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Objectives: This study compares the demographics, diagnoses, re-admission rates, sick leaves, and prescribed medications of patients accessing digital general practitioner (GP) visits with those of patients opting for traditional face-to-face appointments in a primary health care setting. Design: The study adopted a retrospective analysis of patient record data collected in 2019, comparing visits to a digital primary health center with traditional health center visits. Setting: Primary health care. Participants: The data encompassed patients who utilized the digital clinic and those who visited public health centers for primary health care services. Main Outcome Measures: The study assessed demographics, health diagnoses, prescribed medications, sick leave recommendations, re-admission rates, and differences in costs between digital clinic and face-to-face visits. Secondary outcomes included a comparative analysis of medication categories, resolution rates for health problems, and potential impacts on health care utilization. Results: Digital clinic users were typically younger, more educated, and predominantly female compared with health centre users. Digital visits were well-suited for uncomplicated infections, while health centre appointments were associated with a higher prevalence of chronic conditions. Medication patterns differed between the two modalities, with digital clinic users receiving generic over-the-counter drugs and antibiotics, whereas health centre visits commonly involved cardiac and antihypertensive medications. Sick leave recommendations were slightly higher in the digital clinic, but the difference was not significant. Approximately 70% of health problems addressed in the digital clinic were successfully resolved, and the cost of digital visits was about 50,3% of face-to-face appointments. Conclusion: Digital health care services offer a cost-efficient alternative for specific health problems, appealing to younger, educated individuals, when compared to the users of public health center, and may enable improvement of cost-effectiveness combined with acceptable demand management and patient segmentation practices. The results highlight the potential benefits of digital clinics, particularly for uncomplicated cases, while also emphasizing the importance of suitable referral mechanisms for in-person consultations. [ABSTRACT FROM AUTHOR]

Background: Internationally, adolescent alcohol consumption has been a major community concern for decades. Globally, there is a growing array of interventions aimed at preventing youth alcohol-related problems. Notably, the Communities that Care (CTC) process in the USA has proven to be a cost-effective intervention, leading to a reduction in adolescent alcohol-related problems. In Australia, the CTC trial has shown positive outcomes such as reduced adolescent alcohol and drug use, antisocial behaviors, and the availability of alcohol in the community. To encourage wider adoption, it is essential to ascertain the cost-effectiveness of the Australian CTC trial and its potential impact on addressing youth alcohol problems. Method: We conducted a limited societal perspective benefit-cost analysis focused on reducing adolescent (aged 10–14) alcohol use in the initial four CTC communities in Australia, spanning 2001 to 2015. To ensure accuracy, estimated benefits were adjusted for joint effects to prevent the double counting of the benefits over time. Results: The Australian CTC trial, as an adolescent alcohol prevention strategy, demonstrates robust economic credentials, delivering a return of AUD 2.6 for each dollar invested. The cost savings resulting from the reduction in alcohol consumption were estimated at AUD 123 per youth per 15 years and AUD 8 per person per year. The average cost of the CTC trial amounted to AUD 48 per youth over 15 years and AUD 3 per youth per year. The largest contribution to primary benefits were reductions in crime and violence with 93% of the total benefits. Conclusions: This study makes a valuable contribution to the international economic evidence related to youth alcohol prevention initiatives. The results affirm the strong cost-effectiveness potential of the initial CTC trial implementation in Australia. Moreover, conducting further cost-benefit modelling for additional outcomes and beyond the intervention's timeframe is likely to enhance the economic viability of the CTC trial. [ABSTRACT FROM AUTHOR]

Introduction: Antimicrobial resistance is a challenge to be faced by all livestock sectors; within beef farming, antibiotic use patterns vary by country and management practices. Argentina is a country with high beef production & consumption but limited information surrounding antibiotic use. The aims of this project was to understand how antibiotics are being used across the beef industry in Argentina and exploring drivers of usage. Methods: Quantitative and qualitative data was collected by: A survey of breeding and feedlot farms including antibiotic use (from purchase data); a detailed analysis of two feedlot farms' therapeutic antibiotic use records; a survey of vets' views on certain antibiotic practices; and a focus group of farmers and vets focusing on wider influences affecting decision making. Antibiotic use data was calculated using mg/population corrected unit (PCU) (ESVAC) and thematic analysis was used to identify drivers of antibiotic use among participants. Results: The median use across 17 farms that supplied purchase data was 76.52 mg/kg PCU (ESVAC; IQR = 36.81 mg/kg PCU [ESVAC]). The detailed farm records showed that the largest reason for treatment was group treatments (72.92% of treatments) followed by treatment for respiratory disease (12.75% of treatments). Macrolides accounted for 76.37% of treatments. Nearly half of farms used routine prophylactic treatment for arriving animals (n = 7/18). The use of quarantine and 'sick pens' were seen as important by surveyed vets with antibiotic prophylaxis and in-feed antibiotics seen as contributors to antibiotic resistance. The focus group highlighted the influence of the economic and political landscape on husbandry practices and the responsibility the farming sector had towards antibiotic stewardship. Discussion: Overall, Argentine beef feedlots resemble North American beef feedlots in terms of antibiotic practices but with considerably lower usage, with in-feed monensin representing a large proportion of total ABU. The adaptation period presents a challenge to animal health; antibiotics are administered a prophylaxis, metaphylactic and individual treatments depending on farm management practices. Further research into internationally comparable measures of ABU and detailed cost-benefit analysis of practical, on-farm interventions are needed to aid improved antimicrobial stewardship in livestock systems globally. [ABSTRACT FROM AUTHOR]

Introduction: Owing to the lack of local cost and clinical effectiveness data in sub-Saharan Africa, economic evaluations of the rotavirus vaccine are still limited in the region. In this study, we utilize different data sources, including aggregated routine health information system data to examine the net benefits of the rotavirus vaccine in Uganda. We also present ways in which health facility data can be used to assess subnational vaccination coverage as well as the effect of the vaccine on diarrhoea hospitalization. Methods: We used monthly health facility data collected between 2015 and 2021 to study the relationship between rollout of rotavirus vaccine and diarrhoea hospitalization. We gathered information from empirical studies on the cost of diarrhoea (household and health facility) and vaccine administration to estimate the costs averted due to the rotavirus vaccine. As household costs, we considered out-of-pocket payments associated with the episodes of diarrhoea and the productivity loss associated with time spent on treatment and with mortality using a human capital approach. Finally, we employed an interrupted time series analysis to examine the effect of rotavirus vaccine on diarrhoea hospitalization. Costs are presented in 2018 US dollars. Results: As of 2021, nationwide coverage of the first and second doses of the rotavirus vaccine (RV) in Uganda was estimated at 89% and 65% respectively, with variations observed across the regions. The study revealed a decrease in diarrhoea hospitalization by 1% for each 1% increase in RV coverage. Moreover, the study showed that diarrhoea hospitalization reduced by 2% for each additional month post- vaccine rollout. Excluding productivity losses due to mortality, the analyses of costs averted due to the RV reveal that between 2018 and 2021, Uganda saved approximately $57 million ($7 per capita) in expenses associated with diarrhoea. The return on investment (ROI) due to RV was calculated to be $1.48 per dollar invested. When including mortality costs, the net benefit reached up to $3 billion in economic cost ($385 per capita), and an ROI of $78 overall. Furthermore, the study demonstrated that RV provided substantial health benefits, particularly for socially disadvantaged groups. Excluding mortality costs, the ROI for the two most disadvantaged groups ranged from $1.71 to $2.03 per dollar spent, while for the remaining groups, it ranged from $1.10 to $1.14. Conclusion: This manuscript stresses the importance of RV in alleviating the burden of diarrhoeal diseases and associated costs in Uganda. The study not only emphasizes the tangible benefits derived from the vaccine but also highlights the role of routine aggregated healthcare information systems in systematically monitoring the effectiveness and coverage of interventions. [ABSTRACT FROM AUTHOR]

Introduction: Stress-induced volatile organic compounds (VOCs) that induce plant immunity bear potential for biocontrol. Here, we explore the potential of nonanal to enhance the seed yield of common bean (Phaseolus vulgaris) under open field conditions that are realistic for smallholder farmers. Methods and results: Using plastic cups with a nonanal-containing lanolin paste as low-cost dispensers, we observed that exposure of Flor de Junio Marcela (FJM) plants over 48h to airborne nonanal was followed by a 3-fold higher expression of pathogenesis-related (PR) genes PR1 and PR4. Both genes further increased their expression in response to subsequent challenge with the fungal pathogen Colletotrichum lindemuthianum. Therefore, we conclude that nonanal causes resistance gene priming. This effect was associated with ca. 2.5-fold lower infection rates and a 2-fold higher seed yield. Offspring of nonanal-exposed FJM plants exhibited a 10% higher emergence rate and a priming of PR1- and PR4-expression, which was associated with decreased infection by C. lindemuthianum and, ultimately, a ca. 3-fold increase in seed yield by anthracnose-infected offspring of nonanal-exposed plants. Seeds of nonanal-exposed and of challenged plants contained significantly more phenolic compounds (increase by ca 40%) and increased antioxidant and radical scavenging activity. Comparative studies including five widely used bean cultivars revealed 2-fold to 3-fold higher seed yield for nonanal-exposed plants. Finally, a cost-benefit analysis indicated a potential economic net profit of nonanal exposure for some, but not all cultivars. Outlook: We consider nonanal as a promising candidate for an affordable tool that allows low-income smallholder farmers to increase the yield of an important staple-crop without using pesticides [ABSTRACT FROM AUTHOR]

Simple Summary: Chimeric transcripts frequently function as oncogenic drivers and represent potential targets for tumor-specific therapies. Routine methods for detecting these transcripts include (i) approaches that can detect a limited number of pre-defined targets, such as immunohistochemistry, fluorescence in situ hybridization, and reverse transcription–quantitative polymerase chain reaction, and (ii) approaches that can simultaneously detect multiple fusions, such as NanoString assays and NGS targeted panels. Whole transcriptome sequencing enables the analysis of a wide range of cancer biomarkers, including dysregulated genes, molecular pathways, and both known and novel cancer driver fusion transcripts. However, this method is not commonly employed for fusion discovery due to inadequate coverage at the fusion breakpoint. To address this limitation, we have developed a novel bioinformatics approach that enables the highly accurate prediction of clinically significant ALK fusions from RNA sequencing data. This extends the functionality of whole transcriptome NGS and improves its cost-effectiveness. Background: In clinical practice, various methods are used to identify ALK gene rearrangements in tumor samples, ranging from "classic" techniques, such as IHC, FISH, and RT-qPCR, to more advanced highly multiplexed approaches, such as NanoString technology and NGS panels. Each of these methods has its own advantages and disadvantages, but they share the drawback of detecting only a restricted (although sometimes quite extensive) set of preselected biomarkers. At the same time, whole transcriptome sequencing (WTS, RNAseq) can, in principle, be used to detect gene fusions while simultaneously analyzing an incomparably wide range of tumor characteristics. However, WTS is not widely used in practice due to purely analytical limitations and the high complexity of bioinformatic analysis, which requires considerable expertise. In particular, methods to detect gene fusions in RNAseq data rely on the identification of chimeric reads. However, the typically low number of true fusion reads in RNAseq limits its sensitivity. In a previous study, we observed asymmetry in the RNAseq exon coverage of the 3′ partners of some fusion transcripts. In this study, we conducted a comprehensive evaluation of the accuracy of ALK fusion detection through an analysis of differences in the coverage of its tyrosine kinase exons. Methods: A total of 906 human cancer biosamples were subjected to analysis using experimental RNAseq data, with the objective of determining the extent of asymmetry in ALK coverage. A total of 50 samples were analyzed, comprising 13 samples with predicted ALK fusions and 37 samples without predicted ALK fusions. These samples were assessed by targeted sequencing with two NGS panels that were specifically designed to detect fusion transcripts (the TruSight RNA Fusion Panel and the OncoFu Elite panel). Results: ALK fusions were confirmed in 11 out of the 13 predicted cases, with an overall accuracy of 96% (sensitivity 100%, specificity 94.9%). Two discordant cases exhibited low ALK coverage depth, which could be addressed algorithmically to enhance the accuracy of the results. It was also important to consider read strand specificity due to the presence of antisense transcripts involving parts of ALK. In a limited patient sample undergoing ALK-targeted therapy, the algorithm successfully predicted treatment efficacy. Conclusions: RNAseq exon coverage analysis can effectively detect ALK rearrangements. [ABSTRACT FROM AUTHOR]

Cost benefit analysis (CBA) is used in many fields to ensure efficient allocation of scarce resources but is rarely applied in conservation. By using a common metric to evaluate projects in complex social‐ecological systems, CBA can help to maximize the impact of conservation funding. It can also help to interrogate issues of distributional equity, plan for effective community‐based conservation, and inform future research and strategic priorities. We demonstrate this using the example of the Nyerere Selous‐Udzungwa Wildlife Corridor in Tanzania, a wildlife corridor aiming to restore connectivity between two protected areas to enhance African elephant (Loxodonta africana) conservation outcomes and mitigate human–elephant conflict. We combine novel data on elephant crop depredation with crop price and productivity data, elephant valuation methods, and ecosystem service values to analyze corridor costs and benefits from contrasting global and local community perspectives. From the global perspective, we find benefits to outweigh costs by at least 4.6:1. From the communities' perspective, we find that while substantial benefits should secure buy‐in to the project, continued subsidy will be required to cover the costs. Our findings support generalized recommendations for application of CBA across diverse systems and conservation priorities. [ABSTRACT FROM AUTHOR]

Background: Indigenous people in high-income countries have worse eye health outcomes when compared to non-Indigenous people, contributing to ongoing socioeconomic disadvantage. Although services have been designed to address these disparities, it is unclear if they have undergone comprehensive economic evaluation. Our scoping review aimed to identify the number, type, quality, and main findings of such evaluations. Methods: MEDLINE, Embase, Web of Science, Cochrane Library Database, the National Health Service Economic Evaluation Database, EconLit, and relevant grey literature were systematically searched as per our pre-registered protocol. All economic evaluations of real or model services designed to meet the eye care needs of Indigenous populations in high-income countries were included. Two reviewers independently screened studies, extracted data, and assessed quality using the Quality of Health Economic Studies instrument. Results: We identified 20 studies evaluating services for Indigenous populations in Australia (n = 9), Canada (n = 7), and the United States of America (n = 4). Common services included diabetic retinopathy (DR) screening through fundus photographs acquired in local primary health care clinics (n = 7) or by mobile teams (n = 6), and general eye care through teleophthalmology (n = 2), outreach ophthalmology (n = 2) or an Indigenous health care clinic optometrist (n = 1). These services were economically favourable in 85% of comparisons with conventional alternatives, mainly through reduced costs of travel, in-person consults, and vision loss. Only four studies assessed the benefits of increased patient uptake. Only five included patient evaluations, but none integrated these into their quantitative analysis. Methodological issues included no stated economic perspective (n = 10), no sensitivity analysis (n = 12), no discounting (n = 9), inappropriate measurement of costs (n = 13) or outcomes (n = 5), and unjustified assumptions (n = 15). Conclusion: Several Indigenous eye care services are cost-effective, particularly remote DR screening. Other services are promising but require evaluation, with attention to avoid common methodological pitfalls. Well-designed evaluations can guide the allocation of scarce resources to services with demonstrated effectiveness and sustainability. Trial registration: Our scoping review protocol was pre-registered (Open Science Framework DOI: https://doi.org/10.17605/OSF.IO/YQKWN). [ABSTRACT FROM AUTHOR]

Background: Between 2006 and 2016 the prevalence of overweight and obesity among children and adolescents aged 5–19 years in Peru increased from 22.7 to 27.0%. This investment case quantifies the economic impacts of childhood and adolescent overweight and obesity in Peru. It identifies and quantifies the potential impact of a set of new or expanded interventions that can strengthen current national efforts to prevent and reduce child and adolescent overweight and obesity. Methods: A deterministic Markov cohort model with a societal cost perspective estimated reductions in mortality and morbidity from implementing interventions to prevent and reduce child and adolescent overweight and obesity and the impact in savings in healthcare costs and gains in wages and productivity. Interventions identified through a review of published literature includes a school-based social marketing campaign, exclusive breastfeeding promotion and support, a healthy food and drink policy for school premises, and a 20% subsidy on fruits and vegetables for people living below the national poverty line. The return on investment (ROI) was calculated along with the estimated cost savings associated with the interventions. Analysis was conducted to test ROI sensitivity to changes in the key parameters and assumptions. Results: Between 2025 and 2092, the expected combined direct and indirect healthcare costs attributable to child and adolescent overweight and obesity in Peru are 210.6 billion USD. The direct healthcare costs are 1.8 billion USD, and the indirect costs are 208.8 billion USD. Expected savings for all interventions combined is 13.9 billion USD with a per-person savings of 12,089.8 USD. The expected ROI of the four interventions combined is 39.3 USD (30-years), 64.6 USD (50-years), and 164.1 USD (66-years) per one USD invested. Conclusions: The overweight and obesity epidemic among children and adolescents in Peru requires wide-ranging and expanded implementation of policies to achieve long-term reductions in prevalence. This study's findings show that the four priority interventions have high ROIs and can be used to guide policy to address the complex interplay of factors that contribute to the obesogenic environment. [ABSTRACT FROM AUTHOR]

Simple Summary: Currently, pathologists use ultrastaging to detect whether cancer has spread to the lymph nodes. This process is time-consuming and expensive. Our pilot study explored the use of a deep learning algorithm to help detect cancer spread to lymph nodes of early-stage cervical cancer patients. Using this technology could make the detection process faster, more efficient, and less costly. We evaluated an algorithm that was originally designed to identify cancer spread to lymph nodes in breast and colon cancer in cervical cancer patients. The study included 21 women with different types of early-stage cervical cancer. The algorithm was used to analyze 47 lymph node samples and successfully identified all cases where cancer had spread, showing 100% accuracy. Although the algorithm was initially developed for other cancers, it proved highly effective in this new population. More prospective research in a larger group of patients is needed to confirm its cost-effectiveness. Background/objectives: Pathological ultrastaging, an essential part of sentinel lymph node (SLN) mapping, involves serial sectioning and immunohistochemical (IHC) staining in order to reliably detect clinically relevant metastases. However, ultrastaging is labor-intensive, time-consuming, and costly. Deep learning algorithms offer a potential solution by assisting pathologists in efficiently assessing serial sections for metastases, reducing workload and costs while enhancing accuracy. This proof-of-principle study evaluated the effectiveness of a deep learning algorithm for SLN metastasis detection in early-stage cervical cancer. Methods: We retrospectively analyzed whole slide images (WSIs) of hematoxylin and eosin (H&E)-stained SLNs from early-stage cervical cancer patients diagnosed with an SLN metastasis with either H&E or IHC. A CE-IVD certified commercially available deep learning algorithm, initially developed for detection of breast and colon cancer lymph node metastases, was employed off-label to assess its sensitivity in cervical cancer. Results: This study included 21 patients with early-stage cervical cancer, comprising 15 with squamous cell carcinoma, five with adenocarcinoma, and one with clear cell carcinoma. Among these patients, 10 had macrometastases and 11 had micrometastases in at least one SLN. The algorithm was applied to evaluate H&E WSIs of 47 SLN specimens, including 22 that were negative for metastasis, 13 with macrometastases, and 12 with micrometastases in the H&E slides. The algorithm detected all H&E macro- and micrometastases with 100% sensitivity. Conclusions: This proof-of-principle study demonstrated high sensitivity of a deep learning algorithm for detection of clinically relevant SLN metastasis in early-stage cervical cancer, despite being originally developed for adenocarcinomas of the breast and colon. Our findings highlight the potential of leveraging an existing algorithm for use in cervical cancer, warranting further prospective validation in a larger population. [ABSTRACT FROM AUTHOR]

Background: Dynamic transmission models are often used to provide epidemiological guidance for pandemic policy decisions. However, how economic evaluation is typically incorporated into this technique to generate cost-effectiveness estimates of pandemic policy responses has not previously been reviewed. Methods: We systematically searched the Embase, PubMed and Scopus databases for dynamic epidemiological modelling studies that incorporated economic evaluation of public health and social measures (PHSMs), with no date restrictions, on 7 July 2024. Results: Of the 2,719 screened studies, 51 met the inclusion criteria. Most studies (n = 42, 82%) modelled SARS-CoV-2. A range of PHSMs were examined, including school closures, testing/screening, social distancing and mask use. Half of the studies utilised an extension of a Susceptible-Exposed-Infectious-Recovered (SEIR) compartmental model. The most common type of economic evaluation was cost-effectiveness analysis (n = 24, 47%), followed by cost-utility analysis (n = 17, 33%) and cost–benefit analysis (n = 17, 33%). Conclusions: Economic evaluation is infrequently incorporated into dynamic epidemiological modelling studies of PHSMs. The scope of this research should be expanded, given the substantial cost implications of pandemic PHSM policy responses. [ABSTRACT FROM AUTHOR]

The authors call on researchers, public health professionals, medical providers, and policymakers to address the access of foster care youth to preexposure prophylaxis (PrEP) from a number of appropriate dimensions. Topics include independent yet interconnected dimensions of access suggested by R. Penchansky and J. W. Thomas, dimensions of preexposure prophylaxis access, and prioritizing HIV prevention strategies for foster youths.

With the impact and cost of continued river degradation and climate changeinduced extreme rainfall and floods, there is growing urgency to achieve and maintain good river health to meet global sustainable development goals. Upscaling and working with nature-based solutions at regional, catchment and fluvial corridor scales is critical. One way to achieve this is to work within a recovery-enhanced approach to river rehabilitation, incorporating processes of geomorphic and vegetative recovery to build fluvial corridors in areas where they have become fragmented. Geomorphologically-informed cost-benefit analysis has not previously been applied in a riverine or riparian context, at the catchment or regional scale needed. We applied Marxan in a novel manner to undertake the first cost-benefit analysis for geomorphologically-informed rehabilitation of river systems. We estimated that to rehabilitate 75,500 km of streams in coastal catchments of NSW will cost $8.2 billion, comparing favourably to recent single flood event insurance losses, and projected future losses. We developed Marxan scenarios based on three broad approaches to river management: ad hoc and reactive, working with recovery and corridors, across current and future time periods. We found there are considerable current and flow-on future financial and non-financial benefits, and lower initial total and per-hectare rehabilitation costs, by fully adopting working with recovery or corridors approaches and moving away from the ad hoc and reactive approaches which dominate current practice. Implementing targeted rehabilitation based on a rolling sequence over time of corridors scenarios provides optimal holistic solutions to improve geomorphic condition and enhance recovery potential at landscape-scale. Our study demonstrates the use of Marxan as an accessible tool to address prioritisation complexity, and to run and cost landscape-scale rehabilitation scenarios over time. Our study also demonstrates the positive offsite feedbacks that occur through multiplier effects, as recovery occurs, and corridors are built. Geomorphologically-informed decision making becomes more robust, transparent, cost-effective, consistent across catchments, and adaptive to local situations and evolving river management priorities. [ABSTRACT FROM AUTHOR]

Newborn screening (NBS) has been one of the big innovations in public health. It has grown over the decades, especially with the introduction of tandem mass spectrometry. However, it is likely to expand significantly in the coming decades with the introduction of genomic testing. Traditionally, in NBS, there has been a pattern of repeat testing for confirmation and follow-up diagnostic testing. This follow-up is critical as NBS is a screening program. This pathway is appropriate for low-cost tests, but if public health authorities are going to invest in high-cost screening such as whole-genome sequencing, they are likely to baulk at repeating these expensive tests in a diagnostic setting. Our study investigates whether screening-grade data from NBS can be transitioned into diagnostic-grade data using a panel of single-nucleotide variants (SNVs) on a diagnostic specimen. These SNVs could be used to link the diagnostic specimen with all of the provenance requirements associated with routine pathology and the NBS genomic data. This strategy has large cost benefits and opens up the rapid use of NBS genomic data should a child present in an acute care setting and a genetic diagnosis is suspected. This approach will greatly speed up the confirmation of positive NBS results and reduce family anxiety due to delayed diagnostic testing. [ABSTRACT FROM AUTHOR]

This work presents a comprehensive Social Life Cycle Assessment (S-LCA) and Social Cost-Benefit Analysis (S-CBA) conducted as part of a research project, studying biofuel production for the maritime and aviation sectors, from various types of non-food waste biomasses. The inclusion of social considerations complements and expands on the environmental and economic ones. The importance of social group criteria was determined through expert questionnaires, leading to the identification of social impacts groups and social criteria from stakeholders across participating countries. The results successfully identified and quantified social impacts, and align with those reported in similar cases in relevant literature. Social Cost-Benefits, monetarizing social factors, demonstrated several social benefits, including reduction in Greenhouse Gas Emissions. However, it also highlighted social costs, such as Economic Costs associated with the initial investment. The study revealed critical social hotspots within the impact categories, making significant strides in understanding the social impacts of biofuel production, providing valuable insights for decision-makers, and contributing to the broader goal of sustainable and socially responsible biofuel production. [ABSTRACT FROM AUTHOR]

The global banana industry faces a significant threat from Fusarium oxysporum f. sp. cubense Tropical Race 4 (TR4). While prior research has concentrated on TR4's dissemination, reproductive conditions, and resistant banana varieties, this study employs a socioeconomic and cost-benefit analysis to explore the vulnerability of banana producers to TR4 in Colombia. It assesses the financial viability of current monitoring strategies and estimates potential losses in the event of TR4 spreading within the study area. Interviews were conducted with producers and key stakeholders in Colombia's top two banana-producing departments, Antioquia and Magdalena. The findings reveal that farming systems are highly vulnerable to TR4, particularly due to the prevalent use of corms. Producers employ preventive measures such as cement paths, fences, disinfecting stations, and footbaths to counteract TR4's spread. A cost-benefit analysis indicates that the benefits of these prevention methods significantly outweigh the associated costs, with a net present value of implementing prevention strategies per hectare of $95,389 USD and $112,527 USD in Magdalena and Antioquia and a benefit-cost ratio of 3.1 and 4.2, respectively. Considering the substantial impact TR4 could have in Colombia if it becomes more widespread, we recommend widespread adoption of preventive measures, including the construction and utilization of cement paths and disinfectant methods on all banana farms. Additionally, to enhance awareness and early detection, we propose leveraging technology, such as mobile applications (apps) and chat groups, to empower farmers in identifying and preventing the spread of TR4. [ABSTRACT FROM AUTHOR]

Background: Australia's clinical trials sector is highly productive with continued sector investment needed to enhance research impact. Generating economic evidence alongside trials has the potential to facilitate the implementation of trial results into practice. Ascertaining the use of health economic evaluations alongside clinical trials can assist in determining whether clinical trials fully realize and operationalize their potential to change policy and practice. The aims of this study were to ascertain the uptake of health economic evaluations alongside Australian-led clinical trials and explore associations between uptake and trial characteristics. Methods: This observational study comprised a descriptive analysis of clinical trials registries, a cross-sectional survey of Australian Clinical Trials Alliance (ACTA) networks, and a subgroup analysis of completed acute care trials. Descriptive analyses of trial registrations were conducted, with logistic regressions used to identify predictors of proposing and subsequently publishing a health economic evaluation alongside acute care trials. Results: Few randomized Australian-led clinical trials (11% of 9251) and ACTA network trials (43% of 227) proposed a health economic evaluation. In the subgroup analysis, 22% of the 324 acute care trials and 53% of the 38 ACTA network acute care trials proposed a health economic evaluation. Acute care trials funded by government bodies were significantly more likely to propose and publish a health economic evaluation than those funded by hospitals, universities, and other funders, after adjusting for phase, registration year, primary sponsor type, and comparator. Conclusions: Current uptake of health economic evaluations alongside Australian-led clinical trials is low, with uptake higher among the subset of ACTA network trials. This is despite economic evidence playing an increasingly prominent role in health system management, as well as rising health expenditure, limited budgets, and competing demands. There is significant opportunity to embed health economic evaluations alongside clinical trials, particularly phase 3 trials, to increase research outputs and optimize research translation. Investing in clinical trial networks that support funding for a health economist or a health economic evaluation may be an effective strategy to increase the uptake of health economic evaluations alongside trials. [ABSTRACT FROM AUTHOR]

Background: The cost of cancer drugs presents a significant challenge to accessibility of treatment worldwide. Projections indicate that by 2040, two-thirds of cancer cases will occur in low- and middle- income countries. Paradoxically, despite this impending burden, LMICs command less than 5% share of global resources for treating cancer. Morocco, like many LMICs, faces significant obstacles in providing innovative cancer treatments to its population. Aim: Firstly, we aimed to conduct an original research investigating the availability and affordability of innovative cancer drugs in Morocco. Secondly, we sought to review the broader market dynamics, pricing, and reimbursement policies in the country. Methods: For the first objective, we identified a preliminary list of medicines approved for oncological indications in the Moroccan market based on resources from ANAM (National Agency for Health Insurance), pharmacy regulators, and online resources that compile information on approved medicines. For the second objective, we exhaustively reviewed the regulatory documents, legal texts and grey literature reports. All the informations were examined by pharma delegates and local experts. Results: As of January 2024, Morocco has 39 innovative anticancer medicines with market authorization. 30% of these drugs were approved after 2020. The majority of approved drugs were for breast, lung, colorectal, and prostate cancer. The period between FDA approval and entry into the Moroccan market ranges from 2 to 7 years, with a median of 3 years for breast cancer drugs and 7 years for more expensive drugs like Olaparib and Osimertinib. 22 out of the 39 drugs are not reimbursed, with an average reimbursement time of 4 years. Compared to prices in France, the most notable pricing disparities concern immunotherapy agents, priced 600 to 900 euros lower in France, while drugs like Pazopanib and Erlotinib cost 50% less in Morocco. Conclusion: Our study reveals significant disparities in the availability and affordability of innovative cancer drugs in Morocco. Regulatory hurdles, importation challenges, and pricing strategies contribute to this inequitable landscape. Addressing systemic barriers, fostering collaborations between stakeholders, and adopting a value-based pricing approach are imperative steps toward ensuring equitable access to high-quality interventions for patients, regardless of their geographical location. [ABSTRACT FROM AUTHOR]

Background: Blended learning, a pedagogical approach combining traditional classroom instruction with online components, has gained prominence in nursing education. While offering numerous benefits, student satisfaction with blended learning remains a critical concern. This study contributes to the existing literature by providing a comprehensive evaluation of the determinants influencing nursing students' satisfaction with this innovative educational modality. By examining a wide range of factors, including sociodemographic characteristics, academic factors, and environmental influences, this research offers valuable insights for educators to optimize blended learning experiences in nursing education. Methods: A descriptive cross-sectional research design was conducted. This study investigates the factors influencing nursing students' satisfaction with blended learning at Alexandria University, Egypt, where blended learning programs have been integrated into the curriculum primarily through the Microsoft Teams platform. A convenient sample of 1266 nursing students from both bachelor and technical educational institutions participated in the study from September 2023 to the end of December 2023. Data were collected using an online survey containing two measurement tools: the Blended Learning Satisfaction Scale and the Environmental Facilitators and Barriers to Student Persistence in Online Courses scale. Statistical analyses, including descriptive statistics and backward multiple linear regression, were conducted to identify factors that are associated with the satisfaction of nursing students' with blended learning. Results: Findings indicate that factors such as age, gender, income, employment status, access to suitable internet sources, academic year, computer literacy, preferred learning method, and perceptions of environmental facilitators significantly influence satisfaction scores (all p < 0.001). The overall regression model, with an adjusted R² of 0.31, signifies that 31% of the variance in satisfaction scores is explained collectively by the previously mentioned variables (F = 21.21, p < 0.001). Conclusion: Students' sociodemographic variables, preference for blended learning, and perception of environmental facilitators such as encouragement to enroll in the course significantly influence nursing students' satisfaction levels with blended learning. However, limitations in the current study such as self-report bias, convenient sampling, and cross-sectional design limit the generalizability and causal inferences of these findings. [ABSTRACT FROM AUTHOR]

Background: This study will evaluate the Basic Income for Care Leavers in Wales pilot (BIP), which is the most generous basic income scheme in the world. A cohort of care-experienced young people who become aged 18 during a 12-month enrolment period (July 2022-June 2023) are receiving £1,600 (before tax) per month for two years, and the Welsh Government intends this to have a range of benefits. This evaluation will examine the impact of BIP, the implementation of the pilot and how it is experienced, and its value for money. Methods: The study is a theory-based quasi-experimental evaluation, and the design and methods are informed by ongoing co-production with care-experienced young people. We will estimate the impact of BIP on participants using self-reported survey data and routinely collected administrative data. This will include outcomes across a range of domains, including psychological wellbeing, physical and mental health, financial impact, education, training and volunteering. Comparisons between temporal (Welsh) and geographical (English, using administrative data) controls will be done using coarsened exact matching and difference in differences analysis. The process evaluation will examine how BIP is implemented and experienced, primarily through monitoring data (quantitative) and interview, observational, and focus group data (qualitative). The economic evaluation will take a public sector and a societal perspective to identify, measure and value the costs and outcomes of BIP, and to synthesise the evidence to inform a social cost-benefit analysis at 24 months post-intervention. Discussion: BIP is unusual in that it targets a wide range of outcomes and is available to an entire national cohort of participants. The evaluation also has several practical constraints. Therefore, the study will use a range of methods and triangulate between different analyses to assess how successful it is. Findings will inform policy in relation to care leavers, social security and basic income studies worldwide. [ABSTRACT FROM AUTHOR]

This research aims to investigate euthanasia, the act of terminating the lives of humans and certain animals due to their poor living conditions. This study explores euthanasia within the framework of sustainability, including environmental, economic, and social aspects. To achieve this, euthanasia is examined through a cost-benefit analysis using a management accounting approach, considering its implications across the economic, environmental, and social dimensions of sustainability. Data for this study were estimated by the authors. Income and cost factors related to the presence or absence of euthanasia were identified within the economic, environmental, and social realms of sustainability, followed by a comprehensive cost-benefit analysis. It is important to note that the purpose of this analysis is not to advocate for specific decisions but rather to present a nuanced understanding of the issue and invite the reader’s perspective. The cost-benefit analysis showed that the monetary costs and income, as well as the influence of non-monetary factors, may fluctuate depending on the medical specifics of the case and the dynamics of the patient’s family profile. [ABSTRACT FROM AUTHOR]

Background: Respiratory infections refer to any disease of airways and lungs which affects the respiratory system of humans. The nasal cavities, pharynx, larynx, trachea, bronchi and bronchioles, the tissues of the lungs and the respiratory muscles of chest cage are all susceptible to respiratory system diseases. To evaluate cost-benefit and cost-effective analysis of medications used in respiratory tract diseases, an observational prospective study was conducted for 120 patients. Materials and Methods: The patient data and other socioeconomic details were collected. The current index of medical specialists, updated version in March 2022, was used for Cost benefit and Cost effectiveness study. Regression analysis was used for the statistical analysis. Results: Among the 120 participants studied, 74 (61.66%) were male and 46 (38.34%) were female. Out of these participants, 89 had a C/B ratio of less than 1,30 had a C/B ratio greater than 1 and 1 had a C/B ratio equal to 1. The Cost-Effectiveness Analysis (CEA) of various drugs indicated that among bronchodilators, Asthalin is more cost-effective than Duolin; among corticosteroids, Budecort is more cost-effective than Hydrocort; and among anti-tuberculosis medications, AKT-4 is more cost-effective than Ethambutol. Conclusion: The common medications prescribed in our study were Asthalin (bronchodilators). Out of 120 study participants 89 patients were cost benefited from the treatment. The CEA results showed that Asthalin, Budecort and AKT-4 are more cost-effective than Duolin, Hydrocort and Ethambutol. The study found that Asthalin is the most effective treatment for respiratory tract diseases among participants, according to CBA and CEA. [ABSTRACT FROM AUTHOR]

Background: Iran's healthcare system has a significant discrepancy between the national tariff and the cost of global surgical procedures (GSPs). This study aimed to compare the actual costs of GSPs with national tariffs in Iran's public hospitals. Methods: This retrospective cross-sectional study was conducted in 2017. Using the census method, 6126 GSPs performed in three public hospitals were investigated in this study. Additionally, national tariffs from the Supreme Council of Health Insurance were obtained. The tariff-cost gap was the discrepancy between a GSP's actual costs and tariff. Multiple linear regression analysis determined factors affecting the tariff-cost gap. Results: The average actual cost of GSPs was 637 USD, while the average tariff was 495 USD. The reimbursement covered only 78% of the costs. The gap was higher in older (B = 1.05, 95% CI: 0.76-1.35, P < 0.001), females (B = 26.7, 95% CI: 15.5-37.9, P < 0.001), patients with a longer stay (B = 81.2, 95% CI: 77.5-84.8, P < 0.001), and procedures performed by full-time surgeons (B = 67.3, 95% CI: 56.9-77.5, P < 0.001). Furthermore, neurosurgery had the highest effect on forecasting the gap between actual costs and tariffs among surgical specialties (B = 346.9, 95% CI: 214.3-479.5, P < 0.001). Conclusion: Public hospitals suffer from large financial losses due to the national tariff for many GSPs not covering their actual costs. It is suggested that tariffs be increased for certain customer segments that can bear higher costs and global tariffs be adjusted to match actual service delivery costs. [ABSTRACT FROM AUTHOR]

Background: Metastatic colorectal cancer (mCRC) constitutes a significant health burden globally, accompanied by elevated mortality rates. This study aimed to assess the cost-effectiveness of regorafenib, an orally administered multi-kinase inhibitor, compared to the combination of Cetuximab and Irinotecan (CetIri) as third-line therapy for mCRC in Iran. Method: A model-based cost-utility analysis was conducted employing a semi- Markov model for a hypothetical cohort of 1,000 patients, integrating time-dependent transition probabilities. From the perspective of the Iranian healthcare payer, the analysis included direct medical costs, such as therapy, monitoring, and adverse effectrelated expenses, sourced from national databases in Iran. A yearly discount rate of 5% was applied to both costs and outcomes. Data analysis utilized Microsoft Excel, R version 4.1.3, and TreeAge Pro Healthcare version 2022 software, with the significance threshold set at 0.05. Results: The base-case analysis revealed that regorafenib offers a cost saving of $12,154 and an incremental gain of 0.1 quality-adjusted life years per patient over a 19-month horizon compared with the CetIri regimen. Probabilistic sensitivity analysis showed a greater than 99% probability of regorafenib being cost-effective. Conclusion: Consistent with existing evidence, the findings advocate regorafenib as a cost-effective alternative to CetIri for third-line treatment of mCRC in Iran, considering the specific healthcare system context. Given the foundational assumptions, caution is advised when extrapolating these results to other regions. [ABSTRACT FROM AUTHOR]

Mesopelagic fish represent an opportunity for fishing companies and food production, but their exploitation carries substantial environmental risks related to these populations' role in the oceanic carbon pump. We assess the economic viability of mesopelagic fishing from a private economic perspective, focusing on costs and revenues accruing to the fishing industry, and a public economic perspective, considering impacts on society at large, notably climate change. We develop a stylized model, which we apply to four pelagic trawling fleets in the European Union. We find that a mesopelagic fishery operated with current excess capacity in the four fleets considered is profitable from a private perspective, but the climate impacts potentially outweigh the private economic benefits. This implies that strict governance arrangements are needed to safeguard the sustainability of the mesopelagic zone. Considering long-term dynamics, we explore potential natural limits to an expanding mesopelagic fishery. First, a growing fishery will reduce biomass level, affecting profitability. Second, an increase in mesopelagic production may lower the price, also limiting potential for expansion. For the time being, however, it is unlikely that the fishery will reach a scale level where such feedbacks can be expected, making effective governance arrangements even more crucial. [ABSTRACT FROM AUTHOR]

Background: Assisted partner services (APS) is a recommended public health approach to promote HIV testing for sexual partners of individuals diagnosed with HIV. We evaluated the cost and cost-effectiveness of integrating oral HIV self-testing (HIVST) into existing APS programs. Methods: Within the APS-HIVST study conducted in western Kenya (2021–2022), we conducted micro-costing, time-and-motion, and provider surveys to determine incremental HIVST distribution cost (2022 USD). Using a decision tree model, we estimated the incremental cost per new diagnosis (ICND) for HIVST incorporated into APS, compared to APS with provider-delivered testing only. Scenario, parameter and probabilistic sensitivity analyses were conducted to explore influential assumptions. Results: The cost per HIVST distributed within APS was USD 8.97, largest component costs were testing supplies (38%) and personnel (30%). Under conditions of a facility-based testing uptake of <91%, or HIVST utilization rates of <27%, HIVST integration into APS is potentially cost-effective. At a willing-to-pay threshold of USD 1000, the net monetary benefit was sensitive to the effectiveness of HIVST in increasing testing rates, phone call rates, HIVST sensitivity, HIV prevalence, cost of HIVST, space allocation at facilities, and personnel time during facility-based testing. In a best-case scenario, the HIVST option was cheaper by USD 3037 and diagnosed 11 more cases (ICND = 265.82). Conclusions: Implementers and policy makers should ensure that HIVST programs are implemented under conditions that guarantee efficiency by focusing on facilities with low uptake for provider-delivered facility-based testing, while deliberately targeting HIVST utilization among the few likely to benefit from remote testing. Additional measures should focus on minimizing costs relating to personnel and testing supplies. [ABSTRACT FROM AUTHOR]

In recent years, notable incidents have highlighted the vulnerability of wind energy infrastructure, making cybersecurity crucial for the offshore wind industry. However, justifying the costs of cybersecurity measures is essential. A cost benefit analysis (CBA) is commonly utilised to support decision-making for risk mitigation. With a cost benefit analysis, risk mitigation strategies that strike an optimal balance between the costs of mitigation measures and the resulting risk reduction can be identified. This survey of literature was carried out to identify the existing proposed solutions for cost benefit analysis on cyber risk mitigation measures for offshore wind cyber physical systems. After narrowing the area scope, a systematic search across Scopus and Web of Science, yielded 18 articles, of which six met the selection criteria. It was found that the there was a lack of cost benefit analysis of cybersecurity solutions for, or set in, the area of offshore wind directly. From the analysis of the surveyed works, suggestions on future directions were given. The existing literature found lacks detailed cost modelling for offshore wind, beyond general breakdowns encompassing capital, maintenance, and labour/installation expenses, risk and scenario loss. Some of the literature used contextual factors such as compatibility and effectiveness of mitigation measures, effects on OT performance, geographical location, geopolitical context, and installed rated power which could be adapted to suit offshore wind. Since offshore operations contribute significantly to costs, cost modelling and consideration of other relevant factors pertaining to this area would be beneficial if explored. As an emerging area, in the future we expect this research to be a basis and a methodology that can be expanded with a larger data set from other publications in the field. Thus, it represents an opportunity to advance knowledge in offshore wind cyber-physical systems. [ABSTRACT FROM AUTHOR]

The escalating challenges posed by municipal landfill leachate (MUNL) necessitate the quest for green and sustainable solutions. This study aims to introduce Parkia biglobosa seed extract (PKSE) as a potential novel eco-friendly flocculant for efficacious removal of total suspended solids (TSS) from MUNL. Real MUNL samples were obtained from an active landfill managed by Anambra State Waste Management Authority (ASWAMA) Nigeria, enabling the optimization of operational parameters. The objectives encompass assessing PKSE applicability in MUNL treatment, extending beyond removal efficiency; optimizing the MUNL remediation process using response surface methodology (RSM); conducting a comprehensive cost–benefit analysis; exploring the coagulation–flocculation kinetics governing the treatment process; and utilizing optimized parameters for designing a type II settling tank. Physiochemical characteristics of PKSE were determined via Fourier transform infrared (FTIR) and scanning electron microscopy (SEM) methodologies, which revealed its suitability for this purpose. Optimal conditions unveil a remarkable TSS: 95.84% with a 29-min settling time, employing 50 mg/L PKSE dosage at pH 12. Stochastic appraisal endorses cost–benefit viability and sedimentation models, ensuring residuals ≤ 30 mg/L. The proposed tank geometry (aspect ratio of 2/1) aligns with MUNL concentration, offering a pragmatic design implication. This study pioneers green flocculation, harmonizing environmental remediation. [ABSTRACT FROM AUTHOR]

Background: The WHO Regional Office for Africa developed a Member States (MS)-endorsed regional strategy to fast-track the implementation of MS' national action plans (NAP) on Antimicrobial resistance (AMR). This study explored the perspectives of AMR's national focal points in MS on the implementation of the priority interventions of the regional strategy in their countries. Methods: An online survey consisting of ratings and discussions covering the implementation of the six priority interventions was conducted. Sums of the scores per priority intervention were obtained, and their percentage to the total possible scores were calculated to categorize the implementation as inadequate (0–25%), basic (26–50%), intermediate (51–75%), or advanced (76–100%). Results: Thirty-six of the forty-seven national AMR focal points responded to the survey between 12 November 2023 and 8 January 2024. The implementations were rated as 37–62% (basic-to-intermediate), with the multisectoral coordination and collaboration committee receiving the highest overall rating (62%, 421/684), while the promotion of sustainable investment for the NAP on AMR received the least overall rating (37%, 257/700). The focal points mainly recommended awareness campaigns, capacity building, and regulations and guidelines to improve the implementation of the AMR strategy. Conclusions: The survey revealed a need to enhance awareness campaigns, support the establishment and functioning of AMR evaluation and monitoring systems, and build the capacity of AMR staff with cost-benefit analysis and budgeting skills. It also showed the necessity to improve awareness and conduct education on AMR, streamline evidence generation through One Health Surveillance systems, integrate initiatives to reduce hospital-acquired infections in the antimicrobial stewardship programs, and enhance regulations and guidelines to optimize the use of antimicrobials. [ABSTRACT FROM AUTHOR]

In this paper, we conduct a cost-benefit analysis (CBA) of five alternative management strategies for red deer in Denmark: free harvest, trophy hunting, maximum harvest and two cases for natural demographic population compositions. To capture the outcome under each strategy we use a biological sex- and age-structured population model. The net benefit function includes meat values, recreational values, browsing damage costs and traffic damage costs and these values and costs are assumed to differ for the various sex and age classes of red deer. We show that the maximum harvest strategy leads to a reasonably high positive total net benefit, while the free harvest strategy yields a small positive net benefit. On the other hand, the trophy hunting strategy generates a high negative net benefit, while small negative net benefits are obtained under the two strategies for natural demographic population compositions. [ABSTRACT FROM AUTHOR]

Environmental concerns and the depletion of fossil fuel supplies are driving the rapid integration of photovoltaic (PV) systems into the electrical grid and electric vehicles (EVs) into the transportation sector. Issues like unpredictable power outages and shifts in demand require a cost-benefit analysis and efficient scheduling. In order to optimize PV power consumption and EV charging while taking seasonal variations into consideration, this study offers a novel solar-based grid-tied charging station with an improved scheduling technique. The existing charging station connected to the grid and solar promises not only reduced grid demand and cost savings, but also energy independence and environmental benefits. In the actual case in Rajshahi, Bangladesh, it is carried out using a Homer Grid case study. Bangladesh may promote environmental sustainability and resource conservation with this technology. [ABSTRACT FROM AUTHOR]

Audience: This is an in-person escape room and procedure simulation activity based on complications of human immunodeficiency virus (HIV) in India, which was created by using local HIV management guidelines. Emergency Medicine (EM) trainees of all post-graduate levels are the target audience. This may also be used by trainees in other specialties, such as infectious disease or internal medicine, who require an understanding of HIV and its complications. This escape room can be completed in teams of varying sizes and is designed to be adaptable to local resource availability. Background: Patients with HIV present to the Emergency Department (ED) for a variety of reasons such as initial viral syndrome, medication side effects, and opportunistic infections. While the widespread use of antiretroviral therapy (ART) has significantly increased the life expectancy of patients living with HIV and decreased the incidence of classical opportunistic infections, EM providers should still be vigilant and competent in diagnosing and managing these pathologies. This is particularly critical in India, where the prevalence of HIV was most recently estimated at 0.22% (2.2 million people older than 15 years) in 2020.1 This patient population, primarily infected through unprotected heterosexual contact, is at high risk for interruptions in ART and development of opportunistic infections for a variety of reasons including migration for work, low social status of women, and significant social stigma against HIV.2 Simulation is an educational opportunity to review these high-acuity low-occurrence presentations to prepare EM trainees for independent practice. Educational Objectives: By the end of the escape room, learners should be able to: 1) describe the mechanism of action of antiretroviral therapies available in India, 2) prescribe initial antiretroviral therapy to a patient presenting to the emergency department with a new diagnosis of HIV, 3) develop a differential diagnosis for a patient with HIV presenting to the ED with chest pain, 4) identify common dermatologic manifestations of opportunistic infections in patients with HIV, 5) identify computerized tomography scan and lumbar puncture features for central nervous system infections seen in patients with Acquired Immunodeficiency Syndrome (AIDS), 6) identify red flag features and appropriate workup for a patient with HIV presenting with a headache to the ED, 7) interpret images obtained during a Rapid Ultrasound for Shock and Hemorrhage (RUSH) exam, 8) identify cardiac tamponade and perform a pericardiocentesis, and 9) communicate and collaborate as a team to manage a complex, unstable patient with HIV in the ED. Educational Methods: We sought to create and implement an educational tool that could meet the complex education needs of EM trainees while being low cost, easily adapted to local resources, and engaging for trainees. Hospitals participating in the Masters in Emergency Medicine (MEM) program, a global partnership between the Ronald Reagan Institute for Emergency Medicine at the George Washington University and 18 hospitals in India, have resource variability for traditional simulation. The escape room created combines simulation, content review specific to the contextual practice of EM in India focused on HIV and its complications, and critical procedure teaching on pericardiocentesis. This innovation framework is based on Kolb's experiential learning cycle and incorporates the gamification principles of a sense of autonomy, perception of competitiveness, and learner-relatedness.3-4 Escape rooms have been shown to engage learners, and low-fidelity procedure models could further maximize the experience for learners in resource variable settings.5 A pericardiocentesis model was adapted from Lord et al.'s low-fidelity model, ensuring it could be assembled with materials readily available in-country.6 Research Methods: We adapted the escape room format to combine simulation, content review, and procedural training in a cost-effective, contextually relevant, and scalable way. The escape room was trialed using a case of chest pain and altered mental status caused by a pericardial effusion due to tuberculosis in a patient with HIV. Local practice patterns and guidelines were used to develop puzzles and clinical clues. A pericardiocentesis model was constructed using materials readily available in India. Pre- and post-surveys were developed to assess baseline trainee experience with escape rooms, self-reported knowledge of the differential diagnosis and management for altered mental status, and ways to incorporate escape room content into daily practice. Results: A total of 47 trainees participated; 41 of 47 participants completed both pre- and post-surveys (87% response rate). Participants represented all program trainee levels: 49% (n = 20) PGY-1, 27% (n = 11) PGY-2, and 24% (n = 10) PGY-3. Based on a score greater than seven on a 1-10 Likert scale, the escape room was rated as "highly effective" by 93.5% of respondents in reviewing medical knowledge. The trainees were allotted 60 minutes to escape the room; the median time for escape room completion was 57 minutes. The escape room and pericardiocentesis model cost under $100 USD, were repeated up to six times in one day, and could be recycled for future use. Discussion: Utilizing simulation in the escape room format that can be adaptable to variable resource settings is a valuable educational tool. The integrated escape room and procedure training proved to be an effective educational tool that was scalable and maintained efficacy across variable hospital resource levels. The next step includes adapting this format for other disease pathologies. This is a useful way to meet the education needs of MEM program trainees, regardless of hospital resource availability, that could be replicable in other EM training programs. [ABSTRACT FROM AUTHOR]

BACKGROUND AND OBJECTIVES: Efforts to enhance carbon stocks and boost carbon absorption potential are essential for climate change mitigation. Peatland ecosystems, known for their high organic content, are particularly vulnerable to environmental management. The study aimed to examine the alterations in land use and land cover that occurred between 1998 and 2022, spanning a 24-year duration. Additionally, it sought to assess the associated variations in carbon stocks within the designated Kepau Jaya specific purpose forest area. The area under investigation encompasses a peatland ecosystem that has experienced substantial changes in land cover and land use. This study investigated the fluctuations in carbon stock caused by these alterations and provides valuable perspectives on the potential of agroforestry systems to promote a wider range of land uses. Additionally, it highlights their role in ecosystem restoration initiatives and the better management of forest peatland regions. METHODS: A spatial analysis was conducted on Landsat 5 and 8 satellite images by using shapefile data stored within the Google Earth Engine platform. Data analysis was carried out using Classification and Regression Tree, a decision tree algorithm used in machine learning for guided classification. Furthermore, purposive sampling was utilized to gather socioeconomic data, followed by the implementation of a benefit-cost analysis. FINDINGS: The results revealed significant changes in the land cover within the Kepau Jaya specific purpose forest area over a 24-year period, with forested areas and open areas decreasing by 23.15 hectares per year and 16.94 hectares per year respectively, and oil palm plantation areas expanding by 40.10 hectares per year. From 1998 to 2022, there has been a consistent annual decline in carbon stocks, resulting in a reduction of 1,933.11 tons of carbon per year. The changes in land use and cover are closely linked to this decline. In an effort to increase plant species diversity in the area and support the gradual transition away from monoculture, a participatory agroforestry scheme was implemented by intercropping Coffea liberica and Shorea balangeran between oil palm rows in a 2-hectare oil palm plantation block within the agroforestry demonstration plot. According to measurements taken at breast height, the aboveground biomass of these species was measured, leading to projected estimates of carbon stocks in Kepau Jaya specific purpose forest area reaching 19,455 tonnes of carbon by the year 2030, with Coffea liberica contributing 4,148 tonnes carbon and Shorea balangeran contributing 15,307 tonnes carbon. CONCLUSION: The study area experienced a substantial reduction in forest cover, whereas the extent of oil palm areas expanded significantly. The findings underscore the need for proactive measures to strengthen the governance of specific-purpose forest areas through community empowerment and the establishment of demonstration plots to promote agroforestry development. The results of this study provide insights for long-term forest rehabilitation strategies aimed at fostering sustainable forest management that yields environmental and socio-economic benefits in the long run. [ABSTRACT FROM AUTHOR]

Cement production is linked to heavy environmental load with exigences for reduction and substitution of raw materials and energy demands/sources. Recently, with the potential commercial discovery of natural gas (NG) reserves in Lebanon, discussions on the viability of fuel-switching, from petcoke (kiln processes) and heavy fuel oil (HFO) (reciprocating engines) to NG in the cement sector emerged. To that aim three alternative scenarios (SCx) were suggested: shifting petcoke to NG in kiln processes (SC1); shifting reciprocating engines from HFO to NG (SC2); shifting kiln processes and reciprocating engines to NG (SC3). An economic analysis indicated that SC2 is the only viable option. This paper presents a new combination of life cycle impact assessment (LCA) and monetization to quantify environmental impacts for the decision-making processes, within the Lebanese context. The LCA was conducted using primary data and SimaPro v8.5.2.0. The functional unit (FU) was 1 kg of cement. IPCC 2013 GWP 100a V1.03, Cumulative Energy Demand (CED) V1.10 ReCiPe 2016 E v1.02 impact assessment and Stepwise2006 (V1.05.3) monetary valuation methods were used. Results indicated that all scenarios lead to a reduced carbon footprint: 0.016 kgCO2eq., 0.0008 kgCO2eq. and 0.0168 kgCO2eq. for SC1, SC2 and SC3, respectively, from the baseline 1.0327 kgCO2eq.. The baseline CED was 5.06 MJ, and 4.5 MJ, 4.91 MJ and 4.35 MJ for SC1, SC2, and SC3, respectively. SC3 had the lowest environmental burden, followed by SC1 and SC2. Damage assessment results indicated that all alternative scenarios reduce environmental damage, while SC3 brought the highest benefit followed by SC1 and SC2, respectively. Monetization results/ FU indicated a cost burden of 25.54 US¢, 24,64 US¢, 25.5 US¢ and 24.6 US¢ for baseline, SC1, SC2 and SC3, respectively. Finally, the best fit option, after internalizing the environmental cost, shifted from SC2 to SC3 indicating the merits of combining LCA and monetization into decision-making processes. [ABSTRACT FROM AUTHOR]

High percentage of global electrical power production today comes from steam plants. Thus, improving performance of such plants is crucial to minimize its environmental effects and achieve operational economy. This project aim is to study several aspects of plants operation such as pollution, safety, health, economy and dangerous incidents during operation. Thereby, assessment may be conducted through specific rating factor as death rate (DR); greenhouse emissions (CO2EQV); capacity factor (CF); generating efficiency (η); reliability (Rbt); cost; availability; global production (Prd) & consumption rates (Econs). These rating factors were applied to all types of energy sources to evaluate its safety & cleanliness (DR & CO2EQV); reliability at maximum power at specific time (CF & Rbt); generation efficiency to maintain acceptable cost and power losses control (η & Cost); examining finally each source availability to insure continuous operation under regular global production (Prd) & consumption rates (Econs). As a result, the percentage contribution of each energy source showed that fossil fuels are the dirtiest & most dangerous, while both renewable and nuclear are safe & clean. As for DR factor, coal contribution is 47.5% while less than 1% for nuclear, wind and solar. Likewise, (CO2EQV) showed similar outcome in this respect. In addition, the higher the efficiency (%) the lower the operating cost (USc/kWh). Consequently, results showed that poor rating for solar (8.7c/kWh) & wind (5.1c/kWh) which is due to their low generation rate in comparison to cost effective nuclear (2.4c/kWh), hydro (2.2c/kWh) and NG (2.2c/kWh) power generation process. In conclusion, energy sources were grouped as nonrenewable (fossil fuel), renewable and nuclear. Whereby linking all risk factors, favors renewable and nuclear sources while nonrenewable gave environmental damaging effects in most rating aspect. [ABSTRACT FROM AUTHOR]

Background and Aims: Multiple sources of medical oxygen, namely liquid medical oxygen (LMO) tanks, pressure swing adsorption (PSA) plants, concentrators, and gaseous cylinders, are available at different healthcare facilities. These sources of oxygen have varying installation and operational costs. In low-resource settings, it is imperative to utilise these assets optimally. This study investigated the operational costs of multiple oxygen sources available at a healthcare facility. Methods: A Microsoft (MS) Excel-based model was developed to analyse and compare the oxygen manufacturing costs (in ₹/m[sup.3]) using PSA plants and procurement costs (in ₹/m[sup.3]) of LMO and third-party vendor-refilled cylinders. Results: The oxygen manufacturing costs for PSA plants of different capacities and running times on electricity and diesel generators (DGs) as a power source were calculated. This study highlights the cost-benefit of using PSA plants over LMO and third-party vendor-refilled cylinders as a source of oxygen. PSA plants are most economical when they are of higher capacity and used to their maximum capacity on electricity as the power source. On the contrary, they are most expensive when used on a DG set as a power source. Furthermore, this study provides evidence of PSA plants being more cost-effective for refilling cylinders using a booster compressor unit when compared to third-party vendor-cylinder refilling. Conclusion: Given their cost-effectiveness and low third-party dependence, they should be utilised to their maximum capacity as medical oxygen sources at healthcare facilities. Keywords: Booster compressor units, cost analysis, gaseous cylinders, hospitals, liquid medical oxygen, medical oxygen, pressure swing adsorption plants, Author(s): Varun Manhas [1]; Mahipal Rawat [2]; Yogesh S. Kaurav [3]; Sanjay Goyal [4]; Sanjay Dhir [5]; Kalyani Sangineni (corresponding author) [6] INTRODUCTION Oxygen therapy is an essential component of [...]

Analyses of late-life disability based on survey data of the oldest old often suffer from non-representative samples due to selective participation and attrition. Here, we use register data on the Austrian long-term care allowance (ALTCA) as a proxy for late-life disability. In this retrospective mortality follow-back study, we analyze receipt of ALTCA, a universal cash benefit based on physician-assessed disability in activities of daily living during the last 10 years of life, among all decedents aged 65 years and over from 2020 in Austria (n = 76,781) and its association with sex, age at death, and underlying cause of death. We find that on average, ALTCA was received for 3.5 and 5.3 years in men and women. At 10 years before death, 10% of men and 25% of women received ALTCA, which increased to 56% and 77% at one year before death. Both the probability and duration of ALTCA increased with age at death and varied by cause of death: Those who died from cancer, myocardial infarction, and external causes of death were less likely to receive ALTCA and for shorter durations, while those who died from dementia, Parkinson's disease, chronic heart disease, or chronic lung disease were more likely to receive it and longer so. Overall, our register-based estimates of the prevalence of late-life disability were higher than previous survey-based estimates. Policy-makers should be aware that costs of long-term care will rise as life expectancy rises and deaths from dementia and chronic heart disease will likely increase in the rapidly aging European societies. [ABSTRACT FROM AUTHOR]

Background: Antipsychotic medications are the primary treatment for schizophrenia, with olanzapine being an effective medication for schizophrenia. The economic cost for each individual with schizophrenia is high, with antipsychotic medication being a major expense. This study aims to develop an economic decision model that compares different treatment options for schizophrenia patients, including olanzapine Orally Dispersible Tablets (ODT), olanzapine [ODT + Standard Oral Tablet (SOT)], risperidone (ODT + SOT), and aripiprazole (ODT + SOT), to determine their cost-effectiveness with an objective to optimize healthcare resource allocation in Morocco. Methods: The study used published medical literature and a clinical expert panel to develop a decision analytic model. This model was designed to capture parameters such as adherence levels, treatment discontinuation, relapse with and without hospitalization, quality-adjusted life years (QALYs), treatment-related adverse events, healthcare resource utilization, and associated costs. The main outcomes of interest included the total annual direct cost per treatment, QALYs, and incremental cost-effectiveness ratio (ICER) per 1 QALY gained. One-way and probabilistic sensitivity analyses were employed to account for parameter uncertainty. Results: According to the simulation model, the ODT and ODT + SOT as a group form of olanzapine was the most effective treatment option in terms of the lowest percentages of inpatient relapse, and patients who remained stable (11% and 79% respectively) than risperidone (19% and 62% respectively) and aripiprazole ODT (26% and 50% respectively) and ODT + SOT formulation groups. Olanzapine (ODT + SOT) therapy group was cost-effective when compared to the combined group of ODT + SOT forms of risperidone [ICER: Moroccan Dirham (MAD) 103,907], and aripiprazole (ICER: MAD 65,047). Additionally, olanzapine ODT was found to be cost-effective compared to olanzapine SOT with an ICER of MAD 3921, risperidone ODT with an ICER of MAD 1,02,298, risperidone SOT with an ICER of MAD 31,088, and aripiprazole ODT or SOT formulations. All the above ICERs fall under the willingness-to-pay threshold in Morocco of MAD 250,832.40. Sensitivity analyses confirmed the reliability of the findings. Conclusions: The model concluded that olanzapine ODT is the most cost-effective first-line treatment option for schizophrenia in Morocco when compared to other atypical antipsychotic medications in ODT and SOT formulations. [ABSTRACT FROM AUTHOR]

A study conducted in Uganda suggests that using C-reactive protein (CRP) levels to guide the evaluation of young children with lower respiratory tract infections (LRTIs) may help reduce the prescription of antimicrobial therapy without increasing treatment failure rates. LRTIs are a leading cause of morbidity and mortality in children, but there is no clinically feasible reference standard for their diagnosis. The study found that incorporating CRP into the routine management of LRTIs among young children resulted in a nearly 25% reduction in antimicrobial therapy prescriptions, with no difference in clinical outcomes. However, further research is needed to determine the optimal CRP level for withholding antimicrobial therapy and to consider the potential inconveniences and costs associated with implementing this approach. [Extracted from the article]

Introduction: This study explores the impact of Building Information Modelling (BIM) staff on construction project performance, with a focus on the roles of the Unified Theory of Acceptance and Use of Technology (UTAUT) and Task-Technology Fit (TTF). The research aims to understand how BIM personnel attributes influence project outcomes and how these effects are mediated by TTF and moderated by UTAUT. Methods: Partial Least Squares Structural Equation Modelling (PLS-SEM) was employed to analyze the data, allowing for the examination of complex interactions between BIM staff attributes, project characteristics, and outcomes. This method is particularly suited for handling smaller sample sizes and non-normal data distributions. Results: The analysis revealed that BIM staff attributes--such as team size, expertise, training, and experience--significantly influence construction project performance. Key performance areas affected include design efficiency, error reduction, and adherence to schedules and budgets. TTF emerged as a critical mediator, enhancing performance metrics like stakeholder satisfaction and cost management. UTAUT further moderated the relationship between BIM staff, TTF, and project performance, highlighting the importance of technology acceptance and use within BIM contexts. Discussion: The findings emphasize the need for organizations to strategically allocate BIM staff and invest in their professional development to optimize project outcomes. Recommendations include fostering supportive organizational structures and promoting a culture of collaboration and innovation to enhance project resilience and performance, particularly in the face of disruptive events. Future research should expand to diverse project types and scales, investigate emerging technologies, and consider cultural factors through cross-cultural studies. Longitudinal studies and cost-benefit analyses of BIM training and technology adoption are also suggested to provide deeper insights and inform strategic decision-making. [ABSTRACT FROM AUTHOR]

Background: Since December 2021, Wuxi, China has offered a two-dose human papillomavirus (HPV) vaccination to 14-year-old females for free. This study evaluated the costs and benefits of this vaccination scheduled in the Expanded Program on Immunization in Wuxi from the perspective of the cities' demographic characteristics, economic development, and policy support. Methods: The model-based economic evaluation used TreeAge Pro software to construct a decision tree-Markov model for the vaccination strategy in which 100,000 14-year-old females received two doses of bivalent HPV vaccine or no vaccination. Costs and effects of the strategy were assessed from a societal perspective through literature research and data obtained from the Wuxi Centre for Disease Control and Prevention. Univariate, multivariate, and probabilistic sensitivity analyses assessed the stability of the findings. Results: The cost of the bivalent HPV vaccine in Wuxi is 711.3 CNY. The two-dose of bivalent HPV vaccine for 100,000 14-year-old females would cost an additional 658,016 CNY compared to no vaccination, but would result in 1,960 Quality Adjustment Years of Life (QALYs). Using the per capita gross domestic product of 187,415 CNY in 2021 in Wuxi as the willingness-to-pay threshold, the vaccination strategy costs 3,357.37 CNY per QALY gained, which is much lower than the threshold, suggesting that it is a very cost-effective strategy. In addition, the vaccine strategy reduced the incidence of cervical cancer by 300 cases and cervical cancer deaths by 181 cases, representing a benefit-cost ratio of 2.86 (> 1) when health output outcomes were measured in monetary terms. These results suggested that the vaccination strategy was advantageous. Sensitivity analyses showed that changes in the parameters did not affect the conclusions and that the findings were robust. Conclusions: Compared to no vaccination, the delivery of two doses of bivalent HPV vaccine for 14-year-old females was a more highly cost-effective and optimal strategy. [ABSTRACT FROM AUTHOR]

Background: Treatment cost and high prevalence of Poly Cystic Ovarian Syndrome (PCOS) is a very challenging issue globally. Due to this reason; current study was conducted to determine pharmaco-economy of conventional and non-conventional treatments for the management of PCOS. Methods: Prospective Cross-Sectional study was conducted in the metropolitan city of Karachi from January – December 2019. Primary data of 200 PCOS patients were collected from different hospitals and clinics. An instrument was used to collect data pertaining to the direct and indirect cost associated with the disease management. Collected data was analyzed by the tools for cost analysis and software called Statistical Package of Social Sciences (SPSS) – 22. Results: In Cost Minimization Analysis (CMA); Allopathic treatment [Mean cost/month: PKR:4479.32 ± 350.95 (USD:27.46 ± 2.15)], Herbal treatment [Mean cost/month: PKR:1527.78 ± 78.15 (USD:9.37 ± 0.48)], Combination treatment [Mean cost/month: PKR:2803.09 ± 654.22 (USD:17.18 ± 4.01)], and Homoeopathic treatment [Mean cost/month: PKR:976.95 ± 46.19 (USD:5.99 ± 0.28)]. Incremental cost/month for Allopathic treatment is 358%, Herbal treatment is 56%, Combination treatment is 187%. In Cost Effectiveness Analysis (CEA); Allopathic treatment (Incremental cost-effectiveness ratio/month: 1334.24), Herbal treatment (Incremental cost-effectiveness ratio/month: 936.41), Combination treatment (Incremental cost-effectiveness ratio/month: 1017.09). Due to lowest cost of Homeopathic treatment, cost of Homeopathic treatment was considered as a threshold value. In-direct cost/month of Allopathic treatment is PKR:593.33 ± 24.00 (USD:3.64 ± 0.15), Herbal treatment is PKR:307.84 ± 26.69 (USD:1.89 ± 0.16), Combination treatment is PKR:409.09 ± 45.63 (USD:2.51 ± 0.28) and Homoeopathic treatment is PKR:300.00 ± 26.39 (USD:1.84 ± 0.16). Conclusion: The most cost-effective is treatment is Homeopathic; Herbal treatment is second most cost-effective option for the treatment of PCOS. Lowest direct and indirect costs and short treatment duration collaboratively lessen the %incremental cost per year and incremental cost effectiveness ratio per year. [ABSTRACT FROM AUTHOR]

Background: Understanding complex neurosurgical procedures and diseases, such as skull-base meningiomas, is challenging for patients due to the intricate anatomy and the involvement of critical neurovascular structures. Enhanced patient comprehension is crucial for satisfaction and improved clinical outcomes. Patient-specific 3D models have demonstrated benefits in patient education, though they are costly and time-intensive to produce. This study investigates whether the use of 3D volumetric reconstructions with anatomical segmentation, widely available via neuronavigation software, can improve patients' understanding of skull-base meningiomas, surgical procedures, and potential complications. Materials and Methods: This study included twenty patients with skull-base meningiomas. Three-dimensional volume reconstructions and anatomical segmentations were created using preoperative MRI sequences with neuronavigation software. These reconstructions were used during patient consultations where a surgeon explained key aspects of the disease, the surgical intervention, and potential complications. A questionnaire assessed the patients' perceptions of the utility of these 3D reconstructions. Results: The majority of patients (75%) found the 3D volumetric reconstructions and anatomical segmentations to be more beneficial than MRI images for understanding their disease. Similarly, 75% reported improved comprehension of the surgical approach, and 85% felt that the reconstructions enhanced their understanding of potential surgical complications. Overall, 65% of patients considered the 3D reconstructions valuable in medical consultations. Conclusions: Our study indicates that using accessible, cost-effective, and non-time-consuming 3D volumetric reconstructions with anatomical segmentation enhances patient understanding of skull-base meningiomas. Further research is necessary to confirm these findings, compare these reconstructions with physical 3D models and virtual reality models, and evaluate their impact on patient anxiety regarding the surgical procedure. [ABSTRACT FROM AUTHOR]

We present a mathematical model for agri-food industry residual streams flow management, which serves as a decision support tool for optimizing their valorization. The aim is to determine, under a cost-benefit analysis approach, the best strategy at a global level. The proposed mathematical model provides the optimal valorization scenario, namely the set of routes followed by agri-food industry residual streams that maximizes the total profit obtained. The model takes into account the complete stoichiometry of the residual stream at each step of the valorization route. Furthermore, the model allows for the calculations of different scenarios to support decision-making. The proposed approach is illustrated through a case study using a real-case network of a region. The case study bears evidence that the use of the model can lead to significant profit increases compared to those obtained with current practices. Moreover, notable profit improvements are obtained in the case study if the selling price of all the value-added products considered increases or if the processing cost of the animal feed producer decreases. Therefore, our model enables the detection of key factors that influence the optimal strategy, making it a powerful decision-support tool for optimizing the valorization of agri-food industry residual streams. [ABSTRACT FROM AUTHOR]

In the present work, a strategic multi-scenario EV ultra-fast charging station (CS) planning framework is designed to provide advantages to charging station owners, Distribution Network Operators, and EV owners. Locations of CSs are identified using zonal division and the Voltage Stability Index strategy. The number of chargers is determined using the Harris Hawk Optimization (HHO) technique while minimizing the installation, operational costs of CS, and energy loss costs considering all the power system security constraints. To ensure a realistic planning model, uncertainties in EV charging behavior and electricity prices are managed through the 2m-Point Estimate Method. This method produces multiple scenarios of uncertain parameters, which effectively represent the actual dataset, thereby facilitating comprehensive multi-scenario planning. This study incorporates annual EV and system load growth in a long-term planning model of ten years, ensuring the distribution network meets future demand for sustainable transportation infrastructure. The proposed research work is tested on a 33-bus distribution network and a 51-bus real Indian distribution network. To evaluate the financial and environmental benefits of the planning, a cost-benefit analysis in terms of the Return-on-Investment index and a carbon emission analysis are performed, respectively. Furthermore, to prove the efficacy of the HHO technique, the results are compared with several existing algorithms. [ABSTRACT FROM AUTHOR]

Background : Tractors and quad bikes pose a significant risk of fatal injuries among farmers, particularly affecting older farmers. This study aimed to explore the barriers and facilitators to the adoption of machine related safety behaviors among older farmers in Irish farm settings. Method: Four focus groups were conducted via Zoom in February 2021. Nineteen Irish farmers from four farm types participated. The discussions were audio-recorded, transcribed verbatim, and analyzed using an inductive, reflexive thematic analysis approach. The themes identified were then mapped to the COM-B (Capability-Opportunity-Motivation) model, providing a systematic theoretical basis for designing a future intervention to reduce machine-related accidents. Results: The analysis identified five inductive themes that encompassed both barriers and facilitators in farm safety practices: (1) Capability to manage competing responsibilities; (2) Characteristics of the farm and its work environment; (3) Availability and affordability of resources; (4) Prevailing sociocultural opportunities; and (5) Perceived likelihood and cost-benefit analysis in safety decision-making. These themes captured the complex interplay of capability, opportunity, and motivation in farmers' decision-making processes. The study also revealed limitations in existing interventions, such as voluntary guidelines and educational methods, in effectively addressing these barriers. Conclusions: Farmers' abilities (capability), prevailing sociocultural factors, resource availability (opportunity), and their perceived consequences and benefits (motivation) affect how safely they work with machines. The study emphasizes the need for comprehensive, theory-driven approaches that consider the interplay of capability, opportunity, and motivational factors that may support or impede machine safety. Understanding the challenges faced by Irish farmers highlights potential strategies for safety intervention, and these strategies should be co-designed with farmers and attentive to the local context. Practical applications: The study provides a template for understanding farmers' perspectives using the COM-B model. The findings can inform the development of theoretically informed intervention strategies based on the Behavior Change Wheel framework. [ABSTRACT FROM AUTHOR]

Background: Most Chinese blood centers have implemented mini pool (MP) HBV nucleic acid testing (NAT) together with HBsAg ELISA in routine blood donor screening for HBV infection since 2015, and a few centers upgraded MP to individual donation (ID) NAT screening recently, raising urgent need for cost-benefit analysis of different screening strategies. In an effort to prevent transfusion-transmitted infections (TTIs) for HBV, cost-benefit analyses of three different screening strategies: HBsAg alone, HBsAg plus MP NAT and HBsAg plus ID NAT were performed in blood donors from southern China where HBV infection was endemic. Methods: MP-6 HBV NAT and ID NAT were adopted in parallel to screen blood donors for further comparative analysis. On the basis of screening data and the documented parameters, the number of window period (WP) infection, HBV acute infection, chronic hepatitis B infection (CHB) and occult hepatitis B infection (OBI) was evaluated, and the potential prevented HBV TTIs and benefits of these three strategies were predicted based on cost-benefit analysis by an estimation model. Results: Of 132,323 donations, the yield rate for HBsAg-/DNA + screened by ID NAT (0.12%) was significantly higher than that by MP NAT (0.058%, P < 0.05). Furthermore, the predicted transfusion-transmitted HBV cases prevented was 1.25 times more by ID NAT compared to MP-6 NAT. The cost-benefit ratio of the universal HBsAg screening, HBsAg plus ID NAT and HBsAg plus MP NAT were 1:58, 1:27 and 1:22, respectively. Conclusions: Universal HBsAg ELISA screening in combination with HBV ID NAT or MP-6 NAT strategies was highly cost effective in China. To further improve blood safety, HBsAg plus HBV DNA ID NAT screening should be considered in HBV endemic regions/countries. [ABSTRACT FROM AUTHOR]

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