The application of structural health monitoring (SHM) systems to civil engineering structures has been a developing studied and practiced topic, that has allowed for a better understanding of structures’ conditions and increasingly lead to a more cost-effective management of those infrastructures. In this field, the use of fiber optic sensors has been studied, discussed and practiced with encouraging results. The possibility of understanding and monitor the distributed behavior of extensive stretches of critical structures it’s an enormous advantage that distributed fiber optic sensing provides to SHM systems. In the past decade, several R & D studies have been performed with the goal of improving the knowledge and developing new techniques associated with the application of distributed optical fiber sensors (DOFS) in order to widen the range of applications of these sensors and also to obtain more correct and reliable data. This paper presents, after a brief introduction to the theoretical background of DOFS, the latest developments related with the improvement of these products by presenting a wide range of laboratory experiments as well as an extended review of their diverse applications in civil engineering structures. The highway and railway transportation systems are considered to be some of society’s critical foundations. In this complex system, bridges and viaducts assume an important role because of their distinct function of joining these networks as their crucial nodes. They face continuously increasing traffic volumes and heavier truck and rail-loads, which degrade the long-term performance of these structures. In the United States alone, over 11% of the nation’s 607,380 bridges are deemed structurally deficient and the cost to repair these deficient bridges is estimated to be $76 billion . The control and monitoring of the aging process of civil engineering structures is of extreme importance for their quality and safety. Furthermore, there are different external events that can damage a structure. Damage can be defined as alterations that when introduced into a system will have an adverse effect in its current or future performance . The proThe act of damage identification has been around probably, in a qualitative manner, since man started to using tools . NotwithCurrently, assessment of buildings, bridges, dams, tunnels and other vital civil engineering infrastructures are carried out by engineers trained in visual inspection, which sometimes can be inaccurate due to differences in their background for safety condition assessment. In order to improve the inspection accuracy and efficiency, optical fiber sensors (OFS) are one of the fastest growing and most promising researched areas, due to their features of durability, stability, small size and insensitivity to external electromagnetic perturbations, which makes them ideal for the long-term health assessment of built environment .etc. Nevertheless, all of them present genuine challenges when deployed in real world applications [Furthermore, the most regularly practiced SHM approaches are based on electric strain sensors, accelerometers, inclinometers, GNSS-based sensors, acoustic emission, wave propagation, ications . Differeications .Standard monitoring practice is normally based on the choice of a limited and relatively small number of points that are supposed to be illustrative of the structural behavior . For a lThe thousands of sensing points that the DOFS provides enables mapping of strain distributions in two or even three dimensions. Thus, real measurements can be used to reveal the global behavior of a structure rather than extrapolation from a few point measurements. A truly distributed optical sensor is expected to measure temperature, strain and vibration data at any point along an entire fiber through light scattering. The great challenge has been to develop these sensors in a way that they can achieve appropriate sensitivity and spatial resolution . FortunaSeveral general state of the art papers of FOS have been published ,17,18,19The first reference of fiber optic sensors relates to the flexible endoscopes developed in the first half of the twentieth century. With it came a revolution in the medicine field that continues to the present day . HoweverThe fiber optic communications industry has literally revolutionized the telecommunications industry by providing higher-performance, more reliable telecommunication links with ever-decreasing bandwidth cost. As component prices have fallen and quality improvements have been made, the capability of fiber optic sensors to replace the more traditional electric sensors has been improved .There are many inherent advantages related to the application of fiber optic sensors. Among these, it’s possible to highlight their resistance to electromagnetic interference, their light weight, small size, high sensitivity, high-temperature performance, immunity to corrosion and large bandwidth.Initial introduction of this technology into the markets that were directly competing with conventional sensor technology in the last two decades of the past century was relatively slow. This was largely related to the high cost of suitable components. However, this situation has since changed and the projections for the future are tremendously optimistic as can be seen in With the development of each new successful fiber optic product, the cost for existing and newly introduced components continues to drop. By the year 2020 there are many areas where is expected to occur a rapid growth of fiber optics sensors applications. From medical instrumentation, aerospace and industrial applications to structural health monitoring and damage assessment systems in civil structures, the ever-increasing capabilities and lower costs of this technology make it very attractive to end users .Fiber optic sensor based monitoring methods are highly welcome for non-destructive assessment of all types of engineering structures mainly because of the following reasons: they can’t be destroyed by lightning strikes, can survive in chemically aggressive environments, they can be integrated into very tight areas of structural components, and finally are able to form sensor chains using a single fiber .In a simple way, an optical fiber is a cylindrical symmetric structure that is composed by a central “core” with a diameter between 4 and 600 µm and a uniform refractive index . It’s thSince the optical fiber is a physical medium it is constantly exposed to external perturbations. In this way, it experiences geometrical and optical changes due to those same perturbations. For communication applications it is preferred to minimize these effects in order to provide a reliable signal transmission and reception. However, in fiber optic sensing, the response to these external induced effects is intentionally enhanced . This chi.e., modulation and demodulation process, application, measurement points, etc. [In turn, each of these classes of fibers has various subclasses, and even in some cases, sub-subclasses that consist of a large number of fiber sensors. There are different ways to classify optical fiber sensors (OFS) depending of which property is being considered, ts, etc. . Howeverts, etc.   share the same advantages of other OFS. However, they offer the possibility of monitoring variations of one-dimensional structural physical fields along the entire optical fiber in a truly distributed way. Furthermore, an additional benefit regarding distributed sensing is that it only requires a single connection cable in order to communicate the acquired data to the reading unit in opposite of the large number of otherwise required connecting cables when using discrete sensors. This characteristic makes DOFS more cost-effective and at the same time opens a wide range of important applications such as the continuous (in space and time) monitoring of large civil engineering structures.It should be noted, that distributed sensing can, in a sense, also be achieved through the use of quasi-distributed FBG sensors. In addition, this has been the most popular optic fiber technique for spatial continuous measurements, since 2/3 of the SHM projects which includes fiber sensors, have opted for quasi-distributed FBG . HoweverWith DOFS technology, the fibers are bonded to the surface or embedded inside the material . When stScattering is at the origin of truly distributed fiber optic sensors (DOFS) and it can be defined, in a simple way, as the interaction between the light and an optical medium. Three different scattering processes may occur in a DOFS, namely: Raman, Brillouin and Rayleigh scattering .When an electromagnetic wave is launched into an optical fiber, its propagation through the medium interacts with the constituent atoms and molecules and the electric field induces a time dependent polarization dipole. This induced dipole generates a secondary electromagnetic wave and this is called light scattering . When thRaman scattering is greatly dependent of the temperature of the fiber which has been explored in order to instrument very successful techniques with various applications in different areas ,40,41 buIn a similar way, Brillouin scattering is intrinsically dependent on the fiber density, which in its turn is related with temperature and strain being in this way exploited in Brillouin based DOFS ,46,47,48On the other hand, Rayleigh scattering, as a quasi-elastic or linear phenomenon, is by itself independent of almost any external physical field. In fact, in Rayleigh-based DOFSs the scattering is used to measure propagation effects, which can include attenuation and gain, phase interference and polarization variation. It’s worth mentioning that Raman and Brillouin scattering are also influenced by these propagation effects but since they present a direct relation to the measured parameters, these effects are usually neglected.Distributed fiber optic sensors can depend on different techniques and principles. For different SHM applications, different DOFSs sensors can be developed and so different techniques are applied. In the next subsections, the most important techniques related to the scope of this document are described.Truly or intrinsic distributed sensing techniques emerged at the beginning of the 1980s when a technique called Optical Time-Domain Reflectometer (OTDR) was created for testing optical cables in the telecommunications industry. In OTDR technique, a short optical pulse is launched into the fiber and then a photo detector processes the amount of light being backscattered as the beam propagates along the fiber. In this process, loss occurs due to the Rayleigh scattering that is a result of the microscopic and random variations of the fiber core refractive index as mentioned before. By monitoring the variations of the intensity of the Rayleigh backscattered signal, the spatial variations in the fiber scattering coefficient are detected or, as it’s more commonly called, attenuation . If the The spatial resolution of an OTDR instrument is the smallest distance between two scatters that can be resolved. For For a OTDR instrument with a pulse width of 10 ns, a current fiber refractive index of irements .As mentioned before, Raman and Brillouin scattering have been also used for distributing sensing applications. OTDR based on Raman scattering was developed to sense the ambient temperature during the 1980s.As mentioned above, Brillouin scattering occurs from acoustic vibrations stimulated in the optical fiber . These vOn the other hand, Brillouin optical time domain analysis BOTDA, , is baseA coherent detection technique is necessary to detect the usually very weak counterpropagating Brillouin scattering signal . In thisThe first early works on Brillouin-based DOFS were focused on temperature sensors. Among those works, ,44,53 caBOTDR is normally capable of long-distance distributed sensing with a sensitivity of 5 µε, which is suited for large-scale applications of structural and geotechnical monitoring . HoweverThe goal of short spatial resolutions of millimeter scale and cost effective distributed fiber sensors has increased interest in Optical Frequency Domain Reflectometry (OFDR) systems ,62,63. IRayleigh scattering originates from the interaction between the electromagnetic wave propagating in the fiber core and silica impurities . In a siInstead of reading the intensity of the Rayleigh backscattered signal, OFDR measures the interference fringes of the Rayleigh scattered light from a tunable laser source and a static reference fiber in frequency domain. By means of the inverse Fourier transformation, the amplitude and phase in frequency domain are converted to the time/spatial domain .Froggatt and Moore described the random fluctuation of the index of refraction that causes Rayleigh scattering as an equivalent FBG . From thBy scanning the frequency with the OFDR technique the spectral response of each equivalent FBG is obtained and in this way, strain and temperature variations with high spatial resolution. This resolution . ,70. 69,7kscatter .Notwithstanding, the OBR technique, with its high spatial resolution, even if limited to some hundred meters, addresses some applications that aren’t easily covered either by Brillouin- or by Raman-based DOFSs .A review of the performance of the discussed distributed sensing techniques as reported by different research studies is presented below in As already mentioned, Brillouin-based DOFSs are currently the most studied and applied measuring systems in civil structure SHM. This is due to their extended measurement range potential that makes them very useful for application on large structures, such as dams, pipelines, tunnels and long span bridges. Notwithstanding, some applications require a better spatial resolution than that provided by these sensors. The BOTDA sensing technique, through the application of advanced and complex algorithms, can address this point but in the process increases the price of this technology. The OBR technique (Rayleigh OFDR) offers a more cost-effective way of achieving high spatial resolution at the cost of limiting, nonetheless, the sensing range to about 70 m. The great majority of photonic sensing technology applied in the civil engineering area is constituted by discrete sensors such as FBG. This topic has been extensively discussed in different publications in the past decades ,80,81,82Nowadays, DOFS sensors are an attractive technology that offers superior performance and advantages when compared with more conventional sensors applied in SHM practice. Despite their apparently high cost, they are ideal for applications where reliability in challenging environments is essential. Furthermore, they offer lower installation and maintenance costs.However, this is still a recent and developing technology as it can be perceived by the relatively few number of DOFS applications in SHM projects. Notwithstanding, some different DOFSs applications were made in the last two decades in different civil engineering structures such as bridges, dams, tunnels, pipelines and slopes that are presented below. Also, a great amount of work has been done, and discussed below, with the goal of improving these sensors’ capabilities by executing different laboratory experiments.et al., for example, performed a strain measurement of a 1.65 m reinforced concrete beam with a Brillouin scatter-based DOFS where two different installation methods were analyzed: fiber embedded in glass fiber reinforced polymer—GFRP—rods and fiber bonded to steel reinforcing bars [et al. performed a series of axial tension tests on steel plates using polyimide and nylon-coated sensing cables [In order to assure the proper operation of DOFS, one of the most important aspects to consider is the correct transfer of the measurands from the monitored structure to the sensor. Zeng ing bars . Both meg cables . Overallet al. tested through a series of experiments the implementation of an OBR interrogation unit paired with fiber optic sensors in rebars with the goal of obtaining strain measurements in reinforced concrete structures made of Ultra High Performance Fiber Reinforced Concrete as seen in Furthermore, sometimes, the DOFS protection can interfere in the collection of correct strain measurements. In order to overcome, or at least reduce these problems, and in this way effectively measure the strain of a RC structure after cracking, Quiertant i.e., an FO bonded on the rebar surface or mounted into a groove, the geometry of the groove and finally the typology of the used optical fiber . It was then found that a fiber optic sensor with a polyimide coating embedded in a groove cut along the rebar presented the best results.The tested parameters of these experiments were the chosen method for the installation of the optical fiber, et al. studied the possibility of enhancing the spatial and strain resolutions of distributed BOTDA sensors in order to overcome this issue [As already mentioned, one of the most sought-out applications for DOFS is the crack detection in RC structures. However, one of the limitations of Brillouin-based DOFS is related to the fact that very significant strain changes that occur over lengths shorter than one-half of the spatial resolution are not detected and measured, making the application of this technology to crack detection very difficult. Deif is issue . A multiGlisic and Inaudi also evaluated the performance of the application of an advanced algorithm that was developed to avoid this limitation through several laboratory tests where the distributed temperature and strain monitoring system was based on the changes in Brillouin frequency . For theFurthermore, these authors, taking into account the risk of optical fiber breakage when the stress generated by the crack is very high and the fact that this developed algorithm was only suitable if local stress was redistributed over a minimum length of 10 cm, decided to create, at the location of the crack, a mechanism of sensor delamination to ensure that the system would continue to perform even for high strain levels. For this, they paid special attention to the selected adhesive.This delamination mechanism and selected adhesive were then tested in laboratory with the use of a specific set-up where the DOFS was glued to metallic supports that were given a relative translation movement with the objective of simulating a 0.5 mm crack opening. The obtained test results proved the delamination mechanism and confirmed the good selection of the adhesive and the performed installation procedures. This demonstrated the capability of the system in detecting and localizing cracks with openings smaller than 0.5 mm. This system was later tested on a pipeline  and implet al. investigated the development of a health monitoring system  beams with OBR sensors in order to detect induced shear cracks. This is of extreme relevance since that contrary to what happens with bending cracking, where the cracks appear orthogonally to the beam axis, in the case of shear action, the inclination of the cracking pattern is previously unknown and may even change depending on the prestressing force and the location along the element . For thiThese results showed good agreement with the visualized cracks and were obtained without requiring prior knowledge of the cracked zone and consequently proved the feasibility of this methodology.et al. conducted laboratory experiments where a concrete slab was instrumented with Raman-, Brillouin- and Rayleigh-based DOFS in order to obtain strain measurements (the Raman sensor was used for temperature compensation). BOTDR sensor results were limited by their poor accuracy  while OBR sensors provided very promising results [Henault  results . However2 rectangular cross section that was subjected to a four-point bending test through the utilization of different Rayleigh scattering-based DOFS  that were paired with Vibrating Wire Gauges (VWG) sensors as seen in The same research group also monitored a 3.4 m long reinforced concrete beam with a 0.25 × 0.5 mThe test was divided in two phases. In the first one, the applied load level was below the concrete tensile resistance in order to check the performance of the different applied sensing systems. One interesting conclusion obtained from this part of the test was the much reduced influence of the location of sensors for strain measurement since the results obtained for the embedded (both close and far from the rebar) and the external bonded sensors presented a relatively good agreement both in compression and in tension, as seen in In the second phase, the incipient cracks were induced in order to assess the capability of the used DOFS sensors in detecting their location. Despite the fact that the RC specimen was severely damaged at high-load levels, the optical fiber cables didn’t present any tensile rupture. As seen in The same investigation group developed an algorithm to automatically analyze crack evolution in RC elements . This pret al. reported high precision measurements with OBR system over a two kilometer extension [One of the referred limitations of Rayleigh-OFDR-based sensing it’s the relatively short sensing range in order to obtain high spatial resolution measurements. However, Gifford xtension . The samThis research group also performed another general test in order to validate the applicability of Rayleigh-OFDR sensors for temperature sensing . This exThe results, as shown in et al. [et al. compared the strain measurements of Fiber Bragg Gratings, and OBR-based distributed optical fiber and conventional electrical strain gauges sensors [Rayleigh backscatter-based DOFS were also reported in an application where localized heating was measured with millimeter spatial resolution . Anotheret al.  in a nuc sensors . The twoThe fiber optics sensors proved to effectively measure strain and correspondent cracks induced during the test as seen in et al. tested the feasibility of the application of a BOTDR-based distributed optical fiber sensing system for slopes as seen in Due to its wide range capabilities, DOFS are becoming a very attractive technology for the instrumentation of geotechnical structures. However, when monitoring slope stability, the most common applied sensors are discrete ones such as inclinometers, crack detectors, reinforcement stress detectors and displacement meters. In this way, a global behavior of the slope is not easily obtained. To make things worse, these instruments are often incompatible with the deformation of the rock-soil mass, and the difficulties associated with installation procedure and bad measurements situations regularly turns the application of these sensors pointless. Shi The results are shown in et al. built a medium-sized model of soil nailed slope in laboratory in order to assess the efficiency of monitoring slope stability problems through the employment of BOTDA sensing technology [More recently, Zhu chnology   with good results as reported by Shi et al. . This teet al. , and Royet al. . et al. compared an OFDR-based strain sensor with a Brillouin-based one [In the framework of a system to detect sinkholes and embedded soil cavities, Lanticq ased one . Tests pased one .et al. applied BOTDR and FBG sensors in order to monitor the deformation of soil layers and pore water pressure in a 200 m borehole over nearly two years in Suzhou, China [Finally, Wu u, China . Three dThe results showed the incomparable potential of DOFS for soil subsidence monitoring as the strains at any depth of the soil layers were achieved. Regarding the different types of used cables, it was concluded that PSC was unable to monitor land subsidence at deep levels due to its small stiffness. Another borehole strata deformation monitoring with BOTDR-based sensors is also reported in .The application of distributed sensing technology in the Oil and Gas industry is of great interest and therefore has seen a substantially increase in recent years. Distributed and quasi-distributed techniques based on Brillouin and FBG technologies, respectively, have been the most commonly used . Glisic et al. 2015 were able to monitor the deformation of the cross section of a non-circular PVC pipe due to the dead weight of its carrying water reflected as oscillations in strain measurements made by BOTDA sensors that were deployed helically on the pipe [In this test, a relative translation with an angle of approximately 50° was induced by hydraulic jacks between two parts, an immobile and a mobile part, the pipe .One of the most appealing areas for the application of DOFS has been naturally the instrumentation of bridges. The Götaälv bridge  in Gotheet al. [Another slab-on-girder bridge monitoring with a Brillouin based DOFS is reported in Matta et al. . A 1.16 et al. in [i.e., from the early behavior of the concrete to the identification of damage, which was unprecedented. These sensors were validated by FBG sensors that were also deployed on this structure.A complete and interesting long term monitoring application is described by Glisic t al. in . Here DOet al. compared two different Brillouin sensor installation techniques, near-to-surface fiber (NSF) embedding and “smart” FRP sensor bonding [Bastianini  bonding . The two bonding  on a hiset al. implemented the OBR system on the bottom surface of the slab of a newly built highway viaduct in Barcelona for its monitoring during the bridge load test, thus marking the first time that a distributed sensing method with millimetric spatial resolution was used for load testing of a real, newly built concrete bridge [In 2010, Villalba e bridge ,120. et al., implemented a multiscale fiber optical sensing network with both FBG- and BOTDA-based sensors [In order to take advantage of the extended and global range of DOFS and at the same time achieve a high sensitivity, Zhao  sensors . A more Regier and Hoult employed DOFS technology in the monitoring system of a reinforced concrete bridge (the Black River Bridge) outside of the town Madoc, Ontario (Canada) . The OBRet al., instrumented one span of a bridge in Barcelona, Spain with an OBR system, glued without protective coating to the inner surface of the slab girder of the bridge, in order to monitor this structure during a deck enlargement rehabilitation, More recently, Rodríguez With this implemented system it was possible to control the strain variation on the deck due to different and various stages of the widening process, ensuring in this way its structural safety.et al. was some of the first to assess the implementation of Brillouin distributed fiber optic sensors for the monitoring of a dam [Like bridges, also dams constitute an ideal area of application of DOFS monitoring due to their massive dimensions. Thévenaz of a dam . An incrFurthermore, the German Federal Ministry of Education and Research started a national research program named “Risk Management of Extreme Flood Events” (RIMAX) due to extreme floods in two large German rivers (the Oder in 1997 and the Elbe in 2002) in order to come up with smart monitoring systems that would be able to detect incipient effects of failure of hydraulic engineering structures. The main idea was to integrate FOS into geosynthetics that would be applied in the stabilization of geotechnical structures such as dams or dikes as seen in Another case of dam monitoring using a commercial system named DiTeSt based on BOTDA technology is reported by Inaudi and Glisic for the Plavinu dam in Latvia .The most sought out applications of DOFS were reviewed above, nonetheless, this technology, due its remarkable versatility, has found a wide range of potential applications that have been studied and developed in the past years and that are presented below.For instance, historical buildings play an important role in the cultural heritage of any society; therefore the collection of data about their structural behavior is paramount in order to maintain such structures. The field of discrete fiber optic sensors has found a wide range of applications in this area. The same has not been observed with DOFS, except for the already briefly mentioned studies mentioned in  and 123123. In tet al. proposed a novel smart steel strand that combined BOTDA and fiber Bragg grating sensors on a single optical fiber by embedding it into a 5 mm diameter fiber-reinforced polymer (FRP) rebar [Monitoring of loss of prestress in concrete beams is of great importance. Lan P) rebar   over a 20 m single fiber measurement with a 10 cm spatial resolution  and straanalysis . Bao et d sensor .For Rayleigh scattering-based OTDR, the first reported vibration sensor was achieved through polarization OTDR achieving 10 m spatial resolution and 5 kHz event detection  and the et al. performed some experiments in order to investigate the feasibility of distributed dynamic measurements with this technique [Regarding Rayleigh-based OFDR, Zhou echnique . The dynechnique  as preseThese examples showcase the potential of DOFS application for dynamic measurements in civil engineering structures. Nonetheless, this research topic is still in a very early development stage and more field applications need to be performed.As happens with any type of monitoring sensing system there are different challenges associated with the application of DOFS systems like the aforementioned limited spatial resolution and monitored length range. However, probably the major practical concern with fiber sensors in SHM of civil engineering structures is to assure that the sensor itself is not damaged during the installation or measurement process. This is not easily achieved due to the great fragility of bare fibers. As seen in the different applications showcased in this article, a comparison of distinctive coatings and protections for the optical fiber when applied to various structures is of extreme importance ,83,84,86Another concern related with the application of DOFS is the possibility of introducing bending stresses in the fiber during the field installation process, if sufficient care is not taken, which can be very detrimental due to the particularly weak scattering signals.Additionally, in concrete structures, for bonded applications, the roughness of the concrete surface and the heterogeneity due to the presence of aggregates of several sizes leads to an even greater challenge. Cleaning of the grease and additional unwanted particles in the areas were DOFS are intended to be bonded, jointly with a pre-treatment to smooth the surface (brushing) is vital to achieve a good bond between the sensor and the instrumented structure. Also, when analyzing the measured data, low peaks and discontinuities appear due to those same surface irregularities and concrete flaking and spalling so special care should be taken in this step too in order to eliminate false assumptions.Finally, when taking in account the use of DOFS systems in a damage/deterioration SHM system, it is important to imply a certain amount of redundancy into the sensor network in order to guarantee relevant results even after the failure of one of the sensors.During the past decades, journals and project reports have shown that SHM practice has now become a well-established and mature subject. Furthermore, and within this topic, OFS has suffered an exponentially increase of interest and as a result, several studies and applications have been presented in the past years. However, examples of the distributed potential of this technology are still in a relatively early practice stage. As a result, in the present paper, the topic of distributed fiber optic sensing in SHM practice was widely discussed and reviewed, in particular, the applications in civil engineering structures.First the concept of SHM and the role of fiber optics sensors were presented. Then the background theory associated with the most used distributed sensing techniques were described and elaborated, being these divided between time domain reflectometry and frequency domain reflectometry. Afterwards a general review of the state-of-the-art applications of different DOFS in geotechnical structures, pipelines, bridges and dams was shown. This was complemented by the state-of-the-art of laboratory works that led to field applications and the most recent researched developments of this technology in various areas. It is worth mentioning that the applications found on this paper only cover the sensor design and basic implementation techniques and performance. For further information regarding each of the applications, the reading of the respective references is advised. Finally, a brief summary of the most relevant challenges associated with the application of DOFS in SHM was presented.In order to completely establish this technology as a viable solution for civil engineering SHM applications there’s still a lot to be studied and developed. The attempt to enhance the resolution of these sensors is something that should be continued in future works in order to create better damage monitoring solutions based on these sensors. Additionally, the identification of the most appropriate coatings and installation methods for each implementation should be further investigated in order to ultimately provide general guidelines for the use of this technology in civil engineering SHM. As seen in this article, DOFS-based systems can be deployed in different applications which showcase its impressive versatility, but also stress the importance of adapting this system to each solution. The choice of the most appropriate DOFS technique is an obvious result of some parameters such as the size of the structure, spatial resolution, acquisition speed and so forth. While Brillouin- based techniques can easily cover great lengths and therefore acquire global information about a structure, their resolution is not ideal for damage identification. Some attempts to improve this resolution have been made and are presented in this review. However, a more cost-effective technique must be developed in order to achieve high spatial resolution based on Rayleigh OFDR sensing. This is still a recent and developing technology that nevertheless is anticipated to have an important role in structural health monitoring in the near future, if correctly developed and harnessed.


In 2008, 5 years after the Liberian civil war ended, there were an estimated 340,000 orphans in Liberia, 18 % of the total child population of the country. Given that children make up half the population and that these children experienced significant trauma and loss both through direct exposure to the war and then to the Ebola epidemic, and indirectly as a result of the trauma experienced by their parents, the recovery of these children is essential to the recovery of the nation as a whole. The goal of this research was to identify factors contributing to resilience among youth in post-conflict Liberia. Resilience was defined as evidence of adaptive functioning and psychological health.Seventy-five young people (age 13–18) in the capital city of Monrovia, Liberia were recruited in 2012. Semi-structured interviews were conducted, and demographic data were collected. Interviews were then transcribed and coded thematically.Forty-six of the participants were attending school, and 29 were not enrolled in school. Youth enrolled in school demonstrated greater adaptive functioning. This was particularly true for boys in any school setting and girls attending private school. Youth not attending school were more likely to have lost family members or become estranged from them, and many were also engaging in substance use. Emotion regulation, cognitive flexibility, agency, social intelligence and, in some cases, meaning-making were found in participants who showed resilient outcomes.Caregiver relationships mediate the development of psychological capacities that impact resilience. These findings suggest that youth who have lost a caregiver, many of whom are not attending school, are experiencing a significant ongoing burden in terms of their daily functioning and psychological health in the post-war period and should be the focus of further study and intervention targeting substance use and community reintegration.Trial registration Partners Healthcare IRB Protocol# 2012P000367. Post-conflict societies invariably struggle to re-establish order while at the same time facing major health consequences of the trauma experienced by their populations. In addition to medical issues, these consequences frequently include mental illnesses such as post-traumatic stress (PTSD), mood, and substance use disorders. A meta-analysis of 17 studies of children in post-conflict societies from around the world found that PTSD, depression, and anxiety were all increased in this population [In the post-conflict setting, there has been an increasing focus on resilience, which is defined in different ways. Functioning, including income generation and educational attainment, contributes to resilient outcomes, but it is only part of the picture. Psychological health, in terms of subjective sense of wellbeing and safety and absence of unmanageable stress, is also an important factor –5. SenseA number of studies have sought to identify factors common to resilient individuals. Based on their work with non-traumatized clinical populations in the United States, Southwick and his collaborators have found resilient individuals to be capable of emotion regulation and cognitive flexibility . They haA few studies have examined protective factors specifically in children in post-conflict settings. One study examined the sense of coherence among children and adolescents who lived through the war in Croatia. Childhood stability, acceptance of one’s own ethnic identity, management of uncertainty, and finding meaning in work emerged as strengths that contribute to a sense of coherence . A studyNone of the studies referenced above included data from Liberia. Between 1989 and 2003, the country experienced a brutal civil war characterized by ethnic killings, sexual violence and the use of child soldiers. The war left more than 800,000 people displaced, of a total population of 3.5 million, and it destroyed the productive capacity and physical infrastructure of the country, and eroded family and community ties . LiberiaIn the wake of this trauma, access to mental health care is limited. There is only one psychiatrist living and practicing in the country. There is no psychiatric residency training program and no training available for clinical psychologists. A survey of households and healthcare facilities in rural Nimba County, Liberia found that while all of the hospitals and most health clinics provided malaria and HIV care, none of the hospitals and only 11 % of the clinics offered mental health care [The Liberia needs assessment survey sought to characterize and quantify the mental health burden of the war on the children of Liberia . Key infThis study was undertaken in order to capture the needs of Liberian adolescents in their own words and identify the way forward. The goal of this research is to identify factors contributing to resilience among children in post-conflict Liberia. We will assess for the presence of these factors in the participants we interviewed and examine how they interact to promote resilience and adaptive functioning. Considering the findings in the literature reviewed and the observations made about resilience in children exposed to violence, we will define resilience as evidence of daily functioning, ability to make realistic plans for the future, and presentation of an overall consistent and coherent narrative.A qualitative research design was used with a purposive sample of 75 participants. In-depth interviewing was chosen as the data collection method in order to best capture the personal narratives of individual children . The intParticipants were recruited from February 13th through March 1st and December 4th through December 21st, 2012. The initial group was recruited from three schools and the subsequent group of youth not attending school was recruited from neighborhoods in Monrovia and the surrounding area. All children ages 13–18 were eligible to participate, and an effort was made to recruit both males and females. The Republic of Liberia’s Ministry of Education identified three large, well-attended schools in three distinct areas within Monrovia. The participating schools included two government schools (a junior high school and a senior high school) and a private senior high school. These schools were chosen in order to capture distinct age and socioeconomic groups. At each school, the principal notified the students of the opportunity to participate in the research study and answer questions about school, family, and past experiences. Children under 18 had to obtain consent from a parent or guardian and then give their assent to participate. Those who were 18 consented for themselves. Those students who returned signed consent forms first were interviewed.The research team then recruited and interviewed children not attending school. They were identified in two different communities in Monrovia, with the help of community leaders. Both communities had significant problems with poverty, crime, and substance use, and many of the children were not attending school. The leaders went to a few areas in their communities where youth commonly gathered and explained that there was an opportunity to participate in a research study. They distributed printed information and consent forms and told the young people when and where the interviews would take place. They helped to organize a loose schedule with approximate days and times for each child to come. The leaders were present at the building while the interviews were conducted but were not present in the room during the interviews.Initially, a $5 USD phone card was agreed upon by the research team and the IRB as an appropriate compensation for participation. After the initial phase of recruitment, the research team observed that this was a significant inducement to participate. At the suggestion of the IRB, the research team changed the compensation to $2 USD. Any child identified as having acute psychiatric needs was referred to the study physician, a Liberian child psychiatrist.Primary data was collected using semi-structured interviews averaging 1 h in length. Interviews were conducted by the principal investigator together with a Liberian medical student, who acted as both a linguistic and cultural interpreter. The interviews were conducted in a private area. Student participants were interviewed on school grounds. Interviews were conducted for three to 4 days at each school. Those not attending school were interviewed in an office where the community leader worked. Interviews were digitally recorded, and notes were taken by the interviewers regarding participants’ affect and non-verbal communication during the interview. At the end of each day, recordings and notes were reviewed and revisions were then made to the interview guide. The interviews were transcribed by Liberians living in the United States.A directed content analysis was used because there was an existing body of literature about factors impacting resilience in youth, but there was insufficient data about the specific population that was studied . Coding Both inductive and deductive approaches were used . First, Seventy-five participants were interviewed. They reported being between 13 and 18 years of age. The average age of the participants was 16.4 years (standard deviation 1.8 years). There were 38 females and 37 males. There were 35 public school students, 11 private school students, and 29 children not attending school at the time of the interviews  was better for the child and more effective than beating him because then the child would develop an internal sense of right and wrong:For these children, their ideas about meaning supported their sense of agency and their ability to impact their own lives and the lives of others.Five essential factors interact to support the development of resilience in this population: emotion regulation, cognitive flexibility, agency, social intelligence and meaning-making see Fig. . CognitiCognitive flexibility, emotion regulation, agency, and social intelligence all contribute to building the capacity for relating. Children demonstrated this capacity by forming relationships, expressing empathy and behaving altruistically. Empathy strengthens one’s sense of connection. Altruism enhances self-worth while contributing to a sense of purpose or meaning . A belieThere was a group of boys who were attending school who demonstrated greater adaptive functioning than their peers. While the girls in public school did not share this, some of the girls in private school did. At the private school, there were more girls than boys who participated in the study. A group of native Liberians who transcribed the interviews were then interviewed about their reactions to the data. They were not surprised by this finding. They explained that when families could only afford to send one child to private school, they would choose a girl because they believed she would be more protected there. There was an idea that girls needed to be protected from the risk of becoming pregnant and more generally from being corrupted or taken advantage of. Many of the more confident and ambitious boys in public school had previously attended private school and had switched to public school when their families faced financial hardship. Thus the girls in private school likely came from families that were similar to those of some of the boys attending public school.following friends,” a phrase many participants used to explain how they found themselves living on the streets and engaging in drug use. Rather than passively attaching themselves to other troubled children, those with an internal locus of control actively sought relationships that helped them to grow.In this population, adaptive functioning was only possible in the setting of supportive relationships and agency, both of which promoted other factors impacting resilience. While the literature does address the role of factors outside the individual in fostering resilience, the focus is on individual factors. This study highlights the importance of the individual’s capacity to build and sustain relationships with those around them and to access support in their communities. Relationships impact the development of all the individual factors that support resilience, including emotion regulation, cognitive flexibility, agency, social intelligence and meaning-making. Agency promotes an active coping style that leads children to take action to get their needs met, rather than “There were a number of limitations to this study. Participants were recruited from Monrovia only. Children in other parts of Liberia were not included, and the data may not be representative of their experiences. Interviews were conducted at a single time point, so resilience could not be assessed over time. No collateral information was obtained from teachers or family members. This allowed the children’s voices to come through, but it also meant that we were not able to obtain a complete picture of their circumstances. Some may have chosen, for a variety of reasons, to minimize the difficulties they were facing, while others may have chosen to magnify them. There is also the possibility of selection bias, as children who chose to participate may be different from those who did not.All children in Liberia were affected by the war in some way. Some fled the country, others witnessed the impact of the war on their family members, and many were exposed to violence themselves. Children who lost one or both parents during the war and were living on their own were less able to function post war. Many were not attending school and were engaging in substance use. Once they entered the world of substance use and other illegal activities, they became trapped. They were physiologically dependent on substances, and they had severed ties with their families and communities. These children in particular should be the focus of further study and intervention to target their substance use, while helping them to build sober communities for themselves.Next steps toward helping these children include collaborating with organizations working with street children in order to help them reintegrate into the school setting. Identifying community leaders will be important for connecting these children with their communities. This would address the needs of children orphaned or separated from their families by the war and those orphaned by the Ebola epidemic. While children in school were generally functioning better, many were also struggling. A liaison between schools and families could identify children experiencing difficulties and offer additional support to those families. More mental health professionals are also needed, which will require the development of training programs in psychiatry, psychology and social work.


The Post-Graduate Diploma in Public Health Management, launched by the Govt. of India under the aegis of the National Rural Health Mission in 2008, aims to enhance the managerial capabilities of public health professionals to improve the public health system. The Govt. of India invested enormous resources into this programme and requested an evaluation to understand the current processes, assess the graduates’ work performance and identify areas for improvement.Quantitative telephone surveys as well as qualitative in-depth interviews were used. Graduates from the first three batches, their supervisors, peers and subordinates and faculty members were interviewed. Quantitative data were analysed using proportions, means and interpretative descriptions. Qualitative analyses involved transcription, translation, sorting, coding and filing into domains.Of the 363 graduates whose contact details were available, 138 could not be contacted. Two hundred twenty-three (223) graduates (61.43% of eligible participants) were interviewed by telephone; 52 in-depth interviews were conducted. Of the graduates who joined, 63.8% graduates were motivated to join the programme for career advancement and gaining public health knowledge. The content was theoretically good, informative and well-designed. Graduates expressed need for more practical and group work. After graduating, they reported being equipped with some new skills to implement programmes effectively. They reported that attitudes and healthcare delivery practices had improved; they had better self-esteem, increased confidence, better communication skills and implementation capacity. While they were able to apply some skills, they encountered some barriers, such as governance, placements, lack of support from the system and community, inadequate implementation authority and lack of planning by the state government. Incentives (both monetary and non-monetary) played a major role in motivating them to deliver public health services. They suggested that states should nominate candidates expected to make a significant contribution to the health system, recognition from a relevant authoritative national body and need for a placement cell, especially for the self-sponsored candidates.A continuous mechanism for interaction and dialogue with the graduates during and after completion of the programme should be designed. This evaluation helped by providing inputs for refining the programme. The delivery of quality health care is dependent on the knowledge and skills of public health personnel . CompetePost Graduate Diploma in Public Health Management (PGDPHM) in 2008, to train in-service public health professionals as well as self-sponsored candidates in public health management [Although the National Rural Health Mission, now the National Health Mission (NHM), in India has supported initiatives for motivating and empowering health personnel within the public health system  since itnagement . This prnagement .Three hundred eighty-six 386) students graduated across the first three batches of the PGDPHM programme  [86 studenQuantitative telephonic surveys and qualitative in-depth interviews were conducted to gather data for the evaluation. Using two data collection methods aided the comparison of the findings from the quantitative survey and the qualitative interviews. While the quantitative methods facilitated the development of quantifiable information, the qualitative methods contributed to exploring subjective experiences of the study participants in greater detail.Approval for the study was obtained from the Institutional Ethics Committee at the Public Health Foundation of India, New Delhi. The sampling frame for this study included all the 386 graduates of the programme across three batches . Partner institutes  were requested to share the contact details of their graduates . A formal appointment was sought and informed consent was procured for participation into the study. Telephone interviews were conducted by either of two research associates hired for this activity between February and April 2012. The telephonic interview questionnaire was pretested on a group of students of another public health programme and revised based on their feedback. It included open- and close-ended questions regarding student experience during the programme including topics taught, appropriateness of the course curriculum in the context of the health system and new skills learnt. Graduates were also assessed for their performance at the workplace on parameters such as increase in knowledge and skills and better health-care delivery practices, applicability of these skills in the health system, facilitators and barriers in applying the skills based on what they learnt during the programme.For the qualitative interviews, stratification criteria were used for the selection of graduates and their peers/supervisors/subordinates Table . Topic gThe responses from the telephone interviews were initially entered in a paper-based form, which were later entered in Epi-info 7. Responses were analysed as proportions and means for the close-ended questions and quotes and interpretative descriptions for the open-ended questions.Data analysis of the qualitative interviews was done manually aided by computer-based software (Atlas.ti). The qualitative data, which were collected by recording the interview using a dictaphone, were transcribed and translated within the first 2 weeks of the interview. They were then sorted, coded and maintained in established files such as field files, mundane files and analytic files in an iterative process, comparing each interview with the previous interviews . The codOf the total 386 graduates, we could procure the contact details of 363 graduates . Two hundred twenty-two (220) Indian graduates and three foreign graduates participated in the survey. The various stages of loss to follow-up are summarized in Figure The profile of the respondents is summarized in Table Based on the responses of the telephonic surveys and the in-depth interviews, a conceptual model was developed to summarize the findings as Figure The graduates’ main motivations to join the programme were for career advancement in public health (37.5%) and gaining knowledge of public health (26.3%), while some others who wished to continue their medical education needed a higher qualification in public health management or a good administrative job. A majority found the programme useful with respect to their day-to-day functioning of public health management and felt that they had acquired new knowledge and developed some new skills of public health management from this experience. While the vast experience of the government-nominated graduates was advantageous, there was a lack of eagerness from some of the senior candidates to join the programme at a late stage in their careers. They were interested in public health management; however, when asked how they anticipated the use of these competencies at their workplace, they stated that since they were in the late stages of their careers these skills and knowledge, although useful technically for the improvement of the health system, their contribution to the health system based on these competencies would be limited as against younger graduates who could spend a longer time in the health system after graduating the programme, thereby being able to contribute more to the system.The institute heads and faculty members felt that this programme provided a unique focus on public health management and is deemed as a big attraction since it is offered by recognized institutes across the country.Regarding the selection criteria of the candidates, a prominent response was that age of the candidate should be a consideration for enrolment. It was felt that younger nominated candidates and self-sponsored candidates extracted more learning from the programme. Institute heads and faculty members as well as supervisors, peers and subordinates suggested that states should select candidates transparently and in consultation with the institutes. A minimum 5 years of work experience in the health systems before enrolment was suggested.…excellent and provides in-built flexibility in the course to add new things…The graduates openly discussed the course design, curriculum, faculty skills and pedagogy as well as academic infrastructure. Views regarding the programme duration were varied. While some felt the current duration (1 year) should be increased by 6 months to a year to allow for more time for project work, it was deemed appropriate by others. The institutional heads and faculty members, however, thought that the current programme duration was ideal. Almost all graduates agreed that the five core domains of public health, Epidemiology, Biostatistics, Behavioural and Social Sciences, Occupational and Environmental Health and Health Management, were taught in the programme. While 95 (43.38%) graduates found the Epidemiology and Biostatistics modules to be most useful, 45 (20.55%) felt that the Health Management module was the most useful. Twenty-six (11.87%) respondents felt that all modules were equally useful. The content was reported as being theoretically sound, well designed and informative. Some graduates stated that their project was helping them in their work, by aiding development of their research and writing skills, and giving them practical exposure. One of the institutional heads and faculty members also felt that the curriculum wasThey also felt that this programme was focused and covered topics extensively. They mentioned that the PGDPHM programme was able to provide the much needed management perspectives, especially for medical doctors.During the in-depth interviews, the graduates stated that the teaching techniques used to deliver the PGDPHM programme were generally good and emphasized the good practical teaching skills of the Social Sciences department of one particular institute. The participants felt that the teaching was effective and was technology-based. The graduates had a positive view about learning as a mixed group as it encouraged exchange of ideas and perspectives among students who were from different academic backgrounds. The government-nominated candidates were benefited by the familiarity of the self-sponsored candidates with computers, while the government-nominated candidates shared their field experiences with the younger self-sponsored candidates.There was consensus between the graduates and the institute members regarding the supportiveness and expertise of the faculty members teaching the programme. Good interaction with the faculty was reported by most graduates, who felt that this interaction should extend to project work and job hunting. While some graduates were happy with the overall infrastructure, some others felt that library space, Internet access within the hostel, academic space (at some institutes) and personal computers for their use were limited.Another drawback of the programme was the inadequacy of printed learning materials. Availability of these would have assisted the graduates during the programme when the Internet was inaccessible or when they wanted to prepare notes, as also for reference after graduating the programme. Relatively older graduates and those from the health system strongly felt that the absence of easy notes and summarized text made the coursework difficult for them. Graduates also talked about the need to organize additional field visits within the programme. They perceived field visits to be very useful teaching methods alongside group discussions. Teaching practices that permitted the graduates to draw upon their work experience within health systems were preferred. It was suggested that the duration of some modules be readjusted or shortened. Institutional heads and faculty members also had similar views to express about certain modules, particularly Biostatistics. They talked about the programme containing too many modules, and also, management components, like logistics management, operational research and material management, were perceived to need further strengthening.The graduates felt that their public health vision had broadened and they were equipped with new skills after having completed the programme. Figure I am now an improved man having a broader view of public health” was the overall feeling one graduate expressed. They felt that there was a change in their perspective as well as their approach to their self-perceived job profile. They now believed in the concept of “ownership of work”, and their efficiency had also increased. This programme also helped some of them to aspire for further professional learning. Graduates felt that they were more confident, had better communication and language skills and had effective decision-making skills at the completion of the programme. Institute heads and faculty members reported opinions similar to the graduates on issues such as language development; better self-esteem, attitude and behaviour; increased confidence; better communication skills and thinking capacity in implementation. Similarly, the supervisors, peers and subordinates talked about improved communication and more confidence, innovative ideas, better time management, good doctor-patient relationship, leadership skills and a “go-getter” attitude among the graduates. Thus, the telephonic survey responses provided information on the essential technical skills, but the in-depth interviews additionally gave information related to specific context-oriented soft skills.There were positive changes in their attitudes and behaviours. “…In the telephone survey, 123 (56.9%) graduates said that they were able to apply most of the skills acquired during the programme. During the in-depth interviews, they talked about using the newly acquired skills in different areas of their field work to the extent that their job provided Table . They weThe knowledge and skills collectively acquired by the graduates as reported by them and the other stakeholders represent the competencies that the programme content and curriculum are based upon. The graduates are expected to use these competencies during their work in the health system.Table There is no scope; we are entrapped in routine work right now. We do not have anything if we want to do something new…We have learned about some financial things, which we can’t apply. We have been taught budgeting, but that much scope is not there in our day-to-day practice.When the graduates were questioned about the facilitators and barriers encountered while applying their skills, it was evident from most of the graduates’ views that incentives played a major role in keeping them motivated and enthusiastic for delivering their expected services. Some graduates expressed their disappointment on not getting any recognition in the system even after graduation, while 63% of graduates reported that no incentives were given to them in the health system after graduation. Barriers in skill application were issues of governance/politics and bureaucracy, inappropriate placements, frequent transfers, lack of support from the system/seniors/staff, inadequate powers to implement certain procedures, lack of infrastructure, lack of community support, contractual positions and lack of planning by the state government.Another very crucial aspect discussed was the need for the PGDPHM programme to be recognized by a relevant authoritative national body. Self-sponsored graduates reported that recognition/accreditation of the programme is essential for getting them a good job, whereas government-nominated graduates said that non-recognition of the programme was a major hindrance for them in getting promotions and relevant posts in the system.There was a collective feeling among all the stakeholders of the study that the programme could contribute in strengthening the public health system of the country. Graduates felt that the programme provided the essential public health management skills which can help them in their day-to-day work. Some of them highlighted the need and importance of this programme by saying that it should be mandatory for all medical officers in the public health system.Self-sponsored graduates were asked about their current placements as part of the mapping exercise, in which all the graduates who were employed were questioned about where they worked, their job profiles, etc., thus getting an idea of their employment positions across the country. Through this exercise, the utilization of their specific skills was mapped. Nineteen out of 22 interviewed (86.4%) self-sponsored graduates were currently employed. Of these, 42% are working in the government sector; others were involved with private organizations. During the in-depth interviews, the self-sponsored graduates stated that they had to struggle to find their jobs. Some of them stated that as newcomers it was difficult to find a job in the system even after graduating from the programme.During both the telephonic surveys as well as the in-depth interviews, the self-sponsored graduates emphasized the need for a placement cell (a group which facilitates employments for the self-sponsored graduates), preferably within the institutes, to assist them in pursuing a job. Overall, a total of 195 (89%) said that they would recommend this course to others and 189 (86.3%) felt that it was relevant in their career advancement.The PGDPHM programme has been operating since 2008 with a large majority of the graduates from the government sector. The graduates from the health system were less eager to join because they felt that they might not have enough opportunity to apply their skills and knowledge within their current job environment. On the other hand, the self-sponsored graduates, on average a younger group, were more motivated to gain knowledge and skills; this was also true for the young nominated graduates. The PGDPHM diploma provided an added qualification to these graduates. The reputation of the institutes offering this programme across the country was an additional incentive for enrolment of the candidates.This study sampled all graduates of the PGDPHM programme for the telephone interviews. In-depth interviews of three different groups of stakeholders assisted data triangulation. Triangulation was done by collecting data from multiple sources, including graduates and their colleagues as well as teachers involved in implementing the programme at the institutes. Using multiple methods for data collection, including telephone survey and in-depth interviews, and comparing themes among the different methods of data collection helped in revealing a deeper understanding of the subject matter. Adoption of both manual and software-assisted analysis of the qualitative data further helped in minimizing researcher bias. However, despite multiple attempts to contact all graduates for the telephonic interviews, data were only collected from 61% of the graduates although respondents appear to be broadly representative of all graduates, given the available age and sex data of the study participants.The current programme duration of 1 year was short from the perspective of some graduates. This programme was very likely their first formal academic exposure to public health and therefore an opportunity to equip themselves with public health skills since Masters in Public Health programmes are 1 or 2 years long, including project work, but most diploma courses are a year-long. Graduates also favoured a shortening of the modules which had minimal visible application in their day-to-day working in the health system. Previous studies suggest that service learning has been recognized as a useful teaching technique to link academic experience with community service . This alIt was largely observed that, while the opinions about the PGDPHM programme, in terms of the design, curriculum, faculty expertise, pedagogy, etc., were generally positive, there is scope for improvements in some areas, such as the course curriculum, inclusion of application-based teaching and provision of additional study resources. Institutes should design the course structure and learning to reflect the need of adult learners, while supporting the creation of adequate academic support structures. Adult-learning methods, to suit the needs of working professionals, should be relied upon during the course delivery. Modular content and their duration should be rationalized, and infrastructure should be strengthened.The importance of interdisciplinary teamwork for better health care is recognized globally; this development should be fostered through inter-professional courses ,7. MixedThe study also explored the scope for application of the knowledge and skills acquired during the programme by the graduates at their respective workplaces in both the government and the private sector. A large majority of the graduates had limited or no knowledge of public health management at the time of enrolment into the programme but reported to have gained considerable knowledge in the subject during the programme. Some new soft skills and professional skills were also acquired, which had applicability in their work within health systems. The new knowledge and skills enhanced the capabilities of the graduates to contribute towards the health system. The change in their attitudes was also noticeable, as stated by their peers, supervisors and subordinates. They were eager to bring about a positive change in the functioning of the health system. However, there were some hurdles, mentioned by the graduates, which impeded the application of their skills and knowledge within health systems. Although more graduates have been placed at higher levels within the health system after completing the programme, they identified deterrents within health systems in the optimum use of their newly acquired skills.The PGDPHM programme was largely looked upon by the enrolling candidates as an additional qualification for the advancement of their careers. The graduates expected the availability of a conducive environment to enable them to apply their learnings. Financial incentives and appropriate placements are essential motivational factors for candidates who are nominated by the state government. There were affirmative statements from some graduates who have been encouraged by their respective states. Initiatives taken by these states to promote their PGDPHM graduates could set an example for the other states. Additionally, recognition of this programme by relevant national bodies/organizations would boost the morale of the graduates as well as aid in facilitating their promotions and suitable placements.For the self-sponsored candidates, the PGDPHM programme is a stepping stone towards career progression, and most of them look forward to appropriate placements after completing the programme. The current placements of some of these graduates show their willingness to take up not only private jobs but also to gain job experience in the public sector. The emphasis on the need for a placement cell with the assistance of the institutes is reasonable and warrants attention. Moreover, recognition of the programme would be beneficial to these graduates as well.On the whole, the PGDPHM programme was viewed as a beneficial knowledge-gaining platform and was recommended to be continued, taking into consideration certain areas with scope for improvement. Some of these need to be addressed collectively by the partner institutes in consultation with the Ministry of Health and Family Welfare, Govt. of India; some others may be addressed at the level of individual institutes. Candidates with a potential to make a significant contribution to the health system after graduation should be preferably nominated. States should also ensure that there is sufficient opportunity for the trained graduates to apply their knowledge and skills in the health systems after their return. As regards the programme structure, techniques that help students share their experience, latent skills and their competencies within the classroom and in the field should be predominantly adopted for the teaching–learning activities. The learning content of each module, its duration of teaching and its importance should reflect the perceived needs of the health systems and the candidates. Finally, state governments should design an enabling environment for utilizing the skills of the graduates optimally, some of which are mentioned in the “Creation of separate public health cadreProvision of incentives Better coordination between institutes and state health departmentsSecure permanent positions for better performanceAppropriate managerial positions with authorityCandidates interests should be assessed before joining PGDPHM programmeAdequate staff to support initiatives undertakenThe average age of the participants was 42 years; a large proportion (90.13%) was government-nominated doctors. Career advancement and an interest in continuing their medical education were the commonest motivating factors for joining this programme. The overall experience of the graduates about the programme was positive. They found the programme useful with respect to their day-to-day functioning and felt that they had learnt many new things and acquired some new skills during the programme. During the surveys and in-depth interviews, the graduates discussed various aspects of the course and offered suggestions for further improvement in these domains and in the academic infrastructure. Further, inappropriate placements, lack of support from the system, insufficient authority and lack of community support influenced their ability to apply all their learning in their respective workplaces.The recommendations of this evaluation cover suggestions to revise some of the programme content and its delivery by the institutes, as well as an initiative to continue dialogue between the states and the institutes for appropriate and optimum utilization of the training received by the graduates.The overall positive responses from not only the graduates of the programme but also the other relevant stakeholders at the teaching institutes as well as within the health system where these graduates have returned for work would help the Govt. of India take a positive decision about continuing this programme for other health personnel across the country and reap its benefits optimally for improvement of the health systems. It would be worthwhile to conduct a follow-up study to look at the sustainability of the programme in terms of the knowledge and skills acquired by them and their long-term career growth within the health system. It would also be fruitful to assess the influencers for the incorporation of public health management knowledge in undergraduate medical curricula and in situated practices throughout professional training for the purpose of its subsequent translation into practice.


The aim of this study is to identify areas of potential improvement of the European Reference Life Cycle Database (ELCD) fuel datasets.The revision is based on the data quality indicators described by the ILCD Handbook, applied on sectorial basis. These indicators evaluate the technological, geographical and time-related representativeness of the dataset and the appropriateness in terms of completeness, precision and methodology.Results show that ELCD fuel datasets have a very good quality in general terms, nevertheless some findings and recommendations in order to improve the quality of Life-Cycle Inventories have been derived. Moreover, these results ensure the quality of the fuel-related datasets to any LCA practitioner, and provide insights related to the limitations and assumptions underlying in the datasets modelling.Giving this information, the LCA practitioner will be able to decide whether the use of the ELCD fuel datasets is appropriate based on the goal and scope of the analysis to be conducted. The methodological approach would be also useful for dataset developers and reviewers, in order to improve the overall DQR of databases. This support is essential, and is being achieved through the development of a number of different deliverables, being the European Reference Life Cycle Database (ELCD) one of them  proposes a specific Data Quality rating, named pedigree matrix, where include aspects such as geographical, technological and temporal validity, the origin, representativeness and validation of the data, and administrative information  to consider in the subsequent analysis. Moreover, justified criteria and quality standards list have been clearly defined in order to be used in the analytical comparison.Analysis and qualitative comparison of the datasets. Each selected fuel dataset was analysed according to the previously defined quality indicators. Then, findings and recommendations were derived in order to identify the potential improvements of ELCD datasets.The objective of this analysis is to identify areas of potential improvement of the ELCD fuel datasets quality, considering data available in third party life cycle databases and from authoritative bodies and/or business associations. The work has consisted in analysing and comparing fuel datasets from different databases, considering the ELCD database as the basis for this analysis. This effort has been carried out in two stages, which are summarized below:The energy datasets to be analysed should be representative of the European context, and therefore a deep review of the most updated data in terms of fuel for EU -27 has been conducted.According to European statistics EUROSTAT ; EC 2011Biofuels production has significantly increased during the last decade due to a favourable framework and the support of several policies. Nowadays biofuels represent 11% of the total biomass produced in EU-27, being biodiesel the highest contributor to the total production, 60% EC . The conAdditionally, an analysis of the gross heat generation in the EU-27 pointed out the relevance of the natural gas as fuel, being its contribution to the heat generation around 44% EC . Then, nThe current fuel datasets available at the ELCD database have been originated from PE International (GaBi developers). The latest ELCD includes fuel datasets referring to EU-15. Since the scope of this evaluation is to analyse the ELCD datasets under the European context, it seems appropriate the use of datasets from GaBi that consider EU-27 as geographical horizon. Table These datasets have been compared to their counterparts from three other databases, which have been selected based on three main criteria: i) they include data related to Europe, ii) they include large data related to energy products and services, and iii) they are well recognised in the scientific community. The selected databases have been the following: Ecoinvent v2.2, GEMIS 4.7, and E3 database. Considering theses databases and the availability of datasets, Table The evaluation has been based on the quality indicators developed within the ILCD handbook EC-JRC , b, 2011An overall Data Quality Rating (DQR) of the datasets has been calculated by summing up the achieved quality rating for each of the quality criteria indicator, divided by the total number of considered indicators, as shown in Equation According to ILCD Handbook EC-JRC , an overNevertheless, it should be noticed that a single score indicator might lead to misleading interpretation of the results. Some datasets might not contain enough information to evaluate them against all criteria and summing all scores could be misunderstood. The analysis is focused on the improvement of ELCD fuel datasets and has been based on the available documentation and/or information of database providers. The unavailability of certain information does not automatically mean that a dataset is potentially worse than another.TeR, GR and TiR representativeness: These criteria define the degree to which datasets reflect true population of interest regarding technology, geography and time/age of the data, respectively. Datasets related to the most representative fuel technologies in each area, in the European market context, basing on the above mentioned statistic criteria derived from authoritative sources. The origins of the imported raw fuels (if any) for fuel production, have been listed for each chosen country. TiR has been related to the expected obsolescence of the technology applied (based on existing data) defined as the year/s in which inventory was collected, with a deviation of ± 5 years. The framework is the same proposed by the ILCD Handbook, however the sector-specific expert judgement has been used to define the above mentioned criteria , through the analysis of authoritative sources.C: Defines the share of (elementary) flows that are quantitatively included in the inventory and should assess the degree of coverage of the overall environmental impact. It is assessed as the share of elementary flows, weighted on the number of environmental impact categories that are quantitatively included in the inventory. A pre-analysis based on sectorial experience, to identify the elementary flows (and within them a list of the most relevant ones in mass and/or impact basis) that allow the estimation of the 16 environmental impact categories mentioned at the mid-point level ILCD 2011 recommended method was done – see EC . Thus an expert judgement has been considered, based on the quality of the references and their sources, whether measured, calculated or estimated from literature.M: Defines if the applied LCI methods and methodological choices are in line with the goal and scope of the data set, especially its intended applications and decision support context. To evaluate this criterion, a correct and consistent application of the recommended LCI modelling framework and LCI method approaches for the given situation, according to the ILCD Handbook, was applied, focusing on three issues: i) System boundaries; ii) End of Life (EoL) modelling iii) Multifunctionality .From the deep analysis conducted, it must be highlighted that the ELCD datasets have been modelled based on an extensive review of the most relevant literature and statistics. The documentation used to model the ELCD energy related datasets can be found in the Life Cycle Thinking Platform web-site . Although the IEA is of course an important authoritative source, for the European context it seems appropriates the use of data reported by each country to Eurostat. In order to improve precision, it would be advisable to make a more extensive use of Business Associations and Authoritative sources data that have been proposed through the analysis.nd and 3rd generation biofuels, fuel cells, etc.).This analysis aims at providing guidance for the improvement of the fuel ELCD datasets in future versions. Since its first release, the ELCD database has been updated two times. The needs of reviewing and updating the ELCD database depend on the different sectors and the technologies. It would be useful to define periods to revise the fuel related datasets. For this purpose, a deep analysis of the learning curves would identify the level of maturity for new technologies (2e.g. Ecoinvent v3.0 or GEMIS v4.93, so a detailed analysis of these can offer further potential improvements to future ELCD versions.Finally, it should be noted that the selected databases are in a constant process of updating and improvement,