Commercial crocodilian farms face significant economic and livestock losses attributed to stress, which may be linked to their adopted husbandry practices. The development of appropriate and modernized husbandry guidelines, particularly those focused on stress mitigation, is impeded by the limited understanding of the crocodilian stress response. Fifteen grower Nile crocodiles were subjected to simulated acute transport stress, with blood samples collected at various intervals post-stress. Plasma levels of corticosterone, dehydroepiandrosterone (DHEA), adrenaline, and noradrenaline were determined using high-performance liquid chromatography. Glucose and lactate were measured using portable meters, and the heterophil-to-lymphocyte ratio (HLR) was determined via differential leucocyte counts. Significant differences were elicited after the stressor, with acute fluctuations observed in the fast-acting catecholamines (adrenaline and noradrenaline) when compared to baseline. Downstream effects of these catecholamines and corticosterone appear to be associated with a persistent increase in plasma glucose and HLR. Lactate also showed acute fluctuations over time but returned to baseline by the final measurement. DHEA, used as a ratio with corticosterone, showed fluctuations over time with an inverted release pattern to the catecholamines. The study highlights the temporal dynamics of physiological markers under acute stress, contributing to understanding crocodilian stress and potentially informing improved farming practices for conservation and sustainable management.

A community-level nutrition intervention was implemented among tribal children (3 to 6 years) in Telangana, India. The one-year intervention involved six nutrient-rich formulations of millet-pulse-groundnut based products, suited to local taste preferences. Anthropometric measurements of height, weight and Mid-Upper-Arm -Circumference (MUAC) along with haemoglobin (Hb) levels were monitored at baseline and endline. The treatment group showed considerable gain in height (3.2 cm), weight (1.68 kg) and MUAC (0.33 cm), over the control group. Paired t-test indicated significant differences (p<.01) between pre- and post-intervention anthropometric measurements. Positive shifts were observed in wasting (WHZ; -1.2 ±1.3 to -0.9± 1), stunting (HAZ; -1.8±1.6 to -0.3±1.3) and underweight (WAZ; -1.9±1.2 to -0.7±1) among treatment group. Hb levels in the treatment group also improved significantly from 9.70 ± 0.14 g/dl (moderately-anaemic) to 11.08 ± 0.13 g/dl (non-anaemic). Post-intervention Focus Group Discussions (FGDs) involving mothers and teachers confirmed the positive impact. Thus, nutritional intervention formulated using climate resilient millets, pulses and groundnut, promotes dietary diversity and improves the nutrition & health status of children.

Cement manufacturing is one of the most energy-intensive industries in the world. Most of the cost of producing cement is accounted by fuel consumption and power expenditures. Thermal power plants are the major source of electricity in Pakistan. But they are not efficient and environmentally friendly. This study simulates four different models for five cement plants of Pakistan on Homer Pro software and compares the optimal solutions based on the net present cost (NPC), levelized cost of electricity (LCOE) and greenhouse gas (GHG) emissions. Model-1 consists of solar panels, electrolyzer, hydrogen tank, hydrogen generator and converter. Model-2 has only a diesel generator and acts as a base case in this study. Model-3 has solar panels and a battery-converter system. In Model-4, diesel generators, solar panels and converters are considered. Based on NPC, the most optimal model is Model-4, having a 0.249 $/KWh LCOE in islanded systems. The NPC and operating costs are US$540 million and US$ 32.5 million per year, respectively, with a 29.80% reduction in CO2 emissions when compared to the base case. Based on GHG emissions, Model-1 and Model-3 are the best models with 0% GHG emissions. Sensitivity analyses is also performed using the parameters of load, inflation rate and discounted rate. The results prove that the proposed hybrid micropower systems (HMS) can sustainably provide electricity for 24 hours a day to the sites under consideration with minimum objectives.

Access to medicines is one of the essential problems in Public Health of low- and middle-income countries (LMICs). The World Health Organization (WHO) defines access to medicines as the possibility of "having continuously accessible and affordable medicines in public or private health facilities that are within a kilometer of the place of residence." Access to medicines, as defined by the WHO, is not fully guaranteed in many LMICs and even in many regions of high-resource countries. The WHO identifies several factors as determinants of limitations in the access to medicines: rational selection, affordable prices, sustainable financing, and reliable health services. The action on these factors makes it possible to improve universal access to medicines with consequent improvement in Public Health. Adequate access to antibiotics and vaccination will avoid a large part of the deaths caused by infectious diseases in the LMICs. However, the emergence of resistance and the difficulties in vaccination campaigns due to socio-political or cultural problems make it challenging to fight many easily treatable infectious diseases. The use and abuse of antibiotics are inevitably associated with the appearance of resistances that make them ineffective. Thus, whereas limited access to antibiotics raises mortality rates from infectious diseases, generalized open access to them ends up eliminating their clinical value. Moreover, the contraction of research in this field for many years has reduced the success in discovering new drugs. Additionally, local market regulations, inadequate selection, inaccessible prices, especially for those of second and third-generation, inefficient health systems, and difficulties of administration and control of prescription compliance, especially in the case of combined therapies, are additional obstacles to universal access to antibiotics. In order to simultaneously improve access to antibiotics and keep resistances under control, it is necessary to develop training and education activities at different social levels (from patients to various Health Care Providers) to complement the national or supranational strategic plans.

Poultry farming in Slovakia has a tradition and an irreplaceable position to ensure rational nutrition for the population. In terms of a nutritional value, poultrymeat (Galliformes) contains a high amount of proteins, essential amino acids, essential unsaturated fatty acids, minerals, vitamins and a low fat content. Poultrymeat production has a relatively short reproductive cycle and thus allows regulating the demand and supply. The poultry market also influences the development of domestic consumption. According to the Statistical Office of the Slovak Republic, the consumption of meat has witnessed a persistent increase over the last 10 years. [1] According to the 2023 AVEC (The Voice of European Meat Sector) annual report, the consumption of poultrymeat in Slovakia was 20.0 kg per person per year. The average consumption in the EU-27 (2021) was 23.4 kg, with the countries with the highest consumption being Portugal (37.8 kg), Ireland (36.0 kg), Hungary (33.5 kg) and Spain (29.9 kg). On the other hand, the countries with the lowest consumption of poultrymeat, apart from Slovakia, also include Austria and Greece with a consumption of 21.5, resp. 21.0 kg [2]. The breeding of broiler chickens, as well as the production and placing on the market of poultrymeat must comply with the requirements laid down by legislation, while the compliance is regularly checked by the competent authorities.

Neuropsychiatric manifestations of COVID-19 include delirium, general malaise, headache, and psychiatric symptoms. These manifestations are related to the neuroinflammatory response to viral antigens and proinflammatory mediators/immune cells. Tetracyclines, such as minocycline, have antibacterial and anti-inflammatory properties. Saiko-keishi-to, a traditional Japanese Kampo medicine, also has anti-inflammatory properties. Given the anti-inflammatory properties of minocycline and Saiko-keishi-to, we describe two cases of COVID-19 with prolonged headaches and general malaise successfully treated with these medications.

This study aims to describe the commitment to national heritage, patriotism, nationalism of elementary school students in the border areas between Indonesia and Timor Leste. This research was conducted in three elementary schools, they are SD Inpres Moto Ain, SD Inpres Class Jau Halimuti, SD Kristen Nanaeklot, and SD Negeri Motabenar from June to August 2018. The subjects of this study were elementary students in the Indonesia-Timor Leste border areas precisely around Motaain City, Belu Regency, East Nusa Tenggara. The research questionnaire was adapted from Karazawa and analyzed with descripriptive statistics. The results of this study showed that the commitment to national heritage, patriotism, and nationalism of elementary students on the Indonesian border areas with Timor Leste is in the very high level.

The airline sector is critical in today's globalized society, supporting the efficient movement of people and products worldwide. Airlines are continuously looking for methods to enhance their operational performance to remain competitive in the face of increased competition. This study focuses on the application of Multi-Criteria Decision Making (MCDM) techniques to improve low-cost carrier (LCC) also known or low-cost (budget) airlines' ground operational performance. MCDM techniques have gained considerable attention in recent years to address complex decision problems with multiple conflicting goals. This research aims to bridge this gap by proposing a comprehensive framework that combines MCDM techniques to enhance airline operational strategies to increase performance. The study utilizes qualitative and quantitative data, drawing on previously published materials on MCDM techniques in the aviation sector. It utilizes fuzzy Analytic Hierarchy Process (AHP) and fuzzy Technique for Order of Preference by Similarity to Ideal Solution (TOPSIS) methodologies. A case study is conducted to evaluate the ground operational performance of three airline companies based in Türkiye, considering five main criteria and 18 sub-criteria. The findings of this research will contribute to a comprehensive understanding of operational performance in the airline sector. It also highlights the implications and limitations of the research and suggests future research directions.

Aim: To investigate inflammation indices and erythropoietin (EPO) levels for their potential role in distinguishing polycythemia vera (PV) from secondary polycythemia (SP), and to compare different parameter combinations in terms of diagnostic accuracy. Methods: This retrospective cohort was created from patients assessed for polycythemia from January 2020 to December 2023. PV diagnosis was made according to the 2016 WHO criteria (n=145). Those who did not fulfill the criteria were defined as having SP (n=84). Results: NLR, PLR and SII were significantly higher in the PV group (p

The study comprehensively evaluated the prognostic roles of PLR, NLR, MLR, BLR, and ELR in patients with acute exacerbation chronic obstructive pulmonary disease (AECOPD). 619 patients with AECOPD and 300 healthy volunteers were retrospectively included into the study. The clinical characteristics containing laboratory findings of the AECOPD patients and the blood cell counts (CBCs) of the healthy volunteers were collected. Compared with the healthy volunteers, PLR, NLR, and MLR were elevated in COPD patients in stable condition, and were further ele-vated during exacerbation. ELR showed the opposite trend. PLR, NLR, and MLR were all posi-tively correlated with hospital LOS as well as CRP. In contrast, ELR was negatively correlated with hospital LOS as well as CRP. Elevated PLR, NLR, and MLR were all associated with more serious airflow limitation in AECOPD. Elevated PLR, NLR, and MLR were all associated with increased in-hospital mortality while Elevated ELR was associated with decreased in-hospital mortality in AECOPD. A nomogram was construct to predict in-hospital mortality in AECOPD. The nomo-gram had a C-index of 0.850 (95% CI: 0.799 – 0.901) with good predictive value and clinical ap-plicability. In summary, PLR, NLR, MLR, and ELR served as predictors for clinical outcomes in patients with AECOPD.

In this paper we present a city-scale (possibly global) air pollution network made of low-cost sensors for particulate matter concentration in the air. The components of presented system are based on our research and experience from previous studies focused on air quality instruments and sensors for addressing urban air pollution. Sensor nodes are produced locally and distributed over a city of Sarajevo, Bosnia and Herzegovina. The system collects, calibrates and displays particulate metal concentrations in real-time. In comparison to the available measurements from governmental institutions, our system demonstrated good agreement of measured parameters, with several advantages including: higher resolution in space and time, lower costs, both horizontal and vertical measurements and many more. One of the capabilities of the system is the real-time air pollution city map with animations. By installing multiple sensor nodes over a slope (cable car), we receive vertical measurements of temperature, humidity and particulate matter concentration in real time, which gives a valuable insight into the dynamics of temperature inversion episodes and air pollution below the inversion layer.

This retrospective study aimed to evaluate the performance of the hormone treatment protocols, determine the factors associated with pregnancy success after hormone treatment, and compare the cost-efficiencies of two types of hormone treatment among cyclic and noncyclic anestrous dairy cows. The clinical records of 279 anestrous cows who received hormone treatment for artificial insemination (AI) from 64 herds in the western region of Thailand were obtained from Kasetsart University Veterinary Teaching Hospital from January to August 2017. The performance of the hormone treatment protocols, fixed-time AI (TAI) and estrus detection before AI (EAI), showed that the pregnancy risk for the TAI protocol was higher than for the EAI protocol, but pregnancy per AI did not differ significantly between the two protocols in cyclic and noncyclic cows. Multivariate logistic regression analysis showed that cows receiving the TAI protocol were more likely to be pregnant compared to those treated with the EAI protocol. Cows with a 3.00 body condition score (BCS) &lt;3.75 after treatment and loose-housing cows were more likely to become pregnant. Treatment during winter showed higher pregnancy success than in the summer and rainy seasons. The cost-efficiency analysis showed that the TAI protocol was the most cost-efficient option for noncyclic cows, whereas the EAI protocol was the most cost-efficient option for cyclic cows.

The efficient and sustainable management of hospitals is an increasingly relevant challenge in the healthcare sector. With limited financial resources, regulatory pressures and increasing demands for quality services, hospitals are faced with the want to approve sound policies to certify financial and operational sustainability. Management accounting is critical in this instance. In Portugal the DL nº 284, of July 26, 1999, allow us to confirm the need to reinforcement of profitability and efficiency in the provision of healthcare. Management accounting is an essential tool for monitoring and controlling costs, making strategic decisions, efficiently allocating resources and evaluating performance in the hospital environment. It allows a comprehensive view of financial and operational aspects, providing valuable information for management and strategic planning. However, the sustainability of hospital management accounting is a critical and complex topic that deserves special attention. Hospitals face several challenges, such as the complexity of hospital costs, the integration of information systems and the measurement of healthcare value. These challenges can compromise the effectiveness of management accounting and its ability to provide relevant and reliable information for decision making. As a result, it is required to address the sustainability of hospital management accounting by identifying the specific challenges faced in this area and exploring opportunities to overcome them. By addressing these challenges and seizing opportunities, hospitals can strengthen their position in the healthcare sector, improve their operational efficiency, optimize resource allocation and ensure the provision of quality services to patients. In this article, the challenges faced by hospital management accounting will be analysed, such as the complexity of costs, the integration of information systems and the measurement of value in healthcare. Additionally, opportunities to improve financial and operational management will be highlighted through the adoption of advanced technologies, an emphasis on value-based management and collaborative partnerships. By exploring these themes, this essay aims to make a contribution. to the advancement of hospital management accounting and the sustainability of hospitals in the current healthcare scenario.

Low-cost monitors have made possible for the first time measurements of long-term (months to years) potential indoor exposures to fine particles. Indoor and outdoor measurements made over nearly 5 years (2017-2021) by the largest network of low-cost monitors in the United States (PurpleAir) are compared to the prevalence of adult smokers in 1650 Zip codes within the three West Coast states of California, Oregon, and Washington. The results show that mean indoor exposures above the 75th percentile of adult smoking prevalence are more than 50% higher than those below the 25th percentile. Mean outdoor concentrations are also elevated, but by a smaller amount (20%). Both comparisons are significant at the p&lt;0.001 level. The elevation of the PM2.5 concentrations with increasing smoking prevalence is evidence of environmental disparities in income, education, and other socioeconomic indices..

As a new logistics system, Physical Internet (PI) provides a solution to cope with the continuous rise of urban logistics demand by exploring same-level and cross-level paths and flattening. This research suggests a PI-based urban logistics distribution cost minimization model based on the examination of the primary elements influencing PI distribution, intending to maintain the logistic transportation process' integrity. This proposed model enhances the flexibility of goods operation and reduces the global cost of logistics distribution using the interconnected and open PI logistics distribution mode. The experimental results show that the distribution cost of the PI logistics model is significantly better than that of a traditional logistics model. The elastic and cost advantages relatively grow as the infrastructure for distribution scales up and the interruptions from emergencies occur.

This study investigates the role of insulation, in commercial buildings and how it affects energy efficiency and sustainability in different climate regions. Commercial buildings consume an amount of energy making them ideal candidates for energy saving measures. Insulation plays a role in maintaining indoor conditions reducing energy usage and minimizing carbon emissions by limiting heat transfer through the building’s envelope. By conducting simulations using the Hourly Analysis Program (HAP) this research examines how insulation thickness, climate conditions and building characteristics impact energy consumption and greenhouse gas emissions. The study covers climate zones with a focus on Afghanistan, semi-arid, arid and mountainous regions where sustainable construction practices are highly important. The findings demonstrate that insulation has an effect on enhancing energy efficiency particularly when it comes to heating. Additionally, economic factors, future research directions and broader implications, for construction practices are thoroughly discussed. Considering that the construction industry contributes significantly to carbon emissions this research provides insights into promoting sustainable building practices. By optimizing insulation strategies, architects, builders and policymakers can reduce the impact of commercial buildings while advancing energy efficiency and supporting a more sustainable urban future.

Robotic surgery is a rapidly developing and evolving surgical technique. This literature review evaluates the advantages and disadvantages in the context of gallbladder disease comparing robotic Cholecystectomy to the well-established laparoscopic Cholecystectomy. Significant advantages are reduced operative blood loss, hospital stays and post operative pain, alongside increased patient satisfaction and improved visualization and precision compared to the laparoscopic approach. Disadvantages include lack of tactile feedback, significant cost attributed to equipment, training requirements and increased procedural time due to the set-up sequences. The implementation of robotic surgery also poses significant changes for the training of future surgeons. Whilst it can standardize training and increases opportunity for simulation, the concern is the loss of traditional skills. Currently the evidence base remains mixed however the use of robotics in the right setting, with suitably trained operatives and appropriate patients can enable improved outcomes for patients with gallbladder disease. There is a lot of scope for development including the implementation of tactile feedback to aid operative technique and artificial intelligence to aid patient safety. Likely broadening the use and potential benefit of robotic surgery not only for cholecystectomy but many surgical specialties.

Escalation of commitment explains the choice for investing in an option for which great investments have previously been made even though better choices became available. The last 25 years of producing innumerous versions of Alzheimer Disease animal models with virtually no predictive validity should have exposed the fact that using animals for studying AD is clearly a failing course of action and as such should have been abandoned long ago, giving room to other alternatives to flourish. In this assay, I explore the idea that the investment in new animal models for studying Alzheimer (AD) represents a classic case of escalation of commitment, and sunk cost dilemma, in the biomedical research.

Context: Despite the effort put into developing standards for structuring construction cost, and the strong interest into the field. Most construction companies still perform the process of data gathering and processing manually. That provokes inconsistencies, different criteria when classifying, misclassifications, and the process becomes very time-consuming, particularly on big projects. Additionally, the lack of standardization makes very difficult the cost estimation and comparison tasks. Objective: To create a method to extract and organize construction cost and quantity data into a consistent format and structure, to enable rapid and reliable digital comparison of the content. Method: The approach consists of a two-step method: Firstly, the system implements data mining to review the input document and determine how it is structured based on the position, format, sequence, and content of descriptive and quantitative data. Secondly, the extracted data is processed and classified with a combination of data science and experts’ knowledge to fit a common format. Results: A big variety of information coming from real historical projects has been successfully extracted and processed into a common format with 97.5% of accuracy, using a subset of 5770 assets located on 18 different files, building a solid base for analysis and comparison. Conclusion: A robust and accurate method was developed for extracting hierarchical project cost data to a common machine-readable format to enable rapid and reliable comparison and benchmarking.

Osteoarthritis (OA) is the degeneration of cartilage in joints that results in bones rubbing against each other, it causes uncomfortable symptoms such as pain, swelling, stiffness, and can lead to disability. It usually occurs in the elderly and causes a large medical burden. The aim of this study is to evaluate cost-effectiveness between the standard treatment for osteoarthritis and the standard treatment with added crystalline glucosamine sulfate at various stages. The Markov analysis modelling was applied to evaluate the effect of both adding glucosamine compared to standard treatment from a societal perspective during whole patients’ lifetimes. Data input was collected by review in previous studies. The outcome was measured in quality-adjusted life years (QALYs), and the incremental cost-effectiveness ratio (ICER) from a societal perspective was ap-plied with 3%-discounted for all cost and outcome. One-way analysis via Tornado diagram was performed to investigate the change of factors in model. In general, the adding glucosamine into the standard treatment proved to be more cost-effectiveness compared to the standard treatment. Particularly, early stage adding glucosamine in the treatment was cost-effectiveness then post-stage adding glucosamine. The addition of supplementing crystalline glucosamine sulfate to whole regimen at any stage was cost-effectiveness at willingness-to-pay (WTP) threshold

The increase and diversity of low-cost Air Quality (AQ) sensors, as well as their flexibility and low power consumption, offers us the opportunity to integrate them into a broad AQ wireless sensor networks with the aim of enabling real-time monitoring and higher spatial sampling density of pollution in all parts of the cities. Considering that the vast majority of the population lives in these cities and the increase in respiratory/allergic problems in a large part of the population, it is of great interest to offer services and applications to improve their quality of life. In the ECO4RUPA project we focus on this kind of service, proposing an inclusive and intelligent routing ecosystem carried out by using a network of low-cost AQ sensors with the support of 5G communications along with official AQ monitoring stations, assisted with artificial intelligence to improve the AQ monitoring data and by spatial interpolation techniques to enhance its spatial resolution. The goal of this service is to calculate healthy walking and/or cycling routes according to the particular citizen’s profile and needs. We provide and analyse the results of the proposed route planner under different scenarios (different time tables, congestion road traffic and routes) and different user’s profiles, with special interest on citizens with asthma and pregnant women, since both require special needs. In summary, our approach can lead to an approximately average reduction in pollution exposure of 17.82%, while experiencing an approximately average increase in distance travelled of 9.8 %.

In the last two decades, the continuous ever growing demand for energy has determined a significant development in the production of photovoltaic (PV) modules. Anyway, a critical and very important issue in the module design process is the adoption of suitable encapsulant materials and technologies for cell embedding. Therefore, adopted encapsulants have a significant impact on modules efficiency, stability and reliability, and to ensure the unchanged performance of PV modules in time, the encapsulant materials must be selected properly. The selection of encapsulant materials must maintain a good balance between the encapsulant performance in time and costs, related to materials production and technologies for cells embedding. However, the encapsulants must ensure excellent isolation of active photovoltaic elements by the environment, preserving accurately the PV cells against humidity, oxygen and accidental causes that may compromise the PV modules function. This review provides an overview of different encapsulant materials, their main advantages and disadvantages in adoption for PV production, and also in relation to used encapsulant technologies for cell embedding, additives and the interaction of these materials with other PV components.

Background: Stoma closure is a widely performed surgical procedure, with 6295 undertaken in England in 2018 alone. This procedure is associated with significant complications; incisional hernias are the most severe, occurring in 30% of patients. Complications place considerable financial burden on the NHS; hernia costs are estimated at GBP 114 million annually. As recent evidence (ROCSS, 2020) found that prophylactic meshes significantly reduce rates of incisional hernias following stoma closure surgery, an evaluation of this intervention vs. standard procedure is essential. Methods: A cost-utility analysis (CUA) was conducted using data from the ROCSS prospective multi-centre trial, which followed 790 patients, randomly assigned to mesh closure (n=394) and standard closure (n=396). Quality of life was assessed using mean EQ-5D-5L scores from the trial, and costs in GBP using UK-based sources over a 2-year time horizon. Results: The CUA yielded an incremental cost-effectiveness ratio (ICER) of GBP 128,356.25 per QALY. Additionally, two univariate sensitivity analyses were performed to test the robustness of the model. Conclusion: The results demonstrate an increased benefit with mesh prophylaxis, but at an increased cost. Although the intervention is cost-ineffective and greater than the ICER threshold of GBP 30,000/QALY (NICE), further investigation into mesh prophylaxis for at risk population groups is needed.

Aircraft emissions represent a relevant amount of human induced CO2. Globally, up to 2.5 per cent of such emissions stem from the aviation industry. In order to investigate the effects within the atmosphere, realistic flight profiles are necessary to provide quantitatively tangible values of emissions. The flight profiles and the according fuel consumption can be calculated by using waypoints from flight plans and Base of Aircraft Data (BADA). This paper presents an approach to refine the fuel consumption by integrating the passenger load into the calculation. Since effects of emissions have to be assessed on a greater scale, such as on the European air traffic network, the presented approach provides cost functions for CO2 emissions for different aircraft types and load factors. The cost functions were derived by means of regression analyses of BADA based calculated flight profiles with a step size of one second. The calculations are based on real historic traffic scenarios of several days. The derived aircraft specific fuel burn coefficients enable a simple and efficient integration of CO2 estimations depending on the flight distance, load factor and aircraft type. This can be applied to large traffic scenarios to also study different set-ups such as travel restrictions, other disruptions or an alteration in the traffic system as a whole. In order to enable the assessment of further aspects of such changes to the European air traffic system at large and to foster reproducibility and comparability of related studies, we provide further general-purpose cost estimation functions for several important key characteristics. Besides fuel consumption, we develop cost estimations for air navigation fees and maintenance for conventional aircraft. Those functions are also provided for the design concept of a short-range all-electric aircraft. This propeller aircraft features game-changing technologies such as active laminar flow control, active load alleviation and advanced materials and structure concepts. The approaches discussed in this paper will focus on the generic aspects of aircraft related costs, which can be derived from general available data. For the sake of reproducibility, the results will be made publicly available.

Background: Simulation plays a crucial role in health studies, as it helps medical students apply their theoretical knowledge in real-life situations. Moulage is one of the techniques that helps in making simulation more realistic or high-fidelity. It uses special effects to emulate wounds for a better understanding of what the wound is like visually. Still, moulage is expensive, time-consuming, resource-intensive, and requires the training of staff, which is why we need to find low-cost substitutes for moulage materials. Method: When searching the database “PubMed” for the terms “Low-cost and Medical moulage”, we retrieved 222 studies, out of which when excluding results not related to low-cost, we obtained 62 studies, from which when removing studies that do not contain information regarding moulage, we found two papers, after referring to citations and cited articles of those papers, we ended up with six studies. Based on the selected articles and additional articles sourced from their reference list, a total of 11 studies were included in the review. Results: We understand that moulage is a technique that helps make simulations come alive, but the resources required to use it are at times, expensive, which is why we need to find methods to do low-cost moulage, and many studies address that it can be as simple as using homemade ingredients. Students from a previous study have talked about their opinions regarding the realistic component of moulage and whether if it is any different from other moulages. Most of the students agreed that the moulage ranked well in face and content validity. However, further innovations must be introduced in the field to be widely spread and lead to newer opportunities. Conclusion: Although the research done under moulage is limited, it is accepted that moulage is helpful for simulation-based studies and that low-cost moulage can help make medical studies a better experience for students studying it. Students have a favorable opinion on the realistic aspect of the low-cost moulage applied to them. Newer methods can be introduced to moulage, and it can be implemented in low-income countries.

Background: Simulations have historically aided training programs by providing a realistic and holistic replication of professional scenarios and procedures. Simulations have developed over the past 40 years to include varying fidelities and modalities of simulation. Learning in a simulation-centered environment has benefits, ranging from improved patient care to specific skills acquisition while catering to students’ numerous and varied learning approaches. Simulation is a multifaceted field that benefits all parties, the teachers, the learners, and the patients. The application of simulation to medical education and its amalgamation with other modes and substitutes allows for a more integrated learning and testing curriculum that advances the current trajectory of medical education. Such developments, however, are limited to resource rich areas, leaving behind low-middle income countries to use traditional, less evolved methodologies and practices. This review aimed to explore different aspects of simulation and focus specifically on low-cost task trainers and their accessibility. Method: The purpose of the study was to assess the accessibility of low-cost task trainers in terms of cost-effectiveness, distribution, validation, and frequency within specific specialties. To do so, 84 PubMed publications have been screened, and 39 filtered research studies have collected the necessary data. After analyzing the papers, we classified the following information – process, specialization, validation (y/n), costs, development location, and year of publication. Results: After carefully analyzing the accumulated data from the selected 39 publications, we found that most studies (i.e., 6 out of 39) were published in 2020. Emergency Medicine was the most common specialty for which low-cost trainers were developed (9 out of 39 procedural simulators); Otolaryngology followed this with 8 out of 39 trainers and general surgery with 7/39 of the task-trainers. The price ranges fluctuated and fell within the price bracket of USD 0 to USD 400 collectively. Our review also uncovered the concentration of development of such innovations solely in high income countries (HICs). Conclusion: Simulation is an invaluable tool applicable to a diverse range of phases of medical education. Future conjunction of simulation with low-cost substitutes along with increased encouragement and enthusiasm towards developing cost effective simulation-based learning environments (SBLEs) with the reserves and requirements of these areas in mind may prove to be a reliable option for low and middle resource settings

Background. Until now, cost of allergy treatment in insured public health care system and non-insured self-financing private health care system in Indonesia has not been well documented and published, as well as the cost of allergy treatment with subcutaneous immunotherapy. Objective. To evaluate the clinical and cost benefits of allergic rhinitis treatment in children with subcutaneous immunotherapy in non-insured self-financing private health care system. Methods. A retrospective cohort study conducted from 2015 until 2020, compared clinical improvement and health care costs over 18 months in newly diagnosed AR children who received SCIT versus matched AR control subjects who did not receive SCIT, with each group consisting of 1,098 subjects Results. Decrease of sp-HDM-IgE level (kU/ml) from 20.5 + 8.75 kU/ml to 12.1 + 3.07 kU/ml had been observed in the SCIT group. To reduce the symptom score of allergic rhinitis by 1.0 with SCIT it costs IDR 21,753,062.7 per child, for non SCIT it costs IDR 104,147,878.0 per child. Meanwhile, to reduce the medication score (MS) by 1.0 with SCIT it costs Rp. 17,024,138.8 while with non SCIT it costs Rp. 104,147,878.0. Meanwhile, to lower combination symptoms and medication score (CSMS) by 1.0, with SCIT it costs IDR 9,550,126.6, while with non SCIT it costs IDR 52,073,938.9. Conclusion. In conclusion, this first Indonesia-based study demonstrates substantial health care cost savings associated with SCIT for children with AR in an uninsured private health care system and provides strong evidence for the clinical benefits and cost-savings benefits of AR treatment in children.

It is often difficult to extract data on material and energy wates and related costs in the value chain of conventional production units. Many organizations are not fully aware of the actual cost of material and energy waste. For this purpose, advanced costing methods should be used. This study uses material and energy flow cost accounting to determine material costs, losses, and waste management. The case study of this research is the construction of turbine blades in Iran Power Plant Company. In this study, using the extracted data, the construction costs of turbine blades have been studied. The conventional method of making a turbine blade is the machining method, which we will see has a huge amount of wastes of materials and energy. By studying different methods, we will find that there is an alternative method called forging, which reduces losses and costs. Finally, the costs of the two methods are compared. Engineering economics techniques have also been used to compare two methods on a long-term planning horizon.

Introduction: Pharmaceutical products are inevitable for human health. Owing to the growing need for pharmaceuticals, pharmaceutical companies introduce drugs annually into the market in addition to the extensive collection of existing pharmaceutical products. Households, farms, health facilities, and pharmaceutical industries release pharmaceutical waste into the environment at low concentrations through routine pharmaceutical use, damage, and expiry. The effects of active pharmaceutical ingredients (API) on non-target species in the environment are not known. Over the years, pharmaceuticals such as diclofenac and ibuprofen in trace amounts have been detected in public water systems, ground and surface water. Unwanted medicines should be safely disposed of at a reduced financial cost to mitigate the public and environmental health risks. Lack of general knowledge of how to dispose of unused pharmaceuticals leads to improper disposal resulting in accidental toxicity, rising healthcare costs, landfills pilfering/scavenging, water supply pollution, anti-microbial resistance, and death. To mitigate such effects, pharmacists should raise public awareness about safe disposal practices. Objective: This review aims to examine the sources of pharmaceutical waste, disposal costs, secure disposal methods, the effects of inappropriate disposal, and the role of pharmacists in the disposal. Method: The information on the stated objectives was gathered from available sources through a comprehensive literature review. Conclusion: Many countries contain tons of pharmaceutical waste that are expensive to destroy. Because of improper disposal, pharmaceutical waste has been found at trace amounts in drinking and surface water. A practical, environmentally sustainable approach to pharmaceutical waste management, with policies and guidelines, and public awareness campaigns, are necessary to address the problem of safe waste disposal. The national drug regulatory bodies should conduct environmental risk assessment resulting from the disposal of unwanted pharmaceuticals. Pharmacists should facilitate extensive training on sustainable drug use and proper pharmaceutical waste disposal at all levels to reduce the risks associated with improper disposal. Reduction of pharmaceutical waste generation at each step of a drug’s lifecycle, implementing takeback options, collection at approved sites, and modern technology to treat wastewater are highly recommended to reduce the effects of unwanted pharmaceuticals on human health and the environment.

The Planning and implementation of construction projects are difficult processes and are burdened with many risk elements. The budget spread over time, which is developed on the basis of the schedule, presents the expected distribution of costs throughout the duration of the works, which during the implementation of the project is subject to constant changes resulting from time, cost and organizational factors. Managing construction contracts requires managers to be able to analyze on an ongoing basis the variances of production costs - from the values calculated in the offer cost estimate and assumed in the Budgeted Cost of Work Scheduled. The article attempts to analyze the emerging time and cost deviations using proprietary T/S and T/C monitoring, based on simple indicators of the EVM method. An example of construction of a multi-family housing development was used to study the variances of planned and incurred costs.

Planning and implementation of construction projects are difficult processes and are burdened with many risk elements. The budget spread over time, which is developed on the basis of the schedule, presents the expected distribution of costs throughout the duration of the works, which during the implementation of the project is subject to constant changes resulting from time, cost and organizational factors. Managing construction contracts requires managers to be able to analyze on an ongoing basis the variances of production costs - from the values calculated in the offer cost estimate and assumed in the Budgeted Cost of Work Scheduled. The article attempts to analyze the emerging time and cost variances using proprietary C-S and S-C monitoring, based on simple indicators of the EVM method. An example of construction of a multi-family housing development was used to study the variances of planned and incurred costs.

In the last years, the development of low-cost GNSS sensors allowed monitoring in a continuous way movement related to natural processes like landslides with increasing accuracy and limited efforts. In this work, we present the first results of an experimental low-cost GNSS continuous monitoring applied to the unstable slope affecting the Madonna del Sasso Sanctuary (NW Italy). The courtyard of Sanctuary is built of two unstable blocks delimited by high cliff. Previous studies and non-continuous monitoring showed that blocks suffer a seasonal cycle of thermal expansion and long-term trend to downslope of few millimeters per year. The presence of continuous monitoring solution, could be an essential help to better understand the kinematics of unstable slope and to recognize the beginning of a possible paroxysm phase that could end with a failure of the unstable area. We tested the accuracy of the instruments and the first year of experimental measurements are presented. We also propose a methodological approach that considers the use of automatized procedures for the identification of anomalous trends and a risk communication strategy based on monitoring data.

Project complexity is usually considered as one of main causes of cost overruns, resulting in poor performance and thus project failure. However, empirical studies focused on evaluating its effects on project cost remain lacking. Given this circumstance, this study attempts to develop the relationships between project cost and the multidimensional project complexity elements. We establish complexity as a multidimensional factor including the task, organization, market, legal, and environment complexities. This study uses an empirical evidence-based structural model to account for the relationships between project cost and project complexity. By doing so, a quantitative assessment of multi-dimensional project complexity has been developed. The findings suggest that task and organization complexities have direct effects on project cost, while market, legal and external environment complexities have indirect effects on project cost. The practical contribution is that the findings can improve the understanding of which dimension of complexity significantly influence project cost, and the need to focus efforts on strategically addressing that complexities.

Construction projects are usually operating in a complex and dynamic environment in which the accumulation of many interrelated factors causes high uncertainty. Construction projects are complex and frequently involve substantial uncertainties including process complicatedness, intricate organization structure, dynamic environment, and financial strain. The study aims to categorize the influencing factors into three groups, namely construction project system, economic-market climate, and external environment. It attempts to adopt a novel analysis tool to examine the relationship between the project cost and multiple influencing factors by using Bayesian SEM. While the Bayesian SEM method has been receiving increasing attention in exploring the relationship between latent variables, construction studies still heavily rely on the covariance-based SEM approach. This study introduces several advantages of Bayesian SEM that make it more flexible and powerful than covariance-based SEM and provides the foundation of Bayesian SEM estimation and inference by illustrating this method in a project cost application.

Construction projects are usually operating in a complex and dynamic environment in which the accumulation of many interrelated factors causes high uncertainty. Construction projects are complex and frequently involve substantial uncertainties including process complicatedness, intricate organization structure, dynamic environment, and financial strain. The study aims to categorize the influencing factors into three groups, namely construction project system, economic-market climate, and external environment. It attempts to adopt a novel analysis tool to examine the relationship between the project cost and multiple influencing factors by using Bayesian SEM. While the Bayesian SEM method has been receiving increasing attention in exploring the relationship between latent variables, construction studies still heavily rely on the covariance-based SEM approach. This study introduces several advantages of Bayesian SEM that make it more flexible and powerful than covariance-based SEM and provides the foundation of Bayesian SEM estimation and inference by illustrating this method in a project cost application.

The beginning of industrialization human being has observed a variety of environmental troubles in the world. This industrialization has not only brought growth and affluence but ultimately troubled the ecosystem. One of the crashes is visible, in form of water contamination. Here the current study heavy metal contamination of water body has been discussed. Effluents from a great number of industries viz., tannery, textile, pigment & dyes, paint, wood processing, petroleum refining, electroplating, leather etc., have a major amount of heavy metals in their wastewater. The conventional technique of handling heavy metal pollution includes chemical oxidation, chemical precipitation, ion exchange, reverse osmosis, membrane separation, electrodialysis etc. These processes are expensive, energy intensive and frequently related with generation of poisonous by-product. Therefore, the adsorption has been examined as a cost-efficient technique of elimination of heavy metals from wastewater. In the current study different low-cost adsorbent has been a review as an abatement of heavy metal contamination from wastewater. These adsorbent comprise materials of natural origin like peat moss, zeolites, clay, and chitin are found to be an effective agent for removal of deadly heavy metals like Pb, Cd, Zn, Cu, Ni, Hg, Cr etc. Separately from these, a variety of agricultural wastes like rice husk, waste tea, neem bark, black gram; Turkish coffee, walnut shell etc. were also known as a powerful adsorbent for heavy metal removal. at the side of that low-cost industrial byproduct like fly ash, lignin, iron (III) hydroxide and red mud, coffee husks, Areca waste, tea factory waste, sugar beet pulp, battery industry waste, blast furnace sludge, waste slurry, sea nodule remains and grape stalk wastes have been discovered for their technical possibility to eliminate toxic heavy metals from impure water.

Increasing distributed generation and intermittency, along with the increasing frequency of extreme weather events, impose a serious challenge for the electric power supply security. Understanding the costs of interruption is vital in terms of enhancing the power system infrastructure and planning the distribution grid. On the other hand, customer rights and demand response techniques are further reasons to study the worth of power reliability. In this paper, the authors make use of directional distance function and shadow pricing method for a case study from Finland. The aim is to calculate the cost of one minute of power interruption from the distribution network operator perspective. The sample consists of 78 distribution network operators from Finland with cost and network information between 2013 and 2015.

Widespread poverty is the most serious threat and social problem that Bangladesh faces. Regional vulnerability to climate change threatens to escalate the magnitude of this poverty. It is essential that projections of poverty be made while bearing in mind the effects of climate change. The main purpose of this paper is to investigate the agrarian sub-national regional analysis of climate change vulnerability in Bangladesh under various climate change scenarios and its potential impact on poverty. This study is relevant to socio-economic research on climate change vulnerability and agriculture risk management and has the potential to contribute new insights to the complex interactions in household income and climate change risks to agricultural communities in Bangladesh and South Asia. The current study uses analysis of variance, cluster analysis, decomposition of variance and log-normal distribution to estimate the parameters of income variability that ascertain vulnerability levels and help us to understand the poverty levels that climate change could potentially incur. It is found that the income share in income sources revealed that income category shares across the various regions of Bangladesh are far from uniform. The variance decomposition of income showed that agricultural income in Mymensingh and Rangpur is the main cause of income difference. Moreover, large variance of agricultural income in the regions is induced by gross income from rice production. Additionally, constant reduction of rice yield due to climate change in Bangladesh is not such a severe problem for farmers, however, the extreme events like flood, flash flood, drought, sea level rise, and greenhouse gas emission based on RCPs could increase the poverty rates in Mymensingh, Rajshahi, Barisal, and Khulna regions that would be highly affected by unexpected yield loss due to extreme climatic events. Therefore, research and development of adaptation measures to climate change for regions where farmers are largely dependent on agricultural income is important.

This research proposes a framework to assist wind energy developers to select the optimum deployment site of a wind farm by considering the Round 3 zones in the UK. The framework includes optimisation techniques, decision-making methods and experts’ input in order to help stakeholders with investment decisions. Techno-economic, Life Cycle Costs (LCC) and physical aspects for each location are considered along with experts’ opinions to provide deeper insight into the decision making process. A process on the criteria selections is also presented and seven conflicting criteria are being considered in TOPSIS methods in order to suggest the optimum location that was produced by the NSGAII algorithm. Seagreen Alpha was the most probable solution, followed by Moray Firth Eastern Development Area 1, which demonstrates by example the effectiveness of the newly introduced framework that is also transferable and generic. The outcomes are expected to help stakeholders and decision makers to make more informed and cost-effective decisions under uncertainty when investing in offshore wind energy in the UK.

Rifampicin is one of the most important chemotherapeutic agents used in the treatment of tuberculosis. M. tuberculosis clinical strains resistant to rifampicin harbor mainly mutation in an 81-base pair region of rpoB. These mutations mainly consist of single amino acid substitutions. However insertions also can be related with rifampicin resistance strains. Herein, we described an insertion of 12 nucleotides in clinical isolates of M. tuberculosis resistant to rifampicin, all obtained from inmates. To evaluate the importance this insertion in surviving and drug resistance, it were carried out fitness experimental assays as well as in silico studies of 3D structural models, molecular docking simulations and virtual screening. The medical records of the seven patients showed all were previously treated to tuberculosis. Growth curves shown that the insertion determines a biological cost when compared to wild type rpoB and katG; or the double mutated rpoB S531L and katG S315T. From docking and molecular dynamics simulations it can be inferred that the insertion does not affect the process of synthesis of RNA transcripts. On the other hand, in the mutant RNAP-RIF complex rifampicin confirmed a low affinity interaction for the mutant form. Interesting, virtual screening for potential inhibitors for wtRNAP and mRNAP using a library of 1446 compounds approved by the FDA showed that the best ligands were mainly compounds with antibiotic activity, although the targets involved in the pharmacological action are other than RNAP. In conclusion, seven strains of M. tuberculosis RIF resistant that present an insertion of four amino acids in RNA polymerase showed by growth curve assays, a biological cost. Further, bioinformatics tools had characterized the putative drug resistance dynamic as well as the maintenance of RNA polymerase activity.

The pollution of the bays in Abidjan is a major concern for the Ivorian policy makers. In fact, the pollution of the bays induce high costs to the society while impacting population health dramatically. As a result, pollution reduction management of production activities has been undertaken in the Cocody Bay area. To our knowledge, no study has yet proposed a model to evaluate the cost-effectiveness of these pollution management strategies. A cost-effectiveness model, based on Monte Carlo simulation, was developed to assess the economic and environmental impacts of various scenarios characterized by a set of production practices, both in the short term and in the long term. The authors discuss the steps and input parameters of the model presented. The proposed model may serve as the basis for identifying an optimal production scenario defined as the scenario with the best incremental cost-effectiveness ratio considering a willingness to pay (WTP) threshold. The WTP, to be estimated based on the gross domestic product of Côte d’Ivoire, represents the opportunity costs associated with selecting the optimal scenario. The current framework can also be applied to other settings facing similar challenge.

As argued by ‘Declaration of Concrete Environment (2010)’ of Korea and ‘Declaration of Asian Concrete Environment (2011)’ of six Asian countries, concrete as a single material has lately shown extremely large impact on environmental issues such as climate change. Assessment of environmental impact from concrete material and production has considerable importance. Concrete is a major material used in the construction industry that emits a large amount of substances with environmental impacts during its life cycle. Accordingly, technologies for the reduction in and assessment of the environmental impact of concrete from the perspective of Life Cycle Assessment must be developed. At present, the studies in relation to greenhouse gas emission from concrete are being carried out globally as a countermeasure against climate change. In this study, a sustainable concrete mix design algorithm was designed using correlation analyses, and its carbon emission and cost reduction performances were assessed. Using correlation analyses, the concrete strength, w/b and s/a ratios, and CO₂ emissions were identified as major variables of concrete mix design that influenced other variables. Also, this study aims to evaluate the CO₂ emission reduction performance of the algorithm-deduced sustainable concrete mix design, and therefore, the CO₂ emissions of the sustainable concrete mix design are compared with those of the actual concrete mix design applied to the construction of the office building A in South Korea.

This study explores the properties and behavior of bi-close-to-convex functions, introducing new subclasses defined by their relationship with fractional differential operator and bi-univalent functions. Using the Faber polynomial technique, we derive upper bounds for the n^{th} coefficient of functions in these classes. We also investigate the erratic behavior of initial coefficients in bi-close-to-convex functions, as characterized by the (λ,q)-fractional differintegral operator. Furthermore, we address Fekete-Szegö problems and present notable findings from our investigation, contributing to the continued growth and refinement of geometric function theory, yielding new insights and practical uses.

Background. IgA nephropathy (IgAN) is associated with chronic inflammation. Platelet-related parameters, such as platelet (PLT) count, platelet-to-albumin ratio (PAR) and platelet-to-lymphocyte ratio (PLR), were examined as potential prognostic indicators for renal and cardiovascular (CV) outcomes in IgAN. Methods. 150 IgAN patients were devided into two groups based on the cut-off value of PAR. All-cause mortality, major CV events and end-stage renal disease were the primary combined endpoints. Secondary endpoints, such as CV or renal endpoints, were also analyzed separately. Results. The patient’s mean age was 43.7 ± 13.5 years, and the follow-up time was 124 ± 67 months. The K-M curve showed that PLR, PAR and PLT were strongly associated with primary combined (p = 0.002, p = 0.004, p = 0.001) and renal outcomes (p < 0.001, p < 0.001, p < 0.001), but not with CV outcomes in IgAN. However, when combined with left ventricular hypertrophy (LVH) or metabolic syndrome (MetS) PAR was found to be a significant predictor of both primary (p < 0.001, p < 0.001) and secondary outcomes (p = 0.001 and p = 0.038; p = 0.001 and p = 0.015). Additionally, PLR correlated with microalbuminuria (r = -0.165, p = 0.033) and LVH (r = -0.178, p = 0.025), while PLT correlated with eGFR (r = 0.158, p = 0.040). Conclusion. Elevated PAR and PLR may predict progression to end-stage kidney disease, but in combination with LVH and MetS, they showed CV events also in IgAN. The determination of PAR and PLR can be useful and cost-effective parameters for assessing both cardiovascular and renal risks in CKD.

Background: The aim of this study has been to investigate if inflammatory biomarkers such as the systemic immune-inflammation index (SII), neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) have any correlation with the recurrence of pleomorphic adenomas (PA) in patients afflicted by this disease. Methods: A retrospective multicentre study involving two Italian centres, the Maxillofacial Sur-gery at the Policlinico Federico II in Naples and the ENT and Maxillofacial Surgery at the IRCCS G. Pascale National Cancer Institute in Naples, has been performed. The study, involving 608 pa-tients who had received a diagnosis of PA, was conducted between January 2000 and January 2020. A Receiver Operating Characteristic (ROC) curve was used to calculate the optimal cut-off values for the SII, PLR and NLR. A linear regression model (LRM) and a non-linear logistic re-gression model (NLRM) were realized with respect to the NLR, PLR and SII. Results: The highest performance was achieved by the NLR (cut-off 2.960) with the AUC = 0.91, with an accuracy of 96.1%, sensitivity of 78.4% and specificity of 97.2%, PPV = 64.4% and NPV = 98.6%. The LRM and NLRM including all the haematological parameters did not increase the per-formance in terms of recurrence detection. Conclusion: The NLR is an excellent support tool in predicting the recurrence of PA with a cut-off of 2.960. It can be a good reference point for surgical decision-making and follow-up in clinical practice.

Cement industry is one of the highest energy consuming industries. The quantity of fuel and energy needed accounts for most of the cost of cement manufacturing. Thermal power plants generate electricity but are harmful and ineffective by nature. As a backup mechanism to account for main grid failures, batteries can be utilized. In this paper the first ever investigation on battery’s depth of discharge (DOD) for four different kinds of battery technologies is carried out in the framework of cement industry. The intended battery technologies are the lead-acid battery (LA), lithium-ion battery (Li-ion), vana-dium redox battery (VR), and nickel–iron battery (Ni-Fe). Four hybrid energy generation models (HEGMs) for five cement plants of Pakistan using the HOMER pro software are proposed. Cement plants includes Askari Cement Plant, Wah (ACPW); Bestway Cement Plant, Kalar Kahar (BCPKK); Bestway Cement Plant, Farooqia (BCPF); Bestway Cement Plant, Hattar (BCPH); and DG Cement Plant, Chakwal (DGCPC). HEGM-1 comprises of a diesel generator (DGen), a photovoltaic system (PV), a converter, and a battery system. HEGM-2 comprises of a PV system, a converter, and a battery system. HEGM-3 is the grid-connected version of HEGM-1 and HEGM-4 is the grid-connected version of HEGM-2. A base-model consisting of grid only is used as a reference. A multi-criteria decision analysis (MCDA) is performed by formulating a cumulative objective function (COF) which includes net present cost (NPC), levelized cost of energy (LCOE), and greenhouse gas (GHG) emissions. The principal objective is the maximization of COF while simultaneously minimizing the objectives (NPC, LCOE and GHG emissions), based on optimal battery technology and DOD. The results reveal that VR is the most suitable battery technology with 10% DOD. It is achieved for DGCPC with HEGM-3 with 61.49% of NPC, 78.62% of LCOE and 84.00% of GHG emissions reduction as com-pared to the base model.

Background: Tuberculosis (TB) continues to be a serious public health threat that affects the most vulnerable population. Patients who are LTFU after TB diagnosis still represent one of the biggest challenges to TB control. Method: In this prospective observational study, we aimed to identify and analyse the risk factors associated with LTFU among TB patients who started first-line TB treatment in the Sanatorium Hospital in Luanda. Result: A total of 113 patients with TB were included between August 2018 and September 2019. Seventy-six (67.3%) patients were cured, 27 (23.9%) were LTFU, 5 (4.4%) died, 4 (3.5%) were transferred and 1 (0.9%) presented a treatment failure. After excluding those dead, transferred or who failed to treatment, we observed that severe TB at the time of diagnosis (OR 9.24, 95% CI 2.18-39.04) and food insecurity were significantly associated with LTFU (OR 5.96, 95% CI 1.66-21.41). Conclusion: The findings of our study are of enormous value to understand the reasons for the LTFU of patients with TB and can guide polices and facilitate designing measures to allow better adherence, and therefore, greater treatment success

Breast cancer (BC) affects millions of women; it is the leading cause of death by neoplasia in wom-en worldwide, with at least 500 thousand deaths each year, 70% of which occur in developing countries. Elastography evaluates tissue stiffness, making this a promising non-invasive real-time technique. BI-RADS is recognized as a standard and helpful technique for establishing BC risk. This study aimed to determine, by strain elastography (SE), the fat-to-lesion index (F/L index), sen-sitivity, specificity, and optimal cut-off to diagnose BC. This prospective study included 216 wom-en who underwent SE, ultrasound, mammography, and breast biopsy; according to mammogra-phy, we recruited BI-RADS category 2 (n= 5), category 3 (n=29), category 4 (n= 94), category 5 (n= 71) and category 6 (n=17); after biopsy, 108 women were classified as negative, and 108 were pos-itive for BC. Three expert BC radiologists performed all imaging interpretations and biopsies. Our results show mean values of the F/L index for negative biopsies of 3.70±2.57 and positive biopsies of 18.10±17.01; we developed two models for the prediction of BC, a logistic regression model with an AUC of 0.893 and a neural network with an AUC of 0.902. The Youden index yielded a F/L index cut-off >5.76, with a sensitivity and specificity of 84.26%. Positive Spearman's Rho cor-relation coefficient was observed between the F/L index and BI-RADS, r=.073 (p< 0.001). ANOVA test showed a difference between F/L index vs. molecular subtypes (p=0.002). SE is helpful as a di-agnostic complement to mammography, or in cases where the latter is contraindicated, elas-tography has an adequate predictive capacity and is a fast and minimally invasive procedure.

It has been proposed that upregulation of the noradrenergic (NA) system through exposure to novelty might be one of the key components for building cognitive reserve and resilience to neurodegeneration. A personality trait that promotes greater interest in novel experiences is Openness to Experience (OE). Individuals who are high in OE exhibit strong curiosity towards novelty and are more likely to be exposed to novel stimuli throughout the lifespan.Performing voxel-based morphometry analyses, we examined whether OE in 135 healthy young adults was associated with Locus Coeruleus (LC) - the main core of the noradrenergic system. We also investigated whether LC mediates the relationship between OE and a key measure of reserve, I.Q. In comparison with other neuromodulators’ seeds (Dorsal and Median Raphe [DR-MR] -5-HT, Ventral Tegmental Area [VTA] -DA- and Nucleus Basalis of Meynert [NBM] -Ach-), results show that greater LC integrity was related to greater OE and IQ. Additionally, mediation analyses revealed that only LC mediated the relationship between OE and IQ. Furthermore, a Bayesian multiple regression was conducted to model the contribution of both isolated and combined neuromodulator seeds to OE trait express. This approach found that the LC + VTA could account for more variance in OE expression compared to the LC alone. Other weaker but significant associations were observed between DR and OE, between LC + NBM and Conscientiousness and between DR + NBM and Extraversion. These results are together suggestive that OE is primarily underpinned by monoaminergic functioning, and that the LC-NA system plays a central role mediating the interdependence between OE expression and cognition (IQ level). While offering further understanding of the neurobiology of human personality, these findings indicate a pivotal role of LC-NA system integrity in novelty seeking in daily life. This provides a psychobiological account for how OE expression may be beneficial for maintaining the noradrenergic system to facilitate cognitive reserve and resilience to neurodegenerative conditions.

This paper compares the performance of three text-to-speech (TTS) models released from June 2021 to January 2022 in order to establish a baseline for Brazilian Portuguese. Those models were trained using dataset for Brazilian Portuguese. The experimental setup considers tts-portuguese dataset to fine-tune the following TTS models: VITS end-to-end model; glowtts and gradtts acoustic models both using hifi-gan vocoder. Performance metrics are arranged into objective and subjective metrics. As subjective metrics, the naturalness and intelligibility are measured based on the mean opinion score (MOS). Results shows that gradtts+hifigan model achieved naturalness of 4.07 MOS, close to performance of current commercial models.

Background: Vaccinating children against COVID-19 is an essential public health strategy in order to reach herd immunity and prevent illness among children and adults. Parents are facing tremendous stress in relation to the COVID-19 pandemic and the effectiveness of the COVID-19 vaccination program for children. In this study, we aimed to investigate parents’ willingness to vaccinate their children against COVID-19 in North Kivu province (DRC). Methods: A cross-sectional survey between December 01, 2021 to January 20, 2022 in 6 health zones (Goma, Karisimbi, Butembo, Beni, Kamango and Katwa) was conducted in the province of North Kivu. In each health zone, we selected 5 clusters (Health area) using the method of probabilistic selection proportional to population size. In total, 522 parents participated in our study. Results: Overall, 32.8% of parents intended to vaccinate their children. In the multivariate analysis, younger age of parents (aOR : 2.40, CI : [1.50-3.83]), higher level of fear that “a member of my family” could contract COVID-19 (aOR : 2.35, CI : [1.38-4.02]), higher level of perceived vulnerability to COVID-19 within the family (aOR : 1.70, CI : [1.005-2.2881]), higher level of perceived susceptibility to COVID-19 within the family (aOR : 3.07, CI : [1.80-5.23]), and history of vaccination against COVID-19 among parents (aOR : 16.47, CI : [8.39-32.33]), were significantly associated with the intention to have their children or adolescents vaccinated. Conclusion: Willingness of parents to vaccinate their children against the COVID-19 vaccination was low in North Kivu. There is undeniably in this region a need to reinsure the populations about vaccine safety for both children and adults. Public health authorities should also address widespread misinformation about vaccines in a timely manner.

With the COVID-19 pandemic continuing and the resulting economic burden increasingly apparent, the Indonesian government began to prepare a "new normal" phase and make peace with COVID-19. From this new decision arises the question of the readiness of businesses and the industrial sector to resume operations amid COVID-19. This article aims to provide concise and precise information about the preparations that can be made by businesses to operate safely amid COVID-19 based on existing scientific studies and literatures. From the literature visits it can be concluded that transmission and danger of a COVID-19 pandemic can be prevented through: creation of infectious disease prevention and response plan, implementing basic infection prevention measures, policies and procedures for proper identification and isolation of sick people, applying flexibilities in policies, and protections in the workplace.

Here we review and describe a set of research priorities to meet present and future challenges posed to farmed animal production that build on progress, successes and resources from the Functional Annotation of ANimal Genomes (FAANG) project.

South America has become the new epicenter of the coronavirus, especially in Brazil where the disease continues to spread exponentially across the country. This text aims to analyze the psychosocial factors of Covid-19 on back to school strategies in Brazil from a bioecological perspective. At the microsystem level, the population is experiencing different levels of stress and fear; at the mesosystem level, changes in routines, separation from family and friends, and closure of schools; and at the macrosystem level, national guidelines to control the pandemic, institutional standards on a national and international scale. Therefore, the main focus for the success of school return must be in the prevention of contagion and with physical and psychological health, and should not only consider the demands of curricula, financial or administrative management. For this reason, it is paramount that greater female representativeness is increased in decision-making levels of the meso and macrosystem, regarding the resumption of school and academic activities in the pandemic period, since the number of female leaders in decision-making, is still insufficient.

The COVID-19 pandemic has presented the world with increased challenges. The response to this pandemic has led to a sudden disruption of routine medical and elective surgical care. Most hospitals across the globe have had to change the way outpatient clinics are carried out and postpone non-urgent elective surgical procedures. NHS England ceased all elective general surgeries to train and re-deploy their staff to support the increased pressures from COVID-19 in an intensive care setting. However, with a decline of reported cases and deaths, the return to undertaking non-urgent elective services is imminent. In May 2020, Radha and Afzal published the first evidence-based guidelines for the resumption of elective orthopaedic services titled “Evidence based suggestions for the return to elective orthopaedic surgery following the COVID-19 Pandemic”. The pathway presented is adapted from the “Evidence based suggestions for the return to elective orthopaedic surgery following the COVID-19 Pandemic” and could potentially be used as a model for other surgical specialities. We present a three-phased return back to urological services. Safe resumption of elective care is possible but needs to be carefully planned.

Most large fibers in central nervous system of vertebrates are decussated. The cause or the evolutionary force of this phenomenon is not convincingly described. Here we show a pattern for this nervous system property that simultaneously is found to a more basic rule in evolution.The idea here is the "function to anatomy" theorem. We claim that functions of physical, biochemical, enzymatic, etc., in lower scale of living organisms "emerge" to anatomy in larger scales. And reversely, the anatomy we see in multicelular organisms are/were functions in microscopic scales.We propose descriptions, predictions, and a probable road map to what this can implicate in biological and medical issues.

In 2014, the outbreak of adenoviral pneumonia occurred in Korean military training center. However, there is limited data on characteristics of fever and its response to antipyretics therapy in immunocompetent adults with adenoviral positive community-acquired pneumonia (CAP). Medical records of patients who were admitted to Armed Forces Chuncheon Hospital for treatment of CAP between January 2014 and December 2016 were retrospectively analyzed. We evaluated demographics, clinico-laboratory findings and radiologic findings at admission were compared between adenovirus positive (Adv) group and adenovirus negative (non-Adv) group. Out of 251 military personnel with CAP during the study periods, 67 were classified into Adv group while 184 were Non-Adv group. Patients with Adv group had a longer duration of fever after admission and symptom onset. Adv group patients had a higher mean temperature at admission and more observed over 40 and 39 to 40℃. Adv group patients had more commonly observed no response to antipyretic treatment and adverse events after antipyretics use. Length of hospital stay had no significant difference between two groups and no patient died in both groups. In our study, Adv positive CAP in patients with immunocompetent military personnel had distinct characteristics of fever and response to antipyretic treatment.

An understanding of the cultural conditions that determine the factors affecting nurses’ intention to leave is important for countries suffering from nurse shortage. Aim: to examine factors influencing intention to leave among female hospital nurses in a large Japanese sample, classified into four generations by age considering economic conditions. Methods: a cross-sectional survey with convenience sampling was conducted. Anonymous self-administered questionnaires were distributed to all nurses in 30 hospitals. To assess intention to leave, basic attributes, life conditions, work characteristics, and factors of psychosocial work environment were addressed. After classifying data into four generations based on age cohorts, we conducted multivariate logistic regression analysis using the completed data (N = 5,074, mean age = 36.24). Results: regardless of generational characteristics influenced by economic conditions, effort and monetary reward were generation-common factors. Over-commitment, social support, and the presence of a role model were generation-common factors in three generations. While having children increased intention to leave in the generation born 1965–1979, having family members in need of caregiving other than children decreased the risk in the generation born in the 1980s. Conclusion: generational countermeasures considering factors of psychosocial work environment and life conditions are needed to avert female nurse turnover.

Microaggressions are subtle verbal and non-verbal slights based on group membership, and they are ubiquitous in the lives of racial minorities, women, and LGBTQ individuals (Sue, 2010). The goal of the current paper is to introduce a role-playing based exercise on effective responses to microaggressions. The workshop draws on the prejudice responding workshops of Plous (2000) and Lawson, et al. (2010) but integrates research-based strategies. The activity was tested in two groups of undergraduate students, and the findings suggested that both groups felt more prepared to deal with microaggressions after participating.

Monochromatic documents claim for much less computer bandwidth for network transmission and storage space than their color or even grayscale equivalent. The binarization of historical documents is far more complex than recent ones as paper aging, color, texture, translucidity, stains, back-to-front interference, kind and color of ink used in handwritting, printing process, digitalization process, etc. are some of the factors that affect binarization. This article presents a new binarization algorithm for historical documents. The new global filter proposed is performed in four steps: filtering the image using a bilateral filter, splitting image into the RGB components, decision-making for each RGB channel based on an adaptive binarization method inspired by Otsu's method with a choice of the threshold level, and classification of the binarized images to decide which of the RGB components best preserved the document information in the foreground. The quantitative and qualitative assessment made with 21 binarization algorithms in three sets of “real world” documents showed very good results.

HER2/neu positive breast tumors predict a high mortality and comprise 25-30% of breast cancer. We have shown that Flavokawain A (FKA) preferentially reduces the viabilities of HER2 overexpressing breast cancer cell lines (i.e. SKBR3 and MCF7/HER2) versus those with less HER2 expression (i.e. MCF7 and MDA-MB-468). FKA at cytotoxic concentrations to breast cancer cell lines also has minimal effect on the growth of non-malignant breast epithelial MCF10 cells. FKA induces G2M arrest in cell cycle progression of HER2 overexpressing breast cancer cell lines through inhibition of Cdc2 and Cdc25C phosphorylation and down-regulation of Myt1 and Wee1expression leading to increased Cdc2 kinase activities. In addition, FKA induces apoptosis in SKBR3 cells by increasing the protein expression of Bim and BAX and decreasing expression of Bcl₂, Bcl_x/L , XIAP and survivin. FKA also down-regulates the protein expression of HER-2 and inhibits AKT phosphorylation. Herceptin plus FKA treatment leads to enhanced growth inhibitory effect on HER-2 overexpressing breast cancer cell lines through down-regulation of Myt1, Wee1, Skp2, Survivin and XIAP. Our results suggest the promise of FKA as a novel apoptosis inducer and G2 checkpoint abrogating agent in combination with Herceptin for treatment of HER2 overexpressing breast cancer.

Neutrophil to lymphocyte ratio (NLR) is a promising predictive and prognostic factor in breast cancer. We investigated its ability to predict disease-free survival (DFS) and overall survival (OS) in patients with luminal A or luminal B-HER2-negative breast cancer who received neoadjuvant chemotherapy (NACT). Pre-treatment complete blood cell counts from 168 consecutive patients with luminal breast cancer were evaluated to assess NLR. The study population was stratified into NLRlow or NLRhigh according to a cut-off value established by receiving operator curve (ROC) analysis. Data on additional pre- and post-treatment clinical-pathological characteristics were also collected. Kaplan-Meier curves, log-rank tests, and Cox proportional hazards models were used for statistical analyses. Patients with pre-treatment NLRlow showed a significantly shorter DFS (HR 6.97, 95% CI 1.65-10.55, p= 0.002) and OS (HR 7.79, 95% CI 1.25-15.07, p= 0.021) compared to those with NLRhigh. Non-ductal histology, luminal B subtype, and post-treatment Ki67≥ 14% were also associated with worse DFS (p= 0.016, p= 0.002, and p= 0.001, respectively). In multivariate analysis, luminal B subtype, post-treatment Ki67≥ 14%, and NLRlow remained independent prognostic factors for DFS, while only post-treatment Ki67≥ 14% and NLRlow affected OS. The present study provides evidence that pre-treatment NLRlow helps identify women at higher risk of recurrence and death among patients affected by luminal breast cancer treated with NACT.

African scientific research faces formidable challenges, particularly with limited access to state-of-the-art measurement instruments. The high cost associated with these devices presents a significant barrier for regional research laboratories, impeding their ability to conduct sophisticated experiments and gather precise data. This predicament not only hampers the individual laboratories but also has broader implications for the African scientific community and the advancement of knowledge in developing nations—the financial cost barrier considerably impacts the research quality of these laboratories. Reflection on technical and economical solutions needs to be quickly found to help these countries advance their research. In civil Engineering, the thermal conductivity property is the most important measurement for characterising heat transfer in construction materials. Existing devices (i.e., conductometers) in a laboratory are expensive (approximately 30,000 euros) and unavailable for some African laboratories. The study proposes a new and affordable device to evaluate thermal conductivity in construction materials. The method involves establishing a thermal flux between a heat source ( from the Joule effect provided by steel wool where a current is circulating) and a cold source (generated by ice cube) under steady-state conditions. The development of the cylindrical prototype is based on the comparative flux-meter method outlined in the measuring protocol of the ASTM E1225 standard document. Experiments were conducted on four distinct materials (polystyrene, wood, agglomerated wood, and rigid foam). The results indicate a correct correlation between the experimental values obtained from the newly developed prototype and the reference values found in the literature. For example, concerning the experimental polystyrene study, the detailed case analysis reveals a good correlation, with a deviation of only 4%. The percent error found falls within the acceptable range indicated by the standards recommendations of the ASTM E1225 standard, i.e., within 5% acceptable error.

This study was to identify clinical cancer biomarkers for recurrent gastric cancer survivors using artificial intel-ligence. From a hospital-based cancer registry database in Taiwan, the datasets of the incidence of recurrence and clinical risk features were included in 2476 gastric cancer survivors. We benchmarked Random forest with MLP, C4.5, AdaBoost, and Bagging algorithms on metrics and leveraged synthetic minority oversampling technique (SMOTE) for imbalanced dataset issues, cost-sensitive learning for risk assessment, and SHapley Additive ex-Planations (SHAP) for feature importance analysis in this study. Our proposed Random forest outperformed the other models with an accuracy of 87.9%, a recall rate of 90.5%, an accuracy rate of 86% and F1 of 88.2% on re-current category by a 10-fold cross-validation in a balanced dataset. We identified clinical features of recurrent gastric cancer, which are the top five features, stage, number of regional lymph node involvement, Helicobacter pylori, BMI(body mass index), and gender, which significantly affect the prediction model's output, are worth paying attention to in the following causal effect analysis. Using an artificial intelligence model, the risk factors for recurrent gastric cancer could be identified and cost-effectively ranked according to their feature importance. In addition, they should be crucial clinical features to provide physicians with the knowledge to screen high-risk patients in gastric cancer survivors as well.

Recent literature has seen a rapid expansion in the reference to front-end forensics as an indication of the untapped value of forensic science. While some of these contributions have centered on development of forensic intelligence from a single area of investigation, others call for a more fundamental change in the relationship between crime laboratories and policing, particularly relating early laboratory analysis with big datasets to provide leads to investigators. We highlight several recently implemented tactical strategies of crime laboratories that contribute to the body of forensic intelligence. Beyond the scientific gains from these tactical applications, the corresponding details on associated efficiencies, costs, time savings, and quality improvements offer insights towards patterns of success for the community of crime laboratories. Further details expand an interpretation of what constitutes success with an eye on the contributions of the crime laboratory towards public health, safety, and protection of the innocent in addition to societal gains from conviction of the guilty. The economic interpretation of the value provided by the forensic laboratory assists in the cost-benefit review of strategic and tactical decisions and supports the justification for laboratory public funding with measures of the return on investment from public support of the forensic laboratory

The study of velocimetry is important for characterizing and comprehending the effects of fluid flow, and the Particle Image Velocimetry (PIV) technique is one of the primary approaches for understanding the velocity vector field in a test section. Commercial PIV systems are expensive, with one of the main cost factors being high-speed camera equipment capable of capturing images at high frames per second (fps), rendering them impractical for many applications. This study proposes an evaluation of utilizing smartphones as image acquisition systems for PIV technique application. An experimental setup inspired by the known angular displacement of synthetic particles is proposed. A stepper motor rotates a plate containing an image of synthetic particles on its surface. The motion of the plate is captured by the smartphone camera, and the images are processed using PIVlab-MatLab® software. The use of two smartphones is assessed, with acquisition rates of either 240 fps or 960 fps and varying angular velocities. The results were satisfactory for velocities up to 0.7 m/s at an acquisition rate of 240 fps and up to 1.8 m/s at 960 fps, validating the use of smartphones as a cost-effective alternative for the PIV technique.

This work presents a new model to obtain the minimum cost design for a rectangular isolated footing, taking into account that the column is located in any part of the footing. The methodology is developed by integration to obtain the moments, bending shear and punching shear according to the American Concrete Institute ACI 318-14. This document presents the simplified and precise equations of the four moments, four bending shears and one punching shear acting on the footing. Some designs have been developed by the trial and error method to determine the footing dimensions, and later the thickness and steel area of the footing are obtained. Some authors present the minimum cost design for a rectangular isolated footing taking into account that the column is located in the center of gravity of the footing, and other authors present very complex algorithm. Numerical examples are presented to obtain the minimum cost design of rectangular isolated footings under biaxial bending, and some results are compared with those of other authors considering the same conditions. The new model presents a smaller contact area with the soil and a lower design cost than those presented by other authors.

We study the robustness of the cμ-rule for the optimal allocation of a resource consisting of one unreliable server to parallel queues with two different classes of customers. The customers in queues can be served with respect to a FCFS retrial discipline, when the customers at the head of queues repeatedly tries to occupy the server in a random time. It is proved that for the scheduling problem in the system without arrivals the cμ-rule minimizes the total average cost. For the system with arrivals it is difficult directly to prove the optimality of the same policy with explicit relations. We derived for an infinite-buffer model a static control policy that also prescribes for the certain values of system parameters the service exclusively for the class-i customers if both of queues are not empty with the aim to minimize the average cost per unit of time. It is also shown that in a finite-buffer case the cμ-rule fails.

Most of the literature on the optimization problem of transportation in supply chain networks (SCN) considered fixed costs (FC). However, in the practical applications of this problem it is important to study the effect of FC. This paper examines the impact of fixed cost increase as well as the variable cost on the optimization of a Two-Stage SCN. To do so, two mathematical models for mixed-integer nonlinear programming are developed. The first model optimizes fixed and variable costs in addition to the opening cost, whereas the second model only optimizes variable and opening costs. To evaluate the effect of considering FC on the optimization supply chain problem, four groups of instances are randomly generated, and solved using Lingo. The results of the two models are compared utilizing the average percentage deviation. In addition, sensitivity analysis is performed to determine the impact of changes in opening and variable costs on the considered optimization problem. The computational results and the sensitivity analysis show that the first model with minimized FC outperforms the second model, which does not consider the FC in minimization and FC affect the optimization.

Among all Brazilian economic sectors, the livestock sector stands out due to its large production and high export volume. However, beef production is associated to significant environmental impacts, such as deforestation and greenhouse gas (GHG) emission. The Paris Agreement was settled to avoid that global mean temperature rise up to 1.5 – 2º C by 2100. In 2020, Brazil committed in its nationally determined contribution (NDC) to reduce its GHG emission by 43% until 2030. This study aims to identify the association of beef production and beef cattle emissions, as well as assess predictive GHG emission scenarios for 2030 and value these emissions. To translate the environmental impacts of beef production into economic impacts, and thus amplify the discussion, we valued GHG emissions using the social cost of carbon (SCC). The results showed that the business as usual (BAU) GHG emission derived from beef production would range between 0.423 and 0.634 GtCO₂e in 2030, whereas the maximum emission estimated to meet the NDC should be 0.257 GtCO₂e. The SCC revealed the opportunity to reduce between US $18.8 and $42.6 billion in the cost of BAU emissions from beef production in 2030 if the NDC is met. Lastly, assessing a scenario where climate targets and beef exports are prioritized, between 2-10 kg of beef per capita would be available in the domestic market in 2030. Our results reveal the need and urgency of changes in livestock production to emit less GHG per kg of beef produced, and the avoided monetary cost of reducing emissions.

Industrial effluents contain contaminants that pose threats to the environment and human health. Bioremediation is an environmentally friendly, sustainable, and cost-effective approach to degrade or transform pollutants using microbial enzymes. Laccase is a versatile enzyme that oxidizes a wide range of substrates, such as dyes, phenolic compounds, pesticides, and polycyclic aromatic hydrocarbons (PAHs), with the consumption of molecular oxygen. Laccase can also remove heavy metals by forming complexes with organic ligands or reducing them to fewer toxic forms. However, the application of laccase in bioremediation is limited by its low production, stability, and specificity. Recombinant technology has been employed to enhance the expression, activity, and stability of laccase in various bacterial hosts. Immobilization techniques have been developed to improve the reusability and stability of laccase in different environmental conditions. This review summarizes the recent developments in the production optimization of recombinant laccase enzymes and their role in the bioremediation of industrial effluents. It also discusses the challenges of laccase-based biocatalytic systems for environmental cleanup.

Medical tests' cost-effectiveness analysis reveals a strong correlation between their accuracy and analysis results. Theoretically, we provide two lower bounds that medical tests' accuracy must exceed to be considered cost-effective. Theoretically, we provide two lower bounds that the accuracy of medical tests meeting cost-effectiveness must exceed. First, medical tests' accuracy should surpass the lower bound of matching requirements for each patient to receive the most appropriate intervention based on their test results. Second, the overall lower limit should be exceeded for the medical testing to be cost-effective for the patients as a whole. Furthermore, the conclusions from this model also provide an economic explanation for the under-diagnosis of rare diseases and the challenges faced in implementing precision medicine for minority patients. A numerical simulation example validates the conclusions of this paper.

As traditional supply chains face increasingly severe environmental issues and countries promote green development and sustainable development policy concepts, cultivating green supply chain operation models is gradually being highly valued by current governments and enterprises. Generally speaking, the production of green products incurs higher additional costs and thus their total production costs also increase. In this work, the product green level is related to the random demand. Under the green supply chain buy-back contract with the green product R&amp;D cost sharing between the manufacturer and the retailer, both the product green level and the order quantity need to be decided to maximize the channel profit. In order to coordinate the green supply chain, the manufacturer needs to share both the risk of good salvage and the green product R&amp;D cost with the retailer. We find that both the wholesale price and buy-back price increase in the manufacturer’s proposition of the green product R&amp;D cost, but decrease in emission reduction efficiency coefficient or carbon trading price. In addition, the product green level, the optimal order quantity and the channel profit increase in emission reduction efficiency coefficient, but decrease in the R&amp;D cost coefficient of the product green level. Interestingly, we find that if the carbon trading price is low, the manufacturer will set a low product green level and the product carbon emission trading is a cost for the supply chain. The increment of the carbon trading price leads to a higher cost such that the channel profit is decreased. However, if the carbon trading price is high, the manufacturer will set a high product green level and the product carbon emission trading is a revenue for the supply chain. The increment of the carbon trading price leads to a higher revenue such that the channel profit is increased.

3D printing is commonly used to create complex objects at a low cost. It has also been applied in the fabrication of metamaterials and metasurfaces, which alter the propagation path of electromagnetic waves. These structures have diverse applications, including enhancing beam direction, improving antenna gain and signal-to-noise ratio, and creating filters and reflectors. Metasurfaces are cheap to fabricate and their use is expected to boost antenna efficiency in 5G telecommunications and beyond. However, accurately characterizing their profile remains a significant challenge. This paper presents a low-cost fully automated 4-axis instrument for microwave metasurface charac-terization, overcoming limitations of manual methods and offering an efficient and accurate approach. This research represents a significant advancement in microwave metasurface characterization, enabling sophisticated techniques to advance wireless communication technolo-gies, as it is the case of the future 5G and millimeter-wave communication systems. The equipment has an approximate cost of $1550 USD and was able to characterize a metalens with a focal distance of 20 cm designed for signals at 30 GHz. It was possible to create 2D and 3D profiles of the intensity distribution focused by the metalens and extract parameters such as the gain (8.05 dB), 3dB depth of focus (11 cm) and full width at half maximum (2.17 cm). The comparison of the measurements with the diffraction calculations of the metalens showed a very good agreement between the in-tensity distributions and the parameters of the metalens.

Background Out-of-pocket costs are key expenses that many individuals incur in order to receive health services. They have been identified as a key access barrier for vulnerable populations, in particular for populations affected by neglected diseases with a chronic progression, such as Chagas disease. It is important to understand the costs of accessing healthcare services that are borne by patients with T. cruzi infection. Methodology We prepared a structured survey for patients with T. cruzi infection/Chagas disease who were all treated by the healthcare system in endemic municipalities in Colombia. The results were analyzed according to three categories: 1. the socioeconomic profiling of the patients; 2. the costs of and time spent on transportation; and 3. the opportunity costs (money that was not earned) related to treatment at the local primary care hospital or at the high-complexity reference hospital. Main findings Ninety-one patients answered the survey voluntarily. The data revealed that, when treated at the specialized reference hospital, patients spent 5.5 times more on food and accommodation, transportation costs were five times higher, and the loss of earnings was three times higher than when they were treated at the local primary care hospital. Moreover, the amount of time spent on transportation was 4 times higher at the reference hospital. Conclusions Providing comprehensive healthcare services for Chagas management at local primary healthcare hospitals would allow the most vulnerable patients to save on expenses related to medical and non-medical costs (out-of-pocket costs), in turn leading to higher adhesion to treatment thus benefiting the health system as a whole. These findings are in alignment with the WHO’s World Health Assembly 2010 Resolution on the importance of treating Chagas at local primary care hospitals, thereby saving patients time and money, allowing for timely care, and promoting access to healthcare.

BACKGROUND: The National Lung Screening Trial (ILST) and the NELSON study showed that lung cancer-specific mortality can be reduced by 20-24% using low-dose computed tomography (LDCT) screening in high-risk populations, due to an increase in early-stage diagnoses. RESEARCH QUESTION: How much lung cancer-related direct costs may be reduced using a LDCT screening programme based on the ILST protocol in a public healthcare system?STUDY DESIGN AND METHODS: Cost analysis of lung cancer screening (LCS) vs. usual care in the framework of the retail price of the Catalan public healthcare system. The LCS group included costs of screening (ILST protocol), treatment cost according to weighted average distribution of TNM staging in the NLST and NELSON trials, lung cancer detection rate (CDR) and smoking cessation intervention. The usual care group included treatment costs based on distribution of TNM staging registered in the Spanish index hospital. RESULTS: In the usual care group, treatment costs were €91,959. In the 5-year duration of the LCS programme, the average expected costs per subject were €1,342 (range €1,054-1,832 depending on malignancy in detected nodules) for screening and €32,431 for treatment, with an expected reduction of €952 based on an average CDR of 1.6%. The decrease in cost resulting from stage shift offsets 70.6% of the costs of the screening programme. INTERPRETATION: Baseline 5-year LCS costs are low according to the ILST protocol. In the Catalan public healthcare system, the expense reduction from the stage shift due to the LCS programme compensates a substantial part of its costs.

As China put forward its “carbon emissions peak and carbon neutrality” goals, how to achieve carbon reduction had become a key for China’s goal. The manufacturing industry is an important source of carbon dioxide emissions. For a manufacturing country like China, adjustments in various aspects of the industry would have a huge impact on carbon emissions. As an important reform of contemporary production mode, the process of production automation in China will inevitably affect China's carbon emissions. Therefore, the analysis of the impact of production automation on carbon dioxide emissions was an important basis for judging the future carbon reduction in China. Refer to the traditional study of carbon Kuznets curve, this paper analyzed the impact of average wage on production automation and the role of production automation in the carbon Kuznets curve(CKC). This paper proposed that production automation plays a mediating role in the process of carbon emissions, and gives a verification model of the mediating role. By analyzing the relationship between average wage and production automation process, the U-shaped curve relationship between them was verified. By examining the relationship between carbon dioxide emission data and production automation industry in China, we verified that production automation plays a partial mediating role in the change of carbon Kuznets curve. Combined with the analysis of the two parts, this paper believed that with the continuous development of China's intelligent manufacturing industry, China's carbon reduction prospects were more optimistic, and there was a good industrial foundation to achieve the “carbon peaking and carbon neutrality” goals. Finally, this paper proposes policy suggestions as increase research investment in production automation, help promote the application of production automation, encourage the research and application development of low-carbon technology, especially encourage modular design, so as to give full play to the role of production automation in the process of carbon neutrality in China.

Primary and secondary cardiovascular prevention is less effective than expected due to the concern about polymedication by professionals and the lack of patient adherence to medications prescribed in the medium and long term. Polypills have been presented as a possible solution. A comprehensive bibliographic review is presented about polypills as mechanisms for facilitating adherence and a proposed guide for the use of polypills for the prevention of cardiovascular risk. 41 articles were included, showing options for the polypill as a method of primary and secondary cardiovascular prevention.The polypill increases therapeutic adherence in the medium and long term, also increasing the therapeutic results compared to the administration of the various drugs separately. Based on the evidence, a flow diagram is proposed for the prescription of a polypill.Polypills increase the effectiveness and adherence of patients to primary and secondary cardiovascular prevention programs, without increasing the cost of the intervention. The use of a polypill in cardiovascular prevention can be effective as a prescription tool.

River valley bottoms have hydrological, geomorphological, and ecological importance and are buffers for protecting the river from upland nutrient loading coming from agriculture and other sources. They are relatively flat, low-lying areas of the terrain that are adjacent to the river and bound by increasing slopes at the transition to the uplands. These areas have under natural conditions, a groundwater table close to the soil surface. The objective of this paper is to present a stepwise GIS approach for the delineation of river valley bottom within drainage basins and use it to perform a national delineation. We developed a tool that applies a concept called cost distance accumulation with spatial data inputs consisting a river network and slope derived from a digital elevation model. We then used wetlands adjacent to rivers as a guide finding the river valley bottom boundary from the cost distance accumulation. We present results from our tool for the whole country of Denmark carrying out a validation within three selected areas. The results reveal that the tool visually performs well and delineates both confined and unconfined river valleys within the same drainage basin. We use the most common forms of wetlands (meadow and marsh) in Denmark's river valleys known as Groundwater Dependent Ecosystems (GDE) to validate our river valley bottom delineated areas. Our delineation picks about half to two-thirds of these GDE. However, we expected this since farmers have reclaimed Denmark's low-lying areas during the last 200 years before the first map of GDE was created. Our tool can be used as a management tool, since it can delineate an area that has been the focus of management actions to protect waterways from upland nutrient pollution.

The residential sector in the United States is in need of comprehensive policy-making reforms that concurrently address housing affordability and environmental sustainability. This study investigates the feasibility of state-wide zero-energy affordable housing by analyzing historical data on climate, energy use, and solar system costs in the Commonwealth of Virginia. The hypothesis examined is that the net present cost of implementation of rooftop residential solar systems to achieve zero-energy Low-Income Housing Tax Credit (LIHTC) buildings is lower than the discounted present cost of energy of otherwise identical conventional buildings that run without renewable energy generation systems. The authors propose a generalizable framework for analyzing the feasibility of achieving region- or state-wide zero-energy LIHTC developments. To validate the framework, the authors employ a longitudinal sample of monthly energy use data from 2013-2016 obtained from 310 residential units of 15 LIHTC developments across the state. Based on statistical regression analysis, energy simulation, and simulation-based risk analysis, the authors find that the net present value of zero-energy LIHTC investments can be positive with a low risk. The investment value varies often depending on the zero-energy building definition, weather characteristics, retail price of electricity, and incentive rate. This study can help housing policymakers and industry professionals analyze and benchmark the feasibility of innovative zero-energy housing policies and projects.

Microsystems are key enabling technologies, with applications found in almost every industrial field, including in-vitro diagnostic, energy harvesting, automotive, telecommunication, drug screening, etc. Microsystems, such as microsensors and actuators, are typically made up of components below 1000 microns in size that can be manufactured at low-unit cost through mass-production. Yet, the development of microsystems for commercial or educational purposes, has typically been limited to upper income countries due to the initial investment costs associated with the microfabrication equipment and processes. However, recent technological advances have enabled the development of low-cost microfabrication tools. In this paper, we describe a range of low-cost approaches and equipment (below £1000), developed or adapted and implemented in our laboratories. We describe processes including photolithography, micromilling, 3D printing, xurography and screen-printing used for the microfabrication of structural and functional materials. The processes that can be used to shape a range of materials with sub-millimetre feature sizes are demonstrated here in the context of Lab-on-Chips, but they can be adapted for other applications. We anticipate that this paper, which will enable researchers to build a low-cost microfabrication toolbox in a wide range of settings, will spark a new interest in microsystems.

Face milling is a well known commercial process highly used in heavy industries that consumes high amount of power. Besides power issue, modern manufacturing industries are aiming for per part cost reduction keeping the product quality unimpaired. Unexpectedly if the part is rejected in any stage of manufacturing, the cost of manufacturing dramatically increases. Major cause of part rejection is excessive tool wear that imparts poor surface profile or catastrophic tool failure that causes adherence of broken tool debris onto machined surface. Furthermore, the tool wear is associated with sliding distance (frictional distance) and the tool life quantifies the cost of tools. As such, from the perspective of manufacturing industries it is imperative to optimize the surface quality parameter, cost of part, power consumption, and material removal – this is exactly what is accomplished here. By this work, it is possible to conserve power consumption, produce parts with lower cost, manufacture with uncompromising surface quality and enhanced material removal rate. Moreover, as intermediate factors of interest, the influences of sliding distance, tool life and tool flank wear on the overall machining performance are evaluated. The multi-objective optimization by Grey Relational Analysis (GRA) revealed that for improved product performance and fast manufacturing (case 1) optimum results are: feed per tooth fz = 0.25 mm/tooth, cutting speed vc = 392.6 m/min and cutting length l = 0.5 mm; for resource conservation (case 2) the optimum results are: feed per tooth fz = 0.125 mm/tooth, cutting speed vc = 392.6 m/min, cutting length l = 0.5 mm.

Information regarding the cost of a construction project is available to the investor and project participants in order to determine the subsequent success of a project, given that the information they collect has an impact on the decisions they make. Cost calculations, especially in the initial phase of a project, often generate large errors. This paper presents the new approach based on a combination of the Case Based Reasoning method (CBR) with the originally selected criteria for the description of a construction project (as a result of Pearson correlation coefficient and Spearman's rank correlation coefficient) and Building Information Modeling (BIM) technology. The CBR method fulfils expectations for a simple and fast system supporting the cost estimation process. It does not require any specialist knowledge, so it will be comprehensible to cost estimation practitioners. The BIM-based model gives the opportunity for the calculation of quantity take-offs and enables the use of the information contained in the BIM model in the cost estimation process. In order to prepare the model an appropriate relational database had to be developed. With extensive research, a database of 173 construction projects, including the construction of a sports field, was obtained. There were 14 variables defined originally by authors; however, only 10 (as a result of the correlation analysis) were used for the calculation. Data related to the project were collected in the BIM model. Results estimating the project’s unit price, using the CBR method, were presented and discussed. The Mean Absolute Estimate Error was used to evaluate the model.

In this study, the probabilistic exergoeconomic analysis was performed for four industrial gas turbine (GT) units comprising of two (GT16 and GT19) units of 100MW GE engine and two (GT8 and GT12) units of 25MW Hitachi engine at Transcorp Power Limited, Ughelli. These four industrial GT engine units were modelled and simulated using natural gas as fuel. The design point (DP) simulation results of the modelled GT engines were validated with the available DP thermodynamic data from original equipment manufacturer (OEM). This was done before the off-design point (ODP) simulation was carried out which represents the plant operations. The results obtained from exergy analysis at full load operation show that the turbine has the highest exergy efficiency followed by compressor and combustion having the least. For turbines these were 96.13% for GT8 unit, 98.02% for GT12 unit, 96.26% for GT16 unit, and 96.30% for GT19 unit. Moreover, the combustion chamber has the highest exergy destruction efficiency of 55.16% GT8 unit, 56.58% GT12 unit, 43.90% GT16 unit, and 43.30% GT19 unit respectively. The exergy analysis results obtained from the four units show that the combustion chamber (CC) is the most significant exergy destruction with lowest exergy efficiency and highest exergy destruction efficiency of plant components. The exergoeconomic analysis results from four units showed combustion chamber energy destruction cost of 531.08 $/h GT8 unit, 584.53 $/h GT12 unit, 2351.81$/h GT16, and 2315.93$/h GT19 unit. The probabilistic results analysis based on the input parameters distributions evaluated and discussed.

The migration from MATLAB to Python (M-to-PY) has gained significant traction in recent computational research. While MATLAB has long served as a linchpin in myriad scientific endeavors, there's an emerging trend to rejuvenate these projects using Python's extensive AI tools and libraries. This study presents a semi-automated process for M-to-PY conversion, using a detailed case study of an image skeletonization project comprising fifteen MATLAB files and a 1404-image dataset. Skeletonization is foundational for ongoing 3D motion detection research using AI transformers, predominantly developed in Python. The utilization of ChatGPT-4, acting as an AI co-programmer, is pivotal in this conversion. By leveraging the public OpenAI API, we developed an M-to-PY converter prototype, evaluated its efficacy using test cases from the Bard bot, and subsequently employed the converted code in an AI application. The dual contributions encompass a well-tested M-to-PY converter and a Skeleton App capable of sketching and skeletonizing any given image, enriching the AI toolset. This study accentuates how AI resources, like ChatGPT-4, can simplify code transitions, opening doors for innovative AI implementations using primarily MATLAB-coded scientific research.

Waterbomb structures are origami-inspired deformable structural components used in new types of robots. They have a unique radially deployable ability that enables robots to better adapt to their environment. In this paper, we propose a series of new waterbomb structures with square, rectangle, and parallelogram base units. Through quasi-static axial and radial compression experiments and numerical simulations, we prove that the parallelogram waterbomb structure has a twist displacement mode along the axial direction. Compared with the square waterbomb structure, the proposed optimal design of the parallelogram waterbomb structure reduces the critical axial buckling load-to-weight ratio by 55.4% and increases the radial stiffness-to-weight ratio by 67.6%. The significant increase in the radial stiffness-to-weight ratio of the waterbomb structure and decrease in the critical axial buckling load-to-weight ratio make the proposed origami pattern attractive for practical robotics applications.

The world has been highly impacted by the COVID-19 as the virus has spread to all continents – about 200 countries in total. The latest update claims about 4,000,000 confirmed cases and about 300,000 confirmed deaths owing to the COVID-19 pandemic. This probably makes the COVID-19 as the most dangerous contagious disease in the era 2000s. Apart from massive publications on this topic, there is no available qualitative analysis that describes the dynamic spreads of the COVID-19 and its impacts on healthcare and the economy. Through the system archetypes analysis, this paper explains that the dynamic spread of the COVID-19 consists of the limits to growth and the success to successful structures. The limits to growth elucidates that more symptomatic and asymptomatic patients owing to infected droplets may be bounded by self-healing and isolated treatments. The success to successful structure explains that once the COVID-19 affects the economy through the lockdown, there will be a limited fund to support the government aids and the aggregate demand. In overall, this paper gives readers simplified holistic insights into understanding the dynamic spread of the COVID-19.

Background Telomere shortening is related to aging and unfavourable health outcomes. Obesity and metabolic diseases are important factors for accelerating aging. This study aimed to find out the association between obesity, metabolic disease, and telomere length in metabolically healthy adults. Methods 237 adults were enrolled with written consents at a health promotion centre of a tertiary hospital from February 2014 to March 2015. After excluding 99 subjects who met the exclusion criterion, a total of 130 metabolically healthy subjects were selected for final analysis. The subjects were divided into quartile groups according to the telomere lengths of their oral mucosal cells. Results The subjects consisted of 66 (50.8%) males with a mean age of 58.59 years. The body mass index (BMI, kg/m2) increased significantly along with the quartile groups (Q1, 23.00; Q2, 23.96; Q3, 23.70; Q4, 25.20; P-for trend=0.008). Waist circumference (WC, P-for trend=0.022), waist-to-hip ratio (WHR, P-for trend=0.005), and waist-to-height ratio (WHtR, P=0.001) also increased along with the quartile groups. Obesity prevalence (BMI ≥25 kg/m2), abdominal obesity (WC ≥90 cm for men, ≥85 cm for women), WHR 〉1.0 for men or 〉0.85 for women, and WHtR ≥0.5 increased significantly as the telomere length increased (P-for trend <0.05). After adjusting for covariates, the ORs for each obesity markers increased as the telomere length increased (P-for trend <0.05); and the ORs of WHtR were especially meaningful (Q1, 1.00; Q2, 2.53; Q3, 2.97; Q4, 7.81; P-for trend = 0.001). There were no significant trends for metabolic syndrome and its components along with the prevalence of fatty liver disease. Conclusion Obesity markers and telomere length had significant positive correlation despite the established theory. The obesity paradox may exist in metabolically healthy adults with regard to telomere length, However, further studies with larger sample sizes for the association between obesity and telomere length are needed.

Recent advancements in cognitive neuroscience, particularly in Electroencephalogram (EEG) signal processing, image generation, and brain-computer interfaces (BCI), have opened up new avenues for research. This study introduces a novel framework, Bridging Artificial Intelligence and Neurological Signals (BRAINS), which leverages the power of AI to extract meaningful information from EEG signals and generate images. The BRAINS framework addresses the limitations of traditional EEG analysis techniques, which struggle with nonstationary signals, spectral estimation, and noise sensitivity. Instead, BRAINS employs Long Short-Term Memory (LSTM) networks and contrastive learning, which effectively handle time-series EEG data and recognize intrinsic connections and patterns. The study utilizes the MNIST dataset of handwritten digits as stimuli in EEG experiments, allowing for diverse yet controlled stimuli. The data collected is then processed through an LSTM-based network employing contrastive learning and extracting complex features from EEG data. These features are fed into an image generator model, producing images as close to the original stimuli as possible. This study demonstrates the potential of integrating AI and EEG technology, offering promising implications for the future of brain-computer interfaces.

Under different pathophysiological conditions endothelial cells lose endothelial phenotype and gain mesenchymal cell-like phenotype via a process known as endothelial-to-mesenchymal transition (EndMT). At the molecular level, endothelial cells lose the expression of endothelial cell-specific markers such as CD31/platelet-endothelial cell adhesion molecule, von Willebrand factor, and vascular-endothelial cadherin and gain the expression of mesenchymal cell markers such as α-smooth muscle actin, N-cadherin, vimentin, fibroblast specific protein-1 and collagens. EndMT is induced by numerous different pathways triggered and modulated by multiple different and often redundant mechanisms in a context-dependent manner depending on the pathophysiological status of the cell. EndMT plays an essential role in embryonic development, particularly in atrioventricular valve development, however, EndMT is also implicated in pathogenesis of several genetically determined and acquired diseases including malignant, cardiovascular, inflammatory, and fibrotic disorders. Among cardiovascular diseases aberrant EndMT is reported in atherosclerosis, pulmonary hypertension, valvular disease, fibroelastosis and cardiac fibrosis. Accordingly, understanding the mechanisms behind cause and/or effect of EndMT to eventually target EndMT appears to be a promising strategy to treat aberrant EndMT-associated diseases. However, this approach is limited by a lack of precise functional and molecular pathways, causes and/or effects, and lack of robust animal model and human data about EndMT in different diseases. Here, we review different mechanisms in EndMT and the role of EndMT in various cardiovascular diseases.

Background: The risk to physicians who worked with patients without confirmed COVID-19 testing during the pandemic has been little studied. However, they were at high risk. Methods: A total of 1285 Romanian physicians completed an online survey. We performed Mann-Whitney comparisons between physicians who reported that they knowingly had direct contact with COVID patients and those who didn't regarding their willingness to work. Results: Compared with their colleagues, physicians who reported not knowingly having direct contact with COVID patients reported less access to protective equipment, less overall willingness to respond when asked to work with infected patients, more likely to work out of fear of losing their jobs, and fear of legal repercussions. They received less training in the use of protective equipment. Conclusions: Physicians who worked with patients not yet diagnosed with COVID-19 were significantly less willing to work. The perception of invisible risk may explain the observed differences.

The challenge of accessing finance by entrepreneurs from traditional financial sources is pervasive. The COVID-19 pandemic further exacerbated the problem of limited access to finance from banks. Against this backdrop, the objective of the study was to determine the factors driving crowdfunding success during the COVID-19 pandemic in Africa. The ordinary least squares (OLS) and probit regression models were estimated to analyse 216 crowdfunding projects in Africa. The results of the study documented that targeted amount (TA), and COVID-19 pandemic were negative and significant drivers of crowdfunding success. Furthermore, comments (CMM) and duration (DRN) were negative and significantly affected crowdfunding success. Conversely, images (IM), videos (VD), backers (BCK), and updates (UPD) were positive and significantly affected crowdfunding success. The study contributes to the body knowledge by investigating the drivers of crowdfunding success during the COVID-19 pandemic period which hitherto had not been researched on extenisvely.

Background: Smart transport plays a crucial role in urban planning and the transition from traditional to smart cities in developing countries with sustainability requirements.Traditional cities in developing countries often suffer from traffic congestion,air pollution, and inadequate public transportation systems,which can impede economic growth and negatively impact the quality of life for residents. Smart transport solutions can address these challenges by providing more efficient, sustainable.Here is a possible business model for an ITS system in a high-potential city in Iran,Based on IoT analysis, Mashhad city in Iran selected as a high-potential city to be changed to a smart city in the transportation sector.In the localization business model,the Uber smart transportation business model as a successful world experience is considered the base model. Methods: Based on the literature review,various criteria and sub-criteria were identified and determined in designing a new localized transportation business model.A questionnaire was prepared and filled with the help of 11 experts,method IAHP technique; Results:The present study showed the possibility of monthly payments for customers,software development, and the addition of luxury cars are among the most important sub-criteria with high weights;Conclusions: Working with transport companies,schools and universities as key partners solves reaching a strong and sustainable smart transportation system.

We aimed to explore symptoms severity and adherence to therapy for patients with myelofibrosis treated with ruxolitinib in Bulgaria. It is a prospective, non-interventional study performed at the Specialized hospital for active treatment of hematological diseases in Sofia during 2022 - 2023. Date of diagnosis, demographic characteristics, clinical indicators, ruxolitinib dose, and other data points were collected. Clinical indicators were assessed at baseline, in the middle and at the end of observation. Severity of symptoms was measured with MPN-SAF TSS and adherence to therapy with the Morisky 4 questionnaire 6 times during the observation. The mean age of diagnosis was 58.5 years, with the average duration of disease of 3 years. Pa-tients’ laboratory results were within physiological ranges, with spleen size experiencing a con-stant decrease. The average value for the severity of the symptoms per MPN-SAF TSS results decreased significantly, indicating better disease control. The average adherence to therapy did not change and remained high at around 9 points, except for one patient. In conclusion the treatment of myelofibrosis patients with ruxolitinib decreased symptoms se-verity and spleen size. Patients were adherent to the therapy over the observed period but as treatment duration increases the risk of adherence decreasing.

Recent advances in deep learning technology have led to increased interest in text-to-image technology, which enables computers to create images from text by simulating the human process of forming mental images. The GAN-based text-to-image technology involves the extraction of features from input text, which are combined with noise and then used as input to a GAN that generates images that are similar to the original images through competition between the generator and discriminator. Although generating images from English text is a mature area of research, text-to-image technology based on multilingualism, such as Korean, is still in its early stages of development. Webtoon is a digital comic format that allows comics to be viewed online. The creation process for webtoons is divided into story planning, content/sketching, coloring, and background drawing. Since each stage of webtoon production requires human intervention, it is both time-consuming and expensive. As a result, deep learning technologies such as automatic coloring and automatic line drawing are being used to reduce human involvement. However, there is a shortage of technology that can assist authors with story creation in webtoon production. Therefore, this study proposes a multilingual text-to-image model capable of generating webtoon images when presented with multilingual input text. The proposed model employs Multilingual BERT to extract feature vectors for multiple languages, and trains a DCGAN in conjunction with the images. The experimental results demonstrate that the model can generate images that are similar to the original images when presented with multilingual input text after training.

Small and medium-sized enterprises (SMEs) help and support the country in financial and business aspects and employs in the country, overcomes unemployment, and creates job opportunities in different sectors of the country. The study aims to know the entrepreneurial-specific factors like age, gender, education, experience, and skills used as predictors for access to financing of small firms in Khyber Pakhtunkhwa. The questionnaire is used for data collection, and about 204 questionnaires were distributed, of which 192 returned and analyzed through binary logistic regression. The study results reveal that age and level of education have been found significant while gender, experience and skills have insignificant with the access to finance in Khyber Pakhtunkhwa, Pakistan.

Circular Economy involves structural changes in traditional business models and consumers’ behaviour toward recycled products. The recycling of PET products has been increasing but there is still a gap between consumption and demand for PET packaging in Brazil. In this research, the waste reduction was examined under a projective scenario to the current ecological purposes in Brazil for reducing environmental pollution. In that manner, this paper aimed to comprehend the intention to purchase recycled PET products of Brazilian consumers. With a non-probabilistic and convenience sample, the study counts 422 participants. The method employed was based on Structural Equation Modelling and Partial Least Squares, used to test the hypotheses of causality among the variables. Results showed the perception of low quality about recycled products reduced consumers’ intention to purchase. Also, the sustainability of recycled products positively influenced the intention to purchase. In addition, recycled products presented a negative impact on the perceived safety, which could influence the purchase of recycled products in Brazil. We conclude that the image that Brazilian consumers have about recycled products positively affects the intention to purchase.

The origin of cancer remains one of the most important enigmas in modern biology. The prevailing paradigm has failed to grasp a comprehensive view of the disease. Naturally, therapies developed under the current assumptions are inadequate and cancer is practically an incurable disease. Meanwhile, descriptive studies continuously extend the molecular complexity of cancer without an equivalent advancement in its understanding. Furthermore, they tend to accumulate inconsistencies inexplicable under the classical view. This paper presents a compelling theory of the origin of carcinomas. By hypothesis, a series of generic events in epithelial tissues promoted by cellular aging and inflammation enables the reactivation of developmental programs. The origin of carcinomas in vivo is described as the time-ordered cell state transitions undergone by epithelial cells in the hyperplasia due to replicative senescence and inflammation towards a mesenchymal undifferentiated endogenous cell state with cancerous behavior. In support of the theory, the molecular, cellular, and histopathological evidence is critically reviewed. A plausible model for the origin of carcinomas is presented to explain the mechanism underlying carcinogenesis from an evolutive and developmental perspective. The implications of the hypothesis in the current strategies for cancer prevention and treatment are discussed along with rational alternatives and some predictions for possible experimental validation.

Microbial symbioses exhibit astounding adaptations, yet all symbionts face the problem of how to reliably associate with host offspring every generation. A common strategy is vertical transmission, in which symbionts are directly transmitted from the female to her offspring. The diversity of symbionts and vertical transmission mechanisms is as expansive as the diversity of eukaryotic host taxa that house them. However, there are several common themes among these mechanisms based on the degree to which symbionts associate with the host germline during transmission. In this review, we detail three distinct vertical transmission strategies, starting with associations that are transmitted from host somatic cells to offspring somatic cells, either due to lacking a germline or avoiding it. A second strategy involves somatically-localized symbionts that migrate into the germline during host development. The third strategy we discuss is one in which the symbiont maintains continuous association with the germline throughout development. Unexpectedly, the vast majority of documented vertically inherited symbionts rely on the second strategy: soma-to-germline migration. Given that not all eukaryotes contain a sequestered germline and instead produce offspring from somatic stem cell lineages, this soma-to-germline migration is discussed in the context of multicellular evolution. Lastly, as recent genomics data have revealed an abundance of horizontal gene transfer events from symbiotic and non-symbiotic bacteria to host genomes, we discuss their impact on eukaryotic host evolution.

Bidirectional gene promoters affect the transcription of two genes, leading to the hypothesis that they should exhibit protection against genetic or epigenetic changes in cancer. Therefore, they provide an excellent opportunity to learn about promoter susceptibility to somatic alteration in tumors. We tested this hypothesis using data from genome-scale DNA methylation (14 cancer types), simple somatic mutation (10 cancer types), and copy number variation profiling (14 cancer types). For DNA methylation, the difference in rank differential methylation between tumor and tumor-adjacent normal matched samples based on promoter type was tested by Wilcoxon rank sum test. Logistic regression was used to compare differences in simple somatic mutations. For copy number alteration, a mixed effects logistic regression model was used. The change in methylation between non-diseased tissues and their tumor counterparts was significantly greater in single compared to bidirectional promoters across all 14 cancer types examined. Similarly, the extent of copy number alteration was greater in single gene compared to bidirectional promoters for all 14 cancer types. Furthermore, among 10 cancer types with available simple somatic mutation data, bidirectional promoters were slightly more susceptible. These results suggest that selective pressures related with specific functional impacts during carcinogenesis drive the susceptibility of promoter regions to somatic alteration.