifications, audits, and quality control data, ensuring the safety and integrity of food items and fostering trust amongst sellers and customers.4.What are the challenges and limitations of the blockchain-based applications?The following are some problems and limitations with blockchain-based applications in agriculture: (a) Scalability: BCT systems often struggle with scaling, particularly when dealing with the many transactions and data points that are present in the agricultural supply chain. (b) Interoperability: It may be challenging to integrate blockchain technology with current systems and databases, necessitating the use of interoperability standards and protocols.5.What are the open research issues and the areas for future research?Open research questions and future research directions regarding the incorporation of BCT into the agrifood sector include the following:(a) Governance models: Investigating governance models and frameworks for BCT implementation in the agricultural sector to address concerns related to decision-making processes, consensus procedures, and regulatory compliance.(b) Sustainability and environmental impact: Analysing the possible environmental implications of applying BCT to agriculture and looking for strategies to lessen any unfavourable outcomes.(c) User adoption and acceptance: Recognising the elements that may affect how stakeholders in the agricultural and food industries accept and embrace blockchain-based solutions.(d) Integration with emerging technologies: Investigating how BCT may be integrated with other cutting-edge technologies, such as the Internet of Things (IoT) and Artificial Intelligence (AI), to improve the efficacy and efficiency of agricultural systems.(e) Economic and social implications: Analysing the economic and social ramifications of BCT implementation in the agricultural sector, including its impact on small-scale farmers, market dynamics, and overall industry sustainability.This study presented an in-depth bibliometric study on the development and use of BCT in the agrifood sector. This study discussed the present state of research, key research issues, use cases, obstacles, and future research objectives in this subject by analysing a broad variety of academic publications published between 2014 and 2022. The results of this study demonstrate how researchers are becoming more interested in examining the possibility of incorporating BCT into the agrifood supply chain. BCT has established itself as a highly unique idea, drawing the interest of academics and professionals from a variety of fields. The use of BCT in agriculture presents several prospects for enhancing supply chain efficiency, traceability, and transparency. There are a number of important applications for BCT in the agrifood industry, including those associated with supply chain transparency and traceability, certification and authentication, smart contracts for fair trade, the ownership of land and crops, agricultural insurance, decentralised marketplaces, and data management and sharing. These potential use cases show how BCT has the capacity to solve major problems in the industry and transform the market. However, the use of BCT in agriculture also has drawbacks and difficulties. Interoperability and scalability are crucial topics that require further study. To maximise the advantages of BCT and ensure its successful integration into agricultural systems, it is essential to overcome these difficulties. Future research should examine governance frameworks for BCT deployment, evaluate BCT’s sustainability and environmental effect in agriculture, comprehend user uptake and acceptability, and combine BCT with cutting-edge technologies like IoT and AI. These avenues for study will help us to better comprehend BCT’s potential in the agricultural and food sectors. Overall, this study presents insightful information on the current status of BCT usage in agriculture and offers recommendations for policymakers, industry stakeholders, and academics who are interested in using BCT to solve issues and seize opportunities in the agrifood sector. We believe a more open, effective, and sustainable agricultural landscape can be created by adopting BCT and furthering research in this area.


Hospital Infection Prevention and Control Teams (IPCTs) provide clinical cover during weekdays with on call support at weekends. We report the results of a 6-month pilot of extending infection prevention and control nursing (IPCN) clinical cover to weekends at one National Health Service trust in the United Kingdom.We examined daily episodes of infection prevention and control (IPC) clinical advice given before and during the pilot of extended IPCN to weekends. Stakeholders rated the value, impact, and their awareness of the new extended IPCN cover.Episodes of clinical advice given were more evenly distributed across the weeks during the pilot. Advantages for infection management, patient flow, and clinical workload were seen.IPCN clinical cover at weekends is feasible and valued by stakeholders. The UK National Health Service (NHS) is working toward providing a 7-day clinical service as part of the Department of Health’s Sustainability and Transformation plan . Seven-dIn the UK, Infection Prevention and Control Teams (IPCTs) comprising medical and nursing personnel provide infection prevention and control cover during weekdays, with on call medical cover at weekends. Reduced infection prevention and control nursing (IPCN) cover at weekends may increase the length of stay a patient may have in isolation and increase hospital stay, adversely affecting patient flow through to discharge home. For example, patients who could be accommodated in a multi-bed bay may be held in the Emergency Department waiting for a single room, or patients may continue to occupy single rooms who no longer need to be isolated. Delays in appropriate isolation could lead to secondary and cross infection, although to date, for many organisms there is limited evidence to support this. Expanding IPCN clinical services over 7 days may help to avoid such problems .In August 2016, in response to the Department of Health’s plan to improve quality of care for patients and efficiency of services , IPCN seThe feasibility and acceptability of extending IPCN provision to weekends were not known. We conducted a feasibility and acceptability study of extending IPCN to weekends across one NHS Trust. The aims were to a) examine the feasibility and acceptability of extending IPCN cover to weekends and b) to determine the impact of weekend IPCN on work load during the week.We sent a short self-completion questionnaire with six impact statements to key infection prevention and control (IPC) stakeholder groups within the Trust. Stakeholder groups comprised the Trust’s infection prevention and control team, that is, consultants, nurses, and doctors in training, bed and facility managers, cleaning services, and site nurse practitioners.Stakeholders were asked about their awareness of the extended IPCN service to weekends, and the perceived value of the extended service. Stakeholders were also asked to score statements about a) the quality and safety of patient care resulting from the extended service; and b) flow of patients from isolation to the ward and vice versa. Scores were from 0 to 100 on a continuous scale, where 0 was the lowest score and 100 was the highest. Stakeholders were also asked to add free text comments about the weekend IPCN service.https://www.surveymonkey.com/). A link to the survey was emailed to stakeholder groups. We sent one email reminder to all groups. The survey was anonymous, and all responses were recorded in Microsoft Excel. Free text responses were examined for content. Scores were aggregated for each impact statement and presented as scores out of 100. The study was approved as a service evaluation by the Trust.The survey was created in In addition to the survey, we extracted routine IPC workload data from the Trust’s IPC database . Episodes of infection prevention advice given by a member of the IPC team are recorded daily in free text with the date and time of each episode. This information is linked to patient records. Two authors (NW and LM) extracted the date, time, and number of individual episodes of clinical advice given per day before the IPCN weekend cover started, that is, from 04/01/2016 to 12/07/2016; and during the pilot, that is, from 13/07/2016 to 11/11/2016. The mean number of advice episodes per day before and during the pilot was calculated.Thirty stakeholders across different groups responded to the survey. Stakeholders’ awareness of the weekend service and the value of the service was scored very highly. The impact of the service on quality, safety, and patient flow also scored highly .Table 1.Nineteen of the thirty respondents commented on the IPCN weekend service. Overall, responses were very positive. Extending IPCN cover to weekends was feasible and acceptable to stakeholders. Themes to emerge from the free text comments were: additional support for decision making, better resource management, patient movement, workflow, and understanding of IPC workload.‘….Found having advice and support for infection prevention and control decision making extremely useful at weekends, some decisions/discussion would have in the past had to wait until Monday’.Stakeholders reported that patient flow from isolation had improved and that the extended IPCN provision to weekends had impacted positively on bed management especially during infection outbreaks. Stakeholders felt that clarification of diagnosis was timelier and that the availability of advice and support during weekends helped to improve the management of patients with infections as expressed by this stakeholder.‘Huge help to the learning, understanding and workload of infection trainees at the weekend’.IPC workflow during weekends was thought to have improved, and some stakeholders felt they had a greater understanding of the workload associated with infection prevention at weekends.There was overall agreement among stakeholders that the weekend IPCN service continue.Data extracted from the IPC database demonstrated that during the 6 months before the pilot, episodes of infection prevention and control advice were distributed less evenly during the week  with an During the pilot, the mean number of episodes of advice per day was more evenly distributed across the week with an average of five more episodes of advice given on Mondays.We found the introduction of weekend IPCN cover at one NHS Trust was feasible to implement and very highly valued by stakeholders. There were perceived advantages for infection management, patient flow, and bed management at weekends. The IPC workload balance over the week improved, and there was overall agreement among stakeholders that the service continue.Through this pilot, multidisciplinary IPC personnel and other hospital management stakeholders could consider the acceptability, value, and impact of the weekend IPCN cover on the management of patients with infections. Continuation of this service is informed by stakeholder feedback. This study has established a baseline for future IPCN service evaluations within the Trust.Although we gathered stakeholder’s experiences of the IPCN weekend service, patient experiences are not represented. Improvements to delayed discharge or impacts on nursing staff training and continuing professional development were not examined. These factors should be included in any future service evaluation. Furthermore, these results are limited to one acute NHS teaching hospital Trust but could be broadly applicable to other trusts with similar IPC nursing and medical team structures. For the survey, groups of stakeholders rather than individual stakeholders were emailed to protect the anonymity of Trust personnel; therefore, the survey results are presented as aggregate scores rather than separated by professional or stakeholder groups.During the pilot, the mean number of episodes of advice per day from Tuesday to Friday was 25; the mean number of episodes per day on Mondays was 30. The extra five episodes per day is equal to approximately 1 hour of IPCN time. This small residual ‘Monday effect’ is likely to be attributable to patterns of working, for example, the timing of microbiological specimen collection and laboratory processing and/or deferral of clinical decision making to Monday for wider consultation. It is clear from the findings that IPCN workload was more evenly distributed during the weekdays of the pilot. Therefore, the reduction in the numbers of episodes of advice given on Mondays represents a shift to giving IPC advice during weekends.It should be noted that individual patient advice is just one aspect of the role of an IPCN and does not capture other reactive or proactive activities. Episodes of advice were recorded as an indication of workload; however, this is not a complete picture of IPC workload, for example, attending clinical meetings, ward rounds, clinical and environmental audits, meetings with estates and facilities teams, finance, and human resources are not represented.Seven-day working has been piloted and introduced in other clinical settings in the UK , for exaThe introduction of infection prevention and control nursing at weekends is feasible, improves workload distribution over the week, and is greatly valued by stakeholders.