Search

Objectives: To assess the effect of Community Water Fluoridation (CWF) in the prevalence of dental caries and dental fluorosis in 12-year-old children living in Israel. Considering that CWF is important in the prevention of dental caries. Between 2002 and 2014, the water in communities of at least 5,000 individuals was fluoridated. In 2014, CWF in Israel stopped. Method and materials: Data on 12-year-old children from all areas in Israel from the national cross-sectional epidemiological survey conducted in 2011 to 2012 were stratified by city water fluoridation and by city and school socioeconomic status. Two dependent variables were defined: (1) DMFT index of caries experience in the permanent dentition; (2) dental fluorosis in central incisors using the Thylstrup-Fejerskov classification of fluorosis. Results: Data from 2,181 12-year-olds were analyzed. The average DMFT was 1.17 ± 1.72, and 49% were caries-free. Based on DMFT, the caries experience was significantly higher in nonfluoridated cities (1.38 vs 0.98 in fluoridated cities) and there were more caries-free children in fluoridated cities (56.4% vs 40.6% in nonfluoridated). DMFT was higher in cities with lower socioeconomic status than high socioeconomic status (1.29 vs 1.05, respectively, P < .001) and there were fewer caries-free children in low socioeconomic status cities (44.5% vs 53.0% in high socioeconomic status cities, P < .0001). Almost all the 10.3% of children with signs of fluorosis (scoring at least 1 in the Thylstrup-Fejerskov index), had questionable to mild fluorosis (9.3%). Conclusions: CWF is a cheap, simple method of dental health protection that reaches all socioeconomic levels, and cessation of water fluoridation reduced the health of Israel's children. Clinical significance: Water fluoridation provides substantial caries prevention, by reaching a substantial number of people. The relevance of this work is for policymakers to consider CWF as clinically proven method for reducing health inequalities. [ABSTRACT FROM AUTHOR]

Objectives: The prevalence and the economic burden of periodontal disease are high. To save or replace diseased teeth, an objective prognosis assessment using the long-term predictability of the various treatment options should be performed. As dental implants have become a treatment of choice for replacing missing teeth, the number of implant failures and complications has also increased. The objective of this review was to compare the cost-effectiveness of saving and maintaining the teeth vs replacing them with dental implants in patients with severe periodontal disease (with hopeless or questionable teeth). Method and materials: A database search was conducted using Medline (OVID), Embase, Web of Science, and CINAHL electronic sources until July 2023. Two reviewers reviewed the papers in accordance with the specific selection criteria after choosing the abstracts that met the initial selection criterion for full article retrieval. Results: Twelve articles were included, of which nine articles discussed the cost-effectiveness of preserving teeth in severe periodontal disease and three articles discussed the effectiveness of implants that replaced the periodontally compromised teeth. It was found that placing and maintaining implants was more costly than properly treating and maintaining periodontally compromised teeth. Supportive periodontal treatment contributed the most to the cost during the periodontal treatment. Conclusions: Implants are an effective choice to replace missing teeth; however, these are not permanent, present complications, and require strict maintenance. Thus, when deciding whether to maintain a periodontally compromised tooth or to replace it with a dental implant, in terms of cost-effectiveness, implant maintenance cost as well as the cost associated with treating implant complications should be considered. This cost seems to surpass the cost of treatment and maintenance of periodontally compromised teeth. [ABSTRACT FROM AUTHOR]

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

This study investigates the influence of old directors on corporate social responsibility (CSR) using roughly 25,000 firm-year observations from 2001 to 2015 in the United States. We employ the widely used selection, optimization, and compensation (SOC) model from psychology to explain the CSR decisions of old directors. Our results indicate that firms with a higher percentage of old directors tend to have lower engagement in CSR activities. To address endogeneity, we adopt the difference-in-differences method and use the event of sudden deaths and unexpected retirements of old directors and find that our results remain robust. Our analysis also reveals that the negative impact of old directors on CSR is more significant in firms where directors receive fewer reputational spillover benefits from CSR initiatives and/or firms exhibiting poor corporate governance. In addition, this adverse impact of old directors comes from two effects: a reduction in efforts to enhance CSR strengths and an increase in inaction to address CSR concerns. Overall, these findings suggest that the CSR decision-making process of old directors involves assessing the costs and benefits of CSR engagements, consistent with our hypothesis derived from the SOC model. [ABSTRACT FROM AUTHOR]

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

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

Prisoners face inequalities relating to health and social care and educational needs. Peer support (prisoners providing support to other prisoners) is used in addition to professional support to address needs. It is not clear how effective or cost-effective peer-support services are, how they are implemented or experienced, or how best to evaluate such schemes. This review aimed to evaluate the following: 1. Outcomes and economic outcomes that have been studied for prison peer support, and data sources used. 2. Effectiveness and cost of prison peer support. 3. Implementation and experiences with prison peer support. A rapid systematic scoping review (registered on International Prospective Register of Systematic Reviews: CRD42022351592) that focussed on peer support within adult prisons. The search included six databases, grey literature databases, handsearching journals, and reviewing reference lists (June 2022). Studies were screened, and data were extracted. Narrative synthesis was used to analyse findings. Seventy papers were included (qualitative: 30, quantitative: 21, and mixed-methods: 19). No studies measured cost/cost-effectiveness. A range of methods were used to measure effectiveness (e.g., surveys, routinely collected data), implementation, and experience (e.g. interviews, surveys, observation). There was evidence of some positive effects (e.g., disease detection, mental health). Factors influencing peer support in prisons included individual, service, and organisational factors. Benefits (for prisons/prisoners/staff) and challenges (e.g., burden, exploitation) were identified. Prison peer support services are internationally used to address public health. Future research could robustly evaluate effectiveness and cost effectiveness. Attention should be given to potential risks and barriers affecting implementation. [ABSTRACT FROM AUTHOR]

Objective: The present study investigated the association between social media engagement and factors related to well-being (e.g., depression, anxiety, sleep, loneliness, self-esteem). Participants: A sample of 1120 college student-athletes (338 males, 777 females, 5 identified as non-binary) from nine universities participated in this study. Method: Data were collected through self-report measures and screen shots of participants' screen time in the previous week. Results: Overall screen time taken from devices was not associated with self-reported well-being, whereas use of social media during daily activities was related to worse well-being across domains (e.g., lower self-esteem, higher fear of missing out, stress, anxiety, depression). In addition, student-athlete perceptions that social media interfere with their lives were related to worse well-being. Conclusions: The implications of these findings, including the possibility of using protective behavioral strategies (PBS) to reduce negative impacts of social media in college students, are discussed. [ABSTRACT FROM AUTHOR]

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

Given their frontline role in Australia and Aotearoa New Zealand (ANZ) healthcare, trainee medical officers (TMOs) will play a crucial role in the development and use of artificial intelligence (AI) for clinical care, ongoing medical education and research. As 'digital natives', particularly those with technical expertise in AI, TMOs should also be leaders in informing the safe uptake and governance of AI within ANZ healthcare as they have a practical understanding of its associated risks and benefits. However, this is only possible if a culture of broad collaboration is instilled while the use of AI in ANZ is still in its initial phase. [ABSTRACT FROM AUTHOR]

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

Many youths with attention‐deficit/hyperactivity disorder (ADHD) experience significant long‐term impairment and may develop concurrent mental and somatic health difficulties as adults. This is associated with burden and costs for the individual and society which could be prevented through continued support in youth. Yet, only few young people transition to adult mental health services for ongoing care in different countries worldwide. We provide an overview on current transition practices, highlighting the gaps in knowledge and the barriers to effective service transitioning, while considering the large geographical variation in available guidelines and service provision. For ease of use, this review is organized in a question‐and‐answer format covering different aspects of the transition process and considering both service users' and clinicians' perspectives. Consensus is needed to identify those that require continued care, the optimal timing to arrange transition, and the most suitable services. Finally, we discuss cost‐effectiveness of transition practices, consider examples of best practice, and propose recommendations on how to improve transitional care, including the importance of service users' input into transition planning. [ABSTRACT FROM AUTHOR]

Poor oral health has been associated with various systemic diseases (e.g., endocarditis, pneumonia, cardiovascular disease, and diabetes) and decreased quality of life. When enacted in 1965, Medicare excluded coverage for comprehensive dental services. As of 2023, Medicare has allowed coverage of limited dental services inextricably linked to specific medical conditions. Many Medicare Advantage plans (Medicare Part C) offer dental coverage. Yet in 2019, approximately 24 million Medicare beneficiaries (47% of all Medicare enrollees), lacked dental coverage. Seventy-one percent of traditional Medicare enrollees (those not enrolled in a Medicare Advantage Plan) reported that high cost was the primary reason that they did not obtain dental care. The importance of oral health for the older adults has been the main reason that a national interprofessional consortium, which includes several national nursing organizations, has been advocating for legislation to expand Medicare to include dental coverage. The consortium's efforts have been thwarted by fierce opposition from the American Dental Association and many Republican legislators. Given the vital role that nurses and advanced practice nurses play in caring for the nation's older adults and disabled, nursing's voice needs to be strengthened as leaders in advocating for inclusion of dental benefits in traditional Medicare. [ABSTRACT FROM AUTHOR]

The information‐seeking behaviour of adults focuses on optimizing the gathering and utilizing information to minimize search costs. In contrast, children tend to engage in information search during decision‐making with less consideration for costs. This difference in behaviour is believed to be linked to the development of executive functions. Therefore, the present study aimed to investigate the relationship between executive function and cost‐related information‐gathering behaviour. We assessed 56 children aged 4–6 years, involving three tasks: an information‐gathering task, an inhibitory control and a working memory task. In the information‐gathering task, children participated in both non‐cost and cost conditions, where they were given the opportunity to freely gather information or incur a cost to acquire information. The findings revealed that children with higher inhibitory control tended to gather less information when a cost was involved. This highlights the important role of inhibitory control in shaping information‐seeking behaviour in early childhood. [ABSTRACT FROM AUTHOR]

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

Purpose: This pilot study evaluated the cost–benefit of research-based Treatment Foster Care Oregon (TFCO) as an alternative treatment setting to residential care for children in the Illinois child welfare system. Methods: Using secondary analysis of child welfare administrative data, this study observed, for 2 years, 52 children enrolled in TFCO and 67 children who were eligible for TFCO but remained in or entered residential care. Results: Over the 2-year period, the average daily cost of care for children in TFCO was $249, compared to $320 for children in residential care, resulting in cost-savings of $51,058 per child and an overall net benefit of $94,294 per child. Conclusions: The promising cost–benefit evidence of TFCO as implemented in a state child welfare system has implications on social work services and placement decision-making, and system capacity in scaling up short-term therapeutic foster homes for children who might otherwise languish in residential care. [ABSTRACT FROM AUTHOR]

Objectives: This manuscript presents a comprehensive framework for the assessment of the value of real-world evidence (RWE) in healthcare decision-making. While RWE has been proposed to overcome some limitations of traditional, one-off studies, no systematic framework exists to measure if RWE actually lowers the burden. This framework aims to fill that gap by providing conceptual approaches for evaluating the time and cost efficiencies of RWE, thus guiding strategic investments in RWE infrastructure. Methods: The framework consists of four components: (114th Congress. 21st Century Cures Act.; 2015. https://www.congress.gov/114/plaws/publ255/PLAW-114publ255.pdf.) identification of stakeholders using and producing RWE, (National Health Council. Glossary of Patient Engagement Terms. Published 2019. Accessed May 18. 2021. https://nationalhealthcouncil.org/glossary-of-patient-engagement-terms/.) understanding value propositions on how RWE can benefit stakeholders, (Center for Drug Evaluation and Research. CDER Patient-Focused Drug Development. U.S. Food & Drug Administration.) defining key performance indicators (KPIs), and (U.S. Department of Health and Human Services - Food and Drug Administration: Center for Devices and Radiological Health and Center for Biologics Evaluation and Research. Use of Real-World Evidence to Support Regulatory Decision-Making for Medical Devices - Guidance for Industry and Food and Drug Administration Staff. 2017. http://www.fda.gov/BiologicsBloodVaccines/GuidanceComplianceRegulatoryInformation/Guida.) establishing metrics and case studies to assess value. KPIs are categorized as 'better, faster, or cheaper" as an indicator of value: better focusing on high-quality actionable evidence; 'faster,' denoting time-saving in evidence generation, and 'cheaper,' emphasizing cost-efficiency decision compared to methodologies that do not involve data routinely collected in clinical practice. Metrics and relevant case studies are tailored based on stakeholder value propositions and selected KPIs that can be used to assess what value has been created by using RWE compared to traditional evidence-generation approaches and comparing different RWE sources. Results: Operationalized through metrics and case studies drawn from the literature, the value of RWE is documented as improving treatment effect heterogeneity evaluation, expanding medical product labels, and expediting post-market compliance. RWE is also shown to reduce the cost and time required to produce evidence compared to traditional one-off approaches. An original example of a metric that measures the time saved by RWE methods to detect a signal of a product failure was presented based on analysis of the National Cardiovascular Disease Registry. Conclusions: The framework presented in this manuscript offers a comprehensive approach for evaluating the value of RWE, applicable to all stakeholders engaged in leveraging RWE for healthcare decision-making. Through the proposed metrics and illustrated case studies, valuable insights are provided into the heightened efficiency, cost-effectiveness, and improved decision-making within clinical and regulatory domains facilitated by RWE. While this framework is primarily focused on medical devices, it could potentially inform the determination of RWE value in other medical products. By discerning the variations in cost, time, and data utility among various evidence-generation methods, stakeholders are empowered to invest strategically in RWE infrastructure and shape future research endeavors. [ABSTRACT FROM AUTHOR]

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

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

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

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

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

This study provides updated estimates of the cost-of-illness for three common and costly health outcomes: myocardial infarction, asthma and stroke. We use a regression approach based on a large data set which provides a representative sample of individual health-related expenditures in the United States. Our core estimates are that the estimated cost of a first myocardial infarction is $238,000, the cost of new onset asthma is $170,000, and the cost of a first stroke is $175,000. We also demonstrate the importance of including wage income and caregiving costs and document differences in short- and long-term costs for some health outcomes. Looking forward, these cost-of-illness estimates can be used to inform environmental benefit-cost analysis such as those performed by the United States Environmental Protection Agency (EPA). [ABSTRACT FROM AUTHOR]

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

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

Background: While previous studies have examined various platforms that enable providers to connect, Virtual Hallway (VH) stands out with its unique features. The value add is that this online platform connects primary care providers and specialists for synchronous phone-based conversations and aims to reduce referrals and enhance the quality of referrals. VH allows providers to easily log in, select the required specialty, book call times, receive reminders, and have calls documented, ensuring a high connection rate. In May 2022, the provincial health authority in Nova Scotia, a Canadian province, and VH initiated a feasibility study facilitated through the Health Innovation Hub in Nova Scotia. The goal was to enable primary care providers to connect with specialists, thereby reducing wait times and unnecessary referrals, and facilitating timely access to relevant clinical direction for patients. The current evaluation assessed utilization, value for money in economic analysis, and consultation experiences. Methods: The study used post, cross-sectional, and cost-benefit study designs. We collected data through various methods, including administratively recorded utilization, theory-driven surveys, and cost data. Utilization was measured by the number of completed consults and the number of healthcare professionals using the VH platform. We analyzed the data using a combination of descriptive statistics and a cost-benefit analysis, which also involved conducting probabilistic sensitivity analysis. Results: The study found that approximately 84% of the VH consultations avoided needing in-person specialist referrals. The return on investment was 1.8 (95% CI: 0.8 to 3.0), indicating that the monetary value of the measurable benefits associated with VH exceeded the value of the resources invested. The provider experience survey revealed high satisfaction levels with VH across user groups, with 92% of specialists and 96% of primary care providers reporting being satisfied or highly satisfied with their experience. These positive indicators of provider experience were further supported by the fact that 97% of respondents agreed or strongly agreed that they intended to continue to use VH in their practice, and 97% of respondents agreed or strongly agreed that they would recommend VH to a colleague. Conclusions: The study suggests that VH was well-received by users, with high levels of satisfaction reported and a reduced need for in-person referrals. It also represented value for money. Further research could explore how the availability of virtual health services can lead to reduced utilization of healthcare resources among different groups of patients. [ABSTRACT FROM AUTHOR]

The transportation sector holds a substantial influence on our quality of life and the environment. In contrast to rail transport, road transport carries a heightened risk of environmental and social issues. These include, but are not limited to, congestion, accidents, community segregation and encroachment, air pollution, toxic releases, water and soil pollution, and impacts on wildlife vitality. With the surge in global freight volume, the heavy reliance on road transport and underutilization of railroads will prove inadequate to meet the escalating demand and exacerbate existing environmental and social concerns. Therefore, transportation investment evaluations must comprehensively and consistently consider environmental, social, and economic factors. This study develops a Life-cycle Benefit-Cost Analysis and an accessible tool to capture overall nationwide impacts across various stages of transport infrastructure and equipment life cycles. We compare highways and railroads, considering actual and maximum capacities, to identify the most cost-effective and sustainable investment. Our results show that trucking costs $370.07 per thousand ton-miles, 4.85 times higher than rail at $76.37 per thousand ton-miles. We also highlight further research needed to address the issues of data unavailability, limited metric scope, and computational method limitations. [ABSTRACT FROM AUTHOR]

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

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

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

The article focuses on the environmental impact of insulin delivery methods within the UK's National Health Service (NHS) amid efforts to address the climate crisis. Topics include the carbon footprint and plastic waste associated with disposable versus reusable insulin pens, the lack of national guidelines for sustainable prescribing practices, and the need for data on the environmental effects of different insulin delivery systems to inform clinicians and patients.

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

Effective mitigation of climate change requires a robust set of policy interventions. Existing policy appraisal frameworks and approaches impact the design and choice of these policy options. However, their application to transformative climate policy can present several shortcomings. In light of criticism around current appraisal methods, we review the climate policy appraisal landscape and interview policy experts in three major emerging economies: Brazil, China and India. Little research has been done on the perception, approach, and practice of policy appraisal in these countries, even though they will have a significant impact on global progress to mitigate climate change. We find that policy appraisal in Brazil, China, and India is supported by guidelines, but the detail and implementation of those guidelines vary significantly. Cost–benefit analysis (CBA) is the prevailing decision-making framework in both Brazil and India whereas multi-criteria analysis is the dominant framework in China. Practitioners appear to understand CBA and its limitations well but also value its usability and the perception of robustness. Across all countries, political considerations can outweigh appraisal findings; respondents suggested this can be negative, in the sense that appraisal results are sometimes ignored, but can also be positive in the sense that other objectives are considered. Existing approaches present several limitations, particularly regarding transformational change, which could hamper progress to formulate and implement effective climate and energy policy. Key policy insights: Guidelines that standardize the appraisal process are considered better for accountability and therefore increase the influence of appraisal in policymaking. The choice of approach affects the appraisal outcome. The type of policy and its intended aims should inform the method of appraisal used. Climate policies are often transformational in nature. As such, their outcomes can be very uncertain. More efforts are needed to integrate these considerations of uncertainty into appraisal frameworks. More computational models that consider system feedbacks and uncertainty are needed to robustly analyse the impacts of transformative policies. [ABSTRACT FROM AUTHOR]

Radiotherapy (RT) is an integral component in the treatment of breast cancer. The aims of this study were to estimate the cost per 5-year Local Control (LC) and Overall Survival (OS) benefits of the first course of RT, based on breast cancer stage, and the potential cost savings with adoption of the FAST-Forward protocol. All RT activities for breast cancer RT July 2017-June 2020 and their associated costs were consolidated together. The average cost of treatment course was calculated (average cost per fraction X average no. of fractions). Cost per outcome was estimated based on published gains in 5-year LC and OS with optimal use of radiotherapy. 481 patients with breast cancer were analysed. The average cost per fraction was $285 AUD (£148 GBP) for all stages. The average costs for 5-year LC and OS gain were $31,483 AUD (£16 392 GBP) and $235,435 AUD (£122 566 GBP) respectively for all stages. The estimated costs for 5-year LC outcomes were $29,675 AUD (£15 450 GBP), $34,675 AUD (£18 053 GBP) and $32,478 AUD (£16 910 GBP) for Stage I-III respectively. The estimated costs for 5-year OS were $455,909 AUD (£237 378 GBP), $532,727 AUD (£ 277 375 GBP) and $60,717 AUD (£31 614 GBP) for Stage I-III respectively. 266 patients had characteristics that made them eligible for the FAST-Forward protocol. A cost saving of $2592–3864 AUD (£1350–2012 GBP) per patient was estimated had these patients been treated with the protocol. The cost of RT for LC outcome is similar across stages. The greatest value for OS outcome was seen in patients with Stage III breast cancer, due to the greater survival benefit with RT in these patients compared with Stage I-II breast cancer. Significant cost savings can be made by implementing the FAST-Forward protocol. • Cost per 5-year local control outcome was similar for Stage I-III breast cancer ranging from $29,675 AUD to $32,478 AUD. • Cost per 5-year overall survival outcome was cheaper for stage III breast cancer compared with Stage I-II breast cancer. • Use of the FAST-Forward ultrahypofractionation protocol significantly reduces RT costs. [ABSTRACT FROM AUTHOR]

Low-titer O-positive whole blood was used extensively by the military during operations in Iraq and Afghanistan. Studies have consistently shown that this therapy is feasible, safe, and effective in the management of hemorrhagic shock in trauma patients, and it is now the standard of care across the US military Joint Trauma System. The military's success in using low-titer O-positive whole blood has renewed the practice in the civilian setting, with recent research confirming its safety and efficacy. In a few short years, use of this treatment for hemorrhagic shock has expanded to more than 80 US level I and level II trauma centers. However, its use is still relatively rare in the rural hospital setting. This article describes the benefits for patients, staff members, and the overall trauma system of using low-titer O-positive whole blood in rural hospitals. [ABSTRACT FROM AUTHOR]

1. In recent years, public concern regarding animal welfare has increased while, at the same time, cage systems for animal production have been greatly criticised by EU citizens. In addition, large food retailers promote food products that are made with eggs produced in cage-free systems. 2. The objective of this study was to evaluate the economic viability of the transition of laying hens' to production systems; from conventional to alternative systems with improved welfare. Three independent scenarios were assumed as follows: transition from enriched colony cages to barn (S1), transition from barn to free-range (S2), and transition from free-range to organic (S3). Economic assessments of each transition was applied to a model farm in Greece with 12 000 hens, through partial budget analysis and net benefits and costs were estimated. 3. The results showed a positive economic impact in all transitions to a production system of improved animal welfare (€12,044 in S1, €18,957 in S2 and €7,977 in S3) which indicated that they are economically sustainable. In all scenarios, unit cost increased by 19% in S1, 12% in S2, and 85% in S3. 4. In conclusion, transitioning towards improved animal welfare production systems in laying hen farms could be an economically viable option for egg producers in compliance with societal demands and market trends. [ABSTRACT FROM AUTHOR]

This article interrogates the impacts of different types of family benefits expenditures on the positive relationship between female employment and fertility rates in developed welfare states. It does this by theorizing how these family benefits align with welfare state regimes' preferences for different normative gender-role ideologies. Rather than treating family benefits as a monolith, this article investigates the impact of disaggregated expenditures in the Organisation for Economic Co-operation and Development (OECD) family policy database (1. services and in-kind benefits, 2. child-related cash benefits and 3. tax-based financial support for children) on both female employment and fertility rates. This is done using pooled time-series analysis covering the period 2000–9. The analysis yields evidence that expenditure most reflecting a 'full egalitarian' gender ideology including service and in-kind benefit provision has the most positive association with female employment and fertility due to an emphasis on defamiliarization. The picture for child-related cash benefits is mixed due to the presence of cash transfer provisions not employment-contingent captured in the indicator. In contrast, tax-based financial support for children harms female employment, reflecting a maternalistic 'traditional' ideological orientation, but is positive for fertility rates indicating a moderate pro-natal effect of tax-based financial support for children. [ABSTRACT FROM AUTHOR]

Assess the impact of a weight-inclusive podcast (WIP) intervention on body appreciation, intuitive eating (IE), anti-fat attitudes, and weight and health attitudes in university students enrolled in an upper-division nutrition course. Quasi-experimental design: Intervention participants listened to 8 weekly WIP episodes (n = 16); the comparison group listened to 8 weekly general nutrition podcasts (n = 29). Intuitive eating, body appreciation, anti-fat attitudes, and general weight and health attitudes were measured preintervention and postintervention. Two-way, repeated measures analysis of variance revealed significant interaction effects of time × group, with participants in the WIP group experiencing significantly greater improvements in body appreciation (P = 0.03) and IE (P = 0.02) and greater reductions in anti-fat attitude scores (P = 0.006) than the comparison group. Podcasts may be a cost-effective tool to improve body appreciation and IE and reduce anti-fat attitudes in future nutrition professionals. Future research would benefit from recruiting prehealth professionals across different majors. [ABSTRACT FROM AUTHOR]

Secondary analysis of existing data is a powerful method to answer many complex pediatric health questions. Using secondary data has several advantages including decreased time to complete analysis, decreased data collection costs, improved access to less common conditions, and generalizability for national data sets, yet secondary data analysis is often underutilized. While secondary data analysis is not without its challenges, this special issue aims to spotlight the significance of secondary data in pediatric research, showcasing diverse studies that draw upon data from various sources. This introductory article will present a brief overview of each paper emphasizing the distinctive ways in which authors have employed secondary data to contribute to our understanding of pediatric health. [ABSTRACT FROM AUTHOR]

Background This study investigated the relative cost utility of three techniques for the management of symptomatic neuromas after neuroma excision: (1) implantation of nerve into muscle, (2) targeted muscle reinnervation (TMR), and (3) regenerative peripheral nerve interface (RPNI). Methods The costs associated with each procedure were determined using Common Procedural Terminology codes in combination with data from the Centers for Medicaid and Medicare Services Physician and Facility 2020 Fee Schedules. The relative utility of the three procedures investigated was determined using changes in Patient-Reported Outcomes Measurement Information System (PROMIS) and Numeric Rating Scale (NRS) pain scores as reported per procedure. The relative utility of each procedure was reported in terms of quality-adjusted life years (QALYs), as is standard in the literature. Results The least expensive option for the surgical treatment of painful neuromas was nerve implantation into an adjacent muscle. In contrast, for the treatment of four neuromas, as is common postamputation, TMR without a microscope was found to cost $50,061.55 per QALY gained, TMR with a microscope was found to cost $51,996.80 per QALY gained, and RPNI was found to cost $14,069.28 per QALY gained. While RPNI was more expensive than nerve implantation into muscle, it was still below the standard willingness-to-pay threshold of $50,000 per QALY, while TMR was not. Conclusion Evaluation of costs and utilities associated with the various surgical options for the management of painful neuromas suggest that nerve implantation into muscle is the least expensive option with the best improvement in QALY, while demonstrating comparable outcomes to TMR and RPNI with regard to pain symptoms. [ABSTRACT FROM AUTHOR]

• Gel composition in Gel Instillation Sonohysterography does not affect experienced pain, patient satisfaction and image quality. • Electronic pain measurement can be used as an advanced tool next to the Visual Analogue Scale. • Costs can vary greatly depending on the choice of used gel and catheter. Pain experience, physical reaction, image quality and adverse events during Gel Instillation Sonohysterography (GIS) can differ using gels with different compositions. As a result, patient satisfaction can also be affected. The effect of two instillation gels, Endosgel versus ExEmgel, using both the Visual Analogue Scale (VAS) and a Continuous Pain Score Meter (CPSM) was therefore compared. This single centre double blind randomised controlled trial included 80 women planned for outpatient GIS, diagnosed with abnormal intrauterine bleeding or fertility disorders and suspicion on an intrauterine abnormality. Patients were randomly allocated to the instillation of Endosgel containing chlorhexidine or ExEmgel without chlorhexidine. Primary outcome was reported pain during the procedure using VAS. Secondary outcomes included pain score measured using CPSM, satisfaction to the procedure and preference at 3 weeks and 3 months after the procedure and image quality. A cost benefit analysis was also performed. The reported median VAS concerning pain during gel instillation was comparable in the Endosgel and ExEmgel group, 2.50 (IQR 0.00–5.00) and 2.00 (IQR 0.00–5.75) respectively (p = 0.69). The median VAS of the entire procedure was also similar: both 2.00 (IQR 0.00–5.00) (p = 0.86). CPSM-scores were not significantly different either. Both groups were similar in image quality (p = 0.83) and patient's satisfaction (p = 0.36). Concerning the pain experienced during a GIS procedure and patients' satisfaction, the ExEmgel was not proven to be superior to the Endosgel. Our advice is to use the gel that is available at the lowest costs, as the image quality is the same for both Endosgel and ExEmgel. [ABSTRACT FROM AUTHOR]

• The increasing use of robot-assisted hysterectomy in benign indications lowers the need for open surgery. • Implementation of robot-assisted hysterectomy reduces length of stay, complications and hospitalisation costs. • Robot-assisted hysterectomy remains the most expensive technique due to high material and depreciation costs. As a minimally invasive technique, robot-assisted hysterectomy (RAH) offers surgical advantages and significant reduction in morbidity compared to open surgery. Despite the increasing use of RAH in benign gynaecology, there is limited data on its cost-effectiveness, especially in a European context. Our goal is to assess the costs of the different hysterectomy approaches, to describe their clinical outcomes, and to evaluate the impact of introduction of RAH on the rates of different types of hysterectomy. A retrospective single-centre cost-analysis was performed for patients undergoing a hysterectomy for benign indications. Abdominal hysterectomy (AH), vaginal hysterectomy (VH), laparoscopic hysterectomy (LH), laparoscopically assisted vaginal hysterectomy (LAVH) and RAH were included. We considered the costs of operating room and hospital stay for the different hysterectomy techniques using the "Activity Centre–Care program model". We report on intra- and postoperative complications for the different approaches as well as their cost relationship. Between January 2014 and December 2021, 830 patients were operated; 67 underwent VH (8%), 108 LAVH (13%), 351 LH (42%), 148 RAH (18%) and 156 AH (19%). After the implementation and learning curve of a dedicated program for RAH in 2018, AH declined from 27.3% in 2014–2017, to 22.1% in 2018 and 6.9 % in 2019–2021. The reintervention rate was 3–4% for all surgical techniques. Pharmacological interventions and blood transfusions were performed after AH in 28%, and in 17–22% of the other approaches. AH had the highest hospital stay cost with an average of €2236.40. Mean cost of the hospital stay ranged from €1136.77-€1560.66 for minimally invasive techniques. The average total costs for RAH were €6528.10 compared to €4400.95 for AH. Implementation of RAH resulted in a substantial decrease of open surgery rate. However, RAH remains the most expensive technique in our cohort, mainly due to high material and depreciation costs. Therefore, RAH should not be considered for every patient, but for those who would otherwise need more invasive surgery, with higher risk of complications. Future prospective studies should focus on the societal costs and patient reported outcomes, in order to do cost-benefit analysis and further evaluate the exact value of RAH in the current healthcare setting. [ABSTRACT FROM AUTHOR]

Regulatory agencies must balance patient demands to access new treatments for fatal diseases with limited treatment options while ensuring drug safety and efficacy. However, questionable U.S. regulatory actions resulted in the early approval of AMX0035 to treat amyotrophic lateral sclerosis (ALS) by reconvening advisory commissions to obtain positive decisions and designating the drug as a new molecular entity. Data from one randomized clinical trial suggests minimal delays in disease progression and longer survivability, but debate remains about the lack of confirmatory evidence of effectiveness owing to study limitations. A patient's decision-making process details the experience of using the drug, including perspectives on access, cost, effectiveness, and adverse effects. In line with the "nichebuster" business model, the drugmaker, Amylyx Pharmaceuticals, is charging US$158,000/year/patient and thus forecast to turn a profit on a drug with debatable clinical effectiveness prior to completing a Phase 3 trial. Early marketing approval, despite community demands, is unnecessary and may have reduced access because of the end of a compassionate use program, and the high price tag results in restricted coverage and high out-of-pocket costs. Also, the drug's key ingredients are available as a generic and a supplement. [ABSTRACT FROM AUTHOR]

Nurses are uniquely positioned to significantly impact organizational and system improvement through improving quality and reducing costs. Using an evidenced based tool to identify costs and the financial benefit involved iii any quality improvement project is invaluable in developing and evaluating proposals and allocation of resources to support the organization's financial health and viability. The return on investment analysis is an essential accounting tool that will provide nurse leaders with critical information quantifying costs and benefits of both financial and nonfinancial metrics to identify the feasibility, efficacy, risk or efficiency of a proposed project. [ABSTRACT FROM AUTHOR]

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

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

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

This manuscript proposes a probabilistic framework to quantitatively assess communities' resilience by simulating the state and serviceability of their infrastructure systems from the onset of a flood until the end of recovery. It comprises multiple interconnected models. Hazard model characterizes flood parameters (e.g., depth and velocity). Depth-damage curves estimate the damage to infrastructure systems' components. The HEC-FIA mortality model characterizes the flood-induced casualties. Serviceability models determine the ability of interdependent infrastructure systems to meet the demand during the recovery process. The recovery models estimate the recovery duration and cost of damaged components probabilistically. The Monte Carlo analysis is employed to consider multiple relevant uncertainties, generating distributions of the flood-induced losses under various scenarios. The ratio of total losses to the gross regional product characterizes the community's resilience. This framework facilitates the assessment of the impact of various resilience enhancement measures, guiding the selection of appropriate measures through a cost-benefit analysis. [ABSTRACT FROM AUTHOR]

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