Establish of air pollutants and greenhouse gases emission inventory and co-benefits of their reduction of transportation sector in Central China.

Recently, the transportation sector in China has gradually become the main source of urban air pollution and primary driver of carbon emissions growth. Considering air pollutants and greenhouse gases come from the same emission sources, it is necessary to establish an updated high-resolution emission inventory for the transportation sector in Central China, the most polluted region in China. The inventory includes on-road mobile, non-road mobile, oil storage and transportation, and covers 9 types of air pollutants and 3 types of greenhouse gases. Based on the Long-range Energy Alternatives Planning System (LEAP) model, the emissions of pollutants were predicted for the period from 2020 to 2035 in different scenarios. Results showed that in 2020, emissions of SO2, NOx, CO, PM10, PM2.5, VOCs, NH3, BC, OC, CO2, CH4, and N2O in Henan Province were 27.5, 503.2, 878.6, 20.1, 17.4, 222.1, 21.5, 9.4, 2.9, 92,077.9, 6.0, and 10.4 kilotons, respectively. Energy demand and pollutant emissions in Henan Province are simulated under four scenarios (Baseline Scenario (BS), Pollution Abatement Scenario (PA), Green Transportation Scenario (GT), and Reinforcing Low Carbon Scenario (RLC)). The collaborative emission reduction effect is most significant in the RLC scenario, followed by the GT scenario. By 2035, under the RLC scenario, energy consumption and emissions of SO2, NOx, CO, PM10, PM2.5, VOCs, NH3, CO2, CH4, and N2O are projected to decrease by 72.0%, 30.0%, 55.6%, 56.0%, 38.6%, 39.7%, 51.5%, 66.1%, 65.5%, 55.4%, and 52.8%, respectively. This study provides fundamental data support for subsequent numerical simulations.

Economic evaluation of the prevention of falls resulting from missed care in polish hospitals.

Objectives: Falls are associated with increased morbidity, mortality, prolonged hospitalization and an increase in the cost of treatment in hospitals. They contribute to the deterioration of fitness and quality of life, especially among older patients, thus posing a serious social and economic problem. They increase the risk of premature death. Falls are adverse, costly, and potentially preventable. The aim of the study was to analyze the cost-effectiveness of avoiding one fall by nurse care provided by the nurses with higher education, from the perspective of the health service provider. Methods: The economic analysis included and compared only the cost of nurse intervention measured by the hours of care provided with higher education in non-surgical departments (40.5%) with higher time spend by nurses with higher education level an increase in the number of hours by 10% (50.5%) to avoid one fall. The time horizon for the study is 1 year (2021). Cost-effectiveness and Cost-benefit analysis were performed. All registered falls of all hospitalized patients were included in the study. Results: In the analyzed was based on the case control study where, 7,305 patients were hospitalized, which amounted to 41,762 patient care days. Care was provided by 100 nurses, including 40 nurses with bachelor's degrees and nurses with Master of Science in Nursing. Increasing the hours number of high-educated nurses care by 10% in non-surgical departments decreased the chance for falls by 9%; however, this dependence was statistically insignificant (OR = 1.09; 95% CI: 0.72-1.65; p = 0.65). After the intervention (a 10% increase in Bachelor's Degrees/Master of Science in Nursing hours), the number of additional Bachelor's Degrees/Master of Science hours was 6100.5, and the cost was USD 7630.4. The intervention eliminated four falls. The cost of preventing one fall is CER = USD 1697.1. Conclusion: The results of these studies broaden the understanding of the relationship among nursing education, falls, and the economic outcomes of hospital care. According to the authors, the proposed intervention has an economic justification.

Environmental and socio-economic evaluation of a groundwater bioremediation technology using social Cost-Benefit Analysis: Application to an in-situ metal(loid) precipitation case study.

Bioremediation can be an alternative or complementary approach to conventional soil and water treatment technologies. Determining the environmental and socio-economic impacts of bioremediation is important but rarely addressed. This work presents a comprehensive sustainability assessment for a specific groundwater bioremediation case study based on In-situ Metal(loid) Precipitation (ISMP) by conducting a social Cost-Benefit Analysis (CBA) using two different approaches: environmental Life Cycle Costing (eLCC) and Impact Pathway Approach (IPA). Externalities are calculated in two ways: i) using Environmental Prices (EP) to monetize Life Cycle Assessment (LCA) results and metal(loid)s removed at field scale, and ii) following the IPA steps to determine the social costs avoided by removing arsenic contamination at full scale. The results show that, in the baseline scenario, the project is not socio-economically viable in both cases as the Net Present Value (NPV) is -129,512.61 € and - 415,185,140 € respectively. Sensitivity and scenario analyses are performed to identify the key parameters and actions needed to reach a positive NPV. For instance, increasing the amount of water treated per year to 90 m3 and assuming a 20 % increase in operation costs and a 60 % increase in construction costs can make the project socio-economically viable at the field scale, while a reduction in the social discount rate from a 4 % to a 2 % can lead to a positive NPV at the full scale. The approaches proposed in this work may be useful for practitioners and policymakers when evaluating the environmental and socio-economic impacts of bioremediation technologies at different scales and regions, as well as human health impacts caused by contaminants at the current legal limits.

Correlation of Pediatric Surgical Infrastructure With Clinical and Economic Outcomes: A Cohort Study.

INTRODUCTION: A significant burden of unmet pediatric surgical disease exists in low- and middle-income countries. We sought to assess the associations between the installation of a pediatric operating room (OR) and clinical and economic outcomes for families with children in Ethiopia. METHODS: A retrospective cohort study was performed of children who underwent elective surgery in a tertiary-level Ethiopian public hospital, comparing patient outcomes before and after OR installation in August 2019. Clinical data were collected via chart review, and an inpatient economic survey was administered to patient caregivers. Interrupted time series analysis investigated trends in surgical volume over time. The relative economic benefit was determined by comparing the patients' household income to the monetary health benefit gained using the value of statistical life method. RESULTS: One thousand one hundred and ninety-six patients were included from August 2018 to July 2022. Surgery averted 20,541 disability-adjusted life years (DALYs) cumulatively or 17 DALYs per patient. Monthly case volume and DALYs averted significantly increased postinstallation. The median annual household income of the economic survey responders (n = 339) was $1337 (IQR 669-2592). 27.7% (n = 94/339) lived in extreme poverty, and 41.3% (n = 140/339) experienced catastrophic healthcare expenditure. Net monetary health benefit was $29.3 million or $26,646 per patient. The ratio of net monetary health benefit to household annual income was 60:1. CONCLUSIONS: Installing a pediatric OR in a public Ethiopian hospital ensures increased access to surgery for those most impoverished in Ethiopia and improves equitable access to surgical care. Greater investment in expanding pediatric surgical infrastructure can help address global inequities in child health.

Implementing a Streamlined Hypoglossal Nerve Stimulator Pathway: Cost, Time to Surgery, and Outcomes.

Objective: To evaluate the costs, time to surgery, and clinical outcomes associated with implementing a streamlined hypoglossal nerve stimulator (HGNS) implantation pathway. Study Design: Retrospective cohort study. Setting: Single tertiary care center in the United States from 2016 to 2023. Methods: Patients with a lack of complete concentric collapse of the velum during volitional snore on in-office laryngoscopy qualified for the streamlined HGNS pathway. This pathway consisted of confirmatory drug-induced sleep endoscopy (DISE) followed immediately by HGNS implantation during the same surgical encounter. Outcomes were compared to patients in the traditional pathway (standalone DISE followed by HGNS implantation on a later date). Results: A total of 68 patients (13 streamlined, 55 traditional) with obstructive sleep apnea who underwent HGNS implantation were included. Patients were predominately male (70.6%) and White (95.6%) and had a mean (SD) age of 63.5 (10.0) years. The streamlined pathway was associated with a significant reduction in both hospital costs (mean difference $9258, 95% confidence interval [CI]: 3690-14,825; P = .002) and time to surgery (mean decrease of 3.82 months, 95% CI: 0.83-6.80 months; P = .013) compared to the traditional pathway. Patients in both groups had reduction in apnea-hypopnea index and Epworth Sleepiness Scale score, with no significant differences in comparisons between groups. Conclusion: In select patients, the streamlined HGNS pathway may expedite time to surgery and reduce hospital costs with comparable clinical outcomes to a traditional 2-stage pathway. Further research is warranted to validate patient selection and better understand longitudinal outcomes.

Association between Communication Patterns, Benefit Finding, and Relationship Satisfaction in Stroke Couples: An Actor-Partner Interdependence Mediation Model.

AIMS: To explore the mediating role of relationship satisfaction between communication patterns and benefit findings in stroke couples using the actor-partner interdependence mediation model. METHODS AND RESULTS: A cross-sectional study was conducted from October 2022 to April 2023 in China. Based on the actor-partner interdependence mediation model, we used structural equation modeling to explore the mediating role of relationship satisfaction of stroke patients and their spouses in communication patterns and benefit findings. A total of 381 stroke couples (patients: 61.4% male, mean age 54.06; caregivers: mean age 53.58) were included in the data analysis. Actor effects showed that stroke couples' relationship satisfaction mediated each of their own three communication patterns (constructive communication, demand/withdraw communication, and mutual avoidance) and benefit findings. In addition, patients' relationship satisfaction mediated patient demand-spouse withdraw and spouses' benefit findings. Partner effect showed that patients' relationship satisfaction mediated the association between their own three communication patterns and spouses' benefit findings. Patients' relationship satisfaction mediated the association between patient demand-spouse withdraw and patients' benefit findings. Moreover, spouses' relationship satisfaction mediated the association between the two communication avoidance patterns exhibited by patients (spouse demand-patient withdraw and mutual avoidance) and the spouses' benefit findings. CONCLUSION: The results have demonstrated a reciprocal influence on benefit findings between stroke patients and their spouses. The communication patterns within these couples have impacted not only their own benefit findings but also those of their spouses, with relationship satisfaction playing a mediating role.

Recommendations for Interchangeability in a Growing Biosimilar Market in Latin America.

BACKGROUND: Biosimilars offer significant advantages for improving access to biologic treatments in Latin America. However, their uptake has been slow due to misconceptions, regulatory uncertainties, and inadequate pharmacovigilance. OBJECTIVE: To address these issues, Americas Health Foundation convened a multidisciplinary panel of regional experts in biosimilar use and interchangeability from Latin America. The panel assessed the current landscape and recommended steps to enhance access. RESULTS: Key recommendations include strengthening biosimilar regulations, ensuring transparent enforcement, implementing robust pharmacovigilance, and promoting collaboration among stakeholders to educate about the safety, efficacy, and economic advantages of biosimilars and their interchangeability. CONCLUSIONS: By embracing biosimilars and interchangeability, Latin American countries can expand patient access, foster competition, diversify treatment sources, and enhance the sustainability of their healthcare systems. However, achieving these goals requires addressing knowledge gaps and biases among healthcare providers, patients, regulators, and government agencies. This can be accomplished through clear communication and the use of real-world evidence.

Biosimilars offer an opportunity to expand access to crucial biologic treatments in Latin America by providing lower-cost alternatives when patents expire. However, adopting biosimilars has been slow due to misconceptions and regulatory uncertainties. To address this, experts recommend considering approved biosimilars as interchangeable with reference products, allowing for switching without compromising safety or efficacy, with the limitation of switching only once per year. To improve access, well-defined regulations, enforcement, and transparency from regulatory agencies are necessary, along with education for healthcare providers, patients, and other stakeholders to address knowledge gaps and negative perceptions. Improved pharmacovigilance systems and collaboration between stakeholders can help communicate the benefits of biosimilars and interchangeability. By embracing biosimilars, Latin American countries can expand patient access, foster market competition, diversify treatment options, and improve the sustainability of healthcare systems.

A comparative effectiveness study of usual care, simple Chuna manual therapy, and complex Chuna manual therapy for the treatment of pelvic biomechanical lesions in patients with non-acute low back pain: a protocol for multicenter, randomized controlled trial.

BACKGROUND: Chuna manual therapy (CMT), a Korean manual therapy technique predominantly used for treating low back pain (LBP) and related disorders, lacks well-conceived research focusing on its comparative effectiveness, safety, and economic evaluation, particularly with respect to complex CMT with established CMT diagnostic algorithms. This study aims to illustrate a protocol for a randomized clinical study for comparative effectiveness and cost-effectiveness of complex CMT with simple CMT and usual care. METHODS: This is a protocol for a three-armed, multicenter, assessor-blinded, pragmatic, randomized controlled trial study. A total of 81 patients suffering from non-acute LBP with pelvic biomechanical lesions (PBL), characterized by a pain duration of at least two weeks and a Numeric Rating Scale (NRS) score of 5 or higher, will be recruited from two Korean medicine hospitals. These participants will be randomly assigned to one of three groups: complex CMT plus usual care (UC; n = 27), simple CMT plus UC (n = 27), or UC groups (n = 27). They will undergo treatment for 4 weeks, and follow-up assessments will be performed 8 weeks after treatment completion. The primary outcome will be the NRS score of LBP, and secondary outcomes will include the Oswestry Disability Index, Patient Global Impression of Change, credibility and expectancy questionnaire, three-dimensional posture analysis indicators, quality of life assessment, economic evaluation, and safety assessments. DISCUSSION: This will be the first study to assess the comparative effectiveness, safety, and cost-effectiveness of complex CMT compared to UC and simple/complex CMT in patients with LBP and PBL. We will also analyze useful diagnostic methods to help in clinical practice for CMT diagnosis. TRIAL REGISTRATION: Clinical Research Information Service (CRIS), KCT0009210. Registered on February 28, 2024.

The current status and improvement directions of legal rules regarding Chinese national gene banks for farm animal genetic resources.

A gene bank for farm animal genetic resources (FAGR) is an important facility for the diversity conservation of FAGR. The primary purpose of gene banks for FAGR is the reconstruction of those breeds. With the advent of the post-genomic era, gene banks for FAGR have increasingly become an infrastructure for the support of livestock research and animal breeding, and a platform for international research collaboration. China is one of the richest countries in the world in terms of FAGR. Chinese National Gene Banks for FAGR (CNGBFs) have an important legal status and play an important function in the Chinese FAGR protection system. In this paper, we reviewed the current situation of CNGBFs construction, and systematically collected and analyzed legal rules related to CNGBFs. As results, those legal rules were categorized into two types: (a) organization and management, (b) activities. We summarized problems existing in the current legal rules for CNGBFs from three levels: institution, practical operation, and digital development. Improvement directions of legal rules regarding CNGBFs are proposed. They include clarifying the utilization function of CNGBFs and the ownership of FAGR in CNGBFs. Moreover, improving the mechanism of administrative management, rules on domestic and international access and benefit-sharing, and the system of digital sequence information management are also suggested. The improvements in those legal rules will contribute to the appropriate utilization of Chinese FAGR and international collaborations.

Evaluation and optimization of park cooling benefits based on cumulative impact and landscape pattern.

City parks can cool the surrounding environment and mitigate the urban heat island (UHI) effect, considerable improving the city's adaptability to climate. In this study, 20 city parks in Nanjing, China, were considered, and four indexes for quantifying the cooling benefits from a cumulative impact perspective were proposed. These indexes are park cooling area (PCA), park cooling efficiency (PCE), park cooling intensity (PCI), and park cooling gradient (PCG). The results reveal the following: first, city parks have a positive impact on the surrounding thermal environment. The factors park area (PA), park perimeter (PP), landscape shape index (LSI), and normalized difference vegetation index (NDVI) determine cooling benefits. Second, PA and PP are significantly positively correlated with PCA but are significantly negatively correlated with PCE. LSI is negatively correlated with PCE, while NDVI is positively correlated with PCI and PCG. No significant correlation exists between the four cooling indexes and modified normalized difference water index(MNDWI). Finally, different parks exhibit variations in their ability to provide cooling benefits. Special or community parks are more appropriately situated in areas with constrained urban land resources. In designing comprehensive parks, the intricate boundary features and vegetation conditions need to be considered to optimize their cooling effects. Moreover, a larger number of residents are allowed to enjoy cooling services. The findings of this project will aid in the construction and optimization of city parks in future to combat the UHI effect.

PKBOIN-12: A Bayesian Optimal Interval Phase I/II Design Incorporating Pharmacokinetics Outcomes to Find the Optimal Biological Dose.

Immunotherapies and targeted therapies have gained popularity due to their promising therapeutic effects across multiple treatment areas. The focus of early phase dose-finding clinical trials has shifted from finding the maximum tolerated dose (MTD) to identifying the optimal biological dose (OBD), which aims to balance the toxicity and efficacy outcomes, thus optimizing the risk-benefit trade-off. These trials often collect multiple pharmacokinetics (PK) outcomes to assess drug exposure, which has shown correlations with toxicity and efficacy outcomes but has not been utilized in the current dose-finding designs for OBD selection. Moreover, PK outcomes are usually available within days after initial treatment, much faster than toxicity and efficacy outcomes. To bridge this gap, we introduce the innovative model-assisted PKBOIN-12 design, which enhances BOIN12 by integrating PK information into both the dose-finding algorithm and the final OBD determination process. We further extend PKBOIN-12 to TITE-PKBOIN-12 to address the challenges of late-onset toxicity and efficacy outcomes. Simulation results demonstrate that PKBOIN-12 more effectively identifies the OBD and allocates a greater number of patients to it than BOIN12. Additionally, PKBOIN-12 decreases the probability of selecting inefficacious doses as the OBD by excluding those with low drug exposure. Comprehensive simulation studies and sensitivity analysis confirm the robustness of both PKBOIN-12 and TITE-PKBOIN-12 in various scenarios.

Uptake of health economic evaluations alongside clinical trials in Australia: an observational study.

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

Cost-Effectiveness of Salt Substitution and Antihypertensive Drug Treatment in Chinese Prehypertensive Adults.

BACKGROUND: Recent guidelines recommend antihypertensive drug treatment for prehypertensive individuals with blood pressure between 130/80 and 139/89 mm Hg. This study evaluates the cost-effectiveness of 3 interventions in Chinese prehypertensive adults: salt substitution, antihypertensive drug treatment, and their combination. METHODS: We developed a Markov cohort model to estimate cardiovascular disease (CVD) events, costs, and quality-adjusted life years (QALYs) over a lifetime. Data from the China Kadoorie Biobank informed the simulation. Costs and utilities were drawn from published sources. We evaluated the cost-effectiveness of salt substitution alone, antihypertensive drug treatment alone, and a combination of the 2, focusing on the overall prehypertensive population, those at high CVD risk, and different starting ages (40, 50, 60, and 70 years). Incremental cost-effectiveness ratios (ICERs) were calculated per QALY gained. RESULTS: Salt substitution at age 40 years is the only cost-effective strategy for prehypertensive individuals, with an ICER of $6413.62/QALY. For those at high CVD risk, the combination intervention starting at age 40 years is most cost-effective, with an ICER of $2913.30/QALY. Interventions initiated at younger ages yielded greater CVD reductions and lower ICERs. For example, a combined intervention at age 40 years reduces CVD events by 5.3% with an ICER of $2913.30/QALY, compared with 4.9% and $32 635.33/QALY at age 70 years. These results were consistent across sensitivity analyses. CONCLUSIONS: In China, replacing usual salt with a salt substitute is more cost-effective than treating prehypertensive individuals over the age of 40 years with antihypertensive drugs. Furthermore, starting intervention at a younger age in prehypertensive adults can result in even greater cost savings.

Evaluation of orphan maintained biological medicinal products in the European Union between 2018 to 2023: a regulatory perspective.

OBJECTIVES: Orphan medicinal products (OMPs) authorized in the European Union (EU) benefit from market exclusivity, fee waivers, and national incentives. Maintaining orphan status during the marketing authorization application (MAA) requires meeting eligibility criteria, especially demonstrating significant benefit (SB), which is challenging. This study identifies key features linked to successful orphan status maintenance for biological OMPs approved in the EU between 2018 and 2023. METHODS: Data from European public assessment reports and orphan maintenance assessment reports were analyzed. RESULTS: Among the 50 biological OMPs granted orphan designation, 68.0% had to demonstrate SB over existing treatments, with 91.2% leveraging the clinically relevant advantage area, utilizing better clinical efficacy (83.8%) and subpopulation (38.7%) sub-domains. However, 32% did not need to demonstrate SB due to a lack of alternative treatments, most of which were ultra-orphan drugs. Advanced therapy medicinal products and monoclonal antibodies were the most numerous OMP categories, whereas oncology and immunomodulation were the preferred therapeutic areas. CONCLUSION: The Orphan Regulation plays a critical role in advancing treatments for rare diseases, fostering innovation while addressing unmet medical needs. Nonetheless, the insufficient return on investment criterion remains underused, whereas refining major contribution to patient care guidelines and incorporating real-world evidence may enhance regulatory evaluations.

Enhancing production efficiency through optimizing plant density in maize-soybean strip intercropping.

Introduction: Due to limited arable land resources, intercropping has emerged as an efficient and sustainable production method for increasing total grain yield per unit land area. Maize-soybean strip intercropping (MSSI) technology is being widely promoted and applied across China. However, the combination of optimal density for achieving higher production efficiency of both soybean and maize remains unclear. The objective of this study was to evaluate the differences in yield, economic benefits, land, and nitrogen (N) efficiency in MSSI systems under different densities. Methods: Five maize/soybean density combinations (67,500/97,500 plants ha-1, D1; 67,500/120,000 plants ha-1, D2; 67,500/142,500 plants ha-1, D3; 60,000/142,500 plants ha-1, D4; 52,500/142,500 plants ha-1, D5) were set under the same N input in the field experiment. Results and discussion: The results demonstrated that optimizing the density in the intercropping system could enhance production efficiency. Increasing the density of soybean and maize significantly increased the total grain yield (D3 > D2 > D1 > D4 > D5). The D3 treatment, exhibiting the best comprehensive performance, also promoted increases in leaf area index, dry matter accumulation, and N absorption and utilization. Path analysis indicated that density had the most substantial impact on maize yield, while grain number had the greatest influence on soybean yield, with contribution rates of 49.7% and 61.0%, respectively. These results provide valuable insights into optimal field density for summer planting in MSSI, facilitating its wider adoption.

Cost and benefit of parafoveal information during reading acquisition as revealed by finger movement patterns.

Contrary to expert readers, children learning to read have limited ability to preprocess letters in parafoveal vision. Parafoveal letters induce crowding cost: the features of neighboring letters interfere with target letter identification. We longitudinally studied the weight of parafoveal cost and benefit in two group of children (N = 42), during their first school year (Group 1) and at the end of second school year (Groupe 2). Using a novel digit-tracking method, a blurred text was presented and rendered unblurred by touching the screen, allowing the user to discover a window of visible text as the finger moved along it. We compared two conditions: (1) a large window, where crowding was enhanced by the presence of parafoveal information; (2) a small window, where crowding was suppressed by blurred parafoveal information. Finger kinematics were simultaneously recorded. We found that at the beginning of first-grade, digital fixations - brief slowing or stopping of the finger on a specific point - are significantly longer in the large compared to the small window condition, as parafoveal crowding increases text processing difficulty. This effect diminishes and disappears at the end of second-grade as reading performance improves. In the large window condition, longer digital saccades - rapid movements of the finger changing position - appear by the end of first grade suggesting that parafoveal exposure become more beneficial than harmful when children acquire basic reading skills. Our results show that in beginning readers, crowding has a cognitive cost that interfere with the speed of the learning reading process. Our findings are relevant to the field of education by showing that visual crowding in first grade should not be underestimated.

Unravelling the object-based nature of visual working memory: insight from pointers.

Visual working memory (VWM) plays a crucial role in temporarily storing and processing visual information, but the nature of stored representations and their interaction with new inputs has long been unclear. The pointer system refers to how VWM links new sensory inputs to stored information using specific cues. This study aimed to investigate whether the pointer system is based on spatial, feature-based, or object-based cues by employing the repetition benefit effect, where memory performance improves with repeated memory items. Across three experiments, we manipulated spatial positions, shapes, and colors as pointer cues to determine how these features affect VWM consolidation and updating. The results showed that while spatial location serves as a strong pointer cue, shape and color features can also effectively reestablish object correspondence in VWM. These findings support the view that the pointer system in VWM is flexible and object-based, utilizing various feature cues to maintain memory continuity. This study provides new insights into how VWM connects new inputs with stored information through the pointer system.

Initial Experience of CT-Based Online Adaptive Radiotherapy for Nasopharyngeal Carcinoma With a Novel Integrated Platform: A Case Report.

Intensity-modulated radiation therapy (IMRT) improves tumor control and reduces long-term radiation-induced complications of patients with nasopharyngeal carcinoma (NPC), contingent upon accurate contouring and precise delivery of treatment plans. Online adaptive radiotherapy (ART) involves real-time treatment plan modification based on the variations in targets and organs at risk (OARs) to uphold treatment planning accuracy. This study describes the first reported case of fan beam computed tomography (FBCT)-guided online ART for NPC using a novel integrated platform. Online ART was performed at the 25th fraction in this case, as tumors and the patient's anatomy were observed to regress inter-fractionally, necessitating adjustments to the contours based on the anatomy of the day. Online ART plan optimized target volume coverage while reducing doses to OARs. Notably, online ART significantly improved radiotherapy efficiency. This patient achieved a clinical complete response 12 weeks post-treatment, with Epstein-Barr virus DNA levels reduced to 0 copies/ml. Currently, the patient is alive without evidence of high-grade toxicity or local recurrence at approximately 10 months post-treatment. This case confirms the feasibility and dosimetric benefit of online ART for NPC using a novel integrated platform. Further research is needed to confirm its clinical benefits.

Clinical and economic impact of pharmacist interventions to identify drug-related problems in multidisciplinary cancer care: a prospective trial.

BACKGROUND: The prescription of antitumor drugs has often been associated with drug-related problems. Pretherapeutic multidisciplinary risk assessment programs including pharmaceutical care have been established to secure the initiation of injectable and oral antitumor therapies. This prospective cross-sectional double-center study evaluated the clinical and economic impact of the pharmacist in detecting drug-related problems in patients initiating antitumor therapies. MATERIALS AND METHODS: Following pharmaceutical consultations, pharmaceutical interventions were validated by a multidisciplinary team. A committee of independent clinical experts assessed the potential clinical impact of drug-drug interactions. The association of clinical variables with pharmaceutical interventions was tested using a multivariate logistic regression model. Pharmacist cost of the program was assessed by valuing pharmacists' time at their salaries and compared with potentially avoided costs. RESULTS: Four hundred thirty-eight patients with solid tumors were included: 62% males, mean age of 65 ±â€…13 years, and average of 6 medications. Half of the patients required at least one pharmaceutical intervention and independent factors associated with pharmaceutical interventions were the number of medications (5-9 vs <5: OR = 2.91 [95% CI 1.82-4.65], P < .001) and the type of antitumor treatment (immunotherapy vs intravenous chemotherapy: OR = 0.35 [95% CI 0.18-0.68], P = .002). One hundred seventy-four out of 266 pharmaceutical interventions (130 patients) involved clinically significant drug-drug interactions. Pharmacist costs were estimated to range between €4899 and €6125. Average costs were estimated at €11.4-14.3 per patient. Avoided hospitalization costs were estimated to be €180 633. CONCLUSION: Clinical pharmacists contribute to the cost-effective reduction of drug-related problems in pre-therapeutic assessment programs for patients with cancer.