The Zika virus outbreak has triggered a set of local and global actions for a rapid, effective, and timely public health response. A World Health Organization (WHO) initiative, supported by the Department of Chronic Condition Diseases and Sexually Transmitted Infections (DCCI) of the Health Surveillance Secretariat (SVS), Brazil Ministry of Health (MoH) and other public health funders, resulted in the start of the “Study on the persistence of Zika virus in body fluids of patients with ZIKV infection in Brazil – ZIKABRA study”. The ZIKABRA study was designed to increase understanding of how long ZIKV persists in bodily fluids and informing best measures to prevent its transmission. Data collection began in July 2017 and the last follow up visit occurred in 06/26/2020.A framework for the ZIKABRA Cooperation initiative is provided through a description and analysis of the mechanisms, strategies and the ethos that have guided the models of international governance and technical cooperation in health for scientific exchange in the context of a public health emergency. Among the methodological strategies, we included a review of the legal documents that supported the ZIKABRA Cooperation; weekly documents produced in the meetings and working sessions; technical reports; memorandum of understanding and the research protocol.We highlight the importance of working in cooperation between different institutional actors to achieve more significant results than that obtained by each group working in isolation. In addition, we point out the advantages of training activities, ongoing supervision, the construction of local installed research capacity, training academic and non-academic human resources, improvement of laboratory equipment, knowledge transfer and the availability of the ZIKABRA study protocol for development of similar studies, favoring the collective construction of knowledge to provide public health emergency responses. Strategy harmonization; human resources and health services; timing and recruiting particularities and processing institutional clearance in the different sites can be mentioned as challenges in this type of initiative. Aedes aegypti and microcephaly [Strategic Response Framework (SRF) [Aedes mosquito, the development of safe and effective therapies and vaccines and the identification of funding sources to support this extensive research and development agenda.The sudden emergence of the Zika virus (ZIKV) in Brazil, the wide geographical range of the mosquito vector of the virus and the link to microcephaly and other important disorders, triggered a call for a global response. On November 11, 2015, the Brazilian Ministry of Health (MoH) declared the ZIKV epidemic as a Public Health Emergency of National Importance . Consideocephaly . In turnThe “Study on the persistence of Zika virus (ZIKV) in body fluids of patients with ZIKV infection in Brazil – ZIKABRA Study” was conducted to address one of the research gaps identified by the WHO Research Agenda which comprises the characterization of the ZIKV infection . The aimThe ZIKABRA study brought together the expertise of a multi-disciplinary group of scientists to meet the requirements of designing a research protocol with complex clinical, epidemiological, biomedical, virological, laboratory and public policy features. The national epidemiological situation and research capacity dictated the selection of the study sites, notably in three major capitals in the northern (Manaus), northeastern (Recife) and southeastern (Rio de Janeiro) regions of the country, with its reference laboratories at the Tropical Medicine Foundation Dr. Heitor Vieira Dourado (FMT-HVD), Oswaldo Cruz Foundation, in Rio de Janeiro (Fiocruz-RJ) and Brazil Oswaldo Cruz Foundation-Institute Aggeu Magalhães, Recife (CPqAM – Fiocruz - PE). On the international side, the United States Department of Defense laboratory, and the Walter Reed Army Institute of Research (WRAIR) provided technical, material and immunologic assay support.This paper provides a framework for the ZIKABRA initiative through a description and analysis of the mechanisms, strategies and the ethos that have guided the models of international cooperation and scientific exchange between Brazil and international organizations in the context of a public health emergency.The project was jointly funded by the MoH/SVS/DCCI ; WHO ; WRAIR - (0130602D16) - Cooperation Agreement (W81XWH-18-2-0040) between Henry M. Jackson Foundation for the Advancement of Military Medicine and US Department of the Army; Wellcome Trust (WT) (grant 206522/Z/17/Z); and National Institutes of Health (NIH) (Award Number R21AI139777), thus completing the ZIKABRA international cooperation.This is a descriptive and documentary analytical study, based on primary data, produced by the ZIKABRA Cooperation. The documents produced by the research study group and technical reports were reviewed. Basically, the weekly meetings fed the information about the management and governance information, once all the representatives of the participant institutions attend these calls.Data underlying the study cannot be made publicly available due to ethical concerns, as data contain several personally identifiable information. Data are available from Oswaldo Cruz Foundation for researchers who meet the criteria for access to confidential data. To contact information, please report the Declarations section of the Manuscript, Availability data and materials.The study design was developed in partnership by a team of scientists from WHO, Fiocruz-RJ, CPqAM - Fiocruz-PE, FMT-HVD, WRAIR and DCCI and marked the beginning of the formation of the network of collaborators from MoH, PAHO, WHO, WRAIR, Fiocruz, WT and NIH, which is named ZIKABRA Cooperation.In 2016, at the time of the ZIKABRA study development, 216,207 probable ZIKV cases were reported in Brazil . From 20The laboratory component of the ZIKABRA study is a key part of the protocol, whose performance complexity requires mature operational and logistic support, essential to meet the requirements of all steps of the study, which included: recruitment; collection and transport of biological samples and specimens for laboratory testing at partner institutions in Brazil and WRAIR; follow-up of participants; data management and analysis; and production and progressive dissemination of knowledge generated within the scope of the project, , 10–12. Aedes aegypti and Microcephaly [The research agenda integrated into the Brazilian Plan for Fighting ocephaly  guided tocephaly , coverinocephaly . It was The WHO provided the initial funding, concept and planning for the investigation of ZIKV persistence in body fluids, and was responsible for bringing together funding partners, (WRAIR and WT), and providing the research protocol using the “Ebola RNA Persistence in Semen of Ebola Virus Disease Survivors”  as a refPAHO/WHO in Brazil has had a central role in the technical conduct of the public health emergency by ZIKV, contributing to the MoH in the national response to this epidemic in Brazil and in the countries of the region, with the direct participation of its specialized teams in the field, mainly in the infection hotspots, supporting interventions in the areas of surveillance, epidemiological analysis and purchase of laboratory supplies. PAHO has facilitated the dialogue among several health managers in Latin America and contributed to the production of knowledge about ZIKV infection, both in Brazil and in the region. It has also played an important role in the management of funds earmarked for the development of strategic research activities .Fiocruz-RJ was responsible for coordinating the study and managing funds from international sources: Wellcome Trust, WHO and WRAIR. Additionally, it is in charge of carrying out laboratory tests together with FMT-HVD and Institute Aggeu Magalhães (CPqAM), in Fiocruz-PE, coordinating the laboratory management interface of the study with CGLAB/SVS. Fiocruz is a federal agency whose mission is to produce, disseminate and share knowledge and technologies aimed at contributing to the promotion of health and quality of life for the Brazilian population. Besides generating knowledge, Fiocruz is also responsible for the production of medicines, immunobiologicals and diagnostic tests , and worFMT-HVD was the center responsible for the management of the national funding of the study. Patients from the city of Manaus, made up almost the entire sample of the study and the researchers were essential for the recruitment and follow-up of volunteer participants, laboratory analyses and transport of samples to the other sites in the national territory. As a national and world reference center for the treatment of tropical diseases, FMT-HVD plays an important role in clinical research and diagnosis and treatment of tropical diseases in the Amazon.The Wellcome Trust supports major projects in partnership with WHO and other institutions around the world to respond quickly to the global health threat caused by the ZIKV, including ZIKABRA. Its funding schemes offer grants across biomedical sciences, population health, medical innovation, humanities and social sciences, and public engagement .The NIH, more specifically the National Institute of Allergy and Infectious Diseases (NIAID), has partially funded the study through a grant, obtained via a bid notice. It promoted the research in areas such as the natural history of the disease, basic research on ZIKV, pathogenesis, rapid diagnostic tests, as well as treatments and vaccines .In this cooperation, WRAIR added its experience by providing scientific resources as a center of excellence for immunology and the development of vaccines and medicines for diseases such as dengue, Zika, Ebola, coronaviruses, malaria, HIV/AIDS and others. WRAIR’s contributions to the ZIKABRA study included co-funding, protocol review, laboratory testing, technology transfer, laboratory capacity building and production and dissemination of results.The systematization and governance of the ZIKABRA Cooperation was based on the formalization of a memorandum of understanding (MoU) between the Ministry of Health, Fiocruz-RJ, WHO and WRAIR, which established the technical criteria for the cooperation, the allocation of responsibilities among the partners, the sharing of technical and scientific information and the commitment to national and international ethical and regulatory requirements . In addiWithin the scope of the ZIKABRA Cooperation governance, a weekly dialogue routine was established since the study protocol development phase, as proposed by WHO, through the use of virtual platforms, in order to enable the participation of those involved, with transparency and integration of the study management as the ethos that characterizes its governance. In these meetings, events that occurred at each site, advances in recruitment, logistical problems faced, and the solutions found, doubts, decentralized monitoring of the protocol follow-up and other topics are reviewed. Each of these meetings is documented by WHO in minutes that record the topics covered, the decisions and courses of action and are circulated to those involved on a weekly basis. This routine helped everyone in the process of following up the work on different areas and sites.In short, the programmatic instruments supporting the study are analyzed in this locus, namely: the MoU ; the resIn Brazil, the National Commission for Research Ethics (CONEP) regulates research involving human beings and coordinates the institutions’ Research Ethics Committee (CEP) network, forming the CEP/CONEP System. The current regulatory framework is the CNS/MoH Resolution 466/2012 . After tIt is noteworthy that, in the ZIKV emergency context in Brazil, the CEP/CONEP System needed to adapt quickly to this reality  in orderThe ZIKABRA study strictly followed the current regulations for the transportation, processing and use of human biological material, for the purpose of creating biorepositories and sending biological samples outside the country in accordance with national rules , 26. ForThe ZIKABRA Cooperation Fig. , is baseThis cooperation can be thought of as an example of global health governance, a process that makes up the type of collaboration between countries that work with common goals and interests. It can have a wide and flexible range of formal and informal joint activities that may include funding and coordination in health matters . It can The ZIKABRA Cooperation had a direct benefit for Brazil, but it also has potential applicability to other settings. The evidence generated by this cooperation could be used more broadly to address efforts regarding vulnerable and most at-risk population, such as those in countries with active transmission of the ZIKV or other emergent pathogens. It is, also, expected that the scientific information produced can support national and international guidelines for body fluid testing and contribute to the future health technology innovations .However, we point out that one of the main barriers to researching in health emergency scenarios is the bureaucratic mechanisms and the slow chain procedures in conducting the rational use of financial resources in the implementation of the study. For instance, the delay in building the MoU, hiring qualified personnel, procurement and importing supplies, standardizing laboratory tests, transfer of funds to local sites, excessive delay in adjusting the work plan and to reach international quality standards.It should be noted that the team of collaborators and supporters from the institutional partners played a leading role in the implementation of the ZIKABRA Study. The existence of this joint team of collaborators and supporters was key to overcome the barriers that came up during the throughout the execution of the study.Working in cooperation in fact contributes to achieving more significant results than each group working in isolation. For this reason, careful structuring, relevant distribution of functions, well-coordinated collaboration and cooperation are pivotal. Cooperation also enables to provide consultation and coordination mechanisms so that this synergy takes place effectively .Brazilian practices of international cooperation in health have shown fruitful results in tackling public health problems with the consolidation of research and development actions. Other studies have been produced showing the importance of international collaborations for responding to the ZIKV public health emergency, including innovation, joint publications, and research networks .Another Zika research consortia were installed by the European Commission, for instance the Zika Preparedness Latin American Network (ZikaPLAN)  to addreIt’s important to highlight the research protocols coordinated by WHO like the ZIKV Individual Participant Data (IPD) Consortium, that aims the development of systematic review to describe and gather data to IPD from longitudinal studies of pregnant women with ZIKV infection during pregnancy and fetal, infant or child outcomes, in the absence of a ZIKV vaccine or prophylactics , 34.Another network initiative is supported by the European Commission (EC) Horizon 2020, was structured as a Consortium that comprises 53 partners organized in eight scientific and one management work packages (WPs), as well as three cross-cutting WPs, it’s the ZIKAlliance Consortium. This is a multicentre research that covers Latin America and the Caribbean region. Among the goals is to describe the dynamic course of the ZIKV epidemic in pregnant women (PW), children (CH) and natural history (NH) cohorts. This Consortium also collaborates with the EC H2020-funded consortia: ZikaPlan and ZikAction. It works as a spin-off for newly emerging infectious diseases, as now seen for COVID-19 .It is relevant to highlight that for all rare disease outcomes in ZIKV infection, networking has been a concrete response to share action regarding side events such as Guillain Barre Syndrome and other neurological complications, early postnatal symptomatic ZIKV infections and other rare events such as thrombocytopenia. Even more frequent events such as attack rates and sexual transmission  can be bWe understand that organizational , administrative and regulatory processes must be sufficiently agile to meet the demands of scientific research in favor of the benefits that science can bring to public health , withoutIn ZIKABRA study, groundwork was done in the health units of the selected sites, which involved the participation of health service coordinators, doctors, nurses and social workers, through prospecting visits and meetings with the presence of the researchers in charge and members of WHO, PAHO, WRAIR and MoH. During these visits, technical training on the protocol, good research practices, ethical respect for volunteer participants, structuring of services to avoid interruption in the routine care to regular patients, professionalization of non-academic professionals, among other activities, were promoted. The results were particularly enriching due to the experience shared between the site health teams and the ZIKABRA team, favoring the engagement of all actors involved for the good execution of the study.One of the main bottlenecks in the operationalization of the ZIKABRA study was the change in ZIKV epidemiology, making it impossible to recruit participants in Rio de Janeiro, and very few participants in Recife. Additionally, there was a mismatch between the finalization of the ZIKABRA protocol, including all its regulatory and financial aspects completed in January 2017, and the end of the Rapid Action Strategy by SVS/MoH, on October 31, 2016, as well as the PHEIC closure by WHO, on November 18, 2016 . This deOn the other hand, the ZIKABRA Cooperation structure, with clearly defined roles in the operational instruments, has overcome the difficulties encountered, reaching the proposed goals, greater efficiency in fund management and strengthening research autonomy. The ZIKABRA study leaves as a legacy the interaction among the actors experienced in an arena of weekly discussions where decisions were made in full respect for the cooperative ethos among peers, the intertwining of institutional visions, in order to support the team of collaborators, aiming at the common interest and achieving excellence in results.Based on this cooperation, it is suggested that there is greater flexibility and autonomy in the mechanisms of disbursement of funds and execution of the work plan, ease in hiring qualified human resources and in the purchase and import of laboratory supplies, standardization of diagnostic tests, among others. Table The legacy of the ZIKABRA Cooperation includes the construction of installed research capacity in the site, with improvement of laboratory equipment, laboratory and clinical data management platforms, training of academic and non-academic human resources, dissemination of generated knowledge, advancement of knowledge about the studied theme, knowledge transfer, availability of the ZIKABRA study protocol for development of similar studies, thus favoring the collective construction of knowledge to provide public health emergency responses. Additionally, the benefits arising from the study contribute to the strengthening of new partnerships with national and international researchers of recognized excellence in sciences, supported by public and government institutions in political, economic and technical terms .We highlight some steps towards the potential continuity of the ZIKABRA Cooperation initiative, such as the idea of WHO as a global health hub mobilizing experts and putting its tradition, prestige and knowledge to the services of technical responses achieving health goals and sharing understanding and capabilities about the actions, norms and procedures adopted by the set of participating institutions.Another relevant lesson learned is the horizontal cooperation among Brazilian researchers and institutions all over the country. The ZIKABRA project provided  technicaIt would also be important to bear in mind the role of interaction among government bodies of the participating institutions that takes place in the joint follow-up of the sites and project performance. Field supervision of all stakeholders during the implementation of the project occurred periodically. This helped to share the level of knowledge of the site settings by all participants and to avoid institutional constraints.


The Internet of Things (IoT) is of continuously growing interest for research and industry. IoT technologies are reaching maturity, as demonstrated by the increasing number of IoT applications in several markets ranging from smart homes to smart factories and Industry 4.0, with the so-called Industrial Internet of Things (IIoT).However, some issues remain despite this success. Amongst them, the main issue that may slow down the adoption of IoT relates to security. The heterogeneity in terms of protocols, operating systems, and devices, combined with poor adoption of standard solutions, create insecure designs, architectures, and deployments. Furthermore, IoT applications are often associated with sensitive data, core infrastructures, and assets, thus making them attractive in terms of vulnerability, data breaches, and denial of service attacks.Unfortunately, conventional security approaches tend to be inapplicable in the IoT due to the limitations of the resources of IoT devices and the decentralized nature of IoT architectures.Blockchain is a technology that is currently receiving great attention and may help in providing security in IoT scenarios. The decentralized architecture of blockchains, together with the ability to provide data immutability and non-repudiation services, seem to make blockchain a promising technique for securing IoT and protecting user/data privacy.The Special Issue “Blockchain Security and Privacy for the Internet of Things” seeks to explore the innovative developments, technologies, and challenges related to blockchain, security, and privacy for the IoT coming from both the latest research activities and ongoing projects. The presented topic is characterized by many open challenges that need to be solved or improved, and for this purpose, while several manuscripts have been received, only 15 original and high-quality manuscripts were selected for this Special Issue. Each manuscript was reviewed by several reviewers and went through multiple rounds of the peer-review process.We had two interesting review papers ,2 presenThe authors of  present In , the autIn the context of Smart City application and use cases,  presentsThe authors of  propose In , an archIn the challenging ecosystem of intelligent mobility and transportation systems, the authors in  present In , the autIn , a decenPaper  investigAn IoT security transmission and storage solution regarding sensing images for blockchain is proposed by the authors in . The proIn the Smart Grid application scenario, the authors of  introducThe authors in  propose Paper  presentsFinally, we would like to thank all authors and reviewers contributing to this Special Issue, the former for their original solutions and the latter for improvement suggestions. Their excellent work has allowed us to present novel and interesting contributions in the field IoT and blockchain technologies.


To the Editor—The pandemic caused by a novel coronavirus disease, known as COVID-19, carried millions of people around the world to a state of unprecedented panic. The World Health Organization (WHO) stated that more than one-third of the world is currently under some social distancing pattern, which is the oldest and probably one of the most effective methods for controlling infectious disease outbreaks. However, governments of many countries have difficulty implementing social distancing, particularly in developing countries such as Brazil, where income inequality is high and the national economy is fragile. In a recent study, Taghrir et al investigated the efficacy of mass quarantine during the pandemic and found good-quality evidence for the social distancing strategies to have been highly effective in controlling the spread of the disease. Complementing this analysis, other researchers analyzed data of 8 countries extremely affected by COVID-19: China, Italy, Iran, Germany, France, Spain, South Korea, and Japan. They concluded that the rapidly increasing COVID-19 case numbers in European countries occurs due to late contention measures. Therefore, social distancing is currently the most effective way to slow the spread of COVID-19.Several studies in the literature, both in developed and developing countries, have demonstrated the effectiveness of social distancing in slowing the spread of COVID-19. Social distancing measures included the closing of schools, universities, and almost all shops, except food stores and pharmacies. In addition, cafes, restaurants, clubs, gyms, museums, and other institutions across the country have closed. Public gatherings, religious services, and social and sporting events have been cancelled. Nonetheless, the number of cases for COVID-19 has continued to grow exponentially due to difficulties in establishing true and effective social distancing. In the real Brazilian context, a large number of informal workers are still working normally and there is a lack of access to information for a large part of the population regarding minimum infection prevention and control measures, including hand washing and respiratory etiquette.In Brazil, the Ministry of Health recommended measures of social distancing, respiratory etiquette, and hand hygiene.Although handwashing and social distancing are still the best measures to protect against the virus, the flattening the COVID-19 curve will require additional measures in developing countries, where the spreading factor of the virus are different and more complex. In Brazil, it is essential to better understand the true prevalence of COVID-19, but the lack of mass testing is one of the main problems that make it difficult to implement measures to ensure that infected individuals are in an appropriate quarantine. Here, the physical distancing between infected and people is crucial in the high-risk group, such as the elderly and those with respiratory or chronic illnesses, to reduce the lethal effect of the pandemic. Cowling et al demonstrated that the implementation of social distancing measures and changes in population behaviors, including use of facial masks, were associated with reduced transmission of SARS-CoV-2 in Hong Kong. In Brazil, the adoption of this equipment can be difficult due to the low adhesion or the lack of access to facial masks by the Brazilian population. Thus, the correct use of facial masks is fundamental to the effectiveness of the measure and can be encouraged and improved through education campaigns.According to the WHO, wearing a surgical mask, in combination with hand hygiene and other preventative measures, is one of the prevention measures to limit the spread of SARS-CoV-2 in affected areas.In Brazil, coronavirus is advancing exponentially. Although the disease has spread rapidly in large capitals, where the incidence of cases is high, COVID-19 cases are increasing in smaller cities and poorer communities as well. More than three-quarters of the confirmed cases are in southern and southeastern regions of Brazil, which are more densely populated, including many elderly, and with tropical and subtropical climates. In addition, the economic burden that sustained distancing can impose is potentially catastrophic in Brazil and other developing countries. Furthermore, if social distancing is not effective and/or is not sustained for long enough, the healthcare system may collapse, contributing to a greater tragedy.


Maritime safety is a significant topic in the maritime industry since the numerous dangers at sea could lead to loss of property, environmental pollution, and even casualties. Existing research illustrates that human factors are the primary reasons of maritime accidents. Indeed, numerous maritime accidents can be classified into different types of human factors. In this context, the Human Factors Analysis and Classification System for Maritime Accidents (HFACS-MA) model is introduced in this paper. The HFACS-MA framework consists of five levels, complying with the core concepts of HFACS and the guiding principles of the International Maritime Organization (IMO). Based on the five levels of the framework, this research explores the underlying causes of Chinese Eastern Star, Korean Sewol, and Thai Phoenix accidents, and a comparative analysis is conducted. The analysis demonstrates the utility of applying the HFACS-MA model to the maritime industry, and the results emphasize the importance of the following categories: legislation gaps, organizational process, inadequate supervision, communication (ships and VTS), decision errors, and so on. Consequently, the research enables increased support for HFACS-MA and its application and provides valuable information for safety management and policy development in the maritime industry at different levels. The maritime industry is the global economic lifeblood, transporting about 90% of global trade, so maritime safety is a vital factor for the sustainable development of international economics and trade . The marThe International Maritime Organization (IMO), whose intention it is to create a fair and effective regulatory framework for the maritime industry in order to decrease human errors, has issued a number of maritime conventions. The four main maritime regulatory conventions are International Convention for the Prevention of Marine Pollution from Ships (MARPOL), Convention on the International Regulations for Preventing Collisions at Sea (COLREG), International Convention on Standards of Training, Certification and Watchkeeping for Seafarers (STCW), and International Convention for Safety of Life at Sea (SOLAS) . In partThis paper takes three catastrophic maritime accidents as examples to identify different kinds of human and organizational factors in the maritime industry: the Chinese Eastern Star, the Korean Sewol, and the Thai Phoenix accidents. There are several reasons for selecting the three accidents. Firstly, all the three maritime accidents happened in recent years and resulted in loss of property and heavy casualties. Secondly, the three accidents occurred in China, Korea, and Thailand, respectively, and they are all located in the Asian region with similar social contexts. After the capsizing of Eastern Star and Sewol, several scholars conducted detailed analysis on the accident causes ,19,20,21On 1 June 2015 (Beijing time), the Eastern Star, which is owned by the CESC, departed from Nanjing City and was sailing to Chongqing City. At 21:30, the Eastern Star encountered a squall line system accompanied by strong convective weather, tornadoes, as well as torrential rain. Influenced by strong storms, the Eastern Star capsized in a short time when the ship navigated in the Jianli waters affiliated to the Yangtze River of China. The Eastern Star is a large-scale travel ship that was initially built by the Chuandong shipyard in 1994 and renovated in 1997, 2008, and 2015, respectively. The passengers on board were mostly old people from a travel agency named Sunset Red and most of them were sleeping when the accident happened. The accident caused 442 deaths and was deemed to be the most serious maritime accident since 1949 [At 08:58 on 16 April 2014, the Sewol with 476 persons capsized on the way from Incheon port to Jeju Island, and 325 out of the 476 passengers were high school students who were going on a school trip. As an 18-year-old Japanese ship, the Sewol was purchased by the Cheonghaejin Marine Company in 2012. Subsequently, the Cheonghaejin made a series of modifications in a Korean yard to boost capacity in 2013, resulting in the Sewol’s instability . When leOn 5 July 2018, the Phoenix went to sea illegally in spite of the weather warning. At 17:45, the ship encountered a severe storm on the way back to Phuket and capsized near Coral Island, resulting in 47 deaths . The sevThe overview of the three maritime accidents is presented in It is significant to choose an accident model because the choice of the model determines the methods of data collection, and the conclusions and the preventive measures could be different. In other words, ‘what-you-look-for’ determines ‘what-you-find’, and ‘what-you-look-for’ depends on the selected method or model employed in accident analysis ,26. TherHFACS, which is recognized as an epidemiological model, enables one to analyze the visible and underlying causes . In 1997With respect to the HFACS-MA framework, some changes have been made by comparing it with the original HFACS model. Firstly, the level of external factors is added into the HFACS-MA framework to capture the contributing factors that go beyond the scope of the organizational level, the additional level follows the application of HFACS model in the mining industry and railroad industry ,41, and In this section, the utility of applying the HFACS-MA model to the three maritime accidents is demonstrated. In order to extract the causation factors accurately, four safety experts are invited to analyze the three maritime accidents based on the HFACS-MA framework. Each safety expert needs to extract the causation factors independently according to the accident investigation report and some news articles, and an in-depth discussion about the causation factors is conducted among the four safety experts. When the causation factors are determined, they are classified into the appropriate level based on experts’ experience, and a comparative analysis is carried out. Practical implications and limitations are discussed.In terms of the Chinese Eastern Star accident, 19 accident causation factors are identified according to experts’ experience, and the accident causation factors are listed in With respect to the Sewol accident in South Korea, the disaster is the result of neglecting safety by government, supervising authorities, Chonghaejin, and the crew members . Based oRegarding the Phoenix ferry accident, 17 causation factors are identified based on the five levels of the HFACS-MA framework. Based on the cause analysis of the three accidents using the HFACS-MA framework, comparative analysis about the causes of three accidents is conducted, and the analysis results are presented in the form of an adapted fishbone diagram, which is shown in Regarding the level of external factors, legislation gaps are the primary category associated with the three accidents, especially in the Eastern Star accident and Sewol accident, as seen in At the level of organizational influences, As for the level of unsafe supervision, the most frequent categories involved in the three accidents are inadequate supervision and violations in supervision. The efficiency of organizational supervision is one of the influencing factors for the system safety and performance . Figure With respect to the level of precondition for unsafe acts, it was the most vulnerable level since the faults in the ship’s hardware could be inspected at a glance. As the Swiss Cheese Model (SCM) suggests, the defects in the external factors, organizational influences, unsafe supervision, and precondition for unsafe acts result in unsafe acts . TherefoThis research explores the underlying causes of three maritime accidents by employing the HFACS-MA model, and the results indicate that the HFACS-MA model is applicative in analyzing the maritime accidents. In addition, we conducted a comparative analysis on the accident causes, attempting to explore the similarities and differences about the accident causes under the similar social context. Furthermore, the demographic of the causation factors were computed, and the key categories associated with the three accidents were identified.Regarding the three accidents, the main focus concentrated on establishing the corresponding legislations, policies, regulations, and safety culture within the maritime industry. Firstly, the legislations that related to maritime safety should be established and improved, which attempts to provide guidelines for maritime safety. Secondly, the standard procedures should be established and improved, including safety management system and rescue communications, and the in-depth risk assessment should be conducted routinely. Thirdly, the crew members on board should receive regular safety training to improve their safety knowledge and safety awareness and finally reduce unsafe acts. In addition, the rescue workers should be properly trained to improve the rescue operations level. Fourthly, it is significant to improve the meteorological warning capability and establish the information distributing platform of meteorological warning. Consequently, this research contributes to safety management and policy development in the maritime industry at different levels.Some materials of this research come from news articles, and one of the limitations is the inadequate data due to the translation obstacle of local language in Korea and Thailand when collecting evidence, which limits the depth of conclusions that we can draw. Furthermore, there are still many unresolved questions associated with the three accidents, such as the path of each accident and the risk assessment of human factors. In addition, this research is limited to accidents caused by Cruise ship and Ro-Ro passenger vessel only. Therefore, if the scope of research is expanded to multiple types of vessels, it is possible to establish effective maritime safety measures for maritime safety. Finally, HFACS was the only method used in this research. While this research was practical, it might be helpful to compare different analytical methods such as 2–4 Model , AcciMapIn this paper, the HFACS-MA model is introduced to explore the underlying causes of Chinese Eastern Star, Korean Sewol, and Thai Phoenix ferry accidents, indicating that the HFACS-MA model is applicable for maritime accident analysis. A comparative analysis on the accident causes of the three accidents was conducted, and the demographic of the causation factors were computed, and additionally the key categories were identified. Consequently, the research can increase support for HFACS-MA and its application, and provide valuable information for safety management and policy development in the maritime industry at different levels.At the level of external factors, it is important to improve the legislation in the maritime industry, especially in the Eastern Star accident and Sewol accident. At the level of organizational influences, the defects in the organizational process are the key contributing factors for the three accidents, and additionally the Eastern Star accident and Sewol accident emphasize the defects in the asset management. At the level of unsafe supervision, the inadequate supervision and violations in supervision are the primary reasons for the three accidents, and it highlights the importance of adequate safety training for maritime safety. Regarding the precondition for unsafe acts, the physical environment factors featured remarkably in the three accidents, and meanwhile communication (ships and VTS) play an important part in coordination and accident rescue. At the level of unsafe acts, it emphasizes the importance of the following factors: the decision errors and violations. Efforts to reduce unsafe acts should concentrate some critical HFACS categories at the lower levels.Although this research analyzes the causes of three accidents in detail, there are still many unresolved questions associated with the three accidents, such as the path of each accident and risk assessment of human factors. At the same time, this research provides some new insights to encourage further research to establish effective measures for national and international maritime safety.


Of Italian origin but Brazilian by adoption, Luigi Bogliolo was born on April 18, 1908, on the island of Sardinia, in Sassari, the main commune of the province of the same name. He died in Belo Horizonte on September 6, 1981. The firstborn child of Enrico Bogliolo, a railroad worker, and Maria Ruju, he graduated with a medical degree from the University of Sassari in 1930 as the best student in his class. At Medical School, he was a teaching assistant in Pathological Anatomy under the guidance of Prof. Enrico Emilio Franco, who was a source of inspiration for him throughout his life. In the 1931-1932 biennium, he was a volunteer assistant at the Institute of Pathological Anatomy and Histology of the University of Sassari, directed by Franco. At the end of 1932, he moved, along with his mentor, to the Royal Adriatic University Benito Mussolini, based in Bari, where he became a staff assistant in the Pathological Anatomy Department. In December 1936, following the footsteps of Franco once more, he moved to the University of Pisa, where he remained, until March 1939, as a deputy director of the Institute of Pathological Anatomy and Histology.Salomone Enrico Franco) was born in Trieste on November 22, 1881, and graduated with a degree in medicine from the Royal University of Padua in 1906. He was very demanding as a teacher, and apparently his students feared him with the same intensity with which they admired him; nonetheless, in the case of Bogliolo, he created all the conditions for the emergence of the “master” that his disciple, perhaps unsuspectingly, held in the core of his own being. His classes on the cadaver in the autopsy room were belissime, as Prof. Giuseppe Sangiorgi stated in the lecture (posthumous eulogy) that he delivered in Bari on November 18, 1950, to the members of the Italian Society for Experimental Biology. On that topic, his manual atlas of autopsy techniques, originally published in 1926, is an indisputable testimony of the seriousness and mastery with which he performed cadaveric examinations, which he considered a thorough investigation and not a hasty exercise in organ extraction.An Italian of Jewish origin, Enrico Emilio Franco , not only because of their high intellectual stature but also because they descended from a glorious scientific lineage, which is summarized below.While they were working in Pisa, Bogliolo and Franco bonded affectionately and professionally with the regent of the Chair of General Pathology, Cesare Sacerdotti, a disciple of Camillo Golgi and Giulio Bizzozero, whom they respectfully referred to as De sedibus et causis morborum per anatomen indagatis – a systematic confrontation between autopsy findings and clinical records, published in 1761. Therefore, one can consider Enrico E. Franco a legitimate descendant of the “Father of Pathological Anatomy”, from whom he was distanced by a few generations.As mentioned, Luigi Bogliolo (1908-1981) was a direct disciple of Enrico E. Franco (1881-1950) who, as a medical graduate from the University of Padua in 1906, was linked to the School of Giovanni Battista Morgagni (1682-1771), a distinguished professor of that old university and the author of the masterpiece Giovanni Battista Morgagni was a disciple of the anatomist and surgeon Antonio Maria Valsalva (1666-1723), a professor at the University of Bologna who dedicated himself to the study of the anatomy, physiology and pathology of the human ear. Valsalva was a disciple of Marcello Malpighi (1628-1694), founder of microscopic anatomy and author of notable contributions such as the first observation of capillary circulation, which was previously inferred by William Harvey; the first description of the vesicular structure of the human lung, which formed the basis for the formulation of a theory of respiration; the description of the lymphatic follicles of the spleen; the pioneering description of renal glomeruli; a detailed description of the structure and metamorphosis of the silkworm and of plant morphology; the description of the prickle cell layer of the skin; and the establishment of the foundations of a new discipline, Embryology. Marcello Malpighi was, in turn, both a mentor and a disciple of the physicist and mathematician Giovanni A. Borelli (1608-1679), the founder of Iatromechanics (the application of mechanics to medicine). Finally, Borelli was a disciple of the physicist and mathematician Galileo Galilei (1564-1642), a pioneer of scientific thought.Helicobacter pylori in the human stomach. Giulio Bizzozero studied in Germany with Rudolf Virchow (1821-1902), author of the magnum opus Die Cellularpathologie (1858) and of the famous aphorism Omnis cellula e cellula, which is why he is nicknamed the “Father of Cellular Pathology.” In addition, Camillo Golgi himself was a disciple of Giulio Bizzozero.The connections between Bogliolo and Franco with Cesare Sacerdotti allow the exploration of a second branch of what could be called the scientific lineage of Bogliolo. Sacerdotti was a direct disciple of Camillo Golgi (1843/44-1926), who, along with Santiago Ramón y Cajal, won, in 1906, the Nobel Prize in Physiology or Medicine for his brilliant studies on the fine structure of the nervous system; he was also a disciple and collaborator of Giulio Bizzozero (1846-1901), the discoverer of platelets (and of their role in hemostasis) and of spiral bacteria in the stomach of dogs, the first step towards the identification of the species Mus musculus, var. alba) and the rat (Mus norvegicus).The publications of Bogliolo during his academic life in Italy deal with various topics, with an emphasis on those related to leishmaniasis and, in particular, to the experimental production of sarcomas through injections of Thorotrast in the mouse (thorotrastomas) due to exposure to alpha radiation .Thorotrast  was introduced for clinical use in 1928 and was used initially for retrograde pyelography and intravenous hepatolienography. As expected, almost all of the injected thorium dioxide was retained in the body, with 70% deposited in the liver, 20% in the spleen and the remainder in the reticuloendothelial system of the bone marrow and in the periportal lymph nodes. In 1931, Thorotrast began to be used by the Portuguese neurosurgeon Egas Moniz to examine the intracranial vessels, replacing the iodinated contrast that had been used until then for the same purpose. with successive injections of Thorotrast subcutaneously into the posterior half of the abdomen. In a second study, published in 1938, the injection of the contrast in the rat (Mus norvegicus) was able to induce the appearance of malignant blastomas in all 23 animals in the experiment, including 20 cases of fasciculated spindle cell sarcoma and three cases of pleomorphic sarcoma with areas of cartilaginous metaplasia  in hundreds of patients who had received the radiological contrast for diagnostic purposes, sometimes as much as 40 years previously. Nonetheless, the use of Thorotrast continued until the mid-1950s at highly prestigious institutions such as the Massachusetts General Hospital, the Lahey Clinic and the University of Michigan Hospital, in one of the most embarrassing episodes in the history of medicine.In Pisa, Bogliolo obtained the title of full professor in a public examination held in 1938; that same year, he married Geula Bennoun, a medical student of Jewish origin born in Jaffa, a twin city of Tel Aviv. In January 1939, Franco was dismissed from the University of Pisa amid the wave of anti-Semitism that ravaged his homeland and was forced into exile in Jerusalem, where he died on September 20, 1950, from diabetic nephropathy. In March 1939, Bogliolo was dismissed from the same University for his antifascist position, aggravated by his close relationship with Professor Franco and with Geula Bennoun, and was forced to leave his native country as well. After spending a few months in Belgium, he traveled with his wife to Brazil, arriving in Rio de Janeiro on January 5, 1940. In exile, until Franco's death, master and disciple never ceased to correspond, despite the difficulties imposed by World War II, which began on September 1, 1939, and the Arab-Jewish conflict, which experienced its most dramatic moments in 1947-1948. In January 1949, Bogliolo and Franco met, for the last time, in Jerusalem.At the beginning of his life in Rio de Janeiro, Luigi Bogliolo and his wife lived in a second-class guest house near the pier; and to survive, they tanned alligator skins in the bedroom. It is known that ancient Jews knew the method of tanning hides and skins with oak bark, an art that they must have learned as captives in Egypt; however, in the case of the young couple newly arrived from Italy, the place – a small bedroom in a guest house – was not the most suitable for the exercise of that ancient practice. It did not take long for problems to arise: annoyed by the strong smell from the tanning process, the owner of the guest house used to pound the door of the bedroom asking for explanations and threatening to evict the two afflicted artisans who, in an attempt to hide their wrongdoing, quickly threw the skins under the bed.post mortem findings with those observed intra vitam.In January 1941, under the recommendation of Prof. Eduardo MacClure, Bogliolo took on the Pathological Anatomy Service of the 5th Chair of Internal Medicine of the National Faculty of Medicine (now Faculty of Medicine of UFRJ), led by the great clinician Heitor Annes Dias (1884-1943), nicknamed “the Brazilian Jiménez Díaz”. In perfect harmony with Annes Dias, Bogliolo boosted the Clinicopathological Conferences at that institution. Inspired by the unforgettable lessons of Franco, he conducted the autopsies of the cases that were presented in those meetings. Thus, after the clinical features had been explored, the diagnostic hypotheses had been formulated, and the possible reasons for the death of the patient had been considered, he was in charge of the autopsy report. Furthermore, at the end of the conferences, he used to perform the great synthesis – the epicrisis – correlating the post mortem examination, live in the clouds of a vain illusion. Forty-two years after Bogliolo’s retirement, the Clinicopathological Conferences continue to take place at the Faculty of Medicine of UFMG. Regarding the invaluable pedagogical value of this academic activity, which I have coordinated since 1995, I published a book in 2010With the premature death of Annes Dias in 1943, Bogliolo was invited by his compatriot Alfredo Balena, director of the Faculty of Medicine of Belo Horizonte (now Faculty of Medicine of UFMG), to head the Chair of Pathological Anatomy of the institution Balena had helped to found in 1911. Starting in 1944, Bogliolo continued to perform autopsies and to favor Clinicopathological Conferences in his new home until his compulsory retirement in 1978. Certainly, he heeded Morgagni’s wise warning that the physicians who have done or seen many autopsies have learned at least to mistrust their diagnoses, while those who do not confront themselves with the often discouraging findings of Taceant colloquia. Effugiat risus. Hic locus est ubi mors gaudet succurrěre vitae – according to which, in the place where death delights to help the living, there should be no talking or laughing. To describe the Bogliolo’s austere demeanor during the performance of an autopsy, it is worth reproducing the testimony of the late psychiatrist Joaquim Affonso Moretzsohn, who graduated in 1946:In the autopsy room, which he considered a kind of “sacred temple”, Bogliolo demanded absolute respect for the corpse, as if he incorporated the message contained in an ancient Latin maxim – I met Prof. Bogliolo. He debuted with my class in the 4th year of Medical School, in 1944. ‘What? Do you want to smell roses?’ he exclaimed with a heavy peninsular accent when he realized that I took a handkerchief to my nose in the autopsy room.curriculum vitae, a written exam, a practical exam, a didactic exam and a thesis defense, he achieved the Cathedra.As mentioned, in 1944, Luigi Bogliolo became the head of the Chair of Pathological Anatomy at the Faculty of Medicine of Belo Horizonte. In the capital of Minas Gerais State, three of his children  were born, whereas Alexandre, his only son, had already been born in Rio de Janeiro in 1942. Both Alexandre and Ada would tragically die very young, victims of accidents, respectively in 1965 and 1967. Because he was a foreigner, Bogliolo was forced to revalidate his diploma; to accomplish this goal, between 1953 and 1957, he underwent practical, written and oral exams for all subjects of the last three years of the medical program. Therefore, it was not until 1958 that he completed his doctorate, defending a thesis on the pathology of acute toxemic form of schistosomiasis mansoni. In 1959, after a brilliant examination that consisted of an analysis of his Patologia, with the participation of his assistants and renowned professors throughout Brazil and Italy. In 2016, the ninth edition of the book, with 1,542 pages, was printed under the supervision of Prof. Geraldo Brasileiro Filho. In 1978, also through the Editora Guanabara Koogan, Bogliolo published the book Patologia Geral Básica; in 2018, also under the supervision of Prof. Geraldo Brasileiro Filho, the sixth edition of the book was printed.In 1972, through the Editora Guanabara Koogan, Bogliolo published the first edition of the book Working at the Faculty of Medicine of UFMG until 1978, the year of his compulsory retirement, Bogliolo created a School of Pathological Anatomy that through its high level of regard would impose itself onto the scientific environment of his adoptive country. His first assistant professors included Paulo Roberto Ferreira Borges, Nello de Moura Rangel, Iracema Baccarini, João Henriques de Freitas Filho, Edmundo Chapadeiro, Washington Luiz Tafuri and Pedro Raso. The contributions of his School cover various topics in the field of Pathology, with an emphasis on tropical diseases, such as schistosomiasis mansoni and Chagas disease. The contributions of Bogliolo himself to the knowledge of the pathology of the different anatomoclinical forms of schistosomiasis mansoni deserve special attention, and include the following:• the accurate characterization of the morphological findings of the liver in the hepatosplenic form, especially in the case of Symmers fibrosis, which, according to some authors, should be called “Symmers-Bogliolo fibrosis”;• the clarification of the concepts of fibrosis and cirrhosis as they apply to fibrosing liver diseases, thus distinguishing the anatomical picture of the liver in the hepatosplenic form of schistosomiasis and in visceral leishmaniasis from that of liver cirrhosis;• the first description, in patients with the hepatosplenic form undergoing splenoportography, of the peculiar changes in the hepatogram, characterized by the presence, next to the clearer and denser image of the dichotomous portal branches, of a less dense and less defined shadow attributed to the newly formed vascular network around the dichotomous branches (“Bogliolo’s sign”);• the detailed description of the anatomical picture of the acute toxemic form, which was the focus of his doctoral thesis.The post-graduation, so valued today, was, in a way, already being carried out by Bogliolo in the 1950s; in fact, it consisted of a “post-graduation in spirit”, because it lacked regulation and recognition by the relevant authorities. It was only in 1972 that the Teaching and Research Coordination Office of UFMG approved the creation of the Post-Graduate Program in Pathology, with three areas of concentration: General Pathology, Special Medical Pathology and Special Dental Pathology.Luigi Bogliolo was one of the founders of the Brazilian Society of Pathologists and served in virtually all positions therein, including the presidency (biennium 1960-1962). His remarkable presence, his verve, his critical spirit and his unmistakable style were felt in the conferences promoted by that society. He was also a member of the Minas Gerais Academy of Medicine, occupying chair 46, whose patron is José Aroeira Neves, a disciple of Ezequiel Dias. In 1978, shortly after his compulsory retirement, he received the title of Professor Emeritus of the Faculty of Medicine of UFMG.Although he was extremely strict and demanding, to the point – like Prof. E. E. Franco – of stoking undisguised fear in many of those who interacted with him, Bogliolo left an indelible mark on his disciples and collaborators. After all, one of his great passions was the unlocking of young people’s potential, encouraging them to exercise reasoning, ask relevant questions, develop critical awareness and cultivate curiosity. Thus, he certainly endorsed the words of the ancient Greek philosopher Plutarch:For the mind does not require filling like a bottle, but rather, like a wood, it only requires kindling to create in it an impulse to think independently and an ardent desire for the truth.In 1992, I published a book about the fascinating trajectory of the late master.