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The UK's "Restoring Your Railway" (RYR) programme aims to reopen abandoned railway infrastructure to foster local economic growth. However, since 2020, only 30% of RYR proposals have progressed, revealing challenges in the methodological approach, especially for projects introducing rail as a new mode. The current unimodal approach for estimating user benefits in such projects is considered inadequate. To address this, a Cost-Benefit Analysis (CBA) with improved methods for user benefit estimation has been conducted, compared with existing cases to determine if it results in a better Benefit-Cost Ratio (BCR). Historically, early appraisal methods relied on the Strategic Outline Business Case (SOBC), which took six months and incurred costs of approximately Rp. 1.5 billion. To expedite project delivery, sensitivity analysis explores circumstances under which RYR projects are socially justifiable across different Value for Money scenarios. Additionally, a comparative analysis is performed between the UK and Indonesian approaches. This study introduces a new CBA approach, focusing on user benefit estimation and conducting sensitivity analysis on key determinants. The mathematical CBA model, modified for the value of time and diversion factor, forms the basis for sensitivity analysis on BCR, travel time savings, capital and operational costs, diversion factor, and GDP growth. Testing the model against business cases reveals a 17-20% reduction in the required demand for the same BCR compared to conventional CBA approaches, suggesting the new method captures additional benefits related to mode shifts. Sensitivity analysis highlights circumstances under which railway projects are likely to deliver acceptable value for money, considering various BCR values. Total order indices show that operational costs contribute 40% to the model output, followed by capital costs and GDP growth rate at 29% and 25%, respectively. Surprisingly, the In-Vehicle Time (IVT) for trains has only a small contribution, ranging from 1.83% to 4%. [ABSTRACT FROM AUTHOR]

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The aim of this paper is to investigate the problem of designing and building International Environmental Agreements (IEAs) taking into account some normative properties. We consider n asymmetric countries of the world, each one generating a quantity of pollutant emissions from the production of goods and services. We assume that individual emissions yield private benefits and negative externalities affecting all countries. To determine its own level of pollution, each state conducts a cost-benefit analysis. The absence of a supranational entity imposing emissions reduction makes IEAs based on voluntary participation. Examining the standard static non-cooperative game-theoretical model of coalition formation, we discover that the resulting emissions allocations might not be equitable à la Foley. It means that there might exist at least one player preferring to implement some other agent's strategic plan instead of to play her own strategy. With the goal of studying whether equity, at least among coalesced countries, may be a criterion leading to social improvement, we introduce a new optimization rule. We require that members of an environmental coalition have to solve the maximization problem subject to the constraint imposing that they do not envy each other. Analyzing the particular case of two-player games, we get that, when countries are, in a sense, not too different from each other, our new mechanism endogenously induces social equity. By imposing a suitable total emission cap, the same results extend to all those games where our and standard solutions coexist and are different. [ABSTRACT FROM AUTHOR]

Introduction: Technological advancements and the COVID-19 pandemic have highlighted the importance of digital tools for patient care and rehabilitation. This study explores user perspectives on telerehabilitation, comparing it to traditional methods and identifying criteria for determining its suitability for different patients and clinical conditions. Methods: This study was carried out during the period of May–September 2021. Questionnaires were administered to 48 users in rehabilitation for audiophonologopedic and neurodevelopmental disorders in three rehabilitation centres in central Italy. Results: The user responses predominantly emphasize the benefits of time saving (68.75%) and cost-efficiency (37.5%), specifically regarding time saving due to travel and expenses incurred to go to where the therapy is carried out. The disadvantages include increased distraction (60.42%) in following the instructions remotely and logistic problems (39.58%). Patients with hearing loss were subjected to a larger number of telerehabilitation sessions, positively rating this alternative method. Patients with speech and language delay and autism spectrum disorder (ASD) prefer traditional treatment. Discussion: This study reveals a favourable perception of telerehabilitation as a therapy approach to be regarded as a supplement or temporary option to the irreplaceable face-to-face one. More research, as well as a larger sample sizes, will be useful to increase the significance of the correlations reported in this study. [ABSTRACT FROM AUTHOR]

We show that distortion in the size distribution of banks around regulatory thresholds can be used to identify costs of bank regulation. We build a structural model in which banks can strategically bunch their assets below regulatory thresholds to avoid regulations. The resultant distortion in the size distribution of banks reveals the magnitude of regulatory costs. Using U.S. bank data, we estimate the regulatory costs imposed by the Dodd-Frank Act. Although the estimated regulatory costs are substantial, they are significantly lower than banks' self-reported estimates. Authors have furnished an Internet Appendix , which is available on the Oxford University Press Web site next to the link to the final published paper online. [ABSTRACT FROM AUTHOR]

The heading "Wireless Networks in Hospitals: Ensuring Seamless Communication in Critical Situations" examines hospital wireless network enhancement. When patient well-being is at stake, this strategy encourages honest conversation. Service quality, resource efficiency, and network security are crucial. These mathematical models increase hospital wireless network stability based on Internet of Thing (IoT). Service management effectiveness influences who gets vital medical information quickly. Information and crucial messages are delivered faster. A mathematical technique considers the relevance and transmission time of each data payload to estimate its priority factor (P(i)). Network performance determines QoS settings. Priority data is transmitted first to ensure quick delivery to the intended recipients. This technology is essential for updating hospital WiFi networks, especially in critical situations where it can transmit accurate and timely information and save lives. WiFi reliability is essential for building operations. Compare failure frequency and MTBF to assess each network point's reliability. An exponential reliability function determines network dependability. The mean time between failures is used. This method maintains network functionality despite its complexity. Determine which pieces are crucial and how they influences network health. This simplifies network backups and maintenance. Load balancing distributes network tasks among entry points. This strategy helps the network function smoothly and minimize congestion during peak demand. The weighted round-robin timing algorithm determines how busy each access point is to send fresh network traffic to the proper areas. By equally distributing load and prioritizing underutilized access points, this method maintains network stability and keeps critical lines available. These three approaches form a full healthcare WiFi network strengthening plan. Mission-critical data is prioritized, the network is more robust, and resources may be allocated quickly. Our solution often outperforms the existing standard in network stability, communication, and cost. [ABSTRACT FROM AUTHOR]

Our paper explores in a large Romanian sample (2168 adolescents) the relational costs and benefits of the number of friends at school. Using the MEDCURVE procedure to test the non-linear mediation effects, our results show that psychological safety, bullying and negative relations mediate the association between the number of friends and depression and anxiety, while social acceptance and bullying mediate the association between the number of friends and academic self-efficacy. In general, our results show that the relational benefits of friendship tend to diminish as the number of friends increase, in general over 9 friends (depending on the relational state) and parents, teachers and school counselors should help adolescents manage their number of friends in order to prevent the relational costs associated with engaging in too many (superficial) friendships. [ABSTRACT FROM AUTHOR]

The article discusses the importance of identifying somatic RET mutations in patients with medullary thyroid cancer (MTC) to guide treatment decisions. It highlights the need for this analysis in patients with advanced MTC, as it can impact the choice of therapy. The study suggests that performing RET somatic mutation analysis at the time of diagnosis or during the initial postoperative evaluation is crucial for patients with structural disease, while it may not be necessary for patients showing an excellent response or biochemical incomplete response without risk factors for structural recurrence. The article also discusses the challenges and methods of detecting RET mutations in MTC patients, emphasizing the importance of tailored analysis based on individual patient characteristics. [Extracted from the article]

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]

In communities of Sub-Saharan Africa, where local elites participate in the selection of households for cash transfers, there is a tendency to deviate from laid down rules for various reasons. Using qualitative data from selected districts where Ghana's Livelihood Empowerment Against Poverty (LEAP) programme is implemented, this study investigates the reasons why district and community elites deviate from prescribed selection processes of the LEAP programme. Drawing on the concept of competitive clientelism, the findings suggest that elites are deeply guided by political patronage to fulfil one primary goal, protecting their role in office. Such ambition is facilitated by the discretionary power accorded to elites by the local government system and socio-cultural values deeply rooted in Ghanaian society. In conclusion, the study draws out key lessons from the analysis and suggests a design of beneficiary selection frameworks that acknowledges the nature of domestic politics, institutions of power and powerful actors at the subnational level. The article also highlights the implications of the findings for the broad politics of social protection literature. [ABSTRACT FROM AUTHOR]

Background: Almost 2 million people in the UK live with sight loss, and this number is predicted to double by 2050. There is increasing recognition of the need to provide counselling services to people living with sight loss. Aim: The aim of this research was to assess whether there is an unmet need for counselling services for people living with sight loss in North Wales and to estimate the social value and budget impact of the potential roll‐out of counselling services to this population. Method: Between December 2020 and May 2021, a telephone survey was completed by 192 people living with sight loss in North Wales, UK. The survey instrument was a 19‐item questionnaire, which included the Short Warwick–Edinburgh Mental Well‐being Scale (SWEMWBS). Using data from the SWEMWBS and published statistics, a social return on investment (SROI) and budget impact analysis were conducted. Results: Most respondents (84%, n = 161) had never been offered counselling in relation to sight loss. Thirty‐nine per cent (n = 74) stated that they would use a new counselling service if it were available. Fifty‐one per cent (n = 97) indicated that counselling could be especially beneficial for people who have recently been registered or diagnosed with sight loss (the timely window). Of those who completed the SWEMWBS, approximately 25% reported low mental well‐being or probable depression. Social return on investment analysis estimated that providing counselling services for people with sight loss in North Wales could generate a social value of £3.42 for every £1 invested. Conclusion: Timely counselling may improve an individual's ability to cope with sight loss and improve their quality of life over time. [ABSTRACT FROM AUTHOR]

This paper examines the Food and Drug Administration's regulation of drug safety. In one of the most sophisticated cost-benefit analyses to date, (Cost-benefit analysis of the FDA: The case of the prescription drug user fee acts, The Journal of Public Economics, 92, 1306–1325.) argue that between 1998 and 2005 the FDA's drug submission process under the Prescription Drug User Fee Act (PDUFA) increased social surplus by $14–31 billion. However, this conclusion is based upon inappropriate data that underestimate the welfare costs of drugs that were withdrawn from the market due to their harmful side effects. Once appropriate epidemiological data are used to calculate the welfare costs of a single drug, Vioxx, which was withdrawn from the market after it was found to cause heart attacks, PDUFA I-II are found to have caused a net reduction in social welfare of between $1-201 billion. This indicates that statistically infrequent regulatory mistakes may have large social welfare implications that can counteract the benefits of years of accurate regulatory decisions. Thanks to Sarah Bernhardt, Romit Bhattacharya, Stephen DeCanio, Marco Giani, Colin Jennings, John Meadowcroft, and Tariq Thachil for helpful comments and suggestions. Special thanks to the helpful comments offered by two anonymous referees. [ABSTRACT FROM AUTHOR]

Background: Nowadays, metabolic syndrome has become a major health threat, and affects over one billion people globally. It also plays a great role in the growth of diseases like type 2 diabetes, coronary diseases, stroke, and other chronicity. It increases the risk of cardiovascular disorder and stroke by three to ten times and diabetic mellitus by ten times. The prevalence of metabolic syndrome is increasing globally as a result of epidemiological shift. Low and middle-income countries are facing an increasing burden of metabolic syndrome. There is a need for concerted efforts to modify behavioral risk factors that significantly contribute to the prevalence of the syndrome. This can be done by developing and implementing appropriate interventions that can bring behavior change after testing for effectiveness, feasibility, and acceptability. Thus, this study aims to develop and test the effectiveness, feasibility and acceptability of an education intervention promoting healthy lifestyle to reduce risk factors for metabolic syndrome, among office workers in Ethiopia. Methods and analysis: This randomized controlled trial will be implemented with 226 bank employees (age ≥18 years) with metabolic syndrome from government and private banks in Bahir Dar City, Ethiopia. Participants will be randomized to intervention (education) and control (general health advice) groups. The intervention group will be given one-on -one base education about healthy diets, physical exercise, stress management, avoidance of harmful alcohol consumption and smoking cessation by experts on health promotion. Text messages will be sent every two weeks and reading materials will also be provided. Additionally, a review meeting will be held at the 3rd and 6th month of the intervention. The primary outcomes of interest will be change in metabolic parameters (obesity levels, blood pressure, fasting blood glucose, total cholesterol, high density lipoprotein, low density lipoprotein, and triglycerides). Secondary outcomes will be knowledge, attitudes and practice of the participants towards lifestyle and cardiovascular risk factors, feasibility, acceptability, implementation fidelity, and cost-effectiveness of the intervention. Data will be collected at three time points: at baseline, at the 6th month of the intervention and at the end of the intervention (9 months). Generalized linear mixed models will be utilized to compare the desired outcome between the trial arms, after accounting for baseline variations. Cost-benefit analysis and a qualitative process evaluation of the intervention will also be conducted. Discussion: This randomized control trial study will provide information on the effectiveness, feasibility, and acceptability of an education intervention promoting healthy lifestyle to reduce risk factors for metabolic syndrome, among office workers in Ethiopia, where the burden of metabolic syndrome is high among office workers. Clinical trial registration: This trial has been prospectively registered at the Australian New Zealand Clinical Trials Registry: ACTRN12623000409673p. [ABSTRACT FROM AUTHOR]

Purpose: Implanted devices used in metastatic spine tumor surgery (MSTS) include pedicle screws, fixation plates, fixation rods, and interbody devices. A material to be used to fabricate any of these devices should possess an array of properties, which include biocompatibility, no toxicity, bioactivity, low wear rate, low to moderate incidence of artifacts during imaging, tensile strength and modulus that are comparable to those of cortical bone, high fatigue strength/long fatigue life, minimal or no negative impact on radiotherapy (RT) planning and delivery, and high capability for fusion to the contiguous bone. The shortcomings of Ti6Al4V alloy for these applications with respect to these desirable properties are well recognized, opening the field for an investigation about novel biomaterials that could replace the current gold standard. Previously published reviews on this topic have exhibited significant shortcomings in the studies they included, such as a small, heterogenous sample size and the lack of a cost-benefit analysis, extremely useful to understand the practical possibility of applying a novel material on a large scale. Therefore, this review aims to collect information about the clinical performance of these biomaterials from the most recent literature, with the objective of deliberating which could potentially be better than titanium in the future, with particular attention to safety, artifact production and radiotherapy planning interference. The significant promise showed by analyzing the clinical performance of these devices warrants further research through prospective studies with a larger sample size also taking into account each aspect of the production and use of such materials. Methods: The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines were used to improve the reporting of the review. The search was performed from March 2022 to September 2023. Results: At the end of the screening process, 20 articles were considered eligible for this study. Polyetheretherketone (PEEK), Carbon-fibre reinforced polyetheretherketone (CFR-PEEK), long carbon fiber reinforced polymer (LCFRP), Polymethylmethacrylate (PMMA), and carbon screw and rods were used in the included studies. Conclusion: CFR-PEEK displays a noninferior safety and efficacy profile to titanium implanted devices. However, it also has other advantages. By decreasing artifact production, it is able to increase detection of local tumor recurrence and decrease radiotherapy dose perturbation, ultimately bettering prognosis for patients necessitating adjuvant treatment. Nonetheless, its drawbacks have not been explored fully and still require further investigation in future studies. This does not exclude the fact that CFR-PEEK could be a valid alternative to titanium in the near future. [ABSTRACT FROM AUTHOR]

Background: Even if robotic assisted total knee arthroplasty (RATKA) is a widely used technique, there is still a gap of knowledge about whether this technology is effective in improving the patient utility. This measure is of paramount importance for conducting cost effectiveness analysis. The aim of this study was to compare the utility measure derived from self-reported outcomes questionnaires in patients who underwent RATKA compared to patients who underwent the manual surgery. Methods: We compared 72 patients operated with a robotic technique with 70 operated with traditional technique. The utility data were collected with the WOMAC (Western Ontario and McMaster University Osteoarthritis index) self-administrated questionnaire that investigates pain, stiffness and functionality of the patients, an then mapped to a utility value through a validated transforming function. We performed three surveys: the first one before the intervention (t0), the second one 1 year after the surgery (t1) and the third one at the 2 year follow up (t2). Results: we observed higher utility values in both groups. In detail, the mean utility score in the RATKA group increased from 0.37 to 0.71 (t1) and 0.78 (t2), while in the conventional group it increased from 0.41 to 0.78 (t1) and 0.78 (t2). The fixed effect coefficients of t1 and t2 were found to be 0.37 and 0.363 (p < 0.001 for both). The coefficient of the robotic technique, along with its interaction with the t1 and t2 time effect was non-significant. Conclusions: Even if at t1 the utility of patient who underwent RATKA were lower, at longer follow up (t2) we found no significant difference compared to traditional technique, leaving the superiority of robotic assisted technique yet to be proved. Our results may be useful for calculating the gained or lost Quality Adjusted Life Years (QALYs), so that the health care system (or an insurance company) could make an appropriate decision whether to fund the robotic approach or not, after a careful assessment of the incremental costs incurred. [ABSTRACT FROM AUTHOR]

This study summarized and evaluated the cost-benefit analysis methods for typical water environment pollution control measures in China. We conducted a comprehensive comparison of these measures, whose advantages and disadvantages were examined, so the application models and characteristics can be delved into. Through integrating methods and analyzing application cases, we refined a combination of measures with high efficiency and low cost in controlling China's water environment. In our analysis of cost-benefit, we emphasized the importance of implementing scientifically designed control measures and employing rigorous methods to addressing water environment pollution. In order to achieve rapid response and efficient treatment of China's environmental problems, we advocated for establishing a cross regional pollution control mechanism. That is, the collaborative platform and scientific suggestions for all participants in this field should be provided, through interdisciplinary integration, development of domestic models, and expansion of databases. [ABSTRACT FROM AUTHOR]

Background. The misallocation of scarce healthcare resources globally raises concerns regarding the underuse of high‐value care and the overuse of low‐value care. Economic evaluations can help policy makers determine whether an intervention presents a better value for money and desirable clinical benefits, thus realizing value‐based care. Aim. We aimed to conduct a systematic review of the economic evaluations of clinical nursing practices to advance knowledge on value‐based care. Methods. A systematic review was conducted using MEDLINE, Embase, Web of Science, Cochrane Central Register of Controlled Trials, CINAHL, NHS Economic Evaluation Database, Health Technology Assessment, and Tufts CEA Registry for full economic evaluations of clinical nursing practices from January 2013 to January 2023. Outcomes were incremental cost‐effectiveness ratios, incremental cost‐utility ratios, incremental cost‐benefit ratios, incremental net benefit, and the differences in costs for cost‐minimization studies. Methodological quality was evaluated using the Consensus Health Economic Criteria–extended checklist. Results were synthesized using permutation matrices for all studies. The protocol was registered with PROSPERO (CRD42023415918). Results. Thirty‐five studies were included in this review, with 27 studies categorized as good methodological quality and 8 as moderate quality. Clinical nursing practices were dominant (i.e., more effective and less costly) in 19 studies, potentially cost‐effective depending on willingness‐to‐pay thresholds in 15 studies, and were dominated (i.e., less effective and more costly) in 1 study. Conclusion. Our study advanced knowledge on value‐based care for clinical nursing practices. Results suggest that most clinical nursing practices studied may be clearly economically favourable or potentially favourable. Implications for Nursing Management. The results of this review provide valuable insights into value‐based care in nursing and facilitate the decision‐making of healthcare policymakers regarding health resource allocation to achieve value‐based care. [ABSTRACT FROM AUTHOR]

High-quality transparent electrodes are indispensable components of flexible optoelectronic devices as they guarantee sufficient light transparency and electrical conductivity. Compared to commercial indium tin oxide, metal nanowires are considered ideal candidates as flexible transparent electrodes (FTEs) owing to their superior optoelectronic properties, excellent mechanical flexibility, solution treatability, and higher compatibility with semiconductors. However, certain key challenges associated with material preparation and device fabrication remain for the practical application of metal nanowire-based electrodes. In this review, we discuss state-of-the-art solution-processed metal nanowire-based FTEs and their applications in flexible and stretchable optoelectronic devices. Specifically, the important properties of FTEs and a cost-benefit analysis of existing technologies are introduced, followed by a summary of the synthesis strategy, key properties, and fabrication technologies of the nanowires. Subsequently, we explore the applications of metal-nanowire-based FTEs in different optoelectronic devices including solar cells, photodetectors, and light-emitting diodes. Finally, the current status, future challenges, and emerging strategies in this field are presented. [ABSTRACT FROM AUTHOR]

Background: Oral aripiprazole exhibits favorable clinical efficacy and safety in the suppression of tics in children and adolescents with tic disorders. This study aims to evaluate and compare the cost-effectiveness of high-dose and low-dose aripiprazole in children and adolescents with tic disorders from the perspective of the Chinese healthcare system. Methods: A questionnaire survey was conducted on 146 patients with tic disorders, of whom 144 completed EQ-5D-Y and YGTSS. Four models were built to convert YGTSS onto EQ-5D-Y utility using two mapping algorithms. We constructed a decision tree model containing efficacy and safety to compare the cost-effectiveness of high-dose and low-dose aripiprazole based on our mapping function. Results: The GLM with model 1 (YGTSS total tic scores) was selected as the preferred function in our decision tree model. The base case cost-effectiveness analysis showed that compared to low-dose aripiprazole, high-dose aripiprazole improves effectiveness by 0.001QALYs and increases the overall cost by $197.99, resulting in an ICER of $174339.22 per QALY, which exceeds three times the gross domestic product per capita. Hence, high-dose aripiprazole is not likely to be a cost-effective option for child patients with tic disorders. One-way sensitivity analysis and probabilistic sensitivity analysis showed that these results is robust. Conclusion: On the basis of currently available data, low-dose aripiprazole may be a safe, effective, and economical dosage for children and adolescents with tic disorders. Limitations: The main limitation of our study is the lack of utility directly used for cost-effectiveness analysis. We obtained the utility of patients with tic disorders indirectly by the mapping function. This may introduce some bias and uncertainty. And it is a limitation to use the direct medical costs of Germany in our model. Although we converted it to the equivalent value of China using purchasing power parities, caution should be exercised when interpreting the results of this study. [ABSTRACT FROM AUTHOR]

Cycling remains a popular activity for children and youth around the world, combining the fun of moving at speed with numerous health and societal benefits. However, cycling is also associated with risk for serious injury and death. Over the past decade, research has increasingly shown that improving safety for cyclists depends, in large part, on the environment they are cycling in as well as on individual safety measures such as helmet use. The pandemic provided greater opportunity for many children and youth to engage in cycling, and refocused public attention on safer cycling infrastructure such as protected bike lanes. This statement reviews the evidence supporting safer cycling infrastructure for children and youth along with the physical and mental health benefits of cycling. The advantages of active transportation for young people, and how the built environment influences their cycling safety and uptake, are discussed. An overview of measures individuals can take to improve cycling safety is followed by recommendations for clinicians, the cycling community, parents, and policy-makers. [ABSTRACT FROM AUTHOR]

Quantitative risk data are essential for efficient and consistent assessment of risk, and allow for the effective use of cost–benefit analysis to assess mitigating measures. Quantitative assessment of the risk posed by unexploded bombs (UXBs) on construction sites within the UK involves the identification of a set of contributory risk factors and modelling the interaction between them. This interaction of risk factors has been modelled using Monte Carlo simulation built into a new risk assessment tool (JG-MCS). Some of the output results from the tool are presented, including the limited validation that is possible against published work. The tool is used to assess the sensitivity of risk to some of the problem variables, and several of the underlying assumptions are investigated. The model has also been extended to explore the influence of investigative mitigation measures. Fundamental questions are raised regarding the risks being assessed, how they are presented and the efficacy of some mitigation measures. For the scenario used, it was found that the overall risk of UXB encounter was low before mitigation and only slightly lower after mitigation. Also, the cost of implementing measures to reduce the risk posed by UXBs might be considered to be below the bracket of what is described by the UK Health and Safety Executive as 'reasonably practicable'. [ABSTRACT FROM AUTHOR]

The article presents arguments for why all infants should be screened for congenital cytomegalovirus (CMV). Topics discussed include screening methods for congenital CMV, potential sequelae and urgency of antiviral therapy, and comprehensive detection beyond hearing loss. Also mentioned are early intervention and treatment and economic considerations.

Background: Same day discharge (SDD) following atrial fibrillation (AF) ablation procedure has emerged as routine practice, and primarily driven by operator discretion. However, the impacts of SDD on clinical outcomes, healthcare system costs, and patient reported outcomes (PROs) have not been systematically studied. Methods: We retrospectively analyzed patients undergoing routine AF ablation procedures with SDD versus overnight observation (NSDD). After propensity adjustment we compared postprocedure adverse events (AEs), healthcare system costs, and changes in PROs. Results: We identified 310 cases, with 159 undergoing SDD and 151 staying at least one midnight in the hospital (NSDD). Compared with NSDD, SDD patients were similar age (mean 64 vs. 66, p = 0.3), sex (26% female vs. 27%, p = 0.8), and with lower mean CHADS2‐VA2Sc scores (2.0 vs. 2.7; p < 0.011). The primary outcome of AEs was noninferior in SDD versus NSDD patients (odds ratio 0.45, 95% confidence interval 0.21−0.99; noninferiority margin of 10%). There were also no differences in overall cost to the healthcare system between SDD and NSDD (p = 0.11). PROs numerically favored SDD (p = NS for all scores). Conclusions: Physician selection for SDD appears at least as safe as NSDD with respect to clinical outcomes and SDD is not significantly less costly to the health system. There is a trend towards more favorable, general PROs among SDD patients. Routine SDD should be strongly considered for patients undergoing routine AF ablation procedures. [ABSTRACT FROM AUTHOR]

Purpose: To estimate the societal costs of untreated perinatal mood and anxiety disorders (PMADs) in Vermont for the 2018–2020 average annual birth cohort from conception through five years postpartum. Methods: We developed a cost analysis model to calculate the excess cases of outcomes attributed to PMADs in the state of Vermont. Then, we modeled the associated costs of each outcome incurred by birthing parents and their children, projected five years for birthing parents who do not achieve remission by the end of the first year postpartum. Results: We estimated that the total societal cost of untreated PMADs in Vermont could reach $48 million for an annual birth cohort from conception to five years postpartum, amounting to $35,910 in excess societal costs per birthing parent with an untreated PMAD and their child. Conclusion: Our model provides evidence of the high costs of untreated PMADs for birthing parents and their children in Vermont. Our estimates for Vermont are slightly higher but comparable to national estimates, which are $35,500 per birthing parent–child pair, adjusted to 2021 US dollars. Investing in perinatal mental health prevention and treatment could improve health outcomes and reduce economic burden of PMADs on individuals, families, employers, and the state. [ABSTRACT FROM AUTHOR]

Aims: To perform a systematic review of studies that sought to identify diagnostic biomarkers for the diagnosis of cardiovascular diseases (CVDs) and diabetes mellitus (DM), which could be used in low‐ and middle‐income countries (LMICs) where there is a lack of diagnostic equipment, treatments and training. Materials and Methods: Papers were sourced from six databases: the British Nursing Index, Google Scholar, PubMed, Sage, Science Direct and Scopus. Articles published between January 2002 and January 2023 were systematically reviewed by three reviewers and appropriate search terms and inclusion/exclusion criteria were applied. Results: A total of 18 studies were yielded, as well as 234 diagnostic biomarkers (74 for CVD and 160 for DM). Primary biomarkers for the diagnosis of CVDs included growth differentiation factor 15 and neurogenic locus notch homologue protein 1 (Notch1). For the diagnosis of DM, alpha‐2‐macroglobulin, C‐peptides, isoleucine, glucose, tyrosine, linoleic acid and valine were frequently reported across the included studies. Advanced analytical techniques, such as liquid chromatography mass spectrometry, enzyme‐linked immunosorbent assays and vibrational spectroscopy, were also repeatedly reported in the included studies and were utilized in combination with traditional and alternative matrices such as fingernails, hair and saliva. Conclusions: While advanced analytical techniques are expensive, laboratories in LMICs should carry out a cost–benefit analysis of their use. Alternatively, laboratories may want to explore emerging techniques such as infrared, Fourier transform‐infrared and near‐infrared spectroscopy, which allow sensitive noninvasive analysis. [ABSTRACT FROM AUTHOR]

Background: Multiple factors, such as less complex U.S. adult pneumococcal recommendations that could increase vaccination rates, childhood pneumococcal vaccination indirect effects that decrease adult vaccination impact, and increased vaccine hesitancy (particularly in underserved minorities), could diminish the cost‐effectiveness of programs to increase pneumococcal vaccination in older adults. Prior analyses supported the economic favorability of these programs. Methods: A Markov model compared no vaccination and current recommendations (either 20‐valent pneumococcal conjugate vaccine [PCV20] alone or 15‐valent pneumococcal conjugate vaccine plus the 23‐valent pneumococcal polysaccharide vaccine [PCV15/PPSV23]) without or with programs to increase vaccine uptake in Black and non‐Black 65‐year‐old cohorts. Pre‐pandemic population‐ and serotype‐specific pneumococcal disease risk and illness/vaccine costs came from U.S. databases. Program costs were $2.19 per vaccine‐eligible person and increased absolute vaccination likelihood by 7.5%. Delphi panel estimates and trial data informed vaccine effectiveness values. Analyses took a healthcare perspective, discounting at 3%/year over a lifetime time horizon. Results: Uptake programs decreased pneumococcal disease overall. In Black cohorts, PCV20 without program cost $216,805 per quality‐adjusted life year (QALY) gained compared with no vaccination; incremental cost‐effectiveness was $245,546/QALY for PCV20 with program and $425,264/QALY for PCV15/PPSV23 with program. In non‐Black cohorts, all strategies cost >$200,000/QALY gained. When considering the potential indirect effects from childhood vaccination, all strategies became less economically attractive. Increased vaccination with less complex strategies had negligible effects. In probabilistic sensitivity analyses, current recommendations with or without programs were unlikely to be favored at thresholds <$200,000/QALY gained. Conclusion: Current U.S. pneumococcal vaccination recommendations for older adults were unlikely to be economically reasonable with or without programs to increase vaccine uptake. Alternatives to current pneumococcal vaccines that include pneumococcal serotypes associated with adult disease should be considered. See related Editorial by Melissa K. Andrew in this issue. [ABSTRACT FROM AUTHOR]

Despite significant advancements in ocular drug delivery, challenges persist in treating posterior segment diseases like macular edema (ME) and age-related macular degeneration (AMD). Suprachoroidal (SC) injections are a promising new method for targeted drug delivery to the posterior segment of the eye, providing direct access to the choroid and retina while minimizing systemic exposure and side effects. This review examines the anatomical and physiological foundations of the SC space; evaluates delivery devices such as microcatheters, hypodermic needles, and microneedles; and discusses pharmacokinetic principles. Additionally, advancements in gene delivery through SC injections are explored, emphasizing their potential to transform ocular disease management. This review also highlights clinical applications in treating macular edema, diabetic macular edema, age-related macular degeneration, choroidal melanoma, and glaucoma. Overall, SC injections are emerging as a promising novel route for administering ophthalmic treatments, with high bioavailability, reduced systemic exposure, and favorable safety profiles. Key therapeutic agents such as triamcinolone acetonide, dexamethasone, AAV-based gene therapy, and axitinib have shown promise. The field of suprachoroidal injection is progressing rapidly, and this review article, while attempting to encapsulate most of the published preclinical and clinical studies, mainly focuses on those that are published within 2023 and 2024. [ABSTRACT FROM AUTHOR]

We propose a general framework for estimating long-term health and economic effects that takes into account four time-related aspects. We apply it to a reduction in exposure to air pollution in the Canton of Geneva. Methodological developments on the evaluation of long-term economic and health benefits, with an empirical illustration. We propose a unified framework—the comprehensive impact assessment (CIA)—to assess the long-term effects of morbidity and mortality in health and economic terms. This framework takes full account of four time-related issues: cessation lag, policy/technical implementation timeframe, discounting and time horizon. We compare its results with those obtained from standard quantitative health impact assessment (QHIA) in an empirical illustration involving air pollution reduction in the canton of Geneva. We find that by neglecting time issues, the QHIA estimates greater health and economic benefits than the CIA. The overestimation is about 50% under reasonable assumptions and increases ceteris paribus with the magnitude of the cessation lag and the discount factor. It decreases both with the time horizon and with the implementation timeframe. A proper evaluation of long-term health and economic effects is an important issue when they are to be used in cost-benefit analyses, particularly for mortality, which often represents the largest fraction. We recommend using the CIA to calculate more accurate values. [ABSTRACT FROM AUTHOR]

Summary: The refracture rate after major trauma is approximately half (57%) the refracture rate after a minimal trauma injury. Extending Fracture Liaison Service activity to include major trauma patients creates significant additional direct cost, but remains essentially cost neutral if notional savings through refracture risk reduction are taken into account. Purpose: To compare the 3-year refracture rate following minimal trauma (MT) and non-minimal trauma (non-MT) injuries and evaluate the cost of extending fracture liaison service (FLS) operations to non-MT presentations. Methods: Patients aged 50, or above presenting to the John Hunter Hospital with a fracture in calendar year 2018 were identified through the Integrated Patient Management System (IPMS) of the Hunter New England Health Service's (HNEHS), and re-presentation to any HNEHS facility over the following 3 years monitored. The refracture rate of MT and non-MT presentations was compared and analysed using Cox proportional hazards regression models. The cost of including non-MT patients was estimated through the use of a previously conducted micro-costing analysis. The operational fidelity of the FLS to the previous estimate was confirmed by comparing the 3-year refracture rate of MT presentations in the two studies. Results: The 3-year refracture rate following a MT injury was 8% and after non-MT injury 4.5%. Extension of FLS activities to include non-MT patients in 2022 would have cost an additional $198,326 AUD with a notional loss/saving of $ − 26,625/ + 26,913 AUD through refracture risk reduction. No clinically available characteristic at presentation predictive of increased refracture risk was identified. Conclusion: The 3-year refracture after a non-MT injury is about half (57%) that of the refracture rate after a MT injury. Extending FLS activity to non-MT patients incurs a significant additional direct cost but remains cost neutral if notional savings gained through reduction in refracture risk are taken into account. [ABSTRACT FROM AUTHOR]

Simple Summary: Mucosal malignant melanoma is a type of head and neck cancer with a high mortality rate. Although favorable local control has been reported when using carbon ion radiotherapy (CIRT) to treat mucosal malignant melanoma of the head and neck, the prognosis remains unsatisfactory because of the tendency for early distant metastasis. In recent years, favorable outcomes have been reported for the use of immune checkpoint inhibitors (ICIs) as adjuvant therapy for cutaneous malignant melanoma, indicating their potential applicability to mucosal malignant melanoma. In addition to achieving favorable local control with CIRT, the control of distant metastasis using ICIs is expected to prolong survival. The findings of this analysis indicate that the use of ICIs as adjuvant therapy can improve prognosis following CIRT, offering a new treatment option. The development of new treatment strategies to improve the prognosis of mucosal malignant melanoma of the head and neck (MMHN) after carbon ion radiotherapy (CIRT) is essential because of the risk of distant metastases. Therefore, our objective was to evaluate the outcomes of immune checkpoint inhibitor (ICI) treatment to justify its inclusion in the regimen after CIRT. Thirty-four patients who received CIRT as an initial treatment were included in the analysis and stratified into three groups: those who did not receive ICIs (Group A), those who received ICIs after recurrence or metastasis (Group B), and those who received ICIs as adjuvant therapy after CIRT (Group C). In total, 62% of the patients (n = 21) received ICIs. The 2-year local control and overall survival (OS) rates for all patients were 90.0% and 66.8%, respectively. The 2-year OS rates for patients in Groups A, B, and C were 50.8%, 66.7%, and 100%, respectively. No significant differences were observed between Groups A and B (p = 0.192) and Groups B and C (p = 0.112). However, a significant difference was confirmed between Groups A and C (p = 0.017). Adjuvant therapy following CIRT for MMHN may be a promising treatment modality that can extend patient survival. [ABSTRACT FROM AUTHOR]

Palliative care improves the quality of life for patients; however, its value-for-money is not yet established. The objective of the present study was to identify and critically assess published studies which investigate the cost-effectiveness of palliative care. A defined strategy was applied; the identified records were assessed with specific inclusion-exclusion criteria (PICO). Methodological quality of the included studies was assessed with the Drummond checklist. An electronic search was conducted in PubMed, SCOPUS, Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Trials, from January 2010 up to December 2022. A narrative synthesis approach was used. From a total of 3857 records, 21 studies were included in the analysis. Almost half (n = 10) the studies were conducted along randomized controlled trials, while the most common setting was home-based palliative care (n = 9). Quality of life was the most commonly assessed outcome (n = 14), measured almost exclusively in Quality-Adjusted Life Years (n = 13). In more than half of the included studies (n = 13), palliative care was found to lead to improved outcomes, while 3 studies did not find any difference in outcomes between comparators. Also, palliative care yielded lower costs in 13 studies and increased costs in 5 studies. Overall, 11 studies concluded that palliative care was a cost-effective intervention. The results of the review indicate that palliative care has the potential to be a cost-efficient allocation of healthcare resources or, at least, a cost saving approach. However, the need for a commonly aligned methodological framework still remains. [ABSTRACT FROM AUTHOR]

Cataract is the primary cause of treatable blindness in low- and middle-income countries. Due to limited resources, the public sector often fails to provide adequate services, resulting in long waiting times, low quality or significant quantity gaps. Nonprofits are crucial in providing supplementary or complementary funding and resources for affordable eye care and other public goods and services. This study evaluates costs and benefits of cataract surgery at the nonprofit Mexican Institute of Ophthalmology (IMO) using data from interviews conducted in 2022 to estimate its social return. For every peso invested, the average stakeholder receives a 12:1 return in improved autonomy, self-confidence, and reduced stress levels. Sensitivity analysis suggests a SROI ratio of at least 2:1 in the most restrictive scenario, increasing to 33:1 under more lenient assumptions. Measuring and communicating the social value of nonprofit activities is critical for optimizing resource allocation, enhancing accountability, and generating valuable insights into their effectiveness. [ABSTRACT FROM AUTHOR]

Aims: To explore the effectiveness of continuous home wound care on patients with diabetic foot ulcers (DFUs). Design: A non‐randomized parallel controlled non‐inferiority trial. Methods: Patients with Wagner grade I–III DFUs hospitalized in two distant campuses of the same hospital were included. All patients received infection treatment and wound bed preparation during hospitalization; after discharge, patients in one of the campuses received routine outpatient wound care, and those treated in the other received continuous home wound care. The per‐protocol analysis was performed to compare ulcer healing indicators, knowledge, health belief, self‐management behaviour and medical expenses of the two groups. Results: Between October 2021 and December 2022, 116 patients were enrolled in the study; 107 completed. The home care was not inferior in terms of ulcer healing rate and demonstrated significant enhancements in the understanding of warning signs, health belief and self‐management behaviour. Additionally, the home care saved 220.38 yuan (24.32 UK pounds) in direct medical expenses for each additional one square centimetre of ulcer healing. Conclusion: The continuous home wound care enhanced self‐management behaviour of the patients and saved their medical expenses while not compromising ulcer healing. Impact: This is to date the first study to conduct continuous home wound care practice for patients with DFUs and confirmed its safety and non‐inferiority in ulcer healing, and supported its superiority in improving self‐management behaviour and saving medical expenses. Reporting Method: We have adhered to the transparent reporting of evaluations with nonrandomized designs statements and the corresponding checklist was followed. Patient or Public Contribution: The patients and their primary caregivers were involved in intervention design, we received input from them about the factors that facilitate and hinder patient self‐management behaviours to develop intervention strategies. [ABSTRACT FROM AUTHOR]

Background: Health Complex Model was implemented to provide primary health care services in urban, especially in slum areas. As a pilot at a provincial level, Chamran Health Complex offers healthcare for more than 57,000 residents of Tabriz. Despite the necessity of cost information in healthcare decision-making, there was limited knowledge about the unit cost of services. This study aims to analyze the cost and efficiency of health centers. Methods: Activity-Based Costing method with direct and step-down allocation methods was adopted. We estimated unit costs in a hypothetical scenario according to national standards to quantify the gap between current and standard practice. Input-oriented Data Envelopment Analysis was administered to measure the efficiency of health centers. Results: The total cost of the complex was $2,841,897, of which 67% ($1910373) and 33% ($931523) were accounted for direct and indirect costs, respectively. The vaccination center had the lowest ($9), and the occupational health center had the highest average unit cost ($76). The average technical efficiency of the health centers was 0.519, where the HC1 and HC3 showed the best performance. Conclusion: There is remarkable variability in service costs across health centers, which must be addressed in performance management and contracting practices. Although we found a gap between current and standard practice in terms of staff and facilities according to national standards, Chamran Health Complex has an untouched capacity that can be utilized with better planning and without incurring additional costs. It raises the need for revising national standards by the Iran Ministry of Health. [ABSTRACT FROM AUTHOR]

Treatment of pilonidal sinus disease with conventional excision techniques is associated with recurrence up to 20 to 30% (primary closure) or with prolonged healing that might last months (closure by secondary intention). Endoscopic pilonidal sinus treatment (EPSiT) is gaining increasing popularity. This systematic review aims to summarize and evaluate the reported outcomes of pediatric EPSiT (PEPSiT) to date. Systematic search was performed for all studies on PEPSiT in patients younger than 18 years, pertaining to demographics, technique, and outcomes. Fisher's test was used to assess the associations between success/recurrence rates and different approaches (fistuloscope vs. cystoscope, different wound care protocols). A total of 320 patients (9 studies, 2018–2022) with a weighted mean age of 15.7 years and follow-up duration of 13.5 months were included. PEPSiT was successful in 290 patients (90.9%) with weighted mean time to healing of 4.1 weeks. Recurrence was reported in 29 patients (9.1%) with weighted mean time to recurrence of 4.6 months. Outcomes were not significantly altered by the use of fistuloscope versus pediatric cystoscope (p = 1.0), or with perioperative laser epilation (p = 0.06), or postoperative regular shaving, depilatory creams, light pulse, or laser (p = 0.31). The weighted mean operative time was 38 minutes and hospital stay was 16 hours. Summary of available evidence confirms that PEPSiT is safe and effective. Added to its noninvasiveness, PEPSiT's pooled outcomes appear superior to those of numerous conventional techniques. Comparison with conventional techniques, particularly off-midline flap and semi-closure procedures, is, however, lacking. The superiority of PEPSiT needs to be confirmed in future comparative studies, including cost–benefit analysis. [ABSTRACT FROM AUTHOR]

Sexual violence and sexual harassment (SVSH) are prevalent among college and university students; however, the experiences of ethnic minority students, especially Asians, are understudied. This study aimed to reduce this gap by exploring Asian students' perceptions of SVSH on three public university campuses in Southern California. We examined their perceptions about the campus environment related to SVSH, attitudes, and behaviors toward help seeking, and utilization of on-campus resources. A total of 23 in-depth interviews were conducted with Asian students enrolled at the three University of California campuses. Thematic coding was conducted to generate main themes and subthemes. Five main themes emerged: (a) SVSH is considered a "taboo" topic in Asian culture and family systems, and Asian student survivors are often reluctant to disclose incidents or seek support services. (b) Students did not feel their campus environments were tailored to understand or meet the sociocultural realities and needs of Asian student survivors. (c) Campus SVSH services and reporting processes were seen as non-transparent. (d) Peers were the major source of support and SVSH information, as opposed to official campus-based resources and training. (e) Survivors often conduct an internal cost–benefit analysis evaluating their decision about whether to report. This study highlights the lack of conversation surrounding SVSH in Asian families, and how the cultural stigma of sex and sexual violence prevented Asian students from receiving knowledge and resources about these topics in their families. Instead of relying on formal campus resources (e.g., Title IX and confidential advocacy services, mental health services), many students turn to their peers for support. Thus, facilitating peer support groups, training university students to support each other through SVSH incidents, and tailoring campus services to the diverse cultural backgrounds of students are key considerations to foster a safe campus environment and prevent SVSH. [ABSTRACT FROM AUTHOR]

Objectives: This multicentre, assessor‐blinded, two‐arm cluster randomized trial evaluated the clinical and cost‐effectiveness of a behaviour change intervention promoting toothbrushing for preventing dental caries in UK secondary schools. Methods: Pupils aged 11–13 years with their own mobile telephone attending secondary schools with above average free school meals eligibility were randomized (at year‐group level) to receive a lesson and twice‐daily text messages or to usual care. Year‐groups (n = 84) from 42 schools including 4680 pupils (intervention, n = 2262; control, n = 2418) were randomized. Results: In 2383 participants with valid data at baseline and 2.5 years, the primary outcome of presence of at least one treated or untreated carious lesion (D4‐6 MFT [Decayed, Missing and Filled Teeth] in permanent teeth using International Caries Detection and Assessment System) was 44.6% in the intervention group and 43.0% in control (odds ratio [OR] 1.04, 95% CI 0.85–1.26, p =.72). There were no statistically significant differences in secondary outcomes of presence of at least one treated or untreated carious lesion (D1‐6 MFT), number of D4‐6 MFT and D1‐6 MFT, plaque and bleeding scores or health‐related‐ (Child Health Utility 9D) or oral health‐related‐ quality of life (CARIES‐QC). However, twice‐daily toothbrushing, reported by 77.6% of pupils at baseline, increased at 6 months (intervention, 86.9%; control, 83.0%; OR 1.30, 95% CI 1.03–1.63, p =.03), but returned to no difference at 2.5 years (intervention, 81.0%; control, 79.9%; OR 1.05, 95% CI 0.84–1.30, p =.69). Estimated incremental costs and quality‐adjusted life‐years (QALYs) of the intervention, relative to control, were £1.02 (95% CI −1.29 to 3.23) and −0.003 (95% CI −0.009 to 0.002), respectively, with a 7% chance of being cost‐effective (£20 000/QALY gained threshold). Conclusion: There was no evidence of statistically significant difference for caries prevalence at 2.5‐years. The intervention's positive 6‐month toothbrushing behaviour change did not translate into caries reduction. (ISRCTN 12139369). COVID‐19 pandemic adversly affected follow‐up. [ABSTRACT FROM AUTHOR]

Objective: To pragmatically assess the clinical and cost‐effectiveness of water fluoridation for preventing dental treatment and improving oral health in a contemporary population of adults and adolescents, using a natural experiment design. Methods: A 10‐year retrospective cohort study (2010–2020) using routinely collected NHS dental treatment claims data. Participants were patients aged 12 years and over, attending NHS primary dental care services in England (17.8 million patients). Using recorded residential locations, individuals exposed to drinking water with an optimal fluoride concentration (≥0.7 mg F/L) were matched to non‐exposed individuals using propensity scores. Number of NHS invasive dental treatments, DMFT and missing teeth were compared between groups using negative binomial regression. Total NHS dental treatment costs and cost per invasive dental treatment avoided were calculated. Results: Matching resulted in an analytical sample of 6.4 million patients. Predicted mean number of invasive NHS dental treatments (restorations 'fillings'/extractions) was 3% lower in the optimally fluoridated group (5.4) than the non‐optimally fluoridated group (5.6) (IRR 0.969, 95% CI 0.967, 0.971). Predicted mean DMFT was 2% lower in the optimally fluoridated group (IRR 0.984, 95% CI 0.983, 0.985). There was no difference in the predicted mean number of missing teeth per person (IRR 1.001, 95% CI 0.999, 1.003) and no compelling evidence that water fluoridation reduced social inequalities in dental health. Optimal water fluoridation in England 2010–2020 was estimated to cost £10.30 per person (excludes initial set‐up costs). NHS dental treatment costs for optimally fluoridated patients 2010–2020 were 5.5% lower, by £22.26 per person (95% CI ‐£21.43, −£23.09). Conclusions: Receipt of optimal water fluoridation 2010–2020 resulted in very small positive health effects which may not be meaningful for individuals. Existing fluoridation programmes in England produced a positive return on investment between 2010 and 2020 due to slightly lower NHS dental care utilization. This return should be evaluated against the projected costs and lifespan of any proposed capital investment in water fluoridation, including new programmes. [ABSTRACT FROM AUTHOR]

This study estimated the benefits and costs of the U.S. Department of Health and Human Services' We Can Do This COVID-19 public education campaign (the Campaign) and associated vaccination-related impacts. Weekly media market and national Campaign expenditures were used to estimate weekly first-dose vaccinations that would not have occurred absent the Campaign, weekly Campaign-attributed complete vaccinations, and corresponding COVID-19 cases, hospitalizations, and deaths averted. Benefits were valued using estimated morbidity and mortality reductions and associated values of a statistical life and a statistical case. Costs were estimated using Campaign paid media expenditures and corresponding vaccination costs. The net Campaign and vaccination benefit and return on investment were calculated. Analyses were conducted from 2022 to 2024. Between April 2021 and March 2022, an estimated 55.9 million doses of COVID-19 vaccines would not have been administered absent the Campaign. Campaign-attributed vaccinations resulted in 2,576,133 fewer mild COVID-19 cases, 243,979 fewer nonfatal COVID-19 hospitalizations, and 51,675 lives saved from COVID-19. The total Campaign benefit was $740.2 billion, and Campaign and vaccination costs totaled $8.3 billion, with net benefits of approximately $732.0 billion. For every $1 spent, the Campaign and corresponding vaccination costs resulted in benefits of approximately $89.54. The We Can Do This COVID-19 public education campaign saved more than 50,000 lives and prevented hundreds of thousands of hospitalizations and millions of COVID-19 cases, representing hundreds of billions of dollars in benefits in less than one year. Findings suggest that public education campaigns are a cost-effective approach to reducing COVID-19 morbidity and mortality. [ABSTRACT FROM AUTHOR]

Background: Resource scarcity in health professions education (HPE) demands rigorous consideration of costs. Yet, thus far, we have been unable to completely and consistently identify the costs of HPE. To address this knowledge gap and enable use of economic evidence in decision making, a detailed overview of all existing costs and approaches to cost identification in HPE is needed. Objectives: This review summarises the diversity of costs, cost perspectives and cost identification methods used in economic research of HPE to answer the following questions: which educational topics, costs, cost perspectives and cost identification methods are being investigated in HPE literature? Methods: This investigation followed the Joanna Briggs Institute guidelines for scoping reviews. PubMed, ERIC, CINAHL and PsycINFO were iteratively searched for English language publications between 2012 and 2022 that reported costs of HPE. Data was extracted for study characteristics, educational context and economic methodology. Results: A total of 136 articles of original research on the costs of educating all major licence healthcare professionals were included. A diffuse interest in costs is reflected in publications from 93 distinct journals and by the diversity of educational topics and cost types explored. However, the majority of investigations failed to define the cost perspective (86, 63%) and cost identification methods (117, 86%) and did not demonstrate common reporting structure or cost terminology, all of which contribute to persistent inconsistencies in cost identification. Conclusion: The source of disharmonious cost identification in HPE is fuelled by diverse interests and divergent concepts of costs and costing methodology. Left in its current state, disharmonious cost identification will continue to limit transparency, comparison and synthesis of evidence, hamper objectivity in implementation and policy decisions and impede the efficient and sustainable allocation of resources. A research agenda must be developed, prioritised, and validated by the broader community to develop a theoretical framework for HPE cost research, define stakeholders, elicit values and preferences and chart a path toward harmonised costing. To enable better use of economic evidence in health professional education decision‐making, a detailed overview of all existing costs and approaches to cost identification in health professional education is provided [ABSTRACT FROM AUTHOR]

One of the most important issues in the maritime industry is controlling and reducing the amount of emissions caused by marine vessels. In this respect, the International Maritime Organization sets some air pollution-related regulations and encourages maritime companies to utilise current and innovative emission abatement methods on their ships. The application of these approaches to ships not only provides environmental benefits but also creates additional financial costs for the company. In this study, operational data of a container ship has been acquired and examined. Methods such as ammonia, LNG, scrubber, low sulphur fuel use, and selective catalytic reduction have been considered to determine the most appropriate emission reduction approach. Nine different scenarios have been created with the use of stated methods and each scenario is analysed both environmentally and economically and compared to each other. Finally, the most suitable scenario has been determined by calculating the payback period of each investment. Since there is a relatively longer period of redemption, using a dual-fuel engine could be more suitable for long-lasting and newly built ships. For the currently cruising ships, the use of scrubber systems with selective catalytic reduction is an effective solution to reduce the number of emissions. [ABSTRACT FROM AUTHOR]

Background: Previous studies have shown inconsistent results in clinical effectiveness between cryoballoon ablation (CBA) and radiofrequency ablation (RFA), and cost assessment between the procedures is important. The aim of this study was to evaluate the clinical effectiveness and cost‐effectiveness between the procedures in patients with paroxysmal atrial fibrillation (AF) refractory to antiarrhythmic drug therapy. Methods: A systematic review and meta‐analysis were performed. The primary outcome for the meta‐analysis was long‐term AF recurrence. Following the results of the meta‐analysis, the cost‐effectiveness of CBA versus RFA in Japan was assessed. Results: The meta‐analysis included 12 randomized controlled trials and six propensity‐score matching cohort studies. AF recurrence was slightly lower in patients referred for CBA than for RFA, with an integrated risk ratio of 0.93 (95% confidence interval: 0.81–1.07) and an integrated hazard ratio of 0.96 (95% confidence interval: 0.77–1.19), but no significant difference was found. A cost‐minimization analysis was conducted to compare the medical costs of CBA versus RFA because there was no significant difference in the risk of AF recurrence between the procedures. The estimated costs for CBA and RFA were JPY 4 858 544 (USD 32 390) and JPY 4 505 255 (USD 30 035), respectively, with cost savings for RFA of JPY 353 289 (USD 2355). Conclusion: Our meta‐analysis suggests that CBA provides comparable benefits with regard to AF recurrence compared with RFA, as shown in previous studies. Although the choice of treatment should be based on patient and treatment characteristics, RFA was shown that it might be cost saving as compared to CBA. [ABSTRACT FROM AUTHOR]

This study aimed to examine the cost-effectiveness of concurrent hospice care compared with standard care among pediatric patients of different age groups. Using a national Medicaid database of 18 152 pediatric patients enrolled in hospice care between 2011 and 2013, this study calculated and analyzed incremental cost-effectiveness ratios (ICERs) for concurrent care versus standard hospice care for children of 4 age categories: <1 year, 1 to 5 years, 6 to 14 years, and 15 to 20 years. The results indicated that the total Medicaid cost of hospice care was $3229 per patient per month (PPPM; SD, $8709) for those younger than 1 year, $4793 PPPM (SD, $8178) for those aged 1 to 5 years, $5411 PPPM (SD, $7456) for those aged 6 to 14 years, and $5625 PPPM (SD, $11459) for those aged 15 to 20 years. Incremental cost-effectiveness ratio values across all age groups showed that children enrolled in concurrent care had fewer live discharges but at a higher Medicaid cost of care as compared with those enrolled in standard hospice care. Concurrent hospice care was the most cost-effective in the age groups of <1 year and 1 to 5 years, with ICERs equal to $45 (95% confidence interval [CI], $23-$66) and $49 (95% CI, $8-$76), respectively. For the other older age groups, benefits of enrollment in concurrent care came at a much higher cost: in the age group of 6 to 14 years, ICERwas equal to $217 (95% CI, $129-$217), and in the age group of 15 to 20 years, it was $107 (95% CI, $82-$183). Concurrent hospice is an effective way to reduce live discharges but has a higher total Medicaid cost than standard hospice care. [ABSTRACT FROM AUTHOR]

This paper reviews the state of the art in using benefit–cost analysis (BCA) to inform earthquake risk reduction decisions by building owners and policymakers. The goal is to provide a roadmap for the application and future development of BCA methods and tools for earthquake risk reduction. Our review covers three earthquake risk reduction measures: adopting up-to-date building codes for new construction, designing new buildings to exceed code requirements, and retrofitting deficient existing buildings. We highlight the factors that influence the cost-effectiveness of building design and retrofit, as well as tactics for increasing the cost-effectiveness of risk reduction strategies. We also present BCA results, methods, and data sources used in the literature to help researchers and practitioners design and conduct a reliable and robust BCA study. In the process, we develop a set of opportunities and challenges for applying BCA to new areas of research, as well as key gaps and limitations in current BCA approaches, including further investigation of above-code design, incorporation of code implementation and enforcement into BCA, quantification of environmental benefits of seismic retrofits, and optimization of seismic retrofits with energy upgrades. Overall, our review provides practical guidance and useful insights into BCA with the goal of increasing the earthquake resilience and economic efficiency of buildings in the United States. [ABSTRACT FROM AUTHOR]

The complexity of the public value discussion has hindered the development of consensual measurement guidelines for use in public administration practice. This article explores the use of the cost-benefit analysis (CBA) framework in the transportation sector and considers its relevance in assessing public value. A case study is presented on the reconfiguration of a public transport network in the municipality of Arganil, Portugal. The CBA did not fully capture the effects of the network reconfiguration, demonstrating its limitations in assessing public value. [ABSTRACT FROM AUTHOR]

Background: The cost-effectiveness of molnupiravir, an oral antiviral for early treatment of SARS-CoV-2, has not been established in vaccinated populations. Aim: To evaluate the cost-effectiveness of molnupiravir relative to usual care alone among mainly vaccinated community-based people at higher risk of severe outcomes from COVID-19 over 6 months. Design and setting: An economic evaluation of the PANORAMIC trial in the UK. Method: A cost-utility analysis that adopted a UK NHS and personal social services perspective and a 6-month time horizon was performed using PANORAMIC trial data. Cost-effectiveness was expressed in terms of incremental cost per quality-adjusted life year (QALY) gained. Sensitivity and subgroup analyses assessed the impacts of uncertainty and heterogeneity. Threshold analysis explored the price for molnupiravir consistent with likely reimbursement. Results: In the base-case analysis, molnupiravir had higher mean costs of £449 (95% confidence interval [CI] = 445 to 453) and higher mean QALYs of 0.0055 (95% CI = 0.0044 to 0.0067) than usual care (mean incremental cost per QALY of £81 190). Sensitivity and subgroup analyses showed similar results, except for those aged ≥75 years, with a 55% probability of being cost-effective at a £30 000 per QALY threshold. Molnupiravir would have to be priced around £147 per course to be cost-effective at a £15 000 per QALY threshold. Conclusion: At the current cost of £513 per course, molnupiravir is unlikely to be cost-effective relative to usual care over a 6-month time horizon among mainly vaccinated patients with COVID-19 at increased risk of adverse outcomes, except those aged ≥75 years. [ABSTRACT FROM AUTHOR]