Dealing with randomness is a crucial aspect that cost-effectiveness analysis (CEA) tools need to address, but existing stochastic CEA tools have rarely examined risk and return from the perspective of global benefits. This paper proposes a stochastic CEA tool that supports medical decision-making from the perspective of global benefits of risk and return, the risk-adjusted incremental cost-effectiveness ratio (ICER). The tool has a traditional form of ICER but uses the risk-adjusted expected cost. Theoretically, we prove that the tool can provide marginal medical decisions that promote the risk-return level on global benefits within any intervention structure and can also serve as a discriminating condition for the optimal intervention structure. Numerical simulations within a framework of mean-variance support the conclusions in this paper.

The objective of this study aimed to develop biodegradable calcium alginate microspheres carrying doxorubicin (Dox) at the micrometer-scale for sustained-release and the capacity of pH regulatory for transarterial chemoembolization. Ultrasonic atomization and CaCl2 cross-linking technologies were used to prepare the microspheres. A 4 by 5 experiment was first designed to identify imperative parameters. The concentration of CaCl2 and the flow rate of the pump were found to be critical to generate microspheres with a constant volume median diameter (~ 39 m) across 5 groups with different alginate:NaHCO3 ratios using each corresponding flow rate. In each group, the encapsulation efficiency was positively correlated to the Dox-loaded efficiency. Fourier-transform infrared spectroscopy showed that NaHCO3 and Dox were step-by-step incorporated into the calcium alginate microspheres successfully. Microspheres containing alginate:NaHCO3 = 1 exhibited rough and porous surfaces, high Young’s modulus and hardness. In each group with the same alginate:NaHCO3 ratio, the swelling rates of microspheres were higher in PBS containing 10% FBS compared to those in PBS alone. Microspheres with relative high NaHCO3 concentrations in PBS containing 10% FBS maintained better physiological pH and higher accumulated Dox release ratios. In two distinct hepatocellular carcinoma-derived cell lines, treatments with microspheres carrying Dox demonstrated that the cell viabilities decreased in groups with relative high NaHCO3 ratios in time- and dose-dependent manners. Our results suggested that biodegradable alginate microspheres containing relative high NaHCO3 concentrations improved the cytotoxicity effects in vitro.

Background: Mechanical ventilation in preterm neonates aims for synchrony, preventing complications such as lung injury. Neurally Adjusted Ventilatory Assist (NAVA) stands out as a unique mode relying on diaphragmatic electrical signals for synchronization. We attempted to review studies that have explored the long-term consequence of using invasive NAVA in neonates with a specific focus on respiratory outcomes, namely bronchopulmonary dysplasia (BPD). Methods: A systematic review following PRISMA explored invasive NAVA in preterm neonates. Primary objectives compared NAVA to conventional ventilation, assessing BPD incidence, ventilation duration, length of stay, and adverse events. Secondary objectives analyzed ventilator parameters. Results: After screening 282 records, nine studies were included. NAVA showed reduced oxygen requirement at 28 days but no significant differences in oxygen need at 36 weeks postmenstrual age, total length of stay, or ventilator days. Adverse events such as air leak, mortality, patent ductus arteriosus, and intraventricular hemorrhage revealed no substantial variations. Ventilator variables favored NAVA, indicating decreased peak inspiratory pressure, tidal volume, work of breathing, and respiratory severity score. Conclusion: Despite short-term benefits, our study found no significant reduction in BPD with NAVA. Future large-scale trials are essential to comprehensively assess NAVA's impact on preterm infants' long-term outcomes.

A novel reinforcement learning deep deterministic policy gradient agent-based sliding mode control (DDPG-SMC) approach is proposed to suppress the chattering phenomenon in the attitude control for quadrotors, in the presence of external disturbances. First, the attitude dynamics model of the studied quadrotor is derived and the attitude control problem is described by formulas. Second, a sliding mode controller including its sliding mode surface and reaching law is selected for the nonlinear dynamic system, and the stability of the designed SMC system is supported by Lyapunov stability theorem. Third, a reinforcement learning (RL) agent based on deep deterministic policy gradient (DDPG) is trained to adjust the switching control gain adaptively. During the training process, the input signals of agent are the actual and desired attitude angles, and the output action is the time-varying control gain. Finally, the above trained agent is applied to the SMC as a parameter regulator, to implement the adaptive adjustment of the switching control gain related to reaching law, and the simulation results verify the robustness and effectiveness of the proposed DDPG-SMC method.

Cardiovascular disease (CVD) is considered to be one of the leading health issues in Thailand. CVD not only contributes to an increase in the number of hospital admissions year on year but also impacts on the rising health care expenditure for the treatment and long-term care of CVD patients. Therefore, this study is aimed at examining the impacts of risk reduction strategies on the number of CVD hospital admissions, Disability-Adjusted Life Years (DALYs) and the costs of hospitalisation. To estimate such impacts a CVD cost-offset model wasapplied using a Microsoft Excel spreadsheet. The number of the mid-year population was classified by age, gender and the CVD risk factor profiles from the recent Thai National Health Examination Survey (NHES) IV. This survey was chosen as the baseline population. The CVD risk factor profiles included age, gender, systolic blood pressure, total cholesterol, and smoking status. The Asia-Pacific Collaborative Cohort Study (APCCS) equation was applied to predict the probability of developing CVD over the next eight-year period. Estimates on the following were obtained from the model: (1.) the CVD events both fatal and non-fatal; (2.) the difference between the projected number of deaths and the actual number of deaths in that population; (3.) the number of patients who are expected to live with CVD; (4.) the DALYs from the estimated number of fatal and non-fatal events; (5.) the cost of hospital admissions. Four CVD risk strategy scenarios were investigated as follows: (1.) the do nothing scenario; (2.) the optimistic scenario; (3.) achieve the UN millennium development goal; and (4.) the worst-case scenario. The findings showed that over the next eight years there are likely to be 3,297,428 recorded cases of CVD; 5,870,049 cases of DALYs; and, approximately ฿57,000 million, ($1.9 billion), is projected as the total cost of hospital admissions. However, if the current health policy can reduce the levels of risk factors as defined in the optimistic scenario or such policy meets the specifications of the UN millennium development goal,there would be a significant reduction in the number of hospital admissions. These are estimated to be a reduction of 522,179 male and 515,416 female cases. With these results it is expected that health care costs would save approximately ฿9,000 million, ($298.3 million), for CVD and 900,000 million of DALYs over the next eight years. However, if there is an upward trend in the risk factors as predicted in the worst-case scenario, then there will be an increase of 428,220 CVD cases; consequently, DALYs cases may rise by 766,029 while the hospitalisation costs may increase by approximately ฿7,000 million, ($232.1 million). Based on our findings, reducing the levels of CVD risk factors in the population will drastically reduce: (1.) the number of CVD cases; (2.) DALYs cases; and (3.) health care costs. Therefore it is recommended that the health policy should enhance the primary prevention programs which would be targeted at reducing the CVD risk factors in the population.

Background: Extracorporeal cardiopulmonary resuscitation (ECPR) has gradually come to be regarded as an effective therapy, but the hospital mortality rate after ECPR is still high and unpredictable. The present study tested whether age-adjusted Charlson comorbidity index (ACCI) can be used as an objective selection criterion to ensure the most efficient utilization of medical resources. Methods: Adult patients (age ³ 18 years) receiving ECPR at our institution between 2006 and 2015 were included. Data regarding ECPR events and ACCI characteristics were collected immediately after extracorporeal membrane oxygenation (ECMO) setup. Adverse events during hospitalization were also prospectively collected. The primary endpoint was survival to hospital discharge. The second endpoint was short-term (2-year) follow-up outcome. Results: A total of 461 patients included in the study were grouped into low ACCI (ACCI 0–3) (240, 52.1%) and high ACCI (ACCI 4–13) (221, 47.9%) groups. The median ACCI was 2 (IQR: 1–3) and 5 (IQR: 4–7) for the low and high ACCI groups, respectively (P < 0.001). Cardiopulmonary resuscitation (CPR)-to-ECMO duration was comparable between the groups (42.1 ± 25.6 and 41.3 ± 20.7 min in the low and high ACCI groups, respectively; P = 0.754). Regarding hospital survival rate, 256 patients (55.5%) died on ECMO support. A total of 205 patients (44.5%) were successfully weaned off ECMO, but only 138 patients (29.9%) survived to hospital discharge (32.1% and 27.6% in low and high ACCI group, P = 0.291). Multivariate logistic regression analysis revealed CPR-to-ECMO duration and CPR cause of septic shock as significant risk factors for hospital survival after ECPR (P = 0.043 and 0.014, respectively), whereas age and ACCI were not (P = 0.334 and 0.164, respectively). The 2-year survival rate after hospital discharge for the 138 hospital survivors was 96% and 74% in the low and high ACCI groups, respectively (P = 0.002.)Conclusions: High ACCI before ECPR does not predict poor outcome of hospital survival. Therefore, ECPR should not be rejected solely due to high ACCI. However, high ACCI in hospital survivors is associated with a higher 2-year mortality rate than low ACCI, and patients with high ACCI should be closely followed up.

This paper aims to contribute to refining the e-values for testing precise hypotheses, especially when dealing with nuisance parameters, leveraging the effectiveness of asymptotic expansions of the posterior. The proposed approach offers the advantage of bypassing the need for elicitation of priors and reference functions for the nuisance parameters and the multidimensional integration step. For this purpose, starting from a Laplace approximation, a posterior distribution for the parameter of interest only is considered and then a suitable objective matching prior is introduced, ensuring that the posterior mode aligns with an equivariant frequentist estimator. Consequently, both Highest Probability Density credible sets and the e-value remain invariant. Some targeted and challenging examples are discussed.

Burden of diseases measured as disability-adjusted life years per 100,000 people can be mined from public domain data, when they are made available by population health surveillance systems. This can be analysed to allow insightful comparisons with the national average, and to understand differences in trends between the sexes, age groups, time periods, geographic regions and sub-regions. In this illustrative case study, we have analysed the Scottish burden of disease database to understand what ailed the population of the Grampian region before the COVID-19 pandemic. We have identified selected cancers, ischaemic heart disease, Alzheimer’s disease and other dementias amongst the highest contributors to the burden; that drug use disorders and colorectal cancer are showing worsening trends and require health promotion and disease prevention measures from ages 15 and 25 respectively, especially in Aberdeen City; and that males are more vulnerable to atrial fibrillation and flutter, diabetes mellitus and oesophageal cancer, while females are to cerebrovascular disease. We demonstrate the usefulness of our analysis and methodology for the wider health system, allowing targeted medical research investments and coordinated response from public health and health service delivery. We also show the need for up-to-date surveillance data, forecasts and evidence on the impact of interventions to be made available widely.

Rapid and extensive urbanization has adversely impacted humans and ecological entities in the recent decades through a decrease in surface permeability and the emergence of urban heat islands (UHI). While detailed and continuous assessments of surface permeability and UHI are crucial for urban planning and management of landuse zones, they have mostly involved time consuming and expensive field studies, and single sensor derived large scale aerial and satellite imageries. We demonstrated the advantage of fusing imageries from multiple sensors for landuse and landcover (LULC) change assessments as well as for assessing surface permeability and UHI emergence in Tirunelveli, Tamilnadu, India. Cartosat-2 and Landsat-7 ETM+ imageries from 2007 and 2017 were fused and classified using a Rotation Forest (RF), while surface permeability and temperature were quantified using Soil-Adjusted Vegetation Index (SAVI) and Land Surface Temperature (LST) index, respectively. Fused images exhibited higher classification accuracies than non-fused images, i.e. overall kappa coefficient values 0.83 and 0.75, respectively. We observed an overall increase of 20 km2 (45%) in the coverage of urban (dry, real estate plots and built-up) areas, while a decrease of 27 km2 (37%) for vegetated (cropland and forest) areas in Tirunelveli between 2007 and 2017. The SAVI values indicated an extensive decrease in surface permeability for Tirunelveli overall (0.4) and also for almost all LULC zones. The LST values exhibited an associated overall increase (1.30C) of surface temperature in Tirunelveli with the highest increase (2.40C) for urban built-up areas between 2007 and 2017. The SAVI-LST combined metric depicted the Southeastern built-up areas in Tirunelveli as a potential UHI hotspot, while a caution for the Western riparian zone for UHI emergence in 2017. Our results provide important metrics for surface permeability and UHI monitoring, and inform urban and zonal planning authorities about the advantages of satellite image fusion.