This study uses machine learning to identify key factors influencing the cost-effectiveness of over-the-counter (OTC) medications. By developing a novel cost-effectiveness rating (CER) from user ratings and prices, we analyzed data from Amazon. The findings indicate that FSA/HSA eligibility, symptom treatment range, safety warnings, special effects, active ingredients, and packaging size significantly impact cost-effectiveness across cold, allergy, digestion, and pain relief medications. Medications eligible for FSA or HSA funds, treating a broader range of symptoms, and having smaller packaging are perceived as more cost-effective. Cold medicines with safety warnings were found to be cost-effective due to their lower average price and effective ingredients like phenylephrine and acetaminophen. Allergy medications with kid-friendly features showed higher cost-effectiveness, and ingredients like calcium, famotidine, and magnesium boosted the cost-effectiveness of digestion medicines. These insights help consumers make informed purchasing decisions and assist manufacturers and retailers in enhancing product competitiveness. Overall, this research supports better decision-making in the pharmaceutical industry by highlighting factors that drive cost-effective medication purchases.

This study investigated the effectiveness of virtual reality (VR) technology in table tennis education compared to traditional training methods. A 12-week randomized controlled trial was conducted with 120 participants divided equally between VR and traditional training groups. Performance metrics, learning motivation, and satisfaction were assessed at regular intervals. Results demonstrated significant advantages of VR training, with the VR group showing superior improvements in serve accuracy (23.5% vs. 15.8%, p < 0.001), rally endurance (increase of 8.2 vs. 5.7 shots, p < 0.01), and overall skill scores (18.7 vs. 13.2 points improvement, p < 0.001). The VR group also exhibited higher increases in learning motivation (23.5% vs. 12.8%, p < 0.001) and satisfaction (31.5% vs. 18.7%, p < 0.001). Subgroup analysis revealed particular benefits for novice players and younger participants. These findings suggest that VR technology offers a promising approach to enhance table tennis education, potentially revolutionizing sports training methodologies. Future research should focus on long-term skill retention and the optimization of VR training protocols.

Late pear cultivars, such as ‘Conference’, can be stored for a long period, with their storability depending on storage conditions. A three-year study (2011-2013) compared the impact of half-year storage using four technologies – normal atmosphere, normal atmosphere + 1-methylcyclopropene (1-MCP), controlled atmosphere, controlled atmosphere + 1-MCP – on the quality parameters of ‘Conference’ pears, such as mass loss, firmness, total soluble solids, acidity, antioxidant capacity, and the incidence of diseases and disorders. Additionally, the study analysed different storage conditions in terms of profitability, based on the market prices for pears in the seasons during which the pears were stored. The storage conditions had a very strong influence on the fruit quality parameters, and was found to affect most visibly the mass loss and the incidence of postharvest diseases and disorders. The storage of ‘Conference’ pears for 180 days in normal atmosphere is not economically viable, even if the fruit is subjected to 1-MCP treatment.

We analyze a time-delayed SIQR model that considers the transportation-related infections and entry-exit screening. This model aims to determine the measures for preventing and controlling major emergent infectious diseases and the associated costs. We calculate the basic reproduction number (R0), apply the linearization method, and construct an appropriate Lyapunov function to determine the stability of the disease-free equilibrium in the local and global. We collect COVID-19 infection data from two regions in the United States in 2020 for data fitting, obtain a set of optimal parameter values, and show that the model is suitable for simulating the outbreak and spread of emerging infectious diseases. We find that transportation-related infections increase the basic reproduction number, enhancing the impact on disease spread. Entry-exit screening effectively suppress the spread of disease by reducing the basic reproduction number. Furthermore, we investigate the influence of the incubation period on disease and find that a shorter incubation period results in a shorter duration but a larger scale of infection, and the peaks are reduced. We conduct a sensitivity analysis of the R0 and propose three measures to prevent the spread of new infectious diseases based on the most sensitive parameters: wearing masks, implementing urban closures, and administering medication to sick but not yet hospitalized patients promptly. In the case of COVID-19, we use Pontryagin’s minimum principle to get time-varying control measures to control the spread of the outbreak. Optimal control effectively controls the development and deterioration of the disease. Finally, several control measures are compared through cost-effectiveness analysis, and the results show that wearing masks is the most cost-effective measure. Our study provides some practical guidance for controlling the spread of major emerging infectious diseases.

Pneumococcal disease, caused by Streptococcus pneumoniae is the leading cause of high mortality in children worldwide. The tremendous direct cost of hospital admissions and significant indirect costs from productivity loss contributed considerably to the economic burden, with vaccination being the only efficient way against the illness. Our study aims to summarize the cost-effectiveness of the pneumococcal conjugate vaccine (PCV) implemented in the pediatric population. Employing online databases from Pubmed, Embase, and Medline, we looked for economic evaluation from 2018 until March 2024. The Incremental Cost-Effectiveness Ratios (ICER) and Quality-Adjusted-Life-Years (QALY) were the primary outcomes for measuring PCV's cost-effectiveness. A 28-item CHEERS 2022 checklist was applied to assess the quality of collected studies. Of the 16 papers found, 9/16 discussed the lower-valent vaccine (PCV13, PCV10) and 7/16 examined the higher-valent vaccine. (PCV20, PCV15). PCV13 and PCV10 required more cost and generated more QALY compared to no vaccination. Both PCV15 and PCV20 averted substantial healthcare costs and yielded greater quality of life than PCV13. Additionally, PCV20 was a dominant strategy compared to PCV15. Utilizing PCV13 is a very cost-effective option compared to not getting vaccinated. Transitioning from PCV13 to PCV20 would result in higher QALY gain and more cost-saving than switching to PCV15.

This research examines the fire resistance of geopolymer composites (GCs), formulated using alka-li-activated metakaolin and aluminum powder. The production method involves spray-coating carbon steel plates with fresh GCs, followed by a 28-day curing period at room temperature. Sub-sequently, fire performance and aging tests are conducted to evaluate fire resistance. The study investigates GC properties, including apparent density, bending strength, compression strength, thermal conductivity, porosity, and production cost. Morphological changes before and after fire and aging tests are analyzed using scanning electron microscopy (SEM). Results demonstrate GC foams' outstanding thermal insulation, providing up to 75 minutes of fire resistance with a 6 mm coating, reducing temperatures by 300 °C compared to uncoated steel. GCs exhibit a density of 670 kg/m³, thermal conductivity of 0.166 W/m·K, 68% porosity, and cost efficiency at 250 dollars per cubic meter. This study underscores the potential of foamed geopolymer coatings for effective and economical surface protection.

In large-capacity energy storage systems, instructions are decomposed typically using an equalized power distribution strategy, where clusters/modules operate at the same power and durations. When dispatching shifts from stable single conditions to intricate coupled conditions, this distribution strategy inevitably results in increased inconsistency and hastened system aging. This paper presents a novel differentiated power distribution strategy comprising three control variables: the rotation status, the operating boundaries for both Depth of Discharge (DOD) and C-rates (C) within a control period. The proposed strategy integrates an aging cost prediction model developed to express the mapping relationship between these control variables and aging costs. Additionally, it incorporates the multi-colony particle swarm optimization (Mc-PSO) algorithm into the optimization model to minimize aging costs. The aging cost prediction model consists of three functions: predicting health features (HFs) based on the cumulative charge/discharge throughput quantity and operating boundaries, characterizing HFs as comprehensive scores, and calculating aging costs using both comprehensive scores and residual equipment value. Further, we elaborated on the engineering application process for the proposed control strategy. In the simulation scenarios, this strategy prolonged the service life by 14.62%, reduced the overall aging cost by 6.61%, and improved module consistency by 21.98%, compared with the traditional equalized distribution strategy. In summary, the proposed strategy proves effective in elongating service life, reducing overall aging costs, and increasing the benefit of energy storage systems in particular application scenarios.

OBJETIVES: During the COVID-19 pandemic, the risk of collapse of the health system created great difficulties. We will demonstrate that Intermediate Respiratory Care Units (IRCU) provide adequate management of patients with non-invasive respiratory support, which is particularly important in patients with SARS-CoV-2 pneumonia. METHODS: A prospective observational study of patients with COVID-19 admitted to the ICU of a tertiary hospital. Sociodemographic data, comorbidities, pharmacological, respiratory support, laboratory and blood gas variables were collected. The overall cost of the unit was subsequently analyzed. RESULTS: 991 patients were admitted, 56 to the IRCU (of the 81 a critical care unit). Mean age was 65 years (SD 12.8), Barthel Index 75 (SD 8.3), Charlson 3.1 (SD 2.2), HTN 27%, COPD 89% and obesity 24%. Significant relationship (p <0.05) with higher mortality of the following: fever greater than or equal to 39oC [OR 5.6; 95% CI (1.2-2.7); p = 0.020], protocolized pharmacological treatment [OR 0.3; 95% CI (0.1-0.9); p = 0.023] and IOI [OR 3.7; 95% CI (1.1-12.3); p = 0.025]. NIMV showed less of a negative impact [OR 1.8; 95% CI (0.4-8.4); p = 0.423] than IOI. The total cost of the IRCUs amounted to €66,233. The cost per day of stay in the IRCU was €164 per patient. The total cost avoided was €214,865. CONCLUSION: The pandemic has highlighted the importance of IRCUs in facilitating the management of a high patient volume. The treatment carried out in IRCUs is effective and efficient, reducing both admissions to and stays in the ICU.

Background: GaitSmart (GS) is a sensor-based digital medical device that can be used with the integrated app vGym to provide a personalised rehabilitation programme for older people undergoing total hip arthroplasty (THA) or total knee arthroplasty (TKA). This study aimed to determine whether the GS intervention used in the rehabilitation of older people undergoing THA or TKA is potentially cost-effective compared to the current standard of care (SoC). Methods: Decision-analytic modelling was conducted to estimate cost-effectiveness over a seventeen- week time horizon, from an NHS perspective. UK clinical and cost data from the GaitSmart randomised clinical trial was used to obtain input parameters, and sensitivity analysis was performed to address uncertainty. Results: Over a seventeen-week time horizon, GS incurred cost savings of £450.56 and a 0.02 gain in quality-adjusted life years (QALYs) compared to the SoC. These results indicate that GS is the dominant intervention because the device demonstrated greater effectiveness and lower costs. Probabilistic sensitivity analyses confirm the robustness of our results. Conclusion: GS appears to offer short-term efficiency benefits and demonstrates cost-effectiveness for the improvement of gait in people undergoing THA or TKA, compared to the SoC. These findings provided new evidence to inform policymakers.

Integrating optical coherence tomography (OCT) into the pre-surgical stage of cataract management holds significant clinical and economic potential, particularly in low-to-middle-income countries like Kazakhstan. This study aimed to evaluate these impacts by prospectively recruiting 124 patients, aged 70±8 years, from two ophthalmology surgical centers in Almaty, Kazakhstan. Patients undergoing phacoemulsification of cataracts with monofocal intraocular lens (IOL) implantation between January and December 2022 were divided into two groups: the OCT group (n=75) received pre-operative OCT, while the Control group (n=49) did not. Visual acuity (VA) was measured pre- and post-surgery, and the cost-effectiveness of the surgical strategies was analyzed. The OCT group experienced a significantly greater improvement in VA (-0.647±0.232 logMAR) compared to the Control group (-0.543±0.244 logMAR), with a notable interaction between time and group (F(df) = 217.2, p &lt; 0.001). Additionally, pre-existing concomitant diseases were diagnosed in 25.3% of cases in the OCT group and 28.6% in the Control group. The economic analysis revealed that the integration of OCT facilitated multiple surgeries in one appointment, thereby reducing overall costs. These findings suggest that implementing OCT in the pre-surgical stage of cataract management can significantly enhance visual outcomes and decrease the cost of ophthalmology services in Kazakhstan.

At 100% penetration, intermittent renewable energy causes outages. To flatten the leaping supply and demand curves of renewable energy, an energy storage medium and carrier are required. The Hydrogen energy stotrage system (HydESS), which combines a proton exchange membrane (PEM)-based water electrolysis (WE) system and a fuel cell (FC), has the quickest response time, the longest duration, and the greatest storage capacity. HOMER tools for techno-economic analysis are used to evaluate the HydESS hybrid system. Kyiv, Ukraine, is appealing due to its spatial-temporal wind speed, solar irradiance, and energy security. With an LCOE of $0.245 kWh−1 and 9.3% fuel cell power output, the most feasible solution is onshore wind turbine-coupled PEMFC HydESS. As a result 1,000-kW wind power, 250-kW PEMFC, 250-kW PEMWE, and 441-kW BESS are optimized to serve a 3,900 kWh day academic residence load. When compared to a diesel generator and a BESS, the hybrid HydESS reduces CO2 emissions by 4,132 tons over a 25-year period. The LCOE of a hybrid HydESS system is determined by the SOFC lifetime rather than the PEMFC's 2% difference between 40,000 and 50,000 h with the same rated power. This study recommends accelerating PEMFC development with fluctuation-endurable materials and design.

A mathematical model that incorporates human attacks on dogs is presented to explore the dynamics of rabies transmission. The model divided the infection rate into two categories: dog-to-dog transmission rates during the prodromal phase (βdP) and the furious phase (βdF). It has been determined that the model is well-posed and that all of the solutions are positive, as well as the feasibility and positivity of the model's solutions. Both the basic reproduction number (R0) and the effective reproductive number (Re) are computed, and it is demonstrated that the model has a unique disease-free equilibrium that is globally asymptotically stable whenever Re < 1. To identify the model's most sensitive parameters and the ones that intervention efforts should focus on, sensitivity analysis of the effective reproduction number is carried out. We can construct an optimal control system using the state equations, the adjoint equations, and the optimality condition that determines the controls by applying Pontryagin's Maximum/Minimum principle. To help decision-makers in allocating funds for rabies interventions, cost-effectiveness analyses are conducted. To determine the degree to which the intervention strategies are advantageous and cost-effective, this study performs a cost-effective analysis of one or all possible combinations of the optimal rabies control strategies (pre-exposed and post-exposed vaccination for both dog and human populations) for the four different transmission settings. After arranging the techniques to increase effectiveness (total infections prevented), a cost-effective analysis using the Incremental Cost Effectiveness Ratio (ICER) was conducted. The result supports the function that the four intervention options are performing to either completely eradicate or significantly reduce rabies disease among the populations. The dynamical behavior of the system is studied through simulations using the ode45 numerical technique from MATLAB.

The osteoarthritis (OA), the main cause of disability, is a chronic condition that most frequently affects older adults. As the population ages, the cost of treatment is placing pressure on the healthcare budget. As a result, it is imperative to evaluate the medicines' cost-effectiveness and the influence they have on health resource allocation. Hence, our study aims to summarize the cost and outcome of utilizing glucosamine in OA treatment. Authentic databases like Medline, Cochrane, and Scopus were adopted for the identification process up until July 2023. Our primary inclusion criteria centered on the economic evaluation of Glucosamine in OA treatments with provided the incremental cost-effectiveness ratio (ICER) at least. The Quality of Health Economic Studies (QHES) instrument was applied to grade the quality of the studies. A total of 7 qualified studies were selected and discussed the cost-effectiveness of glucosamine with or without other formulations. All of them demonstrated that glucosamine was cost-effective. There was an in-creasement of QALY when incorporating Glucosamine into conventional care. Moreover, Crystalline Glucosamine Sulfate (pCGS) was more cost-effective than the Other Formulations of Glucosamine (OFG). In overall, utilizing pCGS was more beneficial than OFG in terms both of cost and quality of life.

Background: Trichomoniasis is the most common non-viral STI globally and yet is not a reportable disease. Trichomonas Vaginalis is an important source of reproductive morbidity and may increase risk of acquisition and transmission of HIV. WHO and CDC recommend various regimens of Nitro-Imidazoles for treatment. The common Nitro-Imidazoles used for Trichomoniasis are Metronidazole and Tinidazole, which vary in their cost, efficacy and side effect profile and it is relevant to study these factors, for better management of the patients. Objectives: This study aims to compare and study the efficacy, compliance of various treatment regimens, their outcomes and side-effects for Trichomoniasis, among STI clinic attendees in Trinidad. Methods: A clinical trial study was designed and after obtaining the informed consent a routine clinical examination was conducted and the swabs for Trichomoniasis tests were collected for diagnosis from the 692 participants. Out of 692 participants, Eighty two (82) patients with established diagnosis of Trichomonas infection were quasi-randomly treated using different regimens. Compliance to treatment, side effects and outcome were evaluated. Results: The prevalence of the Trichomoniasis in population attending our STI clinic is 11.9% and prevalence of HIV is 9%. Of the total 82 participants for the treatment, 80% were females; nearly 90% of the patients belonged to age group 15-45 years and over 60% were below 30 yrs. Among those diagnosed for Trichomonas vaginalis, 13.3% had associated HIV infection. The compliance with respect to single dose treatment was significantly better than the long duration oral regimen and has significant relation with side effects of the treatment. The outcome is generally better and comparable and shows no significant difference between different treatment regimens used in the study. Conclusions: Metronidazole and Tinidazole are commonly used drugs in various regimens. compliance is better with those treated with Tinidazole and Metronidazole stat, than with other groups. Outcome is comparable between these regimens, especially when combined with other important factors like abstinence and treatment of the partners. The treatment regimens mainly differ in the compliance and side effects profile, which suggests that to improve the compliance the drugs with less side effects, short course regimen would be a preferred choice.

The impulse of the Fourth Industrial Revolution is triggering the demand for few specific metals. These include copper, silver, gold, and platinum group metals (PGMs), with important applications in renewable energies, green hydrogen, and electronic products. However, the continuous extraction of these metals is leading to a rapid decline in their ore grades and, consequently, increasing the environmental impact of extraction. Hence, obtaining metals from secondary sources, such as waste electrical and electronic equipment (WEEE), becomes imperative for both environmental sustainability and ensuring availability. This recovery entails few problems such as allocation due to the simultaneous production of several metals, the use of non-renewable resources, and the exergy destruction during the life cycle of the metals. Therefore, this work analyses the waste printed circuit boards (PCBs) recycling process by proposing different exergy-based cost allocations for the mentioned metals, disaggregating the exergy cost into non-renewable and renewable, and considering the complete life cycle of metals with the Circular Thermoeconomics methodology. The results show a significant saving of non-renewable energy by using renewable energies in primary extraction (67-87%), recycling (97.6-98.5%), and renewable energies in recycling (98.7%, 99.0%), compared to conventional primary extraction. However, when considering the entire life cycle, between 47% and 53% of the non-renewable exergy is destroyed during recycling. Therefore, delaying recycling as much as possible would be the most desirable option for maximizing the use of non-renewable resources, which nature cannot replace in a short time.

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 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.

We aimed to directly compare the cost-effectiveness of the NELSON and NLST screening protocols, two trials influencing lung cancer screening implementation internationally. A decision-analytic model analyzing the cost-effectiveness of the NELSON protocols was manipulated to reflect the protocols of the NLST, while maintaining features specific to the Hungarian healthcare setting. In the NELSON protocol, there are three possible outcomes to the initial round of screening: positive, negative, or indeterminate, indicating an uncertain degree of suspicion for lung cancer. This pro-tocol differs from the NLST protocol, in which the only possible screening outcomes are positive or negative, with no indeterminate option. The NLST pathway for smokers aged 55-74 resulted in a 43 € increase in total average lifetime costs compared to the Hungarian screening pathway and re-sulted in a lifetime gain of 0.006 QALYs. The incremental costs and QALYs yield an ICER of 7875 €/QALY. Our results demonstrate that assigning any suspicious LDCT screen as a positive result (NLST protocol) rather than indeterminate (NELSON protocol) can yield a slight QALY gain that is worth the additional use of resources according to Hungary’s willingness to pay threshold. Our study provides insight on the cost-effectiveness, advantages, and disadvantages of various LDCT screening protocols for lung cancer and can assist other countries as they implement their screening programs.

: There has been an ever-increasing demand for energy from the past decades. Renewable energy technologies play a major role in satisfying the energy demand as well as in a decreased CO2 emissions. Solar and Wind energies are the major upcoming technologies in renewable energies. Decentralized power production is a system where the energy production and consumption are very close to each other. Microgrids can be decentralized or grid connected and they, with renewable energy sources, encounter a problem of storage as the power production from solar and wind is intermittent. This paper discusses the comparison between using batteries and pumped storage hydropower (PSH) as an energy storage system and the integration of wind and solar PV energy sources. HOMER software simulations are used to obtain optimized renewable energy integration in microgrid and to understand its economic analysis. Two scenarios are run with the model where one considers battery and the other considers PSH to obtain the economic and technical best results of these microgrids. The economic analysis showed a lower net present cost (NPC) and levelized cost of energy (LCOE) for the microgrid with PSH. The results show that microgrid with storage of PSH is economical with an NPC of 45.8 M€ and an LCOE of 0.379 €/kWh in comparison with batteries solution which has an NPC of 95.2M€ and an LCOE of 0.786 €/kWh. The role of storage is understood by differentiating the data into different seasons using Python for data analysis. Furthermore, sensitivity analysis is made by varying the capital cost multiplier of Solar PV and Wind Turbine to obtain optimal solutions.

Investments in small and medium-sized anaerobic digestion facilities have the potential to boost biogas production in Greece and other EU countries. This study aimed to evaluate the economic feasibility of anaerobic digestion facilities equipped with combined heat and power (CHP) units ranging from 50 to 400 kW, while treating livestock waste. For this purpose, data were gathered from various livestock operations (dairy cattle, poultry, swine, dairy sheep and goat) regarding their annual production, revenues, electricity and fuel usage, and waste generation. Waste samples were then collected and analyzed to assess their biochemical methane production potential. The capital and operational costs of anaerobic digestion facilities, from 50 and 400 kW, were calculated using the equations developed within the “eMT cluster” project. Findings indicate that current feed-in tariffs (FIT) of 0.21 € kWh-1 are insufficient to incentivize investment in anaerobic digestion facilities with capacities below 250 kW, highlighting the need for increased FIT rates or capital expenditure subsidies. Recommendations include shifting towards simplified technology and business models with reduced farmer involvement, coupled with supportive legislative framework and long-term electricity price guarantees. These measures are expected to foster the implementation of anaerobic digestion projects in the animal husbandry sector.

Abstract: Effectiveness of a Single Fixed Dose 3 mg Rasburicase for Prevention and Management of Hyperuricemia of Tumor Lysis Syndrome in adult Cancer Patients Background: Tumor lysis syndrome (TLS) is a potentially life-threatening complication associated with certain types of cancer. Rasburicase is an essential medicine required to prevent and treat the hyperuricemia associated with TLS. Due to a shortage of rasburicase during the COVID-19 pandemic, a fixed dose strategy of 3 mg rasburicase had been used in many adult cancer patients in our center. Objective: The objective of this study was to assess the effectiveness of a 3 mg fixed dose of rasburicase in preventing and managing hyperuricemia associated with TLS in adult cancer patients. Methods: We conducted a retrospective, observational cohort study between March 2020 and November 2022. The study included adult patients who received a fixed dose of 3 mg rasburicase. The primary outcome measure was the reduction in serum UA levels of

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.

Enclosed public spaces are the hotspots for airborne disease transmission. To measure and maintain indoor air quality in terms of airborne transmission, an open source, low cost and distributed array of Particulate Matter Sensors has been developed and named as Dynamic Aerosol Transport for Indoor Ventilation or DATIV system. This system can use multiple Particulate Matter Sensors (PMS) simultaneously and can be remotely controlled using a Raspberry Pie based operating system. The data acquisition system can be easily operated using the GUI within any common browser installed on a remote device such as a PC or Smartphone with corresponding IP address. The software architecture and validation measurements are presented together with possible future developments.

Numerous studies on evaporative cooling systems have been conducted globally, but there is a scarcity of investigations in eastern Africa. The few studies undertaken in this region have primarily focused on their application in food storage and preservation, rather than for building purpose. The goal of this study is to review the most recent advancements in evaporative cooling technology, which would be relevant in eastern Ethiopia and could provide adequate cooling, give adequate thermal comfort, use less energy, and minimize environmental effect in hot and dry areas. There aren't many studies on evaporative cooling systems for building applications in Eastern Africa as a whole, thus this review has taken into account studies conducted in regions with climates similar to eastern Ethiopia. This study covers the classification, operation, and performance of evaporative cooling systems in hot and dry climate. Evaporative cooling systems work well in hot and dry climates, as revealed by this review study.

This economic evaluation aims to support policy-making on the combined use of pre-exposure prophylaxis (PrEP) with HIV vaccines by evaluating the potential cost-effectiveness of implementation that would support the design of clinical trials for assessment of combined product safety and efficacy. The target study population is a cohort of men who have sex with men (MSM) in the United States. Policy strategies considered include standard HIV prevention, daily oral PrEP, HIV vaccine, and their combination. We constructed a Markov model based on clinical trial data and published literature. We used a payer perspective, monthly cycle length, a lifetime horizon, and a 3% discount rate. We assumed a price of $500 per HIV vaccine series in the base case. HIV vaccines dominated standard care and PrEP. At current prices,PrEP was not cost-effective alone or in combination. A combination strategy had the greatest health benefit but was not cost-effective (ICER=$463,448/QALY) as compared to vaccination alone. Sensitivity analyses suggest a combination may be valuable for higher-risk men with good adherence. Vaccine durability and PrEP drug prices were key drivers of cost-effectiveness. Results suggest that boosting potential may be key to HIV vaccine value.

Aims: The objective of this study was to assess the cost-effectiveness of the CardioMEMS HF system in a HF Clinic in Spain by evaluating the real-time remote monitoring of pulmonary artery pressures, which has shown to reduce heart failure (HF) related hospitalizations and improve the quality of life for selected HF patients. Particularly, the study aimed to determine the value of CardioMEMS in Southern Europe, where healthcare costs are significantly lower and its effectiveness remains uncertain. Methods: This single-centre study enrolled all consecutive HF patients who had been implanted with a pulmonary artery pressure sensor (CardioMEMS-HF system, Abbott Laboratories, Abbott Park, IL, USA). The number of HF hospitalizations in the year before and the year after the sensor implantation was compared and quality-adjusted life years (QALY) gained based on a literature review of previous studies was calculated. Results: The rate of HF hospitalisations was significantly lower at 1 year compared with the year before CardioMEMS implantation (0.25 versus 1.10 events/patient-years, HR 0.22, p=0.001). At the end of first year, the usual management outperformed the CardioMEMS HF system, resulting in a net monetary value difference of 2,540€ per patient and a benefit-cost ratio of 0.38. However, by the end of the second year, the CardioMEMS system is estimated to reduce costs compared to usual management. Conclusions: Based on the results, we suggest that remote monitoring of pulmonary artery pressure with the CardioMEMS HF system represents a long-term cost-effective strategy in a healthcare setting in Southern Europe.

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.

This paper aims at trying to answer the question of whether a low cost drone equipped with a regular camera can serve as a simple device to estimate the size of objects. Ad-ditionally, it assesses if the accuracy of measurement is good enough for using a drone for measurements, relying solely on GPS position and camera. A review of the literature pertaining to ground object measurements was conducted. The availability of such in-struments was evaluated in terms of purchase and rental costs, the number of instru-ments on the market, and the time to obtain them. The most common measurement methods were considered and their unit costs were reviewed. The cost of professional surveying and measuring equipment was compared to the possibility of using low-cost, non-commercial drones to measure objects and surfaces. The quality of the images ob-tained was compared with high-resolution satellite systems. Is an ordinary drone with a standard camera suitable for length measurement without professional measuring equipment? Should the results be considered only in the category of size estimation?

This paper analyzes the mitigation of enteric methane (CH4) emissions from ruminants with the use of feed additives inhibiting of rumen methanogenesis to limit global temperature increase to 1.5 °C. A mathematical simulation conducted herein predicted that pronounced inhibition of rumen methanogenesis with pure chemicals or bromoform-containing algae can contribute to limit global temperature increase by 2050 to 1.5 °C only if widely adopted at a global level and considering an efficacy higher than obtained in most studies. Currently, the most important limitations to the adoption of antimethanogenic feed additives are probably increased feeding cost without a consistent return in production efficiency, and achieving sustained delivery of inhibitors to the rumens of non-supplemented, extensively ranging animals. Economic incentives, and changes in rumen microbial metabolism caused by inhibiting methanogenesis, could potentially be used to make the methanogenesis inhibition intervention cost effective. Also, the composition of the methanogenic community, and rate of disappearance of inhibitors of methanogenesis in the rumen can influence the effective dose of the inhibitors, and hence the cost of their adoption. Possible means for sustained delivery of antimethanogenic compounds to extensively grazing animals are discussed. Limitations and knowledge gaps of these approaches, and future research directions, are examined.

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.

Construction project management and cost management is a difficult process that affects the overall success of construction projects. The success of a construction project can be assessed according to key performance indicators (KPIs). Cost savings and cost optimization over the life of a construction project is one of these KPIs. Cost management is largely performed through intelligent information technology in the construction industry. Information systems and information technologies have seen an increase in use in the management of construction projects. The same goes for cost management. Several studies mentioned in the paper point to this increase in use in recent years also in the management of costs at various stages. Many studies point to the use of information technology and software applications in the field of cost management. Still, to a large extent, there are no surveys focused on the analysis of the impact and impact factor of information technology on cost savings or cost optimization in various phases of construction projects. The research discusses the issue of the impact of information technology on cost management in various phases of a construction project. The main goal of the research is to analyze the influence of information technology factors on cost savings and optimization in individual phases of a construction project. Several statistical methods were used in the research. The resulting model of information technology impact factor was created based on data processing and the use of the AHP method.

A techno-economic model was developed to investigate the influence of components on the system costs of redox flow batteries. Sensitivity analyses were carried out based on a example of a 10 kW/120 kWh vanadium redox flow battery system and the costs of the individual components were analyzed. Particular consideration was given to the influence of material costs and resistances of bipolar plates and energy storage media as well as voltages and electric currents. Based on the developed model it was possible to formulate statements about the targeted optimization of existing battery systems and general aspects for future developments of redox flow batteries.

The present paper deals with research on maintenance strategy and maintenance process improvement procedures to increase the efficiency and quality of the production system. It includes the design of maintenance performance indicators relevant to today's manufacturing systems to track improvements in the sustainable development of the manufacturing system. There are also the basic principles of maintenance strategy with linkages to the manufacturing system and selecting the strategy for the organization. The paper emphasizes maintenance management auditing and quality implementation in maintenance. Further, there is the process of changing the maintenance strategy described. This process includes reassessing the criticality of machines and equipment and their design units, then resource and capacity planning and input for maintenance management. It describes the impact of changing the maintenance management organization and maintenance capacity considering the change of strategy and the evaluation of maintenance choice alternatives, together with an analysis of the optimization procedure, which has an impact on social implication. The paper concludes by presenting the achieved impacts of maintenance strategy are: (1) increase in production efficiency (10%), (2) quality improvement in production (20%), (3) performance improvement (30%), (4) reduction of maintenance process costs (35%).

The work aims to develop an electromagnetic shielding measurement methodology and design an electromagnetic shielding effectiveness test setup for thin sheet material testing. In brief, multiple shielding effectiveness standards are described and analyzed in the thin sheet material testing framework. Two types of the developed shielding effectiveness test probe in high and low-frequency ranges are validated comprehensively. Extensive descriptions and data of developed testing methodology are also reported.

Background/Objectives: The study aimed to assess the reactogenicity and immunogenicity of various SARS-CoV-2 vaccines and compare their protective effects against COVID-19 among healthcare workers (HCWs) during the Omicron outbreak in Taiwan.Methods: Conducted from March 2021 to July 2023, this prospective observational study included healthy HCWs without prior COVID-19 immunization. Participants chose between adenovirus-vectored (AstraZeneca), mRNA (Moderna, BioNTech-Pfizer), and protein-based (Medigen, Novavax) vaccines. Blood samples were taken at multiple points to measure neutralizing antibody (nAb) titers, and adverse events (AEs) were recorded via questionnaires. Results: Of 710 HCWs, 668 (94.1%) completed three doses, and 290 (40.8%) received a fourth dose during the Omicron outbreak. AEs were more common with AstraZeneca and Moderna vaccines, while Medigen caused fewer AEs. Initial nAb titers were highest with Moderna but waned over time regardless of the vaccine. Booster doses significantly increased nAb titers, with the highest levels observed in Moderna BA1 recipients. The fourth dose significantly reduced COVID-19 incidence, with Moderna BA1 being the most effective.Conclusions: Regular booster doses, especially with mRNA and adjuvant-protein vaccines, effectively enhance nAb levels and reduce infection rates, providing critical protection for frontline HCWs during variant outbreaks.

Background: The phase III KEYNOTE-604 study confirmed the benefit of pembrolizumab combined with chemotherapy in the first-line treatment of extensive-stage small-cell lung cancer(ES-SCLC). Intergrated the clinical benefits of pembrolizumab and its high cost into account, this study aim to assess the cost-effectiveness of adding pembrolizumab to standard first-line etoposide-platinum (EP) for patients with ES-SCLC from the the US payer perspective. Methods: A Markov model was developed to compared the costs and quality-adjusted life-years (QALYs) of pembrolizumab plus EP and placebo plus EP over a 10-year time horizon. Clinical efficacy, treatment utilization and safety data were pooled from the KEYNOTE-604 trial. Utilities were obtained from published resources. Costs were mainly collected from Medicare in 2020. Sensitivity analyses were performed to examined the robustness of our model. Results: Adding pembrolizumab to standard first-line EP, resulted in better effectiveness than the use of EP alone for ES-SCLC by 0.22 QALYs. Pembrolizumab plus EP was dominated economically by placebo plus EP, leading to an incremental cost-effectiveness ratio(ICER) of $334,373/ QALY. Deterministic sensitivity analyses indicated that the uncertainty in model parameters exerts no substantial effect on our results. Probability sensitivity analysis indicated that probabilities for pembrolizumab plus EP being cost-effective within a wide rang of willingness to pay were modest. Conclusion: From the US payer perspective, the first-line treatment for ES-SCLC with pembrolizumab plus EP was not cost-effective compare with placebo plus EP. Although pembrolizumab combination chemotherapy was beneficial to the survival of ES-SCLC, price reduction may be the necessary measure to improve its cost-effectiveness.

Antiviral therapy such as Oseltamivir has been recommended for hospitalized children with suspected and confirmed influenza for almost 20 years. The therapy is officially authorized for newborns two weeks of age or older, however, questions about its safety and effectiveness still surround it. Our goal was to assess the epidemiological features of two consecutive seasonal in-fluenza cases in children following the COVID-19 pandemic and also to observe the clinical ef-fectiveness and tolerability of oseltamivir in hospitalized children who were not vaccinated against influenza and who had different influenza subtypes, including A (H1N1), A (H3N2), and influenza B, and to identify specific comorbidities associated with influenza in children. We performed an observational study on 1300 children, enrolled between 1st October 2022 and 30th May 2023 and 1st October 2023-4th of May 2024, to the IX Pediatric Infectious Diseases Clinical Section of the National Institute of Infectious Diseases "Prof. Dr. Matei Balș". During the 2022-2023 influenza sea-son, 791 pediatric patients tested positive for influenza and received Oseltamivir. Of these, 89% (704/791) had influenza A, with 86.4% subtypes A(H1N1) and 13.6% of cases had A(H3N2), and influ-enza B 11%(87/791) pediatric patients. Of the total group, 59% were male, and the median age was 2,4 years (1.02-9.28). For the 2023-2024 influenza season, 509 pediatric patients tested positive for influen-za, 56.9% were male gender and were treated with Oseltamivir. 81.6 % had Influenza A, and 18.4% had influenza B. Treatment with neuraminidase inhibitors like Oseltamivir, 2mg/kg/dose twice daily for 5 days, was well tolerated by the children, and we recorded no deaths. The duration of fever hospitaliza-tion after the Oseltamivir administration was significantly longer for patients with A(H1N1) infection than A(H3N2), during both seasons. We identified more complications in the 2022-2023 season and a decreasing number of Influenza B for the 2023-2024 season. Among children with comorbidities, the most common were asthma, gastrointestinal disorders, and metabolic and endocrine diseases. In terms of effectiveness, oseltamivir significantly reduced the intensity of influenza symptoms, thus reducing the number of days of hospitalization (p=0.001) as well as post-infection complications (p=0.005) in both groups. Oseltamivir was less effective in Influenza A (H1N1) than A(H3N2), (p=0.0035). In this study, we evaluated the clinical effectiveness of oseltamivir therapy for all influenza types/subtypes in children, and the length of hospitalization. We identified comorbidities associated with prolonged dura-tion of hospitalisation. Influenza vaccination should be the main tool in the prevention of influenza and its complications in children, especially with comorbidities.

Installations of decentralised Renewable Energy Systems (RES) are becoming increasing popular as governments introduce ambitious energy policies to curb emissions and slow surging energy costs. This work presents a novel model for optimal sizing for decentralised renewable generation and hybrid storage system to create a Renewable Energy Community (REC), developed in Python. The model implements PV Solar and Wind Turbines combined with a hybrid battery and Regenerative Hydrogen Fuel Cell (RHFC). The electrical service demand is derived using real usage data from a rural island case study location. Cost remuneration is managed with an REC virtual trading layer, ensuring fair distribution among actors in accordance with the European RED(III) policy. A multi-objective Genetic Algorithm (GA) stochastically determines the system capacities such that the inherent trade-off relationship between project cost and decarbonisation can be observed. The optimal design results in an LCOE of 0.15€/kWh, reducing costs by over 50% compared with typical EU grid power, with a project IRR of 10.8%, simple return of 9.6%/year, and ROI of 9 years. Emissions output from grid only use is reduced by 72% to 69 gCO2e/kWh. Further research of lifetime economics and additional revenue streams in combination with this work could provide a useful tool for users to quickly design and prototype future decentralised REC systems.

Methods to handle uncertainty in economic evaluation have gained much attention in the literature and the cost-effectiveness acceptability curve (CEAC) is the most widely used method to summarize and present uncertainty associated with program costs and effects in cost-effectiveness analysis. Some researchers have emphasized the limitations of the CEAC for informing decision and policy makers as the CEAC is insensitive to radial shifts of the joint distribution of incremental costs and effects in the North-East and South-West quadrants of the cost-effective plane (CEP). Furthermore, it has been pointed out that the CEAC does not incorporate risk-aversion in valuing uncertain costs and effects. In the present article we show that the cost-effectiveness affordability curve (CEAFC) captures both dimensions of the joint distribution of incremental costs and effects on the CEP and is therefore sensitive to radial shifts of the joint distribution on the CEP. Furthermore, the CEAFC also informs about the budget impact of a new intervention as it estimates the joint probability an intervention is both affordable and cost-effective. Moreover, we show that the cost-effectiveness risk-aversion curve (CERAC) allows to incorporate risk-aversion into the analysis and can therefore be used to inform decision-makers who are risk-averse. We use data from a published cost-effectiveness model of palbociclib in addition to letrozole versus letrozole alone for the treatment of oestrogen-receptor positive, HER-2 negative, advanced breast cancer to demonstrate the differences between CEAC, CEAFC and CERAC and show how these can jointly be used to inform decision and policy makers.

Under the new pattern of "Double-Cycle" economy, how to restructure the domestic economic structure to cope with the continuous softening of the global economic structure is an urgent issue. This paper empirically examines the impact of digitalization level on the division of labor in National Value Chain (NVC) within cities using panel data from 263 cities between 2001 and 2016, employing a spatial Durbin model.The study demonstrates that the digitization level can enhance division of labor in NVC in neighboring regions through spatial spillovers. An increase in digitization not only positively deepens the construction of NVC but also contributes to the development of NVC in adjacent areas.The digitization level can deepen the division of labor in NVC through the impact of cost reduction, consumption upgrading, and market integration. This effect exhibits regional variations, with consumption upgrading playing a crucial role in expanding the division of labor in NVC in the eastern region through improving digitization levels, while cost reduction is a key factor in the central region. The research results of this paper provide some empirical evidence for further progress and transition of China's NVC developing mode from the perspective of digital level.

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: Severe eosinophilic asthma (SEA) represents a substantial global health burden. Benralizumab has been shown to restore good control of asthma. Robust data on benralizumab effectiveness over periods longer than 2 years are still scarce. Methods: This retrospective multicentric study was conducted on 108 Italian SEA patients treated with benralizumab for up to 36 months. Clinical outcomes were evaluated at 6, 12, 24 and 36 months. Partial and complete clinical remission (CR) were also assessed. Data were analysed either with descriptive statistics or using linear, logistic, and negative binomial mixed-effect regression models. Results: Benralizumab induced a persistent reduction in exacerbation rates (p

The growing demand for clean energy transitions has become increasingly significant, with solar energy emerging as one of the most prominent clean energy resources contributing to this effort. However, there remains limited knowledge regarding the economic feasibility of solar project development across different geographic locations and scales. This study introduces a comprehensive economic analysis framework to assess the economic viability of residential and utility-scale solar projects, using California, Tennessee, and Texas as case studies. The economic assessment is conducted through a cost-benefit analysis that adopts a full life-cycle approach, encompassing phases from permitting to demolition for both scales of solar projects. We found that utility-scale solar projects generally offer more favorable investment return ratios compared to residential projects, despite the absence of land acquisition costs and lower initial capital expenditures for the latter. Furthermore, the incorporation of energy storage solutions, such as Battery Energy Storage Systems (BESS), is shown to be essential for improving the efficiency of residential solar energy usage, with efficiency gains of up to 50%. Finally, region-specific strategies, including net metering policies, electricity retail market structures, and the promotion of solar adoption, play a crucial role in enhancing the financial viability of solar projects for both residential and utility scales.

Nowadays the relationship between planning land use and actual land use is not so clear in general. A lot of efforts have been put in the failures of regulation for the expansion of construction land. However, it still lacks an integrated approach to study the effectiveness of land use regulation in terms of different land use types. Furthermore, the existing evaluation of land use plan mainly focuses on a general level, a detailed research on the regulation effectiveness of each construction land use type is absent. Therefore, this research tries to evaluate regulation effectiveness of land use plan, which takes Cangwu country, Guangxi Province as an example. The finding by analysis is that the total area of construction land expansion was about 3494.73 ha, nearly 1.1 times of the plan quota. Moreover, the effectiveness differs greatly in various construction land use types. Town, industrial/mining sites can be well regulated through the quota of land use plan. While, the quota regulation system is not as effective for other type of construction land. Thus, we suggest to improve the regulation effectiveness of construction land through different plan instruments.

Umbria is an Italian region with a highly fragmented water supply, with many small water distribution systems fed by local sources. The chlorination in these small water systems faces many difficulties related to the high demand variation, low economic relevance, and access to infrastructures. As a result, there are many noncompliances with the quality of the supplied water, which causes a decrease in the performance indicators and tariff. This research investigates the possibility of using a low-cost chlorination system to consider different environmental conditions (e.g., temperature variations of water and environment, pH, ...) and discontinuous consumption. A device for this specific use is developed and tested by laboratory tests and is ready for use in the field.

This study addresses the pressing energy constraints in nations like Bangladesh by proposing the implementation of photovoltaic (PV) microgrids. Given concerns about environmental degrada-tion, limited fossil fuel reserves, and volatile product costs, renewable energy sources are gaining momentum globally. Our research focuses on a grid-connected solar PV system model at Char Jazira, Lalpur, Natore, Rajshahi, Bangladesh. Through PVsyst simulation software, we assess the performance ratio (PR) and system losses, revealing an annual solar energy potential of 3375 MWh at Standard Test Condition (STC) efficiency. After considering losses, the system generates 2815 MWh annually, with 2774 MWh exported to the grid. We analyze an average PR of 78.63% and calculate a levelized cost of energy (LCOE) of 2.82 BDT/kWh [1 USD = 110 BDT]. The financial assessment indicates a cost-effective LCOE for the grid-connected PV system, with an annual gross income of 27744 BDT from selling energy to the grid and operating costs of 64060.60 BDT/year. Remarkably, this initiative can prevent 33074.061 tCO2 emissions over the project’s 25-year lifespan.

Tropical rock lobsters (Panulirus ornatus) are a highly cannibalistic species with intermoult animals predominantly attacking animals during ecdysis (moulting). Rapid, positive characterisation of pre-ecdysis lobsters may open a pathway to disrupt cannibalism. Ecdysial suture line development is considered for pre-ecdysis recognition with suture line definition compared for lobsters emerged and immerged, using white, near ultraviolet (365 nm), near infrared (850 nm) and spe-cialty Osram SFH 4737 broadband IR LEDs against a reference of intermoult lobsters with no suture line development. An alternative pre-ecdysis recognition strategy used a novel low-cost spectral camera composed of the Sony IMX219, AMS AS7265x spectral sensors and Osram SFH 4737 broadband infrared LEDs. Images and data using the novel low-cost spectral camera was acquired from intermoult, pre-ecdysis, and post-ecdysis lobsters. Compared with the white light appear-ance, suture line definition was enhanced under 850 nm, 365 nm, and SFH 4737 LEDs for immerged lobsters, while the 850 nm LED achieved the best suture line definition of emerged lobsters. The spectral camera was unable to characterise pre-ecdysis. A least squares regression for binary classification decision boundary successfully separated 86.7% of post-moult lobsters. Achieving post-moult characterisation validated the speculative exploratory approach in developing this novel low-cost spectroscopy tool.

Background: The clinical impact of withdrawal of sodium-glucose cotransporter 2 inhibitor (SGLT2i) on the all-cause readmission in patients with heart failure remains unknown. Methods: Consecutive 212 patients who were hospitalized for heart failure and received SGLT2i during the index hospitalization between February 2016 and July 2022 were evaluated. Of these, 51 patients terminated SGLT2i during or after their index hospitalization. The primary outcome was defined as an all-cause readmission rates/times. Results: Over a median of 23.2 months, an all-cause readmission occurred in 38 of 51 patients (74.5%) withdrawn from SGLT2i and 93 of 161 patients (57.8%) with continuation of SGLT2i (p = 0.099). The total number of all-cause readmissions per year was 0.97 [0-1.50] in patients withdrawn from SGLT2i and 0.50 [0-1.03] in patients with continuation of SGLT2i (p = 0.030). There was no significant difference in total medical cost (62,906 [502-187,246] versus 29,236 [7,920-180,305] JPY per month, p = 0.866) between both patient groups. Conclusions: Termination of SGLT2i may be associated with incremental all-cause readmission and no benefit in reducing total medical costs.

Already more than 140 countries consider or have pledged to reach net-zero emission targets by 2050 or earlier and the share of global emissions falling into an emission pricing scheme has steeply increased over the past three years. Even where there are no direct implications for industry (yet), there is a series of subtle pressure points driving an increasing number of companies across the globe to work towards climate neutrality and pledging ambitious emission reduction goals. This article sheds light on the pressure points, the subtle triggers, the underlying considerations as well as the hoped-for benefits for industrial companies from achieving net-zero emissions. The observations and ideas presented in this paper are derived from quantitative data obtained via the Energy Efficiency Index of German Industry (EEI) and qualitative data. Not only societal, work force, supply chain and investor expectations play a large role, but also many strategic considerations which have the potential to make the company more resilient and profitable, particularly in time of crisis. Those companies that do not move towards decarbonisation, on the other hand, may face a costly late-mover disadvantage. This piece uncovers subtle interconnections, helping stakeholders from industry and beyond to grasp opportunities and challenges ahead.

Jakarta is the capital city of Indonesia, which has its own problems in building transportation facilities, especially on land routes. For private vehicle users, congestion is a common thing, given the very dense number of people living in Jakarta, both natives and migrants from outside the region. And for users of public transportation services such as city transportation (angkot) and transjakarta, convenience is the main obstacle. And even though it is a public vehicle, it cannot avoid congestion because it is in one lane with private vehicles except for the transjakarta bus which has its own lane. Meanwhile, for train-based public transportation such as MRT (Mass Rapid Transit), LRT (Light rail Transit), and electric railroad (KRL), the problem is the lack of integration, namely that many stations are not yet integrated with other transportation. Various policies have been implemented to overcome these problems. This study aims to determine the level of effectiveness and efficiency of public transportation in DKI Jakarta today. The method used in this research is qualitative-descriptive through a literature review on 16 journal articles and 4 websites. The results of this study indicate that congestion is a major problem in the means of transportation in Jakarta. This is due to the increase in population due to urbanization which is also accompanied by an increase in the number of private vehicles. Therefore, to overcome this, the Jakarta Provincial Government has made improvements, reforms, and developments in public transportation. And it is hoped that people who originally used private vehicles will switch to using public transportation. But in reality, various problems in public transportation in Jakarta have not been resolved properly. Especially why traffic jams still occur?, and what are the solutions to overcome them?. It is hoped that the results of the findings of this study can be used as a reference in making or designing policies and can contribute to overcoming problems in the transportation sector, especially in the DKI Jakarta area. The limit of this research is that it only focuses on land transportation facilities in Jakarta.

Introduction: People with severe and persistent mental illness (SPMI) present unique challenges in mental healthcare due to the enduring nature and complexity of their conditions. This study evaluated the clinical effectiveness and potential cost benefits of a multidisciplinary community psychosocial rehabilitation team catering to individuals with SPMI in Nova Scotia, Canada. Method: The Canadian billing system of Medical Service Insurance (MSI) was used to compare inpatient service use and emergency department visits during the year before and the year after receipt of one year of community rehabilitation for patients referred to the team from September 2016 to September 2017. Result: Results demonstrated a statistically significant reduction in mean admission rates and length of inpatient admissions in the year following rehabilitation compared to the pre-rehabilitation year. A substantial percentage of patients experienced no inpatient admissions (88% v. 60%) or ED visits (82% v. 67%) in the post-rehabilitation year compared to the pre-rehabilitation year. There was a significant reduction in inpatient days by 90%, translating into substantial cost savings. The findings highlight the potential economic benefits of community rehabilitation for people with SPMI. Conclusion: This uncontrolled study suggests that community rehabilitation is associated with favourable clinical outcomes for individuals with SPMI in terms of reduced inpatient service use and related costs. Further research into community psychosocial rehabilitation services in the Canadian setting is needed, including controlled and cost-effectiveness studies.

Nature-based solutions (NbS) have gained global attention for addressing societal challenges, benefiting biodiversity, and promoting human well-being. NbS have been increasingly recognized for their role in mitigating climate change impacts, such as coastal flooding. However, despite their integration into policy frameworks in Europe and parts of Africa, there remains limited empirical evidence regarding their effectiveness. This study seeks to address this gap by exploring the factors influencing perceptions and awareness of the effectiveness of NbS in coastal communities. A structured survey questionnaire was administered in three coastal communities—Kula, Oyorokoto, and Bonny—examining how perception, knowledge, and socio-economic factors affect the effectiveness of NbS. Results show that socio-economic factors such as age, education, and occupation significantly influence the perceived effectiveness of NbS. Additionally, awareness was found to have a stronger impact on effectiveness than perception. The study concludes that awareness-raising initiatives, particularly those focused on the protective benefits of mangroves, are crucial for enhancing the effectiveness of NbS. Conservation, afforestation, and restoration of coastal ecosystems are recommended as key strategies for promoting NbS and their role in climate resilience.

Using the PLCC advantages generates revenue and lowers costs more than might be anticipated. It ensures better decisions by using a more perfect and practical assessment of revenues and costs. Although the supplier selection (SC) product life cycle cost (SCPLCC) is an important consideration among corporations, SCPLCC problem has become associated with deciding how one supplier should be selected from possible alternatives. In this study, we applied two types of goal programming, multiobjective linear programming and revised multichoice goal programming to develop a PLCC-based concept to solve the SCPLCC problem and construct a decision-making tool for application to a case of supply chain management in a Taiwanese light-emitting diode company in the high-tech industry. Our study main contribution Company managers can easily use the two approaches of the SCPLCC model with different parameters to solve SCPLCC model problems. Finally, we comparing five models found RMCGP with weighted linear goal programming had an adequate effect for application to the PLCC concept for high-technology company; this cloud make company decision–makers focus on low PLCC and select better supplier.

A low-cost bio-mass-derived carbon substrate has been employed to synthesize MoS₂@carbon composites through a hydrothermal method. Carbon fibers derived from natural cotton provide a three-dimensional and open framework for the uniform growth of MoS₂ nanosheets, thus constructing hierarchically coaxial architecture. The unique structure could synergistically benefit fast Li-ion and electron transport from the conductive carbon scaffold and porous MoS₂ nanostructures. As a result, the MoS₂@carbon composites, when served as anodes for Li-ion batteries, exhibit a high reversible specific capacity of 820 mAh g^-1, high-rate capability (457 mAh g^-1 at 2 A g^-1), and excellent cycling stability. The superior electrochemical performance makes the MoS₂@carbon composites to be low-cost and promising anode materials for Li-ion batteries.

Consumer trust in supply chain certifications plays a pivotal role in shaping contemporary consumer behavior and marketing effectiveness. This qualitative research investigates consumer perceptions of supply chain certifications and their impact on purchasing decisions and brand loyalty. Through semi-structured interviews and focus group discussions with 30 participants, the study explores themes such as credibility, transparency, perceived value, and the influence of certifications on consumer trust. Findings reveal that consumers value certifications that signal ethical sourcing practices and sustainability commitments, viewing them as assurances of product quality and social responsibility. Credibility and transparency in certification processes emerged as critical factors influencing consumer trust, while perceived benefits such as environmental sustainability and fair labor practices positively influenced purchase intentions. Moreover, certifications were found to enhance brand loyalty by aligning with consumers' ethical values and beliefs. However, the study identifies challenges including high certification costs, complexity in compliance, and consumer skepticism, which hinder broader adoption and effectiveness of certifications. The implications of these findings suggest that businesses can enhance consumer trust and market competitiveness by investing in rigorous certification standards, clear communication strategies, and sustainable practices. Addressing barriers through improved transparency and consumer education is crucial for maximizing the impact of certifications on ethical consumption. Future research directions include longitudinal studies on certification impacts and comparative analyses across industries and global markets to further enrich understanding of consumer behavior and certification influences.

The limited supply of drinking water has aroused people's curiosity in recent decades. Adsorption is a popular method for removing hazardous substances from wastewater, especially heavy metals, as it is cheap, highly efficient and easy to use. In this work, a new sludge-based activated carbon adsorbent (SBAC1 / SBAC2) was developed to remove hazardous metals such as cadmium (Cd+2) and lead (Pb+2) from an aqueous solution. The chemical structure and surface morphology of the produced SBAC1 and SBAC2 were investigated using a range of analytical tools such as CHNS, BET, FT-IR, XRD, XRF, SEM, TEM, N2 adsorption/desorption isothermal and zeta potential. BET surface areas were examined and SBAC2 was found to have a larger BET surface area (498.386 m2/g) than SBAC1 (336.339 m2/g). SBAC2 had a lower VBJH (1.5026 cm3 g-1) than SBAC1 (1.59873 cm3 g-1), but a higher VT (0.3748 cm3 g-1) than SBAC1 (0.2688 cm3 g-1), while the average pore size was 10-100 nm for SBAC1 and 45-50 nm for SBAC2. The ideal conditions investigated for the removal of Pb+2 and Cd+2 were 10 mg SBAC1 / SBAC2, Pb+2 / Cd+2 at an starting concentration of 30 mg/L, a temperature of 40 and 50 °C, pH = 6, 8 and contact times of 10 and 15 minutes for Pb+2 and Cd+2, respectively. SBAC1 and SBAC2 eliminated approximately 99.99% of Cd+2 and Pb+2 out the water under all conditions tested. The results of the adsorption of Cd+2 and Pb+2 were in good agreement with the pseudo-second-order equation (R2 = 1.00). Under the experimental conditions, the Cd+2 and Pb+2 adsorption equilibrium data were effectively linked to the Langmuir and Freundlich equations for SBAC1 and SBAC2, respectively. Langmuir model calculated the adsorption capacities of SBAC1 and SBAC2 for Cd+2 (309.24 and 329.62 mg/g) and for Pb+2 (318.46 and 339.61 mg/g), respectively. The regeneration showed high recyclability for the fabricated SBAC1 and SBAC2 during five consecutive reuse cycles. As a result, the produced SBAC1 and SBAC2 are attractive adsorbent for the elimination of heavy metals from various environmental and industrial wastewater samples.

Despite the success of recent efforts to increase access to improved water, sanitation, and hygiene (WASH) globally, approximately one-third of schools around the world still lack adequate WASH services. A lack of WASH in schools can lead to the spread of preventable disease and increase school absences, especially among women. Inadequate financing and budgeting has been named as a key barrier for integrating successful and sustainable WASH programs into school settings. For this reason, the purpose of this review is to describe the current knowledge around the costs of WASH components as well as financing models that could be applied to WASH in schools. Results show a lack of information around WASH costing, particularly around software elements as well as there is a lack of data overall for WASH in school settings as compared to community WASH. This review also identifies several key considerations when designing WASH budgets or selecting financing mechanisms. Findings may be used to advise future WASH in school programs.

Green and low-carbon development has become an important embodiment of China's path to becoming a strong agricultural country. How to enable agricultural enterprises to better adopt green technologies and conduct production and operation with the concept of sustainable development has become a key link. This article utilizes a structural equation model (SEM) to analyze the role paths and mediating effects of organizational learning ability and policy orientation in agricultural enterprises' market orientation and willingness to adopt green technologies[ The definition of green technology in this paper refers to Guo Kesha, Tian Xiaoxiao. Green technology and green transformation of industrial development mode [J]. Tianjin Social Sciences, 2024 (02) :99-107, including green manufacturing (production) technology and green service technology.]. The results show that market orientation, organizational learning ability, and policy effectiveness have significant direct positive impacts on the willingness to adopt; market orientation has a significant positive impact on agricultural enterprises' organizational learning ability, organizational learning ability has a significant positive impact on policy orientation, and market orientation has a significant positive impact on policy effectiveness; the results of mediation analysis also indicate that learning ability has a significant mediating effect between market orientation and willingness to adopt, and policy effectiveness has a significant mediating effect between market orientation and willingness to adopt. Through difference analysis, it is believed that the mediating effects of the three paths are equally important, and organizational learning ability and policy effectiveness play a partial mediating role in agricultural enterprises' willingness to adopt green technologies. Based on this, policy suggestions are proposed to improve enterprises' own organizational learning ability, increase the promotion of policies related to green technologies, improve relevant policies for the application of green technologies, and increase research and development efforts for green technologies.

This study explores an optimal strategy for muscle force estimation by integrating simplified cost functions with detailed muscle models, demonstrating significant advantages over traditional complex methods. Using elbow flexion as a case study, we characterize the interplay between muscle models and cost functions, showing that accurate muscle force estimations can be achieved effectively without electromyography (EMG) data while also substantially reducing computational demands. Validated against established bio-mechanical data, our models confirm their accuracy in predicting muscle behavior. This approach has profound implications for enhancing rehabilitation protocols and athletic training, providing a more accessible and adaptable tool for muscle force analysis. It broadens the applicability of muscle force estimation in clinical and sports settings and paves the way for future innovations in bio-mechanical research.

Vaccination against the SARS-CoV2 virus has shown great promise in managing the spread and severity of Covid-19. While these vaccines were able to provide a favourable response in controlling the SARS-CoV2 infection, its use came with accompanying side effects. This systematic review aimed to determine the effectiveness of the different Covid-19 vaccine subtypes and discover the side effects associated with each vaccine elsewhere but specially in Trinidad and Tobago. For this systematic review, the keywords “Pfizer-BioNTech OR Moderna OR Oxford-AstraZeneca OR Janssen OR Sinopharm OR Novavax AND Covid-19 vaccine efficacy” and “Covid-19 vaccines AND Trinidad and Tobago” were researched under PubMed, MEDLINE and other internet sources through which other notable journals, and documents were discovered and searched similarly as outlined previously. In doing so, 65 relevant articles were included as part of this review. Of the studies examined, overall the vaccine with the greatest VE was found to be Pfizer-BioNTech (95%), followed by Moderna (94.1%), Novavax (89.7%), AstraZeneca (70.4%), Sinopharm (67%) and finally Janssen (66.9%). The use of Pfizer-BioNTech or Moderna was most efficacious in response to the different Covid-19 variants. Some side effects were common for all vaccine types however adverse effects were more commonly seen with vaccination by mRNA vaccines, Pfizer-BioNTech and Oxford-Astrazeneca. Researchers targeted individuals aged 18 and above residing in various geographical areas of TT, specifically focusing on those who had not received the COVID-19 vaccine and expressed hesitancy towards it. Convenience sampling was used to select the study participants, and formal in-depth virtual interviews were conducted on a one-to-one basis, employing a semi-structured questionnaire to guide the discussions. The interviews were meticulously recorded and transcribed, following the principles of reflexive thematic analysis, to distill key insights from the participants' responses. The study's findings, derived from the perspectives of 25 participants, illuminated a complex tapestry of reasons underlying vaccine hesitancy in Trinidad and Tobago. Notably, prominent themes emerged, including fear, doubts regarding vaccine efficacy, a perceived inadequacy of information, a sense of susceptibility to the virus, deep-seated mistrust, alternative herbal remedies, and religious reservations. Interestingly, the motivations expressed by these vaccine-hesitant individuals for potentially receiving the vaccine in the future were rooted in notions of necessity, an increased sense of susceptibility to the virus, a desire to reach a certain health benchmark, and a need for assurance regarding the vaccine's safety and effectiveness. This comprehensive exploration of vaccine hesitancy in TT provides valuable insights for public health officials and policymakers in crafting targeted strategies to address this critical issue within the local context. Conclusion: The findings of this study determined that vaccination against the SARS-CoV2 virus provided beneficial outcomes against infection, Covid-19 related hospitalizations, ICU admissions and mortality. While vaccination was deemed highly appropriate in managing the spread of the SARS-CoV2 virus and enhancing the outcomes in infected persons, the effectiveness of the different vaccine platforms indicated that certain vaccine platforms are preferential to others in different populations. In terms of vaccine efficacy, nucleic acid vaccines such as Pfizer-BioNTech and Moderna showed the greatest effectiveness while inactivated whole virus vaccines such as Sinopharm and viral vectors like Janssen had the least effectiveness. The side effects, joint/muscle soreness, pain at the injection site, shoulder pain, headaches, fever, chills, weakness, epistaxis, renal and certain cardiovascular events were common for all vaccine types. Adverse effects were more frequent and severe with the mRNA vaccines by Pfizer-BioNTech and Oxford-Astrazeneca than inactivated whole virus vaccines. The data collected in this research can be very useful to help individuals make a decision on which vaccine would be appropriate for them. More long-term studies are needed to better gauge the scope of side effects for each vaccine type.

For the last two decades, an increasing demand for low-cost adsorbents for drinking water treatment has been challenged in the rural areas of developing countries that have problems with arsenic (As) contamination. In this work, spent bleaching earth (SBE), a residual material that is formed during the process of refining vegetable oil, has been utilized to prepare the new magnetic adsorbent Fe-SBE/C by modifying its surface area through calcination and co-precipitation with iron. The experimental results demonstrate that Fe-SBE/C exhibits a substantial adsorption capacity towards both arsenite (As(III)) and arsenate (As(V)). Optimal pH conditions were found to be pH 10 for As(III) and pH 3 for As(V), resulting in adsorption percentages of 76.7% and 94.1%, respectively. Other experimental parameters such as calcination conditions, adsorbent dosage, iron-loading ratio, and the presence of co-existing ions were thoroughly investigated. The kinetic study revealed that the adsorption processes follow the Elovich and intraparticle diffusion models, suggesting a combined adsorption mechanism of boundary layer control and chemisorption. Furthermore, the isotherm followed the Langmuir model with a maximum adsorption capacity of 202.61 μg g-1 for As(III) and 187.61 μg g-1 for As(V). Through thermodynamic analysis and reinforcement by activation energy data, this research validates that the observed adsorption process is indicative through chemisorption. The regeneration study revealed the potential for multiple cycles of arsenic removal, highlighting the practical applicability of Fe-SBE/C in environmental contexts. In conclusion, the findings of this study underscore the efficacy of Fe-SBE/C in arsenic removal and present it as a promising and environmentally friendly solution for mitigating arsenic pollution.

This qualitative study explores the transformative role of digital technologies in enhancing supply chain efficiency and marketing effectiveness across diverse industries. The integration of Internet of Things (IoT), artificial intelligence (AI), blockchain, and advanced analytics has reshaped organizational practices, enabling real-time data collection, analysis, and decision-making in supply chain management (SCM) and marketing. Through semi-structured interviews with 25 professionals, including supply chain managers, marketing executives, and IT specialists, insights were gathered into the adoption, integration, and impact of digital technologies within organizational contexts. Key findings highlight IoT's contribution to enhancing supply chain visibility, predictive maintenance, and operational efficiency through continuous monitoring and data-driven insights. AI technologies support demand forecasting, inventory optimization, and personalized marketing strategies, improving customer engagement and satisfaction. Blockchain enhances supply chain transparency, traceability, and security, reducing risks associated with fraud and ensuring compliance with regulatory standards. Advanced analytics provide organizations with actionable insights into consumer behavior and market trends, guiding strategic decision-making and optimizing marketing campaigns. Despite these benefits, organizations face challenges such as technological complexity, integration issues, data privacy concerns, and organizational resistance to change. Strategic planning, leadership support, and investment in digital infrastructure are essential for overcoming these challenges and maximizing the potential of digital technologies. Future research directions include exploring sustainability initiatives in digital SCM, advancing AI-driven analytics, and understanding digital transformation in emerging markets.

Digital transformation is revolutionizing supply chain management, profoundly influencing marketing effectiveness across industries. This qualitative study explores the impact of digital transformation on supply chains and its implications for marketing strategies. Through in-depth interviews, case studies, and document analysis, the research elucidates how digital technologies such as IoT, blockchain, AI, and advanced analytics are reshaping supply chain dynamics. Key findings highlight enhanced supply chain visibility, improved decision-making capabilities, and strengthened collaboration among supply chain partners. These technological advancements empower organizations to optimize inventory management, anticipate market trends, and deliver personalized customer experiences, thereby enhancing operational efficiency and customer satisfaction. Furthermore, the study underscores the role of digital transformation in promoting sustainability and ethical practices within supply chains. Technologies like blockchain facilitate transparent and traceable supply chains, supporting initiatives for responsible sourcing and environmental stewardship. Despite the transformative benefits, the study identifies challenges including significant investment requirements, integration complexities, and data security concerns. Strategic approaches to technology adoption, robust cybersecurity measures, and employee training are essential for overcoming these challenges and maximizing the benefits of digital transformation. Overall, this study contributes to understanding how digital transformation drives innovation in supply chain management and enhances marketing effectiveness. By embracing digital technologies and aligning supply chain strategies with marketing objectives, organizations can navigate competitive landscapes, meet evolving consumer expectations, and achieve sustainable growth in the digital era.

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 decline in assisted reproductive technology (ART) success among older women, attributed to decreased oocyte quantity and quality, poses a significant challenge. Currently, no consensus ex-ists on the optimal ovarian stimulation protocol for older women undergoing IVF. This retrospec-tive registered cohort study aimed to compare cumulative live birth rates (CLBR), time to live birth (TTLB), and cost-effectiveness in women over 35 years using gonadotropin-releasing hor-mone agonist (GnRHa) or clomiphene-primed ovarian stimulation (CPOS). We performed pro-pensity score matching (PSM) on 2,871 IVF cycles in women over 35 who received either GnRHa or CPOS protocols, resulting in 375 cycles in each group to compare treatment outcomes. Addition-ally, a decision tree model was utilized to assess the cost-effectiveness of the two protocols. Fol-lowing PSM, both groups showed similar baseline characteristics. The CPOS protocol exhibited a higher cycle cancellation rate (13.07% vs 8.00%, p=0.032), yet maintained comparable fertilization and embryo quality. While CLBRs per initial cycle (41.07% vs. 45.33%, p=0.269) and delivery out-comes were similar between the groups after a 24-month follow-up, TTLB was longer in the CPOS group. Notably, the average cost per live birth in the CPOS group was 21.27% less than that in the GnRHa group (￥32,301.42 vs ￥39,174.22). In conclusion, for women over 35 undergoing IVF, the CPOS protocol demonstrated similar CLBR to GnRHa but with lower costs, suggesting its potential as a viable and cost-efficient ovarian stimulation option.

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 assesses the effectiveness of HCV self-testing (HCVST) distribution models compared to provider-led HCV testing (PL-HCVT), including the standard of care facility-based HCVT (SOC-HCVT) and community-based organization HCVT (CBO-HCVT) among people who inject drugs (PWID) in Vietnam. A cross-sectional study was conducted as part of a larger implementation science study in Hanoi and Ho Chi Minh City from September 2023 to April 2024. We engaged 8 CBOs and 10 public and private clinics in offering choice of HCVST through community-based and facility-based distribution, and secondary distribution), or PL-HCVT via SOC-HCVT and CBO-HCVT. Among 1,165 PWID, 693 opted for HCVST and 472 for PL-HCVT. The proportion of first-time testers was significantly higher in HIVST community-based and secondary distribution as well as CBO-HCVT compared to SOC-HCVT and facility-based HCVST (87.1%, 93.3% and 82.7% vs. 41.9% and 35.7%, respectively; p < 0.001). Overall, HCV seropositivity rate was lower in HCVST than PL-HCVT, however, higher in HCVST facility-based and community-based distribution compared to HCVST secondary distribution (28.1% and 20.4% vs. 5.7%, respectively). Community-based HCVST was most effective, followed by facility-based HCVST and secondary distribution. Our findings indicate that HCVST effectively reaches first-time testers and results in more people diagnosed and treated among PWID.

The study examined the effectiveness of developed instructional module on the enhancement of learners’ academic achievements specifically this current situation of COVID-19 pandemic under distance learning delivery modalities. This instructional module in Physics was personally developed by the researcher and intended to used in teaching-learning process in Senior High School under the Department of Education. The participants of the study are the grade 12 SHS students at Aliaga National High School into two groups –the controlled and experimental. The parameters are the content knowledge, alignment to learning competencies, learning tasks, assessment method, design course, friendliness and timeliness. To examine the effectiveness, the experimental research designed was employed. The following findings were made: the mean pre-test scores of two groups had 5.40 and 5.33 which means almost the same while the post-test mean scores of controlled group had 14.40 and experimental group had 17.80 which means the mean scores of experimental group were higher than the mean scores of the controlled groups. The pretest of two groups of participants had value of 14.976 with significant value of .000 and found out “not significant” while the post-test had value of 14.976 with significant value of .000 and interpreted as “significant” therefore the developed instructional module in Physics found “effective” and had impact to students’ academic performance. On the assessment made on the effectiveness of developed instructional module in Physics the overall weighted mean got 3.77 with an interpretation of “Very Satisfactory”. Continuous development and enhance of instructional module is recommended.

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.

Background: Significant national and global costs were incurred from recent emerging infectious disease outbreaks, notably H1N1 highly pathogenic influenza, Zika and Severe Acute Respiratory Disease (SARS), both in the medical sphere and within the socioeconomic context around it. With forecasts expecting an increase in direct and indirect burden of novel infectious disease events, costs of future outbreak events are likely to be exacerbated. In this scope, it is critical for countries to identify this trend and work towards minimizing costs while continuing to improve prevention, treatment and mitigation. Objectives: The impacts of the West Africa Ebola crisis have largely focused on the response to the outbreak abroad. The aim of this paper was to determine the direct and indirect domestic costs of the Ebola Virus Disease (EVD) introduction into the United States (U.S.), compare the economic consequences of the epidemic with other disease outbreaks and identify the primary drivers of such costs to leverage more global health preparation to prevent, prepare for, and respond to disease threats more effectively. Methods: I conducted a literature review of 1) EVD cases documented by the U.S. Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO), 2) scientific articles identifying the costs of Ebola for the U.S. and countries around the world and 3) grey literature on treatments and public reactions. Extrapolating data from these sources, I then performed a cost-analysis of direct costs (preparation, treatment and contact tracing) and indirect costs (loss of productivity owing to disease, death, and risk avoidance behaviors) of the disease. Findings: The country spent between $300-$700 million in direct costs. Additionally, roughly $200-$340 million were forgone as results of loss of productivity from to disease, death or social risk avoidance behaviors. The cost-per-case for the United States was vastly higher than for any other country. Conclusions: High direct costs suggest that either the United States took disproportionate preparative measures to mitigate a potential American outbreak or were unprepared for a potential outbreak of this magnitude. The significant risk avoidance behavior estimates hint that forces having the ability to shape social attitudes and norms – namely traditional and online media – played a significant role in driving social behavior towards fear of exposure to others. The findings reinforce that outbreaks occurring in a single part of the world can have dramatic economic effects globally, even in areas with existing public health capacity and other preventive measures, highlighting the need for change in global health systems to shift from a passive responder and incorporate other societal actors to effectively reduce the ever-increasing costs of disease threats.

This paper presents a comprehensive cost-benefit analysis of producing alternative phosphorus (P) fertilizers from recycled water treatment residuals (Fe-WTR) and cowshed effluents, under the umbrella of circular economy approach. Fe-WTR is compared to a synthetic adsorbent, layered double hydroxide (LDH). Dairy wastewater is used as a P source for both adsorbents. The cost of 1 ton P-Fe-WTR sums up to 329 Euro. In contrast, the use of synthetic adsorbents (P-LDH) incurs significantly higher costs, amounting to 3329 Euros per ton, underscoring the economic advantage of utilizing waste-derived materials. Adopting Fe-WTR fertilizer not only offers substantial cost savings by avoiding landfill fees (40-150 Euros per ton) and wastewater discharge fines (500 Euros per ton) but also reduces environmental impacts. This sustainable method mitigates eutrophication and pollution, presenting a dual benefit of cost-effectiveness and environmental protection. Although our results are based on a specific case study, they reflect the potential value of extending the circular economic approach to P production worldwide: Recycling P from waste streams can be economically viable and environmentally preferable at large, aligning with global sustainability goals and demonstrating the practicality of circular economy principles in environmental management.

Context: As software industries, adopted different frameworks where Scrum is play a vital role in different software industries. Scrum basis the three main stakeholders i.e. Product Owner, Scrum Master and Development. Where Scrum Master is a very crucial role for any agile project. However, in the past Scrum Master Faces different challenges, which discovered in several studies. However, we need to measure the effectiveness of the Scrum master in Agile Projects, how presently Scrum Master are performing in Pakistani software industries. Objective: The main objective of this research to identify the effectiveness of the Scrum Master in agile projects in Pakistani software industries. Method: Research Method (Qualitative Research) For this purpose, we gathered the facts from Pakistani software industries by using the qualitative method. We conducted a survey from different software industries; almost 12 participants responded the survey as per their best knowledge as well as they agreed for face- to-face interviews. Results: The results indicated that, mostly organization compliance with the Scrum ceremonies. In addition, 65% Scrum Masters has a great effectiveness in any agile project. 21% of Scrum Master generates negative impact in agile project. Conclusion: The main highlights of this research, we have presented the compliance of the Scrum in different software organization. Further, we explore the both positive and negative impact of the Scrum master in Pakistani software organizations.

Knee osteoarthritis is the most popular type of osteoarthritis that causes extreme pain in elderly. Currently there is no cure for osteoarthritis. To lessen clinical symptoms, glucosamine was suggested. The primary goal of our study is to evaluate the efficacy and safety of glucosamine from recent studies. Electronic databases such as PubMed, Scopus, Cochrane were used to assess RCT. From the beginning through March 2023, the papers were checked, and if they fulfilled the inclusion criteria, they were then examined. WOMAC and VAS scales were considered as main outcome measure. A total of 15 studies were selected. Global pain was significantly decreased in comparison to placebo, as measured by the VAS index, with an overall effect size SMD of -7.41 ([95% CI] 14.31, 0.51). The WOMAC scale confirmed that pain, stiffness, and physical function had improved, however the effects were insufficient. A statistical update also revealed that there were no reports of serious medication interactions or significant adverse events. To summarize, glucosamine is more effective than a placebo at reducing pain in knee osteoarthritis patients. In long-term treatment, oral glucosamine sulfate 1500 mg/day is believed to be well tolerated.

This research assesses the effectiveness of the Socio-Technical Assistance (STA) program combined with Owner-Driven Housing Reconstruction for rural private housing recovery after Nepal’s 2015 earthquake, particularly targeting vulnerable households. Through a quantitative 304-questionnaire survey, the study reveals that 96% of households credited STA activities for accelerating reconstruction, with 95% acknowledging its significance and 78% emphasizing its necessity. Notably,89% expressed dependency on STA for reconstruction, and 85% believed it heightened disaster risk reduction awareness. In conclusion, the study establishes that STA activities significantly contributed to the successful reconstruction of vulnerable households, addressing critical aspects such as financial support, technical assistance, housing accessibility, earthquake-resilient construction, improved livelihoods, and safety enhancements. The field study presents crucial recommendations to enhance the effectiveness of Socio-Technical Assistance (STA) activities in post-earthquake rural private housing reconstruction. Emphasizing the need for tailored, demand-driven interventions, the study cautions against relying solely on an Owner-driven Reconstruction model, challenging the one-size-fits-all strategy. The study proposes integrating tailored interventions into overarching recovery strategies, advocating for coordinated efforts to enhance Disaster Risk Reduction (DRR) awareness and cultivate resilient communities in particularly vulnerable households. Aligned with United Nations Sustainable Development Goal 11, which focuses on sustainable cities and communities. This research aims to enhance the literature on post-disaster humanitarian shelter and settlement by emphasizing the significance of inclusive and comprehensive approaches to recovery and reconstruction.

The use of low cost sensors has dramatically increased in recent years in all the engineering sectors. In the field of buildings and automotive, low cost sensors open very interesting perspectives, because they allow to monitor temperature and humidity distributions together with air quality, in a widespread and punctual way and allow control of all energy parameters. The main issue still open remains the validation of the measurements. In this work, we propose an innovative approach to verify the measurements given by some low-cost systems built ad hoc for automotive applications. Two independent low-cost measurement systems have been set to measure Particulate air Matter (PM) concentration, TVOC concentration, CO2 concentration, formaldehyde concentration, air temperature, relative humidity, pressure, air flow velocity and GPS position. These systems have been calibrated by the comparison with standard and certified sensors used by the regional authority of Emilia-Romagna region (ARPAE, Italy) for characterising the air-quality. The innovation of this approach lies in both the in-field comparison of low-cost and high quality sensors and the use of proper conversion approaches for mass concentration measurements. A quantitative analysis of the sensors performance is given, with a focus on effects of time-granularity, relative humidity, mass conversion from particle counts and size detection response. The results show that the low-cost sensors measurements of air temperature, relative humidity and particle number concentration are in a good agreement with high quality sensors measurements, with a strong impact of relative humidity on performance indicators. Overall, a good quality and consistency of the data among the sensors has been achieved.

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.

In order to evaluate the economy of superhighway, on the basis of the analysis of the cost of the ordinary expressway and high speed railway, the cost of superhighway is estimated. On this basis, the standard of the toll of superhighway at all levels is determined by reference to the standard of the construction cost and the toll collection standard of the ordinary expressway. According to the toll collection standard of superhighway and the fuel consumption cost of superhighway at all levels, the cost of single car and the single person cost of superhighway are calculated. Based on the analysis of highway passenger transport, railway passenger transport and civil aviation ticket price, the single person cost per kilometer of the above travel modes is calculated and compared with the single person travel cost per kilometer of superhighway. The results show that the single person cost of superhighway is between 0.29 and 0.47 yuan /km, which is 0.28 yuan /km higher than the highway bus, 0.18 yuan /km higher than the ordinary expressway self driving and 0.23 yuan /km higher than the express train, but 0.78 yuan/km lower than that of the first class seat of high-speed train, and is 0.92 yuan/km far lower than that of civil aviation flight economy class and 2.42 yuan/km lower than the business class. Therefore, the superhighway trip has certain advantages in economy.

This article presents a novel sustainable business management technique, emphasizing description and estimation over the outdated profit metric. Due to the intricacies and challenges of implementing the 2019 capital management method based on capital valuation (implemented in 2020–2022), a simpler approach became essential. While it is plausible for organizations to implement capital management based on their valuation, undertaking it with no outside help presents a challenge. The new descriptive method is fundamentally distinct in that detailed monetary valuations of capitals are omitted in favor of description and estimation. This paper establishes the groundwork for applying the new approach in several stages and introduces three new management indicators—the overall accomplishment of management goals index (evaluating management efficacy), the capital level index, and the adjustment (compliance) index—replacing the profit metric. Noteworthy advantages include separating the assessment of management outcomes from the organization's condition, including human and social capital into efficiency evaluations, and removing the profit indicator for management purposes, which prevents resource waste and enhances company efficiency and effectiveness.

This paper is focused on the analysis of methods used to assess effectiveness and efficiency of the occupational safety and health management system (OSHMS) in a company. It reviews current Russian and international occupational safety and health standards. The paper details the method outlined in International Standard GOST 12.0.230.3-2016 “Occupational safety standards system. Management systems for occupational safety. Evaluation of effectiveness and efficiency” based on the data collected during the external audit of OSHMS function efficiency in a Russian mining company. Effectiveness and efficiency indicators were determined, and a generalized desirability coefficient was calculated. Weaknesses of the method proposed in GOST 12.0.230.3-2016 were identified and mathematical and linguistic solutions were proposed to improve it. Harrington function was used to determine a numerical and linguistic score. The performed calculation demonstrated that the company needed strategic management decisions to improve the current situation. Practical approaches were offered to enhance the company's systems-based occupational safety and health performance..

Toll plaza optimization is essential for improving traffic flow and easing congestion on road networks. This study aims to suggest and assess potential optimization solutions for the Peshawar toll plaza, considering variables like traffic volume, toll-collecting effectiveness, and customer facilitation. Different resources are used for data collection, like the National Highway Authority of Pakistan. Physical data is collected from the established Toll Plaza of Peshawar, along with the development of each line. The goal of this study is to suggest and assess potential optimization solutions for the Peshawar toll plaza, considering variables like traffic volume, toll-collecting effectiveness, and customer happiness. The analysis of present traffic patterns, the detection of bottlenecks, and the creation of plans to ease congestion and enhance overall traffic flow are all part of the optimization process. The approaches used in this study include data analysis, simulation, and traffic modeling. PTV VISSIM is software for transportation planning, design, and analysis. The simulations consider various conditions, such as variable traffic volumes, toll collection methods, and lane configurations. When comparing the different optimization strategies, performance indicators like trip time, latency, and queue length are utilized to determine which approach is practical. Waiting time Vs. Existing each lane, etc, is explained. In the end, comparing queue lengths and throughput across different lane scenarios shows that maximizing throughput with existing lanes yields up to 45% improvement with E-tag lanes, 40% with existing E-tag lanes, 38% with E-tag plus additional toll and cash lanes, 32% with three cash lanes, and 28% with two E-tag lanes. Failure to regularly monitor and adjust the existing lane pattern scenario based on traffic patterns can lead to queues being 20% longer. Without proactive evaluation and optimization, there is a potential 63% opportunity for queue length improvement

Our aim is at three feels: i) study safe haven properties of sectoral CDS; ii) study hedging effectiveness and measure the diversification benefits of introducing them in both Conventional and Islamic stock markets portfolios and iii) compare these results with VSTOXX, Gold and Bitcoin indices. To do this, we estimate time varying hedge ratio using (A)DCC and GOGARCH models and then deduce hedging effectiveness.. We follow the same methodology for each sub-period and each refit to test the effect of bubble crypto currency and COVID-19 pandemic on hedging effectiveness. Empirical results show the superiority of industrial CDS sectoral index to hedge both conventional and Islamic stock markets whether long or short term despite that their performances were reduced slightly during the second and third periods. VSTOXX and Others sectoral CDS indices offers Hedging performances that are generally better than Bitcoin and gold.

Varicella (chickenpox) is one of the most common infectious diseases in preschool children and can be prevented by immunization. While immunization program promotes higher vaccine coverage, there are still challenges with implementing vaccination programs particularly in low-income countries. Economic barriers can increase inequality in vaccination, which highlights the importance of distributing cost-effective varicella vaccines. Varicella vaccines have been developed with two main Varicella-Zoster Virus (VZV) strains globally: MAV/06 and Oka strains. Most of the vaccines are based on the Oka strain, while MAV/06 strain vaccines were exclusively developed by GC Biopharma. Although more than 30 million doses of MAV/06 vaccines as cost-effective vaccines have been distributed internationally, there is no comprehensive review on safety, immunogenicity, and effectiveness of MAV/06 vaccines in the literature. This paper aims to summarize and present more than 30 years of accumulated evidence from research on safety, immunogenicity, and effectiveness of MAV/06 vaccines. We expect that MAV/06 vaccines as cost-effective varicella vaccines make a significant contribution to improving global public health and health equality in children.

To estimate the recreational value provided by the Foy’s Lake annually using the most applicable model for on-site data is the main objective of this study. Adhere to the objective of this study; Individual Travel Cost Method (ITCM) has been applied and Zero Truncated Poisson Regression Model has been found plausible among other models to estimate consumer surplus. Based on the findings of the study, an estimate of the consumer surplus or recreational benefits per trip per visitor can be recommended as BDT 5,875 or US $ 73.44 and counting the consumer surplus per trip per visitor, the annual recreational value (total consumer surplus) provided by the lake is found to be BDT 321 million or US $ 40.2 million.

In Malaysia, as in many parts of the world, vocational education and training (VET) is frequently perceived as the solution to improving the opportunities of youths who lack the resources, skills or motivation to continue with higher education. The focus of the study falls on the effectiveness of the apprenticeship scheme during the 10^th Malaysia Plan. This study may provide an opportunity to find out how the related parties react towards the apprenticeship scheme. This is important, as feedbacks are central to the success or failure of any scheme. It is expected that the relevant government bodies, private sectors, trainers and trainees will have a valuable insight on the progress this far and what need to be done in the future based on the outcome of the research. This study follows snowballing sampling method and gathers the information from apprentices from variety of industrial sectors. The findings indicate effectiveness at some types of training but lacks comprehensiveness and efficient use of resources and future direction, especially during the 10^th Malaysia plan period from 2011 to 2016. This exploratory research is a first chapter of the deeper study in this niche.

In the context of high energy costs and energy transition, the optimal use of energy resources for industrial consumption is fundamental. This paper presents a decision-making structure for large consumers having flexibility to manage electricity or natural gas consume to satisfy the demands of industrial processes. The proposed modelling energy system structure relates monthly medium and hourly short-term decisions to which these agents are subjected, represented by two connected optimization models. In the medium term, the decision occurs under uncertain conditions of energy and natural-gas market prices, as well as hydropower generation (self-production). The monthly decision is represented by a risk-constrained optimization model. In the short term, hourly optimization considers the operational flexibility of energy and/or natural-gas consumption, subject to the strategy defined in the medium term and mathematically connected by a regret cost function. The model application of a real case of a Brazilian aluminum producer indicates a measured energy cost reduction of U$ 3.98 million over a six-month analysis period.

BackgroundAdvanced radiological stage of knee osteoarthritis (OA) and obesity are predictive of poorer and shorter response to viscosupplementation, but very few is known regarding the impact of other factors such as sport practice, comorbidities or anatomical features of OA. ObjectivesTo investigate the patient’s and OA characteristics associated with the duration of effectiveness (DE) of viscosupplementation in patients with knee OA.MethodsCross-sectional single center trial in patients with knee OA treated with intra-articular (IA) hyaluronic acid (HA) injection(s) within the previous 3 years. The investigator collected demographic and radiographic data (Kellgren grade, involved knee compartments), dosing regimen (single or repeat injections), presence and volume of joint effusion, previous or concomitant IA corticosteroid injection, number of previous viscosupplémentations and the comorbidities. The patient completed a questionnaire including the self-assessment of DE (number of weeks during which viscosupplementation was effective on symptoms), the activity level (sedentary, active, athletic), the level of sport activity (light, moderate or intensive). Predictors of DE were studied in univariate and multivariate analyses ResultsOne hundred five patients (149 knees) were analyzed (62% women, mean age 66.1 ± 13.2 years, mean BMI 27.5 ± 7.5 kg/m²). The mean DE was 48.2 + 24.8 weeks. In a bivariate analysis, the predictors of a shorter with DE were BMI >27.5kg/m2, more than 3 previous viscosupplémentations, Kellgren grade 4, sedentary patients, and more than 1 affected compartment. In the multivariate analysis, 4 independent factors remained associated with a shorter DE: BMI >27.5 kg/m2, knee multi-compartment damage, number of viscosupplements >3, sedentary lifestyle. A statistically significant association between a longer DE and treated arterial hypertension was found suggesting a beneficial effect of certain antihypertensive drugs. ConclusionThe study confirms the harmful influence of an increased BMI, It also shows that viscosupplementation is more effective in unicompartmental OA. Other points worth highlighting are the reduction in the duration of efficacy with repeated cycles of injections and the benefit of a regular physical activity.

Phenacoccus manihoti (Hemiptera: Pseudococcidae), is an invasive pest that is very detrimental to cassava cultivation in Indonesia. Control efforts by utilizing natural enemies of the parasitoid have succeeded in overcoming the cassava mealybug in 25 countries such as in Africa and Thailand. The purpose of this study was to specifically evaluate the potential for parasitoid species associated with the mealybug P. manihoti by (1) determining the level of parasitization against mealybugs on various varieties of cassava, (2) determining parasitoid preference for P. manihoti instars, and (3) determining the type of parasitoid. This study was undertaken in the field to re-evaluate the kinds of parasitoids associated with cassava pests, and in the laboratory to assess the amount of parasitization, predilection, and functional response of parasitoids to P. manihoti population density. The findings revealed three of parasitoids linked with P. manihoti in the field: Anagyrus lopezi, Acerophagus sp., and Blepyrus sp. The parasitoid A. lopezi had the greatest parasitization rate in the field, which was 18.67 %. Furthermore, the parasitoids A. lopezi and Blepyrus sp. preferred 3rd instar nymphs, but Acerophagus sp. preferred 2nd instar nymphs. The parasitoid A. lopezi demonstrated a type-III functional response, while Acerophagus sp. and Blepyrus sp. demonstrated a type-II functional response. The handling capacity (Th) of A. lopezi is the shortest at 3.42 minutes. This work is a comprehensive study of the parasitoid A. lopezi's potential as a biological agent, highlighting how it effectively suppresses P. manihoti on various cassava varieties in Bali, providing an inexpensive, environmentally friendly, and applicable control in tropical countries.

Supplier selection/replacement strategies and optimized purchasing policies play a key role in efficient supply chain management in today’s dynamic market. Here we study supplier replacement in a one-level assembly system (OLAS) producing one type of finished product. To assemble the product, we need to provide multi-type components, but assembly will be interrupted if any single component is missing, and incoming units will get hoarded until the missing component arrives. The assembly process can be interrupted by various sources of uncertainty, including delays in component deliveries. There is consequently a non-negligible risk that the assembly process may get stopped any moment. This brings inventory-related costs, which should be minimized. Here we consider discrete lead-time distributions to mimic industry-world reality. We present a model that takes into account not only optimal assignment of component order release dates but also replacement of a critical supplier. For a given unit, we model several alternative suppliers with alternative pricing and lead-time uncertainties, and we evaluate the impact on the total assembly system. For a more general case where several suppliers may be replaced, we propose a genetic algorithm.

The objective of this research is to show the family farms as an energy consumers and producers from renewable sources. It is a possibility for them to reduce operating costs. Time scope of the study covers the period 2014-2022. The data source is the Farm Accountancy Data Network. On the basis of the value of energy output and energy costs the rankings were prepared. After the ranks were awarded, the strong position of the Netherlands and Germany was indicated. It has been shown that the production and consumption of energy depend on the economic size of the farm, and do not depend on the type of production. As such, panel models were built for energy output and costs. The determinants that affect them were indicated. Energy output depends on total inputs – the higher they are, the higher the output. The energy costs are related to utilized agricultural area, total output and family farm income. The results obtained are discussed within the framework of recommendations of the European Commission.

The aim of this study was to measure one-year total cost of stroke and to investigate the value of stroke care, defined as cost per QALY. The study population included 892 patients with first ever acute stroke, hemorrhagic and ischemic, (ICD-10 codes: I61, I63 and I64) admitted within 48 hours of symptoms onset to nine public hospitals located in six cities. We conducted a bottom-up cost analysis from the societal point of view. All cost components including direct medical costs, productivity losses due to morbidity and mortality and informal care costs were considered. We used an annual time horizon, including all costs for 2021 irrespective of the time of disease onset. The average cost (direct and indirect) was extrapolated in order to estimate the national annual burden associated with stroke. We estimated the total cost of stroke in Greece at €343.1 mil a year in 2021, (€10,722/patient or €23,308 per QALY). Out of €343.1 mil., 53.3% (€182.9 mil) consisted direct healthcare cost representing 1.1% of current health expenditure in 2021. Overall, productivity losses were calculated at €160.2 mil. The mean productivity losses were estimated to 116 work days with 55.1 days lost due to premature retirement and absenteeism from work, 18.5 days lost due to mortality and 42.4 days lost due to informal caregiving by family members.This study highlights the burden of stroke and underlines the need for stakeholders and policy makers to re-organize stroke care and promote interventions that have been proved as cost-effective

Background & Objective: Acne Vulgaris is a common skin disease, with 5 % prevalence in Pakistan and has a significant physiological, psychological, emotional and social impact on the population, our study aims to estimate its annual economic burden per person in Pakistan.Methodology: Economic burden was estimated by using Cost of Illness analysis. All types of costs, including direct medication costs, direct non-medical costs and indirect costs due to loss of work. Data were collected from online databases and literature reviews. Results: Cost of illness analysis estimated that the cost of Acne Vulgaris treatment varies for mild, Moderate and severe acne. Acne is causing an annual economic burden of PKR 1,92,366 PKR per person (direct cost is PKR 1,86,366 and indirect cost 6,000) for an expensive treatment and PKR 53,550 (direct cost is PKR 47550 and indirect cost 6,000) for a cheap treatment. Limitation: Being an LMIC, Pakistan needs extensive study on the pharmacoeconomic analysis of Acne for proper and rational allocation of resources. Conclusion: Acne has a significant economic burden in Pakistan. Even with significant impact of Acne, there is very minute work done about Acne in Pakistan.

Climate change is an undeniable global phenomenon with severe and long-lasting impacts on the environment, economy, and society [1]. Like countless other nations, Bulgaria is already feeling the effects of climate change, with rising temperatures and heat waves [2], erratic precipitation patterns, and frequent occurrences of extreme weather events. Bulgaria is under imminent threat from climate change. The country is projected to experience a temperature increase of up to 4°C by 2100. This will lead to changes in precipitation patterns, resulting in numerous consequences. These include reduced water storage, impacts on public health, disruptions in agricultural production, stress on the country's biodiversity and forests, damage to infrastructure and private property, changes in tourism patterns, and many other potential issues [3]. Climate change has recently become a significant concern in Bulgaria due to its impact on ecosystems, the economy, society, and infrastructure. This study aims to examine the varying perspectives of different stakeholders regarding the bar-riers that impede the effective implementation of climate policies in Bulgaria. Key representatives from public administration, NGOs, businesses, and academia were interviewed in-depth. Additionally, an online and face-to-face survey was conducted among a diverse sample of the Bulgarian population. Results show that the most cited barriers include political instability, long-term vision, inadequate financial resources, limited public awareness, conflicting interests across sectors, and slow administrative processes. Moreover, the survey highlights notable disparities in perceptions among different stakeholder groups.

Self-efficacy and perfectionism play an important role in high-performance activities. This cross-sectional study analyses the relationship between these constructs and resilience in a sample of 145 music students (57.9% female) with a mean age of 27.77 years. Perfectionism was assessed using the Multidimensional Inventory of Perfectionism in Sport, resilience using the Resilience Scale, and self-efficacy using the General Self-Efficacy Scale. Compared to those with low resilience, students with high resilience score higher on self-efficacy and lower on dysfunctional perfectionism. No differences were observed in the total perfectionism score or adaptive perfectionism. Self-efficacy shows significant predictive power for resilience (β = .525, p &lt; .001). Although functional perfectionism did not significantly predict resilience, a marginal negative relationship was found between dysfunctional perfectionism and resilience (β = - .156, p = .063). The results are discussed concerning their implications for music pedagogy and teacher intervention.

The attempt of this study made us to Study the Competency Mapping (CM) in Software Companies”. CM is a process of categorizing the gap of a person or an employee’s performance routine or professional related skills to fill the gaps through effective programs. (1) Background: Integrating competencies such as “Developing people through Empowering and Training Programs, Providing Feedback, and Rewards, Recognizing the Employee for their work, Effective Communication, Aligning right values ensuring standards, etc. to evaluate and improve the performance an employee to get desired results; (2) Methods: This study involved 100 software employees (n = 100) to state that the competencies that are mapped have a significant impact on performance.. Chi- square and one – way ANOVA tests we used to identify the relationship between two variables; (3) Results: Goal oriented people can adopt the changes and work in any kind of circumstance for better outcomes; (4) Conclusions: competencies that are mapped have a significant impact on performance. And the person who is goal oriented will try to achieve his/her goals in any type of circumstances.

This paper investigates the impact of debt financing on dividend payments when they face the agency costs of free cash flow. Focusing on a sample of 120 firms listed on the Saudi Stock Exchange during the period 2011-2021. The study found a negative association between agency cost of free cash flow and dividend payment. More importantly, our research highlights the significant role of long-term debt in making more prudent use of free cash flow. The obligation to meet interest and principal payments acts as an incentive for them to steer clear of unprofitable expenses and risky investments. Concurrently, long-term debt imposes restrictive clauses in debt contracts, such as minimum dividend distribution requirements, which further encourage higher dividend payments. Since interest and debt repayments are fixed obligations, using free cash flow for dividend disbursement is considered a more profitable and beneficial approach for shareholders in the context of Saudi Arabia.

Supplier collaboration and partnership in procurement are essential elements for enhancing organizational efficiency, innovation, and resilience in today's globalized markets. This qualitative study investigates the dynamics of effective supplier relationships, focusing on trust, communication, innovation, quality, cost savings, and resilience as critical factors. Data were gathered through semi-structured interviews, case studies, and document analysis across diverse industries, highlighting insights from procurement professionals and supplier representatives. Key findings underscore the foundational role of trust and communication in fostering successful collaborations. Establishing transparent, ongoing communication channels facilitates mutual understanding, reduces conflicts, and enhances overall satisfaction. Collaborative innovation emerged as pivotal, enabling organizations to pool resources and expertise for product development and process improvement. Quality and reliability were identified as significant outcomes of close partnerships, particularly in industries with stringent standards such as aerospace and healthcare. Furthermore, the study reveals substantial cost savings and efficiency gains through collaborative efforts in process optimization and waste reduction. Effective risk management practices within these partnerships enhance supply chain resilience, enabling organizations to anticipate and mitigate disruptions proactively. Despite these benefits, challenges such as cultural differences, technological integration, and regulatory compliance require strategic mitigation strategies. In conclusion, organizations can optimize supplier collaborations by prioritizing trust-building, fostering a culture of innovation, and investing in robust relationship management practices. This approach not only enhances operational performance but also positions organizations to navigate market uncertainties and achieve sustainable growth in a competitive landscape.

This qualitative study explores the pivotal role of supply chain collaboration (SCC) in enhancing marketing effectiveness within organizations. By integrating supply chain management (SCM) practices with marketing strategies, companies can optimize operational efficiencies, anticipate consumer demands, and deliver personalized customer experiences. The study emphasizes technological integration, such as IoT, big data analytics, and blockchain, which enables real-time data sharing, predictive analytics, and enhanced visibility across the supply chain. Strategic alignment between SCM and marketing functions ensures efficient resource allocation and strategic deployment of marketing investments, fostering synergistic outcomes and maximizing market impact. Collaborative innovation within supply chains drives continuous improvement and product innovation, strengthening brand reputation and customer loyalty. Additionally, supply chain resilience, achieved through robust risk management and agile strategies, enables businesses to maintain operational stability and mitigate disruptions, safeguarding customer relationships and brand integrity. This research underscores the strategic imperative for organizations to embrace SCC as a driver of sustainable growth and competitive advantage in dynamic market environments. By leveraging SCC to integrate SCM and marketing functions, companies can navigate complexities, capitalize on market opportunities, and sustain long-term success. The findings provide valuable insights for business leaders seeking to enhance marketing effectiveness through effective SCC strategies.

Anxiety disorders affect patient quality of life (QoL). This study aimed to examine the associations between improved QoL and reduced clinical symptoms and Korean medicine (KM) in patients with anxiety disorders. Medical records of patients with anxiety who were treated with KM (acupuncture, Anxiety disorders affect patient quality of life (QoL). This study aimed to examine the associations between improved QoL and reduced clinical symptoms and Korean medicine (KM) in patients with anxiety disorders. Medical records of patients with anxiety who were treated with KM (ac-upuncture, psychotherapy, Chuna therapy, aromatherapy, or herbal medicine) for at least 4 weeks were retrospectively analyzed. Clinical, QoL, and cost outcomes were measured at baseline and at 4 and 12 weeks (Anxiety: State-Trait Anxiety Inventory[STAI X-1(state), X-2(trait)], Beck Anxiety Inventory[BAI]; anger: State-Trait Anger Expression Inventory State[STAXI-S(state), T(trait)], Anger Expression Inventory[AXI-K-I(anger-in), AXI-K-O(anger-out), AXI-K-C(anger-control); depression: Beck Depression Inventory-II[BDI II], QoL: QoL-related instruments Euro Quality of Life 5 Dimensions utility score[EQ-5D], Euro QoL Visual Analog Scale[EQ-VAS]). The quali-ty-adjusted life years (QALYs) and average cost-effectiveness ratio of KM for anxiety were esti-mated. The medical records for 67 patients were evaluated. KM treatments were found to be as-sociated with decreased anxiety (STAI X-1; STAI X-2; BAI, p

Micronutrient deficiencies (MNDs), also known as hidden hunger, affects more than a quarter of the global population. Agronomic biofortification helps to increase concentration of a target mineral in food crops and improve human mineral dietary intake. It is a means of providing nutrient dense foods to a larger population especially among rural resource poor settings, providing that they have access to mineral fertilizers. However, the feasibility of agronomic biofortification in combating hidden hunger depends on several factors besides fertilizer access, including crop type, genotype, climate, soils, and soil mineral interactions. Consideration of its effectiveness to increasing human mineral intakes to daily requirements and improvement to human health and the cost effectiveness the program is also important. In this paper we reviewed available literature regarding the potential effectiveness and challenges of agronomic biofortification to improve crop micronutrient concentrations and reduce hidden hunger.