Development of Remote Monitored Vaccine-1

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THE DEVELOPMENT OF REMOTE MONITORED MOBILE VACCINE COOLING

SYSTEM

OMOTOLA FAITH SAMUEL FPA/ME/22/3-043

ORIOLA ABIODUN OJO FPA/ME/22/3-044

OSANIPIN ABEL AYANFE FPA/ME/22/3-045

IN PARTIAL FUFILLMENT FOR THE AWARD OF HIGHER NATIONAL DIPLOMA

APRIL 2024

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ABSTRACT
While dealing with the daily challenges of the COVID-19 pandemic, everyone is looking to
science for a solution in the form of effective vaccine preservation in transportation. According
to studies, temperature changes in vaccine storage cause up to 10% of vaccinations to be lost
during transport. Especially in rural areas where electricity is relatively limited, making it
difficult to maintain the ideal temperature range of -5°C to -10°C for vaccine preservation. This
vortex tube refrigeration system includes a vortex tube, a cold box, a compressed air storage
tank, compressed air hoses and a cooling coil. The Purpose of this project is for storing vaccine
and can be controlled remotely and can use solar battery as its source of power.

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CHAPTER ONE

1.1 INTRODUCTION

WHO (1998) asserts that “Effective management and delivery of vaccines is an important aspect
of improving healthcare for under-served communities in developing countries”. The World
Health Organization (WHO) estimates that vaccines prevent over 2.5 million child deaths from
fatal diseases annually. Access and availability of vaccines has improved tremendously over the
last 5 to 10 years with the influx of donor resources and increased supplies from several new
manufacturers. However, delivery and storage of these temperature and time sensitive vaccines
continues to pose challenges in many developing countries. The WHO specifies the procedures
to be followed for safe storage of vaccines, which include routine monitoring and reporting of
alarm conditions (e.g. storage temperatures deviating from the allowable range for a prolonged
period of time).
Vaccines typically need to be stored in a controlled +2° to +8°C environment in order to ensure
their potency (e.g. Figure 1 shows a few pictures of equipment used to store vaccines at a
SILIAS Health Clinic in Nicaragua). However, country cold-chains (the supply chains for goods
requiring constant refrigeration) are not always reliable; as a result, vaccines may be exposed to
temperatures that are either too hot or too cold, causing vaccines to be spoiled. Intermittent
power outages, limited availability of skilled staff for equipment maintenance, lack of spare
parts, and interruptions during transportation are common causes for these losses (WHO, 1998).

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Figure 1.1: Cold-boxes for vaccine storage at a SILIAS Health Clinic in Nicaragua

Organs and vaccines are frequently stored and transported in thermal containers. In distant areas,
where electricity is unavailable, these areas require consistent long-term refrigeration to maintain
the ideal temperature range of 2 to 8°C for vaccines in India. The requisite temperature
conditions are normally maintained for 6 (at best, 12) hours in light, compact containers.
Using vortex tube refrigeration, several researchers have offered a number of ideas.
Voronchikhin and Tuev (2022), proposed the prospect of using the vortex effect in a
transportable thermostatic unit. The temperature of the effective volume and its contents is
determined by the airflow pressure in the pipe. As a biological item, test tubes with 200 ml of
blood at 23°C were used to prove this.
Karthikeya, Amba and Madhu (2015), evaluated the energy separation in a vortex tube.
Additionally, they applied and evaluated turbulence models such as LES and k–ε, k–ω and used
CFD confidently throughout a wide range of operating conditions and geometries.
Nellis and Klein (2011), studied the potential performance benefit of replacing a refrigeration
system's throttling valve with a properly adjusted vortex tube.
According to Akash and Sumit (2020) experimental findings, the temperature drop is inversely
proportional to input pressure intensity; the higher the inlet pressure, the greater the temperature
drop at the cold exit.
In the intricate tapestry of global healthcare, the backbone of vaccine distribution lies in the cold
chain—an intricate network ensuring vaccines maintain their effectiveness from the moment of
production to the instant they protect an individual from disease. However, this network often
grapples with significant challenges, particularly in the context of remote or underserved regions.
The conventional cold chain, while admirable and functional in well-established healthcare
infrastructures, encounters hurdles when attempting to reach the farthest corners of the globe.
Thus, the focus of this project is rooted in the necessity to bridge the gaps in vaccine distribution,
especially in areas where conventional solutions fall short. The project's objectives are driven by
a collective vision to democratize healthcare access, aligning with the fundamental principle that
no individual should be deprived of vital vaccines due to geographical barriers or logistical

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constraints. Through this project, we endeavor to spearhead a tangible transformation that
enhances the reach and impact of vaccination programs, fortifying global health in an
increasingly interconnected world.

Fig. 1.2 Schematic diagram of Counterflow vortex tube

1.2 Statement of the Problem

Remote and underserved areas present a unique set of obstacles to the traditional cold chain. The
scarcity of resources, the vastness of uncharted territories, and the unpredictability of climatic
conditions can disrupt the delicate balance needed to preserve the potency of vaccines. These
regions often face a concerning issue: inadequate access to adequate cold chain facilities,
resulting in compromised immunization efforts and an increased risk of preventable diseases.

According to WHO (1998), up to 10% of vaccines can be lost in transit due to temperature
changes required for preservation. Vaccines include sensitive biological molecules that can be
irreversibly destroyed by extremes of heat and cold. As a result, it's critical to keep a close eye on
vaccination temperature throughout its life cycle.

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In this backdrop, the need for a versatile and adaptive solution becomes evident. A mobile
vaccine cooling system, fortified with the latest technological advancements, offers a promising
strategy to circumvent these challenges. Such a system would not only ensure the optimum
storage and transportation of vaccines but also overcome geographical barriers that hinder
traditional cold chain systems.

Understanding the pulse of this urgency, the marriage of advanced technology and healthcare
innovation is poised to redefine the traditional paradigms. The envisioned mobile vaccine
cooling system, underpinned by cutting-edge temperature control and real-time monitoring
technologies, holds the potential to revolutionize how we approach vaccine distribution. Real-
time monitoring capabilities would equip healthcare professionals with immediate insights into
temperature deviations, system performance, and location, enabling swift interventions and
bolstering the preservation of vaccine efficacy.

1.3. AIM AND OBJECTIVES

The primary aim of this project is to design, develop, and implement an innovative Remote
Monitored Mobile Vaccine Cooling System, addressing the challenges of traditional cold chain
systems and ensuring the preservation of vaccine potency and effectiveness during storage and
transportation. The all-embracing goal is to contribute significantly to global public health by
improving the accessibility and efficiency of vaccine distribution, especially in remote and
underserved regions while the specific objectives are:
i. To design a robust and reliable system capable of maintaining precise temperature
conditions essential for vaccine storage and transportation.
ii. To produce a compact, easily transportable system that can adapt to various modes of
transportation and effectively reach remote and underserved areas.
iii. To develop a sophisticated real-time monitoring system capable of tracking temperature,
location, and system status.
iv. To optimize the system for energy efficiency and environmental sustainability, exploring
renewable energy sources and eco-friendly technologies such as solar power.
v. To reduce operational costs and minimize the system's carbon footprint, aligning with
global sustainability objectives.
vi. To conduct performance evaluation of the developed mobile vaccine cooling system

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vii. To conduct training programs and capacity-building initiatives for healthcare
professionals and technicians involved in operating and maintaining the mobile vaccine
cooling system.
viii. To gather feedback from healthcare practitioners and stakeholders, facilitating
iterative improvements to enhance the system's functionality and address any identified
limitations.

1.4 Scope of Study


The scope of this study include; designing a robust and reliable system capable of maintaining
precise temperature conditions essential for vaccine storage and transportation, producing a
compact, easily transportable system that can adapt to various modes of transportation and
effectively reach remote and underserved areas, developing a sophisticated real-time monitoring
system capable of tracking temperature, location, and system status, optimizing the system for
energy efficiency and environmental sustainability, exploring renewable energy sources and eco-
friendly technologies such as solar power, reducing operational costs and minimize the system's
carbon footprint, aligning with global sustainability objectives, conducting performance
evaluation of the developed mobile vaccine cooling system, conducting training programs and
capacity-building initiatives for healthcare professionals and technicians involved in operating
and maintaining the mobile vaccine cooling system, gathering feedback from healthcare
practitioners and stakeholders, facilitating iterative improvements to enhance the system's
functionality and address any identified limitations.

1.5. Significance of Study:

The proposed project to develop a Remote Monitored Mobile Vaccine Cooling System holds
immense significance, addressing critical gaps in the current cold chain management for
vaccines. This initiative is not merely a technological advancement but a pioneering endeavor
that stands to impact global public health profoundly. The mobile vaccine cooling system will
break down barriers of accessibility, especially for underserved and remote communities. By
ensuring that vaccines can reach even the most distant corners of the world, we bridge the gap in
healthcare delivery and contribute to equitable access to life-saving immunizations. This project
will ensure that vaccines remain within the optimal temperature range during transportation and
storage, safeguarding their effectiveness and potentially saving countless lives.

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The incorporation of real-time monitoring capabilities adds a layer of safety and efficiency
previously unseen in vaccine distribution. Rapid detection and immediate responses to
temperature deviations will minimize the risk of administering compromised vaccines, bolstering
public trust in immunization programs. The mobile nature of the cooling system allows for
strategic deployment, optimizing resource allocation. Vaccines can be transported directly to
communities in need, reducing logistical complexities and lowering operational costs associated
with traditional centralized cold chain systems.

In regions susceptible to extreme weather conditions, the adaptability of the mobile cooling
system is paramount. This project addresses climate sensitivity, ensuring vaccine integrity is
maintained even in challenging environmental circumstances, bolstering healthcare resilience in
the face of climate change. With an ever-increasing threat of pandemics and emerging infectious
diseases, a robust vaccine distribution system is essential for global health security. This project
is a step towards fortifying our defenses against health crises by establishing a reliable and
adaptable mechanism for rapid vaccine deployment.
The emphasis on energy efficiency and sustainability aligns with global environmental goals.
Utilizing renewable energy sources and optimizing energy consumption not only reduces
operational costs but also demonstrates a commitment to a greener and more sustainable future.
The training and capacity-building component empower healthcare professionals with the
knowledge and skills needed to operate and maintain the system effectively. This enhances their
capabilities, contributing to a stronger and more responsive healthcare workforce.

In summary, the significance of this study extends beyond the technological realm. It represents
a step towards a more inclusive, effective, and sustainable healthcare ecosystem, ensuring that
life-saving vaccines reach every corner of the globe. Through this initiative, we envision a world
where preventable diseases are a thing of the past, made possible by a well-distributed,
technologically advanced vaccine delivery system

1.6. Expected Contribution to Knowledge


The proposed project to develop a Remote Monitored Mobile Vaccine Cooling System is
anticipated to make significant contributions to the field of healthcare logistics, vaccine
distribution, and technological innovation. The knowledge generated through this initiative is
expected to impact various domains in profound and transformative ways. It offer several

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advancements in vaccine storage and distribution. These systems enable real-time monitoring,
improving knowledge of optimal temperature control throughout the supply chain. Early
warnings of temperature fluctuations can prevent spoilage, leading to more efficient resource
management. Additionally, collected data can contribute to optimizing storage protocols for
diverse environments.

CHAPTER TWO
LITERATURE REVIEW

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2.1. Introduction
This chapter gives an extensive review on works and study related to this project, emphasizing
on different designs, analysis, and areas of application and safety aspects of view.

2.2 Technological Innovation and System Development

2.3 Portability and Adaptability

2.4 Real-time Monitoring and Alert System

2.5 Energy Efficiency and Sustainability

2.6 Capacity Building and Training:

2.7 Cold Chain Management and Vaccine Distribution


Jadhav, Gautam, Gairola, & Shete (2019) analyzed some of the challenges faced in vaccine
distribution, such as temperature control, logistics, and accessibility, to identify areas for
improvement. Vaccines are temperature-sensitive biological products that, to ensure potency,
must be stored between 2 °C and 8 °C from the time of manufacture to the point of
administration. Exposure to temperatures above this range may result in reduction of shelf-life,
while exposure to freezing temperatures is likely to cause irreversible loss of vaccine potency.
Ensuring vaccines and temperature sensitive medicines are not exposed to temperatures outside
2–8 °C is known as ‘cold chain management’. Pharmacists have a professional responsibility to
administer efficacious and immunogenic vaccines. Breaches in the vaccine cold chain may result
in the administration of vaccines that cannot elicit an immune response and therefore may leave
the individual and community at risk of vaccine-preventable diseases (Lee, Cakouros, Assi,
Connor, & Welling, 2019). Figure 2.1 below shows a vaccine supply chain.

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Fig.2.1. Vaccine Supply Chain

2.8 Vaccine Storage Technologies and Innovations


Karp, Lans, Esparza, & Edson (2017) opined that Vaccine storage technologies have undergone
significant advancements in recent years, driven by the need for efficient distribution and
preservation of vaccine efficacy. These innovations encompass a range of approaches aimed at
maintaining the integrity of vaccines throughout the storage and transportation process.
One notable area of innovation revolves around cold chain management. Ensuring vaccines are
kept at the appropriate temperature is crucial for their effectiveness. Traditional methods rely on
refrigeration, but modern technologies have introduced more sophisticated temperature control
mechanisms, such as thermoelectric cooling systems and phase-change materials.
Additionally, there has been progress in the development of temperature monitoring devices.
These tools enable real-time tracking of vaccine temperatures, providing crucial data to ensure
vaccines remain within the required temperature range during storage and transportation.

2.9 Real-time Monitoring Systems for Vaccine Cold Chain


Varela, Devaux, Milstien, Krudwig, & Carrasco (2017) explores the current landscape of real-
time monitoring systems used in cold chain management. It assesses the effectiveness of these
systems in ensuring temperature integrity, their integration with existing infrastructure, and their
potential to revolutionize vaccine distribution.
Chitguppi & Ye (2018) revealed that Real-time monitoring systems for vaccine cold chains are
essential tools that ensure the integrity and efficacy of vaccines during storage and
transportation. These systems utilize various technologies to continuously monitor temperature
and other environmental conditions. By providing real-time data and alerts, they help maintain
vaccines within the required temperature range, safeguarding their potency. Additionally, these
systems enable proactive management and intervention, minimizing the risk of temperature
excursions and ensuring vaccine quality.

2.10 Sustainable Energy Solutions for Cold Chain Systems

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This section explores sustainable energy sources and technologies that can be integrated into
cold chain systems to enhance energy efficiency and reduce environmental impact. Emphasis is
placed on renewable energy solutions suitable for powering the mobile vaccine cooling system.
Fuss, Canadell, Peters, Tavoni, Andrew, Ciais, & Yamagata (2014) opined that Sustainable
energy solutions for cold chain systems are essential for reducing greenhouse gas emissions,
minimizing reliance on fossil fuels, and mitigating the environmental impact of refrigeration and
transportation processes. These solutions encompass a range of technologies and strategies aimed
at improving energy efficiency, utilizing renewable energy sources, and optimizing the overall
sustainability of cold chain operations. By adopting sustainable energy solutions, cold chain
systems can achieve significant reductions in carbon emissions, enhance resilience to climate
change, and contribute to a more environmentally sustainable future.

CHAPTER THREE
METHODOLOGY
3.1. Introduction

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This section will cover the design of a robust and reliable system capable of maintaining precise
temperature conditions essential for vaccine storage and transportation, production of a compact,
easily transportable system that can adapt to various modes of transportation and effectively
reach remote and underserved areas, development of a sophisticated real-time monitoring system
capable of tracking temperature, location, and system status, optimizing the system for energy
efficiency and environmental sustainability, exploration of renewable energy sources and eco-
friendly technologies such as solar power, reduction of operational costs and minimization of the
system's carbon footprint to align with the global sustainability objectives, performance
evaluation of the developed mobile vaccine cooling system, conduction of training programs and
capacity-building initiatives for healthcare professionals and technicians involved in operating
and maintaining the mobile vaccine cooling system, gathering of feedback from healthcare
practitioners and stakeholders, facilitating iterative improvements to enhance the system's
functionality and address any identified limitations.

3.2 System Design


This section will outline the design process for the remote monitored mobile vaccine cooling
system, including the selection of components, specifications, and system architecture. It will
also address the power source, cooling mechanism, and insulation requirements for the system.

3.2.1 Selection of Vaccine Container as per the requirement.


According to Swami and Bhavsar (2022), the size (volume) and other specifications of modern
thermal containers vary as per the applications and requirements. For this study, a lightweight,
small-volume container from Nilkamal model RCB 503L with a gross volume of 23.3 L is
selected. This sort of thermal container is passive, meaning that its main purpose is to keep the
stored biological material cool. The cold box's external surface is made of LLDPE (Linear low-
density polyethylene) thickness (Xi) varies as per the side of the cold box ranging from 6mm to
13mm and the inside insulation is CFC-free polyurethane with a thickness of 111mm and
thermal conductivity of (λi) 0.035(W/mK). With that this cold box can provide the required
temperature conditions for up to 96 hours.

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Fig3.2: Cold box RCB 503L

Calculation of Cooling Load for Cold Box RCB 503L.


Calculating the cooling load of the cold box determines heat intake. As a result of that, the
required refrigeration capacity is established to match the calculated cooling load, allowing for
optimal vortex tube selection.
 External Dimensions of the cold box = 0.774(L) x 0.616 (W) x 0.530(H)m,
 Inner Dimensions of the cold box = 0.528(L) x 0.382 (W) x 0.282(H)m,
 The outside temperature (To) can be the ambient temperature where the box will be kept
is 318K (taking maximum).
 The inside temperature (Ti) will be decided by the vaccine requirement of 276K (in
between 2°C to 8°C) (taking the minimum).
1) Transmission heat load (H1):
Calculations of Heat conducted through the walls of the cold box:
Where, Qc is heat transmission at the flat surface (W), U is
Qc= UA (To-Ti) (1)
n
1 1 Xi 1
= +∑ + (2)
u αi i=1 y i α 0

total heat transmission coefficient (W/m2K), area (A) of heat transmission (m2), coefficient of
heat transmission of inside (αi), and outside (αo) surfaces are 6 W/m 2K and 45 W/m2K
respectively (ref.).

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The overall transmission load of all six walls is calculated as 33.0444W, with a 10% allowance
(for each side) taken into account as a precautionary measure in the form of heat infiltration from
unidentified sources.

2) Infiltration heat (H2):


The thermal infiltration load comes mainly from the entry of hot air into the cold box in the event
of a door opening or structural deformation such as wall fractures in the cold box RCB 503L that
contribute to small leakage.
1
H 2=z ×V × ×∆h (3)
V
Where, volume of the cold storage (V) is calculated using the internal dimensions of the cool box
RCB 503L [25]. The reference value for the total number of air exchanges (z) in this scenario is
taken as 5 [23]. And the specific volume of air at 45°C and 60% relative humidity is calculated
as 0.9 m3/kg. In this case, h1 and h2 are 142 Kj/kg and 15 Kj/kg, respectively.

3) Total heat (H3):


H 3=H 1 + H 2 (4)

The refrigeration system only after considering the safety factor of 15%, and the total
refrigeration capacity is determined as 84.087W.

3.3. Selection of Vortex Tube.


Vortex Tubes from Exair Corporation are a low-cost, reliable and maintenance-free solution to
industrial spot cooling problems. Based on the calculated cooling load of 84.087W, the overall
refrigeration capacity is determined to be 286.9167 BTU/hr. Temperatures, and cooling power
may very well be adjusted to produce temperatures ranging from -46°C to 127°C. for this study
Vortex tube model 3208 with a cooling load capability of up to 550 Btu/hr is selected, for the
cold box RCB 503L. In comparison to calculations, this vortex tube model 3208 have higher
refrigeration capacity (Swami. and Bhavsar, 2022).

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Fig. 3.3. EXAIR Vortex Tube model 3208

3.4. Numerical methodology of vortex tube analysis.

Swami and Bhavsar (2022) estimated that the essential requirement in this research work is to
achieve 276K at the cold end while maintaining a low temperature and pressure loss. For that,
the present study focuses on optimizing the design of a vortex tube model 3208 by utilizing
design parameters (such as the number of nozzles, and control valve settings) as well as
operational parameters (like varying input stagnation pressures, mass fractions and temperatures
at the cold and hot end, etc.) based on the design criteria. This research work is carried out by
using the ANSYS Fluent 2021R2 finite volume-based solver to solve the governing equations
and the boundary conditions.

1) Geometry Modeling
Fig. 3.4.1. shows the schematic diagram and the dimensions of the vortex tube under study. A
geometric model of the vortex tube with 2, 4, and 6 number of inlet nozzles were considered, as
shown in Fig. 3.4.2., and the following geometrical parameters are taken into account based on
manufacturing data and research for optimal performance.
1. D = 9.5 mm, L/D < 8.21 [26], where L is length and D is the diameter of the vortex tube;
2. The total relative area of inlet tubular nozzles Ai/A is equal to 0.14;
3. Ac/A = 0.44 is the cold air relative exit area [24];
4. The ring-shaped relative hot air outflow area Aho/A = 0.052, where Aho is the area of
the hot outlet and Ac is the area of the cool outlet [25];
5. In addition, for Conical
control valves with
diameter D1/D =
0.667 [25].

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Fig.3.4.1: Specifications of the Vortex Tube model 3208

a b

Fig.3.4.2. Geometry of (a) Case1 (b) Case2 and (c) Case3.

As illustrated in Fig. 3.4.2., there are primarily three cases based on the number of nozzles (2, 4,
and 6) that are taken into consideration for the flow and temperature analysis of the vortex tube.
Each of these cases is further subdivided into several subcases depending on the air inlet pressure
(3bar, 4bar, 5 bar, and 7bar).

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2) Meshing model
The ANSYS mesh 2021R2 workbench has its own meshing tool. The mesh is created using
hexahedral volumes and wedges. Along with face meshing and body sizing, inflation is applied
to all boundaries, including nozzle inlets, hot and cold outlets, and so on. To increase the number
of cells, the sizing option is also used with element sizes of 0.4 mm. As a result, the final mesh
created is a structured mesh with boundary inflation.

Fig.3.4.3. Structured mesh on - (a) Case 1 with 2 nozzles, (b) Case 2 with 4 nozzles and (c) Case 3
with 6 nozzles.

3) Mathematical Modelling
The flow entering the vortex tube changes velocity from subsonic to sonic, resulting in a
significant change in density. Therefore, a compressible flow model is used. The available
pressure gradient causes the flow structure to form inside the vortex tube. It is clear that the
phenomena of energy separation are not caused by any external energy interaction. Instead, it is
merely a redistribution of energy associated only with entering compressed flow. The energy
equation and the equation of an ideal gas are used to analyze variations in density in the flow

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field and temperature distribution. To develop a mathematical model for the current problem, the
following assumptions are made.
1. The working medium is an ideal gas,
2. The vortex tube wall is considered adiabatic.
3. The flow is steady, turbulent, compressible, and
4. The body force is negligible.

3.5. Prototyping and Testing Phase


Assemble the first prototype of the remote monitored mobile vaccine cooling system, following
the technical design specifications.
Conduct a series of laboratory tests to evaluate the system's temperature control accuracy, energy
consumption, and overall performance.
Perform field tests with healthcare providers to assess the system's usability, reliability, and
practicality in real-world scenarios.
Gather feedback from healthcare providers and incorporate it into the design for further
improvements.

3.6. Implementation Phase


Finalize the design based on the results of laboratory and field tests.
Manufacture the remote monitored mobile vaccine cooling system, ensuring quality control and
adherence to safety standards.
Deploy the system to healthcare providers for pilot implementation and monitor its performance.
Provide training and support to healthcare providers on the proper use and maintenance of the
system.

3.7. Remote Monitoring System Integration


Develop a remote monitoring system that can track the temperature of the vaccine cooling
system in real-time.
Integrate the remote monitoring system with the mobile vaccine cooling system.
Test the remote monitoring system's functionality and efficiency in providing real-time
temperature data.

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Implement the remote monitoring system for healthcare providers to ensure optimal vaccine
storage conditions.
The development of a remote monitored mobile vaccine cooling system involves a systematic
approach that includes research, design, prototyping, testing, implementation, and remote
monitoring system integration. This methodology aims to ensure the creation of an efficient,
reliable, and user-friendly system that can significantly contribute to maintaining the efficacy
and safety of vaccines during transportation and storage.
Strengths
- Can recall information from previous conversations to provide personalized responses.
- Allows users to correct any misunderstandings or errors in the previous interaction.
- Is programmed to refuse inappropriate or harmful requests.
Weaknesses
- Can occasionally provide incorrect information due to limitations in its training data or
understanding.
- May inadvertently provide instructions or suggestions that are harmful or biased without
realizing it.
- Limited knowledge of current events and developments beyond the training data cut off of
2021.

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REFERENCES
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Vaccines &Immunotherapeutics, 16(1), 1-11.
3. Lee B. Y, et.al. (2019). Economic Impact of Thermostable Vaccines. Expert Review of
Pharmacoeconomics & Outcomes Research, 19(4), 369-373.
4. Karp, C. L., et.al. (2017). Creating a More Versatile, Effective, and Equitable Global
Vaccine Supply Chain. Health Security, 15(4), 363-369.
5. Moja, L, et.al. (2019). Timing of Adjuvant Chemotherapy and Survival in Colorectal,
Gastric, and Pancreatic Cancer. JAMA Oncology, 5(10), 1483-1495.
6. Varela, Y, et.al. (2017). Temperature Data Loggers to Monitor the Distribution Cold
Chain: A Review of Available Devices. Journal of Vaccines & Vaccination, 8(6), 2-6.
7. Chitguppi, C., et.al. (2018). Development of a Real-Time Monitoring System for Vaccine
Cold Chain. IEEE Global Humanitarian Technology Conference (GHTC), 1-6.
8. Fuss, S., et.al.(2014). Betting on negative emissions. Nature Climate Change, 4(10), 850-
853.
9. Lujala, P., et.al. (2017). Low carbon development: Key challenges in Nepal's hydropower
sector. Energy Policy, 101, 248-257.
10. Swami S.M. et.al. (2022). Design and Development of a Cooling System for A Vaccine
Container by using Vortex Tube Refrigeration. International Journal of Engineering
Research & Technology (IJERT), 11(7), 1 – 5.

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