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Animal manure is a valuable organic resource of nitrogen (N) for crops, but it can also be a potential source of environmental pollution, depending on how it is managed and utilized at the farm level. Whilst manure is commonly used as an organic fertilizer amendment in crop production in many smallholder farming systems in southern Africa, this is not necessarily the case in South Africa. The objective of this study was to investigate and evaluate the productivity of crop and livestock components. The study focused on the quantities of manure production and its utilization as N source in croplands using a case study of the Eastern Province Cape, which typifies smallholder rural South Africa. A purposive random sampling of one hundred and fourteen households in the Raymond Mhlaba Local Municipality was interviewed using semi-structured questionnaires. The households practice an integrated crop-livestock system, in which livestock rearing is the dominant diversified component, with 69.3% of the households raising more than one type of animal. The majority (78.7%) of farmers with access to communal arable land had outfields with land sizes ranging from 0.6 to 2 hectares (ha). Only 35.1 and 22.8% of households used manure and processed it before applying it to crop fields as N fertilizer. The overall quantities of manure utilized in crop fields amounted to 515 t, and manures that remained unutilized were 4367 t. The findings of this study show the weak linkage between the crop and livestock enterprises regarding manure use. The underutilization of manure and its impacts on the environment requires further study to assist in defining sustainable management practices for this and similar smallholder environments. [ABSTRACT FROM AUTHOR]

Despite the fact that dishwashers have been optimised in recent decades in response to policy requirements, consumers still use more energy and water than necessary. This has been deeply investigated by two research groups with complementary approaches and published in this journal. When translating these scientific findings into recommendations, it is essential to ensure that these recommendations can be easily integrated into consumers' everyday lives and do not lead to significant failures or disappointments that result in compensatory behaviours among consumers and consume even more resources. In this context, the authors suggest the introduction of a 'short eco' programme, which is just as economical as the 'eco' programme, but, achieves similar cleaning results in a much shorter time when using a high-performance detergent. This would overcome one of the biggest limitations that consumers currently have when using the 'eco' programme. The authors discuss the possible consequences of this proposal and invite readers for comments. [ABSTRACT FROM AUTHOR]

The wood duck (Aix sponsa) consistently ranks within the top 5 harvested duck species for both Illinois and the Mississippi Flyway. While substantial research has been done on wood ducks, especially their breeding ecology, few studies have investigated the postbreeding ecology of the species. We captured and marked wood ducks with either a very high frequency (VHF) radio transmitter or a solar‐charged global system of mobile communication (GSM) transmitter during the postbreeding period from August through September 2018–2020. Capture locations were within the La Grange Pool of the Illinois River extending from near Pekin, Illinois to the La Grange Lock and Dam near Meredosia, Illinois, USA. We used conventional radio‐telemetry techniques to track wood ducks to determine cover type use, home range size, daily movement patterns, survival, and migration chronology. Home range size (95% minimum convex polygon) for wood ducks averaged 6,820 ± 572 ha (SE) and we did not find evidence for a difference by age, sex, or transmitter type. Daily movement distance in August (2,031 ± 51 m) was similar to daily movement distance in September (1,922 ± 44 m), but daily movement distances for August and September were less than daily movement distance for October (3,509 ± 53 m) and November (3,347 ± 106 m). Wood ducks primarily used wetlands with woody (45.0%) and emergent vegetation (40.4%), and the most commonly used wetland types by wood ducks were impounded wetlands (53.8%), lakes (17.6%), and ponds (10.7%). Model‐derived survival during the postbreeding period was 0.79 (95% CI = 0.74–0.84). Daily survival was positively related to increased river level and had a mean increase of 4.06 ± 0.67% for every 0.3‐m increase in the Illinois River level at low river levels (1.5–3.0 m) and a mean increase of 1.38 ± 0.32% for every 0.3‐m increase in the Illinois River level at high river levels (4.0–5.5 m). Average departure date of wood ducks leaving the Illinois River Valley was 27 October (range =13 August–15 December), and adult male wood ducks left the study area 11–16 days earlier than the other age and sex cohorts (H2 = 11.6, P = 0.01). Providing additional waterfowl sanctuaries that contain wooded wetlands, especially in years of low river levels, may increase survival for wood ducks during the postbreeding period. [ABSTRACT FROM AUTHOR]

Novel introductions of largemouth bass, Micropterus salmoides, often cause negative impacts on endemic populations of prey fishes and interspecific competitors. Although many studies have investigated trophic interactions between M. salmoides and smallmouth bass, Micropterus dolomieu, few have included chain pickerel, Esox niger, as a competitor despite similarities in their habitat use. We used stable isotope analysis to investigate the trophic ecology of a recently introduced population of M. salmoides in the Wolastoq|Saint John River. Specifically, we measured carbon (δ13C) and nitrogen (δ15N) isotopes to describe isotopic niches and infer resource use of introduced M. salmoides, M. dolomieu, E. niger, and native yellow perch, Perca flavescens, at various life stages. Our results showed that isotopic niche overlap occurred between M. salmoides and other study species, indicative of resource competition. However, resource use plasticity, as demonstrated by a wide variety of resources (marine, terrestrial, littoral, and pelagic) used by all study species, could potentially reduce interspecific competition. Our findings indicate that competition is highest between adult M. salmoides and E. niger, but the presence of a seasonal marine resource can provide important contributions to diets and potentially reduce competition. Further research should focus on monitoring of long‐term trends to identify the dynamics of all study species as M. salmoides populations become further established and dispersed. [ABSTRACT FROM AUTHOR]

Freshwater is an important natural resource that is increasingly stressed due to a changing climate, economic productivity, and population growth, among other factors. Globally, the United States is a top freshwater user, both in total and per capita use. This water is used throughout the U.S. economy, dominated by irrigation and thermoelectric uses. However, analysis to better understand freshwater use is limited by the frequency and timeliness of data available. In this paper, we develop econometric models, forecasts, and mathematical programming models to generate subnational estimates of annual U.S. freshwater use from 1995 to 2021 by water use category. When reviewing the results at the national level, we find that freshwater withdrawals are generally decreasing over time, but the year-to-year and subnational variation differs by water use category. This work combines several methodologies to create a useful, timely dataset on freshwater for applied research applications. The results may also be informative on where and by whom water is being used, indicating areas of potential regional stress or scarcity. [ABSTRACT FROM AUTHOR]

Mutualisms, reciprocally beneficial interactions between two or more species, are ubiquitous in nature. A common feature of mutualisms is extensive context‐dependent variation in fitness outcomes. This context‐dependency is hypothesized to stem from the environment's mediation of the relative costs and benefits associated with mutualisms. However, traits related to the exchange of goods and services in mutualisms have received little attention in comparison to net fitness outcomes. In this study, we quantified the contribution of host and symbiont genotypes to variation in resource exchange, use, and production traits measured in the host using the model mutualism between legumes and nitrogen‐fixing rhizobia. We predicted that plant genotype × rhizobia genotype (G × G) effects would be common to resource exchange traits because resource exchange is hypothesized to be governed by both interacting partners through bargaining. On the other hand, we predicted that plant genotype effects would dominate host resource use and production traits because these traits are only indirectly related to the exchange of resources. Consistent with our prediction for resource exchange traits, but not our prediction for resource use and production traits, we found that rhizobia genotype and G × G effects were the most common sources of variation in the traits that we measured. The results of this study complement the commonly observed phenomenon of G × G effects for fitness by showing that numerous mutualism traits also exhibit G × G variation. Furthermore, our results highlight the possibility that the exchange of resources as well as how partners use and produce traded resources can influence the evolution of mutualistic interactions. Our study lays the groundwork for future work to explore the relationship between resource exchange, use and production traits and fitness (i.e., selection) to test the competing hypotheses proposed to explain the maintenance of fitness variation in mutualisms. [ABSTRACT FROM AUTHOR]

Abstract Background Conducting high-quality randomized clinical trials (RCTs) is challenging, time consuming, and resource intense. Academic investigators usually depend on scarce financial resources; however, current literature lacks systematically collected empirical data on the detailed resource use and costs of investigator-initiated RCTs. Methods The aim of this study is to generate a database of detailed empirical resource use and cost data from 100 investigator-initiated RCTs in Switzerland, Germany, and the UK. Investigators enter their empirical costs data into an online data collection form, which is followed by a short interview and a detailed cost report. We plan to investigate cost patterns and cost drivers and examine planned versus actual RCT costs as well as explore different strata of costs across the planning, conduct, and finalization phases, in drug and non-drug trials, and across medical fields and countries. Discussion This study will add detailed empirical data to the limited research on investigator-initiated RCT costs currently available. A study limitation will be that cost data will be retrospective and self-reported, which might be inaccurate depending on how costs were recorded. Trial registration Open Science Framework (OSF) https://doi.org/10.17605/OSF.IO/QY2GU . Registered on June 4, 2021.

Background: Conducting high-quality randomized clinical trials (RCTs) is challenging, time consuming, and resource intense. Academic investigators usually depend on scarce financial resources; however, current literature lacks systematically collected empirical data on the detailed resource use and costs of investigator-initiated RCTs. Methods: The aim of this study is to generate a database of detailed empirical resource use and cost data from 100 investigator-initiated RCTs in Switzerland, Germany, and the UK. Investigators enter their empirical costs data into an online data collection form, which is followed by a short interview and a detailed cost report. We plan to investigate cost patterns and cost drivers and examine planned versus actual RCT costs as well as explore different strata of costs across the planning, conduct, and finalization phases, in drug and non-drug trials, and across medical fields and countries. Discussion: This study will add detailed empirical data to the limited research on investigator-initiated RCT costs currently available. A study limitation will be that cost data will be retrospective and self-reported, which might be inaccurate depending on how costs were recorded. Trial registration: Open Science Framework (OSF) https://doi.org/10.17605/OSF.IO/QY2GU. Registered on June 4, 2021. [ABSTRACT FROM AUTHOR]

This review draws on a long history of ichthyological and fisheries research to examine the changing stock status of the estuary-dependent white steenbras Lithognathus lithognathus in the South African Swartkops and Knysna estuaries. The available evidence points to a major decline in the L. lithognathus population of the Swartkops Estuary, from an already exploited status in the late 1800s and early 1900s to a collapsed status by the late 1900s, and the loss of adults which were recorded as prevalent in the estuary in 1915. In recent decades, the spotted grunter Pomadasys commersonnii appears to have occupied the niche previously used by L. lithognathus in the Swartkops Estuary, although climate change may also be playing a role in this trend. The Knysna Estuary had a healthy juvenile L. lithognathus population in the 1970s and 1980s, but increasing anthropogenic pressures on the system, including exploitation by recreational anglers and small-scale fishers, are cause for concern, particularly as fishery regulations for this species are not being adhered to in this and other systems. No-take marine protected areas (MPAs) appear to have been successful in providing some opportunity for stock recovery by adult populations of L. lithognathus in certain coastal regions within the distributional range. In conjunction with adequate enforcement of current fishery regulations, the proclamation of estuarine protected areas (EPAs) for juveniles in important estuarine nursery areas is required to enable the stock to recover and for the status of this fishery resource to be upgraded from collapsed to sustainable in the future. By providing protection for L. lithognathus in selected no-take EPAs, these same areas could also benefit other overexploited marine fish species, such as the dusky kob Argyrosomus japonicus and leervis Lichia amia. [ABSTRACT FROM AUTHOR]

Peripheral intravenous catheters (PIVCs) are required by most hospitalised patients. Difficult intravenous access (DIVA) makes insertion challenging, with poor patient outcomes, treatment delays and resource waste from multiple insertion attempts, often by multiple clinicians. This exploratory qualitative case study aimed to investigate how clinical and executive hospital staff view PIVC insertions for patients with DIVA from a cost and efficiency perspective. Fifteen semi-structured interviews were conducted with staff from three large, urban Australian hospitals. Data was thematically analysed, with four themes generated: (1) PIVCs are not considered from a cost or resource use perspective; (2) resources required for successful PIVC insertion are variable and unpredictable; (3) limited funding and support exist for advanced skill and ultrasound-guided insertion; and (4) processes for PIVC training and competency are inefficient. Investment in advanced PIVC inserters (with ultrasound-guided cannulation skills, and ability to train and assess novice inserters), with clear escalation pathways to these clinicians may reduce inefficiencies and waste associated with difficult PIVC insertions. What is known about the topic? Peripheral intravenous catheters (PIVCs) are required in most hospital admissions, but multiple insertion attempts, device failure and post-insertion complications are common, resulting in poor patient outcomes and wasted healthcare resources. What does this paper add? This case study explored how clinical and executive hospital staff in three Australian hospitals view PIVC insertion from a cost and resourcing perspective, in order to better understand attitudes around PIVC use and practice. What are the implications for practitioners? Hospital staff reported that PIVC insertions are considered as part of routine care and therefore the varying and unpredictable costs of successful cannulation are largely 'hidden'. Improved escalation procedures and investment in advanced insertion skills (including ultrasound-guided cannulation) may help reduce inefficiencies and waste. [ABSTRACT FROM AUTHOR]

Crafting an effective strategy is critical for startups striving to build a competitive edge, adapt to uncertainty, and scale in fast-changing markets. This article examines essential frameworks and approaches designed to address the unique challenges and opportunities that early-stage companies encounter, in the Romanian environment, precisely in Gorj County. By focusing on quality management and on foundational elements such as market positioning, value proposition, resource allocation, and responsiveness to change, it offers practical insights to help startup teams develop resilient, flexible strategies. Emphasizing the need to balance a visionary outlook with adaptable, short-term tactics, this article highlights the value of data-driven decisions and an innovation-centered culture. A business has to find its strategic roadmap to align their goals with feasible, scalable plans that foster growth, optimize resources, and challenge risks in uncertain market environments. The article further emphasizes the importance of balancing long-term vision with short-term flexibility, fostering a culture of innovation and continuous learning and skills improvement, collaterally with local and European funds attracting. [ABSTRACT FROM AUTHOR]

Biological communities are structured by a variety of biotic and abiotic relationships, whose understanding forms the basis for effective conservation. Among the myriad factors influencing community dynamics, resource partitioning stands out, potentially enriching ecosystem complexity but also carrying risks for conservation if disregarded. In this study, we investigated intersexual and ontogenetic niche differences among populations of the West African softshell turtle Trionyx triunguis in Liberia, Cote d'Ivoire, Ghana and Nigeria. We observed that these distinct populations exhibited similar habitat preferences, favouring large rivers with abundant riverbank and aquatic vegetation, and muddy substrates. Disparities in habitat preferences were evident among populations and across various life stages, indicating the adaptability of the species. We found that the species was active throughout the year, but most of our sightings and captures occurred during the wet season. In light of the species' vulnerability to overhunting, our research findings provide important data on the ecology of this species that can assist in its effective conservation across all life stages. [ABSTRACT FROM AUTHOR]

Annually, over 300 million surgeries occur globally, requiring numerous surgical instruments. However, many instruments on the tray are returned to the central sterile supply department (CSSD) unused, creating an unsustainable pattern of unnecessary consumption. To address this, we developed a method for optimising surgical instrument trays (SITs) that is straightforward to implement in other hospitals. This optimisation aims to enhance patient safety and sustainability and to improve working conditions and reduce costs. We identified actual instrument usage (IU) in the operating room (OR) and obtained expert recommendations (ERs). Data from both methods were combined in a computer model (CM) to adjust the SITs. The performance of the adjusted SITs was assessed over a year. IU of three different SITs was collected during 16 procedures (mean = 28.4%, SD = 6.4%). Combining IU and ERs resulted in a 36.7% reduction in instruments and a 31.3% weight reduction. These measures contribute to reducing the carbon footprint and enhancing sustainability. During the evaluation of the new SIT contents (n = 7 procedures), mean IU increased from 28.4% (SD = 6.4%) to 46.5% (SD = 11.0%), with no missing instruments during surgery. A one-year follow-up showed no need for further alterations. Combining both methods yields better results than using them individually, efficiently reducing unnecessary items in SITs without compromising patient safety. [ABSTRACT FROM AUTHOR]

Although intraspecific trait variation is increasingly recognized as affecting ecosystem processes, few studies have examined the ecological significance of among-population variation in behavioral traits in natural ecosystems. In freshwater habitats, crayfish are consumers that can influence ecosystem structure (e.g., macroinvertebrate communities) and function (e.g., leaf litter breakdown). To test whether crayfish behavioral traits (activity, boldness, and foraging voracity) are major contributors of leaf litter breakdown rates in the field, we collected rusty crayfish (Faxonius rusticus) from eight streams across the midwestern USA and measured behaviors using laboratory assays. At the same streams, we measured breakdown rates of leaf packs that were accessible or inaccessible to crayfish. Our results provide evidence that among-population variation in crayfish boldness and foraging voracity was a strong predictor of leaf litter breakdown rates, even after accounting for commonly appreciated environmental drivers (water temperature and human land use). Our results suggest that less bold rusty populations (i.e., emerged from shelter more slowly) had greater direct impacts on leaf litter breakdown than bold populations (P = 0.001, r2 = 0.85), potentially because leaf packs can be both a shelter and food resource to crayfish. Additionally, we found that foraging voracity was negatively related to breakdown rates in leaf packs that were inaccessible to crayfish (P = 0.025, r2 = 0.60), potentially due to a trophic cascade from crayfish preying on other invertebrates that consume leaf litter. Overall, our results add to the growing evidence that trait variation in animals may be important for understanding freshwater ecosystem functioning. [ABSTRACT FROM AUTHOR]

Lizard diets are highly diverse and have contributed to the diversification, biogeographical distributions, and evolution of novel traits across this global radiation. Many parts of a lizards ecology-including habitat preferences, foraging modes, predation risks, interspecific competition, and thermal constraints, among others-interact to shape diets, and dietary niche partitioning simultaneously contributes to co-occurrence within communities. We used DNA metabarcoding of fecal samples to identify prey items in the diets of three sympatric Sceloporus lizards in the Madrean Sky Islands of Arizona, USA. We found evidence for dietary niche partitioning between interacting species concomitant with their respective ecologies. We also compared diet composition between populations to understand how conserved or plastic species diets are between different environments. Our findings suggest that habitat generalists are also diet generalists in this system, while the same may be true for specialists. The identification of prey items to much lower taxonomic levels than previously documented further reveals hidden diversity in the diets of these species and underscores the utility of metabarcoding for understanding the full complexity of lizard diets.

Aim: Exploring the healthcare costs and resource use among privately insured US patients with posttraumatic stress disorder (PTSD). Methods: This study used Merative MarketScan data. The index date was defined as the first PTSD claim. Study period included a 1-year pre-index and 2-year post-index follow-up. Cases with only acute PTSD, cancer, or insurance gap during the study period were excluded. The PTSD with (PwC) and PTSD without comorbidities (PwoC) cohorts were defined by the presence/absence of comorbid mental health conditions (schizophrenia, bipolar and major depressive disorder). Baseline PTSD (BP) cohort included PwoC cases with only index PTSD event and without FDA-approved PTSDmedications or psychotherapy. Sub-analysis is conducted among patients with PTSD and substance/alcohol use disorder. Study cohorts were matched in a 1:1:1 ratio. Results: The matched sample included 5076 patients (1681 PwC, 1681 PwoC, 1714 BP). PwC patients had higher 2-year PTSD-related costs than PwoC and BP patients ($3762 vs $1750 and $841; all p < 0.001). The same trend was noted among all-cause and anxiety-related costs. PwC patients had higher 2-year PTSD-related inpatient and emergency department (ED) rates than PwoC (10.2% vs 1.7% and 6.8% vs 2.6%, all p < 0.001) and inpatient and outpatient rates than BP (10.2% vs 2.1% and 98.0% vs 93.1%; all p ≤ 0.004). The sub-analysis had 3776 patients (3154 PwC, 537 PwoC, 85 BP). PwC had higher 2-year PTSD-related costs than PwoC and BP ($7668 vs $2919 and $1,483; all p < 0.001). The same trend was noted in all-cause and anxiety-related costs. PwC also had higher 2-year PTSD-related inpatient and ED rates than PwoC (25.6% vs 10.4% and 12.7% vs 5.2%; all p < 0.001) and inpatient and outpatient rates than BP (25.6% vs 8.2% and 95.5% vs 84.7%; all p < 0.001). Conclusion: PTSD is associated with high healthcare costs and resource use. The highest economic burden was observed in patients with PTSD and mental health comorbidities.

Abstract While promoting manufacturing growth is imperative to boost economic growth, potential adverse consequences on natural resources and ecology have created sustainability-related concerns and challenges. In India, with the reform processes deepening further and the business environment becoming more market-oriented over the years, the adoption of appropriate measures for sustainable manufacturing growth under such conditions would require a deeper investigation of the underlying dynamics, particularly to address the impacts of external shocks. This is especially true when external shocks alter market dynamics and, hence, input is used significantly in the manufacturing sector. Given this backdrop, the present paper examines how the major external shocks to the Indian economy during in the post-reform era have altered the resource use patterns in selected manufacturing industries. The paper uses secondary data collected from the KLEMS database of the Reserve Bank of India for the period from 1980–81 to 2019–20 and applies descriptive statistics and econometric techniques to address the research objective. It is found that energy intensity, vertical integration, capital intensity, and rate of growth of total factor productivity decreased over the decades, whereas labour productivity experienced an increasing trend in most industries. However, the trends are mixed in the case of material intensity. Further, the regression results indicate significant effects of external shocks on resource use, factor productivity, and structural changes. There are also industry-specific differences in the nature and extent of such changes. Hence, a deeper investigation of the underlying factors and impacts at a disaggregate industry level is necessary to draw more robust insights.

Abstract Background Idiopathic pulmonary fibrosis (IPF) is a fatal progressive lung disease entailing significant impairment in health-related quality of life (HRQoL) and high socioeconomic burden. The course of IPF includes episodes of acute exacerbations (AE-IPF) leading to poor outcomes. This study aimed to compare management, costs and HRQoL of patients with AE-IPF to patients without AE-IPF during one year in Spain. Materials and methods In a 12-month, prospective, observational, multicenter study of IPF patients, healthcare resource use was recorded and costs related to AE-IPF were estimated and compared between patients with and without AE-IPF. HRQoL was measured with the St. George’s Respiratory Questionnaire (SGRQ), EuroQoL 5 dimensions 5 levels questionnaire (EQ-5D-5L), EQ-5D visual analogue scale (EQ-VAS) and the Barthel Index. Results 204 IPF patients were included: 22 (10.8%) experienced ≥ 1 acute exacerbation, and 182 (89.2%) did not. Patients with exacerbations required more primary care visits, nursing home visits, emergency visits, hospital admissions, pharmacological treatments and transport use (p

While promoting manufacturing growth is imperative to boost economic growth, potential adverse consequences on natural resources and ecology have created sustainability-related concerns and challenges. In India, with the reform processes deepening further and the business environment becoming more market-oriented over the years, the adoption of appropriate measures for sustainable manufacturing growth under such conditions would require a deeper investigation of the underlying dynamics, particularly to address the impacts of external shocks. This is especially true when external shocks alter market dynamics and, hence, input is used significantly in the manufacturing sector. Given this backdrop, the present paper examines how the major external shocks to the Indian economy during in the post-reform era have altered the resource use patterns in selected manufacturing industries. The paper uses secondary data collected from the KLEMS database of the Reserve Bank of India for the period from 1980–81 to 2019–20 and applies descriptive statistics and econometric techniques to address the research objective. It is found that energy intensity, vertical integration, capital intensity, and rate of growth of total factor productivity decreased over the decades, whereas labour productivity experienced an increasing trend in most industries. However, the trends are mixed in the case of material intensity. Further, the regression results indicate significant effects of external shocks on resource use, factor productivity, and structural changes. There are also industry-specific differences in the nature and extent of such changes. Hence, a deeper investigation of the underlying factors and impacts at a disaggregate industry level is necessary to draw more robust insights. [ABSTRACT FROM AUTHOR]

Circularity is becoming increasingly important for Distribution System Operators (DSOs) as their infrastructure ages and needs replacement, alongside compliance with stringent environmental regulations like the Corporate Sustainability Reporting Directive (CSRD). However, implementing circular economy (CE) practices is challenging due to the fragmented nature of the current CE landscape and its limited interaction with practical application. A longitudinal case study at the Dutch DSO, Liander, focusing on the circularity of distribution transformers, was conducted to generate prescriptive knowledge on operationalizing circularity. This resulted in the formulation of six design propositions for circular action that suggest to (1) initiate small-scale circularity experiments; (2) involve technical and strategic experts; (3) synergize circularity with more urgent, primary goals; (4) translate circular initiatives bottom-up and top-down; (5) collaborate with other DSOs; and (6) create multidisciplinary teams. The propositions suggest to situationally select interventions and build upon the outcomes of previous interventions in order to incrementally contribute to circular change. Other DSOs could use these propositions to optimize their strategy toward circular action. Additionally, the findings contribute to advancing scientific knowledge to implementable actions in order to initiate and sustain circular change. [ABSTRACT FROM AUTHOR]

Purpose: Impacts of mineral resource use on the availability of resources can be assessed using a broad range of methods. Until recently, life cycle inventory (LCI) and life cycle impact assessment (LCIA) models have been based on resource extraction. As extracted resources are not necessarily "lost" for future use, recent methodological developments have shifted the focus from resource extraction to resource dissipation. This paper aims at reviewing dissipation-based LCIA methods, testing them in a case study, analyzing potential implications for the product environmental footprint (PEF), and providing recommendations for future method development. Method: Five recently developed LCIA methods have been reviewed and compared based on 22 criteria, such as the forms and time horizons of dissipation considered, scientific publication, and number of characterization factors (CFs). Additionally, the abiotic depletion potential (ADP) method has been included to serve as a non-dissipation-based reference. All methods are tested in a case study on a theoretical product, designed solely for demonstration purposes, and consisting of 1 kg of the metals aluminum, cobalt, copper, molybdenum, nickel, and zinc. In addition to the absolute LCIA results, the contributions of metal production stages and individual resource extractions/emissions have been investigated. Finally, normalization and weighting have been carried out to analyze consequences of replacing ADP with the new dissipation-based methods in the context of PEF. Results and discussion: Most recently developed LCIA methods take a long-term perspective, cover emissions of resources to the environment (and partly technosphere), and vary in the number of CFs and resources covered. The case study results obtained by ADP are dominated by the molybdenum dataset; the results of the dissipation-based LCIA methods are strongly influenced by the cobalt dataset. All results are strongly sensitive to the LCI database used (ecoinvent or GaBi). Normalization and weighting revealed that the mineral resource use impact result dominates the aggregated PEF score (57%), when using the currently recommended ADP model. Shifting from the resource extraction-based ADP to dissipation-based models can reduce the contribution to 23% or < 1% depending on the method. Conclusion: The development of methods addressing mineral resource use in LCIA has shifted from resource extraction to dissipation. The analyzed methods are applicable and lead to different findings than the extraction-based ADP. Using the newly developed methods in the context of PEF would significantly change the relevance of the mineral resource use impact category in comparison to other environmental impacts. [ABSTRACT FROM AUTHOR]

Background: A systematic review on acceptability, feasibility, equity and resource use was conducted as part of updating recommendations from the Public Health Agency of Canada on prenatal screening for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG). Methods: Information sources, including MEDLINE® All, Embase and Cochrane CENTRAL (January 2003-January 2021) electronic databases were searched for studies that assessed acceptability, feasibility, equity and resource use of screening for CT or NG in pregnant persons aged =12 years. The Risk of Bias Assessment Tool for Non-Randomized Studies was used for quality assessment and a narrative synthesis was prepared. Results: Of the 1,386 records identified, nine observational studies (approximately 5,000 participants) and three economic evaluations met the inclusion criteria. In general, pregnant persons and healthcare providers accepted screening. Most pregnant persons and partners supported universal testing for CT. Pregnant persons preferred non-invasive sampling Methods. Inequities in feasibility (accessibility to screening) exist in certain populations. Studies have shown that targeted screening can miss cases. Screening all pregnant persons for CT has net cost savings compared to no screening. Limitations include not identifying eligible literature on acceptability of prenatal screening for NG among partners of pregnant persons and some studies with increased risk populations that restrict the generalizability of the findings highlighting areas for future research. Conclusion: Prenatal screening for CT and NG is generally acceptable among pregnant persons and healthcare providers. Evidence has shown that targeted screening can miss cases. The findings were included when updating PHAC's recommendations on prenatal screening for CT and NG. This work was presented at the Society of Obstetricians and Gynaecologists of Canada's 2024 Annual Clinical and Scientific Conference in Edmonton, Alberta. [ABSTRACT FROM AUTHOR]

Guilds have been used to assess how vegetation or environmental perturbations influence the community structure of animal communities. Spiders use a variety of hunting strategies. In arid environments they are the main predators of arthropods. Despite this, spider guilds have not been studied in desert ecosystems. Our study was carried out in one area of the Chihuahuan Desert. We used ramp-type traps and manual collection to capture the spiders. After identifying the specimens caught, we used a classification based on 20 and 23 traits to group the species into guilds. We used new traits for classification (eg horizontal web, triangular web, vertical web, threads coming out of the retreat). As a result, we obtained 11 guilds. Some species of the same family (e.g Gnaphosidae, Oxyopidae, Philodromidae, Theridiidae, Thomisidae) were positioned in different guilds. In addition to the classification, we provide information on the natural history of the species found. This information can be used to understand the differences between spider communities in desert vegetation types and those in other biomes. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to compare emergency orthopedic trauma admissions between the pre- and pandemic periods and detect changes in orthopedic trauma epidemiology. Methods: A total of 40,700 patients admitted within 1 year between March 2019 and March 2020 comprised the pre-pandemic group and 16,935 patients admitted between March 2020 and March 2021 comprised the pandemic group. Demographic characteristics of the patients, such as age and gender, were recorded. In addition, the injury mechanisms of the patients, diagnosis, injured extremity or anatomical region, broken bone, fracture classification, multitrauma rates, trauma-related complications, hospitalization days, and treatment modalities were examined. Results: In the pre-pandemic period, the mean age of the patients was younger, and the distributions of pediatric/adolescent patients and female patients were higher compared with the pandemic period (p=0.001, p=0.001, and p=0.001; respectively). Fractures and dislocations were more frequent in the pandemic period, whereas soft tissue injuries were more common in the pre-pandemic period (p=0.001). Home accidents increased and occupational accidents decreased during the pandemic period (p=0.001). The rate of surgical treatment statistically increased during the pandemic period (p=0.001). Conclusion: Considering the epidemiology of orthopedic trauma, estimating the trauma burden and optimizing resource use and allocation are very important for maintaining safe and effective treatment services for patients in extraordinary situations such as the coronavirus disease-2019 pandemic, which can cause serious disruptions in the healthcare system. [ABSTRACT FROM AUTHOR]

Strokes remain a leading cause of death and disability worldwide. The STROKE OWL study evaluated a novel case management approach for patients with stroke (modified Rankin Scale 0–4) or transient ischemic attack (TIA) who received support across healthcare settings and secondary prevention training from case managers for one year. The primary aim of this quasi-experimental study was a reduction in stroke recurrence. Here, we report the results of a health economic analysis of the STROKE OWL study, conducted in accordance with CHEERS guidelines. The calculations were based on claims data of cooperating statutory health insurance companies. In addition to a regression analysis for cost comparison, the incremental cost-effectiveness ratio was determined, and a probabilistic sensitivity analysis was carried out. In total, 1167 patients per group were included in the analysis. The intervention group incurred 32.3% higher direct costs (p < 0.001) than the control group. With a difference of EUR 1384.78 (95% CI: [1.2384–1.4143], p < 0.0001) and a 5.32% increase in hazards for the intervention group (HR = 1.0532, 95% CI: [0.7869–1.4096], p = 0.7274) resulting in an ICER of EUR 260.30, we found that the case management intervention dominated in the total stroke population, even for an arbitrarily high willingness to pay. In the TIA subgroup, however, the intervention was cost-effective even for a low willingness to pay. Our results are limited by small samples for both TIA and severe stroke patients and by claims data heterogeneity for some cost components, which had to be excluded from the analysis. Future research should investigate the cost-effectiveness of case management interventions for both severe stroke and TIA populations using appropriate data. [ABSTRACT FROM AUTHOR]

Aquaculture is a strategic sector that aims to meet the increased demands for healthy food for current and future populations. However, this progression needs to be sustainable, which can potentially be achieved by the implementation of circular practices. Integrated multi-trophic aquaculture (IMTA) systems promote the incorporation of circular principles. Nevertheless, the lack of harmonized definitions and standards impedes the quantification of these circular attributes. This study aims to explore the potential principles embedded in IMTA and the existing alternatives to quantify circularity. Two basic pillars (nutrient management and resource use efficiency) were identified as the most relevant circularity attributes for IMTA systems and were quantified through aquaculture-specific indicators. Bioremediation indicators, together with the efficiency indicators in terms of feed, water, energy, and infrastructure materials used, were selected to evaluate the circularity performance of four IMTA trials in three aquaculture facilities in Ireland, Brazil, and South Africa. Salmon, white shrimp, tilapia, abalone, and sea urchins were studied and cultivated together in various combinations with several low-trophic species in these IMTA trials to evaluate the improvement in circularity compared with corresponding monoculture conditions. The results showed an increase in circularity of up to 90% in terms of water recirculation, as well as bioremediation, which was improved by 80%–90%, providing evidence for the potential role of IMTA in the circularity transition. [ABSTRACT FROM AUTHOR]

Elucidating the underlying mechanisms behind variations of animal space and resource use is crucial to pinpoint relevant ecological phenomena. Organism's traits related to its energy requirements might be central in explaining behavioral variation, as the ultimate goal of a forager is to fulfill its energy requirements. However, it has remained poorly understood how energy requirements and behavioral patterns are functionally connected. Here we aimed to assess how body mass and standard metabolic rate (SMR) influence behavioral patterns in terms of cumulative space use and time spent in an experimental patchy environment, both within species and among individuals irrespective of species identity. We measured the behavioral patterns and SMR of two invertebrate species, that is, amphipod Gammarus insensibilis, and isopod Lekanesphaera monodi, individually across a range of body masses. We found that species of G. insensibilis have higher SMR level, in addition to cumulatively exploring a larger space than L. monodi. Cumulative space use scaled allometrically with body mass, and it scaled isometrically with SMR in both species. While time spent similarly in both species was characterized by negative body mass and SMR dependence, it was observed that L. monodi individuals tended to stay longer in resource patches compared to G. insensibilis individuals. Our results further showed that within species, body mass and metabolic rate explained a similar amount of variation in behavior modes. However, among individuals, regardless of species identity, SMR had stronger predictive power for behavioral modes compared to body mass. This suggests that SMR might offer a more generalized and holistic description of behavioral patterns that extend beyond species identity. Our study on the metabolic and body mass scaling of space and resource use behavior sheds light on higher‐order ecological processes such as species' competitive coexistence along the spatial and trophic dimensions. [ABSTRACT FROM AUTHOR]

Managing invasive species is essential for achieving mineland rehabilitation goals and ensuring the long‐term provision of critical ecosystem services while preventing new dispersion sources to neighboring areas. Traditional techniques include chemical and manual weeding, but frequent reinvasion limits their long‐term success. Therefore, additional integrated tools, such as stimulating natural competitors, may become necessary, especially where sensitive ecosystems, e.g. the ferruginous savanna ecosystem (cangas) from the Carajás National Forest, Eastern Amazon, Brazil, are found nearby rehabilitation sites. Here, we investigate the influence of different substrates and fertilization levels on the biotic interactions between two native canga grasses (Axonopus longispicus and Paspalum cinerascens) and the invasive molasses grass (Melinis minutiflora), which is frequently found in anthropized and natural ecosystems in Latin America. Nutrient application significantly influenced the growth, resource use strategies, and competitive outcomes of M. minutiflora. Nutrient application has positive effects on the growth of native species when cultivated in isolation but reduces plant development when subjected to competition with molasses grass, potentiating the invader. Although neither of the tested native species exhibited competitive advantages over M. minutiflora, increased nitrogen availability favored the competitive ability of this invasive grass. Thus, eliminating fertilization during mineland rehabilitation may be important for reducing the cover of M. minutiflora in the Carajás region, as sensitive canga ecosystems lack natural barriers against invasion. This strategic approach mitigates the operational risks and costs associated with combating invasive species from rehabilitating minelands, reducing propagule pressure on neighboring canga areas. [ABSTRACT FROM AUTHOR]

Introduction: The study objective was to estimate all-cause healthcare resource utilization (HCRU) and medical and pharmacy costs for women with treated versus untreated vasomotor symptoms (VMS) due to menopause. Methods: A retrospective study was conducted using US claims data from Optum Research Database (study period: January 1, 2012–February 29, 2020). Women aged 40–63 years with a VMS diagnosis claim and ≥ 12 and ≥ 18 months of continuous enrollment during baseline and follow-up periods, respectively, were included. Women treated for VMS were propensity score matched 1:1 to untreated controls with VMS. Standardized differences (SDIFF) ≥ 10% were considered meaningful. A generalized linear model (gamma distribution, log link, robust standard errors) estimated the total cost of care ratio. Subgroup analyses of on- and off-label treatment costs were conducted. Results: Of 117,582 women diagnosed with VMS, 20.5% initiated VMS treatment and 79.5% had no treatment. Treated women (n = 24,057) were matched to untreated VMS controls. There were no differences in HCRU at follow-up (SDIFF < 10%). Pharmacy ($487 vs $320, SDIFF 28.4%) and total ($1803 vs $1536, SDIFF 12.6%) costs were higher in the treated cohort. Total costs were 7% higher in the treated cohort (total cost ratio 1.07, 95% CI 1.05–1.10, P < 0.001). The on-label treatment pharmacy costs ($546 versus $315, SDIFF 38.6%) were higher in the treated cohort. Off-label treatment had higher medical costs ($1393 versus $1201, SDIFF 10.4%). Conclusions: Most women with VMS due to menopause were not treated within 6 months following diagnosis. While both on- and off-label treatment increased the total cost of care compared with untreated controls, those increases were modest in magnitude and should not impede treatment for women who report symptom improvement as a result of treatment. [ABSTRACT FROM AUTHOR]

ABSTRACT: In poultry behavior research, the reliance on presence data to estimate actual resource usage has substantially increased with the advent of tracking technologies such as radio frequency identification (RFID) and image-based systems. Although such widely used technologies are fundamentally designed for presence tracking, many studies claim to use them to investigate actual resource usage. This study investigates whether the duration of chickens' presence near key resources accurately reflects their actual usage. To this end, we analyzed 210 ten-min video sequences from 5 days of recordings of 21 chickens, focusing on their proximity to and use of 6 key resources in a mobile poultry barn. Human observers manually assessed the durations of proximity—presence in defined functional areas of interest—and resource use for each individual in the video sequences. Significant correlations (Spearman's coefficient 0.83–1) were found for most resources, except the pophole (Rho = −0.30). Usage-to-presence ratios varied: perches exceeded 87%, feeder and enrichments around 66%, drinker 50%, and pophole 10%. Our findings highlight that mere proximity to resources does not always guarantee their effective use. We emphasize the need for careful interpretation of data from tracking technologies, acknowledging the distinction between mere proximity and actual resource use. Future studies should include larger sample sizes and varied conditions to ensure broader applicability.

The US golf industry, especially the Golf Course Superintendents Association of America (GCSAA) and the United States Golf Association (USGA), have relied heavily on the concept of best management practices (BMPs) to advance environmental sustainability initiatives. However, few previous studies test whether BMP uptake by golf course superintendents actually leads to improved environmental outcomes. This study tested whether resource efficiency BMPs led to more efficient resource use on golf courses in four resource use categories: water, energy, fertilizer, and pesticide. Information on BMP uptake and resource use was collected via a survey from 96 golf courses across five regions of the US (Midwest, Northeast, East Texas, Florida, and Northwest) and three regions in Europe (Denmark, Norway, UK). Resource use efficiency on each golf course was estimated considering relevant factors specific to the resource (e.g., climate, soil type, and grass type). Uptake of individual BMPs was measured on a five-point scale (never, rarely, sometimes, often, always) and the adoption intensity (i.e. bulk uptake) of all BMPs in a given resource use category was quantified using a combination of principle component analysis and data envelope analysis. Analysis of the effect of individual resource efficiency BMPs on resource use efficiency found that uptake of only one of 34 BMPs correlated to more efficient resource use. Avoiding fertilizing roughs was correlated with more efficient N use. Surprisingly, uptake of three BMPs correlated with lower resource use efficiency and the remaining 30 BMPs had no effect on resource use. No significant correlations were found between water, energy, fertilizer, and pesticide use efficiency and the adoption intensity of BMPs in each respective resource use category. As such, self-reported BMP uptake was not indicative of improved environmental performance, an important consideration for future environmental initiatives in the golf industry.

Though golf courses utilize many of the same resource inputs as agriculture, including water, fertilizer, pesticide, and energy, the outputs of production are not physical goods like in agriculture. Instead, golf courses are part of the service industry, where the output of production is an experience. Eco-efficiency studies in the service industry, specifically the tourism industry, commonly use economic impact as the output of production. We hypothesize that for golf courses, which are most commonly independent small businesses, the output of production is best defined by the number of rounds hosted by the course or as the profit made by the course. The number of rounds quantifies the recreational utility that the golf course provides, while profit quantifies the economic output of the golf course. In this study, the ratio of rounds of golf played to water, energy, fertilizer, and pesticide use is referred to as social eco-efficiency, while the ratio of profit generated to water, energy, fertilizer, and pesticide use is referred to as economic eco-efficiency. Climate normalized eco-efficiency scores were also developed so that eco-efficiency scores could be compared across golf courses in different climates. Both climate normalized and non-climate normalized social and economic eco-efficiency scores within each resource category were weighed equally to generate social and economic eco-efficiency indices for each golf course in the study. The climate normalized mean social and economic eco-efficiency indices were higher on average on golf courses in Europe than golf courses in the US. Public golf courses had higher mean social eco-efficiency indices than private golf courses, and resort courses had the highest mean economic eco-efficiency indices. The eco-efficiency framework holds promise as a tool to help golf course managers reduce inputs that do not support the social or economic benefits of golf.

Abstract Generalisation and specialisation in species‐species interactions are key ecological concepts for interpreting the different interaction patterns observed in nature. Hence, finding the best way to operationalise them has been a major quest in Ecology. This quest has led to considerable conceptual development, and now the observed interaction pattern of a species is assumed to be a combination of three factors: its degree of generalisation, abundance‐driven neutral effects, and sampling effects. Here, we aimed to assess the influence of these factors on the performance of previously proposed indices of generalisation. To do so, we used simulated data that allowed us to separate and analyse independently the influence of each factor. Our assessment shows that the estimates made by most traditional indices are affected by differences in resource abundance distribution, leading to over‐ or underestimation of how generalised a consumer is. To solve this problem, we propose a new index that remains unaffected by neutral effects and is robust to sampling effects. Our new index may help to understand what interacting species require to keep viable populations and how they might respond to changes in resource availability.

Abstract Background Children’s emergency care visits are common, although the costs and reasons for visits vary. This register-based study examines the costs of pediatric emergency care and the diagnoses related to visits made to the Pediatric Emergency Unit at Tampere University Hospital (Tays), Tampere, Finland. Methods This retrospective study described pediatric emergency care visits made between September 2018 and December 2019 to a single center in Tampere, Finland. The data were gathered from medical files and from cost-per-patient software and analyzed in groups by age, season, level of treatment in the ED (primary or secondary), and hospitalization, as well as by diagnosis groups. Results During the study period, 11,454 visits were made. The total costs were over €3,380,000 ($2,837,758), with a median cost per visit was €260 ($217.90). Higher costs were associated with hospitalization and treatment in secondary care. The most common diagnoses were respiratory tract infections, counseling, other infections, GI symptoms, and other reasons. Conclusion Seriously ill children incur the highest costs per visit in pediatric emergency care. Respiratory tract infections are common reasons for emergency care visits, and the reasons why children come to emergency care in Finland are similar to those in other countries.

The width of a populations resource-use niche is determined by individual diet breadth (within-individual component) and the degree of niche partitioning between individuals (between-individual component). The balance between these two factors affects ecological stability and evolutionary trajectories, and may shift as ecological opportunity permits broader population niches. Lakes in Californias Sierra Nevada Mountains vary in resource diversity for introduced brook trout (Salvelinus fontinalis) due to elevation, lake morphometry, and watershed features. We compared the relative contributions of within- and between-individual niche components to two measures of the dietary niches of thirteen populations of brook trout: prey taxonomic composition and prey size distribution. For both taxonomic and size diversity of fish diets, population niche width was positively related to both the within- and between-individual components. For taxonomic diversity, the two components increased in parallel, while for size diversity, the between-individual component became more important relative to the within-individual component in populations with the greatest niche widths. Our results support the Niche Variation Hypothesis that populations with broader niches are more heterogeneous among individuals and show that individual niche width and individual specialization can operate in parallel to expand the population niche.

Background: There are limited data on the real-world healthcare resource use (HCRU) and management costs of myasthenia gravis (MG) in England. Objective: This study aims to assess the burden of disease for patients with MG in England. Design: A retrospective, observational cohort study of adult patients diagnosed with MG, using data from the Hospital Episode Statistics data warehouse. Methods: Patients with a first-ever recorded diagnosis of MG between 30 June 2015 and 30 June 2020 were followed up until 30 June 2021 or death, whichever occurred first. Post-diagnosis patient characteristics, treatment patterns, HCRU, and costs were described. Costs were evaluated using National Health Service reference costs. Results: A total of 9087 patients with a median follow-up time of 2.9 years (range, 1.7–4.3 years) were included. The mean age at diagnosis was 66.5 years and 53% of the patients were male. A large proportion of patients (72.8%) were admitted as inpatients during follow-up with a mean number of 1.3 admissions. Patients hospitalized for MG-related complications spent a mean of 9.7 days per patient-year in the hospital. During follow-up, 599 (6.6% of the total cohort) and 163 (1.8%) patients had a record of rescue therapy with intravenous immunoglobulin (IVIg) and plasma exchange (PLEX), respectively. Rituximab was administered to 81 (0.9%) patients and 268 (2.9%) patients underwent thymectomy. In those patients receiving rescue therapy or rituximab, >10% received at least three cycles of the same treatment. The average annual cost of hospital admissions across all patients treated with IVIg, PLEX, and rituximab were £907,072, £689,979, and £146,726, respectively. Conclusion: A majority of MG patients required hospitalization or accident and emergency attendance, resulting in high HCRU and costs. A subset of patients required rescue therapy (including IVIg and PLEX), rituximab administration, ventilation, or thymectomy. [ABSTRACT FROM AUTHOR]

The threatened fishing cat (Prionailurus viverrinus) is an elusive and medium-sized cat that is adapted to mangroves, swamps, wetlands and riverine habitats. A close look at the literature indicates that fishing cats are piscivorous; however, this is based on very few studies. Understanding the patterns of resource utilisation by species is crucial for assessing their role in ecosystems and in ensuring their conservation. Therefore, our study presents insights into fishing cat feeding patterns from mangroves of the Godavari delta, Andhra Pradesh, India. We collected 303 putative fishing cat scats and conducted diet analysis using 120 genetically identified scats. Our analysis revealed that fish was the most important prey for fishing cats in the study area (61.6% in frequency of occurrence), followed by crabs (30%) and rodents (28.3%). The prey composition did not vary significantly between the three seasons but there were differences between the survey years. The niche breadth also varied across the three seasons, with lowest niche breadth estimated in summers (0.36) with highest contribution of fish in the diet and highest in winters (0.75) probably due to increased contribution of other prey items along with fish. Our results suggest that long-term conservation and survival of the fishing cats depends on fish populations, which are the main prey of the species and thus recommend the need to protect the fish populations in the Godavari delta and the surrounding riverine habitats. Given the importance of fish to the diet of the fishing cat, the health of waterways throughout their distribution must be one of the focal strategies of conservation action. [ABSTRACT FROM AUTHOR]

Quantifying the resource use and cost of antimicrobial resistance establishes the magnitude of the problem and drives action. Assessment of resource use and cost associated with infections with six key drug-resistant pathogens in Europe. A systematic review and Bayesian meta-analysis. MEDLINE (Ovid), Embase (Ovid), Econlit databases, and grey literature for the period 1 January 1990, to 21 June 2022. Resource use and cost outcomes (including excess length of stay, overall costs, and other excess in or outpatient costs) were compared between patients with defined antibiotic-resistant infections caused by carbapenem-resistant (CR) Pseudomonas aeruginosa and Acinetobacter baumannii , CR or third-generation cephalosporin Escherichia coli (3GCREC) and Klebsiella pneumoniae , methicillin-resistant Staphylococcus aureus , and vancomycin-resistant Enterococcus faecium , and patients with drug-susceptible or no infection. All patients diagnosed with drug-resistant bloodstream infections (BSIs). NA. An adapted version of the Joanna Briggs Institute assessment tool, incorporating case-control, cohort, and economic assessment frameworks. Hierarchical Bayesian meta-analyses were used to assess pathogen-specific resource use estimates. Of 5969 screened publications, 37 were included in the review. Data were sparse and heterogeneous. Most studies estimated the attributable burden by, comparing resistant and susceptible pathogens (32/37). Four studies analysed the excess cost of hospitalization attributable to 3GCREC BSIs, ranging from -€ 2465.50 to € 6402.81. Eight studies presented adjusted excess length of hospital stay estimates for methicillin-resistant S. aureus and 3GCREC BSIs (4 each) allowing for Bayesian hierarchical analysis, estimating means of 1.26 (95% credible interval [CrI], −0.72 to 4.17) and 1.78 (95% CrI, −0.02 to 3.38) days, respectively. Evidence on most cost and resource use outcomes and across most pathogen-resistance combinations was severely lacking. Given the importance of this evidence for rational policymaking, further research is urgently needed. [ABSTRACT FROM AUTHOR]

Background: Children's emergency care visits are common, although the costs and reasons for visits vary. This register-based study examines the costs of pediatric emergency care and the diagnoses related to visits made to the Pediatric Emergency Unit at Tampere University Hospital (Tays), Tampere, Finland. Methods: This retrospective study described pediatric emergency care visits made between September 2018 and December 2019 to a single center in Tampere, Finland. The data were gathered from medical files and from cost-per-patient software and analyzed in groups by age, season, level of treatment in the ED (primary or secondary), and hospitalization, as well as by diagnosis groups. Results: During the study period, 11,454 visits were made. The total costs were over €3,380,000 ($2,837,758), with a median cost per visit was €260 ($217.90). Higher costs were associated with hospitalization and treatment in secondary care. The most common diagnoses were respiratory tract infections, counseling, other infections, GI symptoms, and other reasons. Conclusion: Seriously ill children incur the highest costs per visit in pediatric emergency care. Respiratory tract infections are common reasons for emergency care visits, and the reasons why children come to emergency care in Finland are similar to those in other countries. [ABSTRACT FROM AUTHOR]

The integration of invasive species into native communities may result in the destabilization of food webs through predation of native prey and competition with native predators. These negative effects are likely to be exacerbated by climate change, increasing the frequency of heat waves, droughts, and high-flow events. Invasive Round Goby (Neogobius melanostomus) and native White Sucker (Catostomus commersonii) were collected from the wild and acclimated to a range of temperatures expected to capture increases in temperature under climate change. In the laboratory, we measured the effects of temperature (19, 22, 25, and 28°C) and velocity gradients (0, 0.15, 0.3, 0.6 m/s at 22 and 25°C) on the prey consumption and foraging behavior of each species. We found that the prey consumption and number of attacks (lunges at prey) of both species increased with temperature but were consistently higher in Round Goby. Velocity had an interactive effect with temperature for prey consumption and foraging behavior, where generally, velocity tolerance for both species was higher at 22°C than at 25°C. White Sucker tolerance to velocity was higher than Round Goby, suggesting that systems with higher velocities may provide a competitive advantage in high-flow environments. Our results stress the importance of interactive experiments when examining the impact of invasive species on native competitors under shifting climatic conditions. [ABSTRACT FROM AUTHOR]

Background: The Acarbose Cardiovascular Evaluation (ACE) trial (ISRCTN91899513) evaluated the alpha‐glucosidase inhibitor acarbose, compared with placebo, in 6522 patients with coronary heart disease and impaired glucose tolerance in China and showed a reduced incidence of diabetes. We assessed the within‐trial medical resource use and costs, and quality‐adjusted life years (QALYs). Methods: Resource use data were collected prospectively within the ACE trial. Hospitalizations, medications, and outpatient visits were valued using Chinese unit costs. Medication use was measured in drug days, with cardiovascular and diabetes drugs summed across the trial by participant. Health‐related quality of life was captured using the EuroQol‐5 Dimension‐3 Level questionnaire. Regression analyses were used to compare resource use, costs, and QALYs, accounting for regional variation. Costs and QALYs were discounted at 3% yearly. Results: Hospitalizations were 6% higher in the acarbose arm during the trial (rate ratio 1.06, p =.009), but there were no significant differences in total inpatient days (rate ratio 1.04, p =.30). Total costs per participant, including study drug, were significantly higher for acarbose (¥ [Yuan] 56 480, £6213), compared with placebo (¥48 079, £5289; mean ratio 1.18, p < 0.001). QALYs reported by participants in the acarbose arm (3.96 QALYs) were marginally higher than in the placebo arm (3.95 QALYs), but the difference was not statistically significant (0.01 QALYs; p =.58). Conclusions: Acarbose, compared with placebo, participants cost more due to study drug costs and reported no statistically significant difference in QALYs. These higher within‐trial costs could potentially be offset in future by savings from the acarbose‐related lower incidence of diabetes. [ABSTRACT FROM AUTHOR]