A low cost and labor-efficient method for rearing an invasive beetle, Carpophilus truncatus (Coleoptera: Nitidulidae).

The carpophilus beetle, Carpophilus truncatus Murray, 1864 (Coleoptera: Nitidulidae) is an invasive pest recently detected in California's tree nut crop orchards. Here we report a simple, labor-saving, and cost-effective rearing system for C. truncatus utilizing banana and industrial sand components. Banana slices served as both a larval and adult diet source as well as a moisture source to facilitate pupation within the underlying sand. The combination of banana and sand within a single container successfully supported the development of all C. truncatus life stages over multiple generations. The average developmental times recorded in rearing units placed under environmental conditions of 26°C, 60% relative humidity, and 16:8 h (light:dark) photoperiod were: egg to wandering stage larva, 7.54 days; wandering stage to adult, 11.08 days; and adult longevity, 94.33 days. These banana-sand rearing units facilitated the easy collection of all C. truncatus developmental stages, except for eggs. To address this challenge, standalone oviposition chambers utilizing a lima bean-based agar diet were evaluated. These chambers effectively enabled the collection as well as tracking of eggs for different research purposes. The average developmental time recorded for eggs, from initial oviposition to neonate hatching, was 3.20 days. These rearing as well as egg collection approaches provide cost-effective tool to investigate biology, life-history traits and ecology, as well as evaluate approaches to control this invasive pest.

Particle Markov Chain Monte Carlo Approach to Inference in Transient Surface Kinetics.

In this work, we develop a novel Bayesian approach to study the adsorption and desorption of CO onto a Pd(111) surface, a process of great importance in natural sciences. The motivation for this work comes from the recent availability of time-resolved infrared spectroscopy data and the need for model interpretability and uncertainty quantification in chemical processes. The objective is to learn the relevant parameters that characterize the process: coverage with time, rate constants, activation energies, and pre-exponential factors. Our approach consists of three main schemes: (i) a problem design and probabilistic model for the whole system, (ii) a particle Markov chain Monte Carlo sampler to learn the hidden coverages and rate constant parameters, and (iii) two Bayesian formulations to infer the activation energies and pre-exponential factors. The flexibility of the Bayesian framework allows for uncertainty quantification where possible and integration of mathematical constraints in the model to reflect the system physically. We found that our results for the activation energies and pre-exponential factor are in agreement with those reported in the experimental literature, independently, and we provide discussions on the advantages and disadvantages as well as applicability to other systems.

Cost-utility analysis of empagliflozin for heart failure in the Philippines.

AIMS: Empagliflozin confers cardioprotective benefits among patients with heart failure, across the range of ejection fraction (EF), regardless of type 2 diabetes status. The long-term cost-effectiveness of empagliflozin for the treatment of heart failure (HF) in the Philippines remains unclear. This study aims to determine the economic benefit of adding empagliflozin to the standard of care (SoC) vs the SoC alone for HF in the Philippines. METHODS: Using a Markov model, we predicted lifetime costs and clinical outcomes associated with treating HF in the Philippine setting. We used estimates of treatment efficacy, event probabilities, and derivations of utilities from the EMPEROR trials. Costs were derived from hospital tariffs and expert consensus. Separate analyses were performed for patients with left ventricular EF >40%, categorized under mid-range ejection fraction or preserved ejection fraction (HFmrEF/HFpEF), and patients with left EF ≤ 40%, categorized under HF with reduced ejection fraction (HFrEF). RESULTS: Our model predicted an average of 0.09 quality-adjusted life year (QALY) gains among HFmrEF/HFpEF patients and HFrEF patients when empagliflozin was compared to SoC. The addition of empagliflozin in the treatment results in a discounted incremental lifetime cost of PHP 62,692 (USD 1,129.99) and PHP 17,215 (USD 308.67) for HFmrEF/HFpEF and HFrEF, respectively. The incremental cost-effectiveness ratio (ICER) of empagliflozin is PHP 198,270 (USD 3,570.72)/QALY and PHP 742,604 (USD 13,385.08)/QALY for HFrEF and HFmrEF/HFpEF, respectively. LIMITATIONS: This study employed parameters derived from short-term clinical trial data, alongside metrics representative of Asian populations, which are not specific to the Philippine cohort. CONCLUSIONS: Adding empagliflozin to the SoC in comparison to the SoC is associated with improved clinical outcomes and quality of life, at additional costs for both HFrEF and HFmrEF/HFpEF.

Heart failure is a medical condition where the heart pumps blood to the rest of the body less than it should. Patients with type 2 diabetes ­ a long-term condition where patients have excessive blood sugar ­ are much more prone to developing heart failure, develop it earlier, and have more severe heart failure consequences such as hospitalization and death. A new medication for type 2 diabetes, called empagliflozin, reduces these severe consequences and can lead to better health. This medication has been shown to represent good value-for-money in several countries, but economic studies in the Philippines have not yet been carried out. Therefore, we performed mathematical calculations and forecasted the medical costs and benefits of adding this medication to the standard treatment of patients with type 2 diabetes in the Philippines. Our results showed that taking empagliflozin once-a-day increased the number of healthy life years (called quality-adjusted life years or QALYs) in Philippine patients with diabetes by almost 9%. The cost for one QALY gained was PHP 198,270 (USD 3,571) for patients with normal- to moderately-weak heart pump and PHP 742,604 (USD 13,385) for patients with severely-weak heart pump. These results suggest that empagliflozin may represent good value-for-money for patients with heart failure in the Philippines, depending on the payer's willingness to pay for the gain of an additional year of healthy life.

The triple threat: unpacking the interplay between inflation, government expenditure, energy efficiency, and environmental pollution.

This study investigates the relation and Granger causality among inflation, fiscal expenditure, energy consumption, economic growth, energy efficiency, renewable energy consumption, and environmental pollution in the G7 countries utilizing the PLSTRVAR model for 1975-2022. Our findings highlight the results that inflation and fiscal expenditure have impact on environmental pollution across different regimes. On the other hand, unlike some studies in the literature, it emphasizes that renewable energy consumption may have pollution-increasing effects on environmental pollution. In the context of PLSTRVAR-GC results, it determines that the selected variables are the Granger cause of environmental pollution. However, within the framework of the direction of Granger causality, the results differ between regimes and variables. Notably, the causality analysis reveals a bidirectional causality between energy policy; energy efficiency and renewable energy, and environmental pollution in both regimes, while a unidirectional causality from inflation and fiscal expenditure to environmental pollution. These insights underscore the necessity for governments to adeptly balance fiscal policy, inflation control, and environmental pollution. Policymakers are thus challenged to implement fiscal measures that simultaneously stimulate economic growth, manage inflation, and support the transition to a low-carbon economy, thereby reducing CO2 emissions.

Trends and cost structure of drug-based secondary prevention of ischemic strokes.

BACKGROUND: Advances in secondary stroke prevention, including direct oral anticoagulants (DOACs), dual antiplatelet therapies (DAPT), and cardiovascular risk management, have changed costs over the past decade. This study aimed to evaluate annual treatment costs and trends in drug-based secondary prophylaxis after ischemic strokes. METHODS: Annual treatment costs were evaluated using the net costs per defined daily dosage (DDD) of discharge medications for ischemic stroke patients treated in 2020 at the University Hospital Frankfurt, Germany. Evaluated drugs included acetylsalicylic acid, adenosine diphosphate inhibitors, DOACs, vitamin K antagonists, lipid-lowering drugs (LLD), antihypertensives (AHT), and oral antidiabetics (OD). Kruskal-Wallis test examined intergroup differences in substance groups and stroke etiologies. DDD development between 2004 and 2021 was further evaluated for significant trend changes using an interrupted time series analysis. RESULTS: The study included 422 patients (70.5 ± 12.9 years, 43.1% female). Etiologies divided into large-artery atherosclerosis (29.9%), cardioembolic (25.6%), cryptogenic (26.8%), and small-vessel disease (17.8%). The total estimated annual drug expenditure was € 241,808; of which 51.6% was due to DOACs (median € 1157 [Q1-Q3:1157-1157], p < 0.006), 20.0% to AHTs (€127.8 [76.7-189.8]), 15.7% to ODs (€525.6 [76.7-641.5]), and 8.7% to LLDs (€43.8 [43.8-43.8]). Cardioembolic strokes had the highest annual costs per patient (€1328.6 [1169.0-1403.4]) with higher expenditure for DOACs (p < 0.001) and AHTs (p < 0.026). DAPT costs were highest for large-vessel strokes (p < 0.001) and accounted for 2.5% of total costs. There was a significant trend change in DDDs for clopidogrel in 2010 (p < 0.001), for prasugrel in 2017 (p < 0.001), for ASA in 2015 (p < 0.001) and for DOACs in 2012 (p = 0.017). CONCLUSIONS: DOACs for cardioembolic strokes were the primary cost driver in drug-based secondary stroke prevention, whereas permanent ASA and DAPT only accounted for a minor cost proportion. LLDs were associated with lower costs than AHTs and ODs. There were significant changes in DDDs for the respective substances, whereas the costs for DOACs as the most expensive pharmaceuticals remained widely stable across the last decade.

Cost-Effectiveness of Breast Cancer Screening Using Digital Mammography in Canada.

Importance: Evolving breast cancer treatments have led to improved outcomes but carry a substantial financial burden. The association of treatment costs with the cost-effectiveness of screening mammography is unknown. Objective: To determine the cost-effectiveness of population-based breast cancer screening in the context of current treatment standards. Design, Setting, and Participants: In this economic evaluation, the Canadian Partnership Against Cancer/Statistics Canada OncoSim-Breast microsimulation model was used to estimate the impact of various screening schedules in terms of clinical outcomes and treatment costs. Breast cancer treatment costs were derived from activity-based costing published in 2023 specific to a publicly funded health system in Ontario, Canada. A single birth cohort of individuals assigned female at birth in 1975 was modeled until death or age 99 years (whichever came first). Exposures: Five screening scenarios were modeled: no screening, biennial (ages 50-74 years and 40-74 years), hybrid (biennial ages 40-49 years and annual ages 50-74 years), and annual screening (ages 40-74 years). Main Outcomes and Measures: Incremental cost-effectiveness ratios for deaths averted, life-years (LYs) gained, and incremental cost-utility ratios for quality-adjusted life-years (QALYs) gained were determined for screening scenarios. Sensitivity analyses were conducted by varying screening participation rates and reducing recall rates to 5% and the estimated mortality benefits of screening. Results: Earlier initiation of breast cancer screening at age 40 years (vs age 50 years) was associated with improved clinical outcomes (deaths averted, LYs saved, and QALYs gained) and reduced health care spending on breast cancer treatment. From a health system perspective, incremental cost-effectiveness ratios for biennial screening at ages 40 to 74 years compared with biennial screening at ages 50 to 74 years were cost saving, with CAD$49 759 saved per death averted, $1558 per LY saved, and $2007 saved per QALY gained. Annual screening at ages 40 to 74 years was cost-effective while achieving the best breast cancer outcomes, with costs of $25 501 per death averted, $1100 per LY saved, and $1447 per QALY gained compared with the current Canadian standard of biennial screening at ages 50 to 74 years. Conclusions and Relevance: In this economic analysis, although screening costs increased according to the number of lifetime screens, they were completely or largely offset by reduced breast cancer therapy costs. Digital mammography was a highly cost-effective tool to reduce breast cancer mortality. These results have important policy implications for all single-payer health systems and call for greater investment in screening programs.

Cost-of-illness analysis of chronic urticaria clinical management in five countries of Latin America.

INTRODUCTION: Chronic spontaneous urticaria (CSU) is a disease with a high impact on the quality of life of patients. There are some evaluations of the economic cost of the disease in developed countries, but there is little information about the economic cost of the disease in developing countries. Our aim was to assess the economic diagnostic and therapeutic expenses of CSU in five Latin American (LA) countries. METHODS: A noninterventional multicenter cross-sectional study was conducted in five LA countries: Brazil, Colombia, Ecuador, Mexico, and Peru. To determine the frequency of medical interventions as well as clinical and sociodemographic characteristics of CSU patients, questionnaires were administered to patients, primary care physicians, allergists, and dermatologists. In each country, diagnostics and therapeutic expenses were calculated by reviewing medical records, health insurance, and interviews. The main outcome was the yearly economic burden from the healthcare insurance perspective in each country. RESULTS: According to the projected costs, Brazil had the highest urticaria cost per patient/year (7009.4 USD), followed by Mexico (3695.1 USD), Ecuador (3132.8 USD), Peru (2693.9 USD), and Colombia (2392.8 USD); the cost and the frequency of use of omalizumab and antihistamines explain the total cost differences between countries. Interventions such as medical visits and exams had similar costs between countries and represented less than 10% of total urticaria cost analysis in the five countries. CONCLUSION: The cost of the CSU in LA varies widely based on the health insurance coverage, the cost of the therapies, and the frequency of therapies used. Strengthening national health systems, as well as following the recommendations of international guidelines, seems to reduce the cost of CSU and improve the quality of patients.

The Political Sociology of NICE: Investigating Pharmaceutical Cost-Effectiveness Regulation in the UK.

The National Institute for Health and Care Excellence (NICE) was established a quarter of a century ago in 1999 to regulate the cost-effectiveness of pharmaceuticals (and other health technologies) for the NHS. Drawing on medical sociology theories of corporate bias, neoliberalism, pluralism/polycentricity and regulatory capture, the purpose of this article is to examine the applicability of those theories to NICE as a key regulatory agency in the UK health system. Based on approximately 7 years of documentary research, interviews with expert informants and observations of NICE-related meetings, this paper focuses particularly on NICE's relationship with the interests of the pharmaceutical industry compared with other stakeholder interests at the meso-organisational level. Consideration of the interaction between the UK Government and the pharmaceutical industry in relation to NICE is presented together with the analysis of revolving doors and conflicts of interest of NICE experts/advisors. The nature of policy changes over time (e.g. accelerated assessment pathways and industry fees for regulatory appraisals) and how they relate to the relevant stakeholder interests is also investigated. It is concluded that NICE is largely characterised by neoliberal corporate bias, though some elements of its organisation are also consistent with theories of capture, pluralism and polycentricity.

Path integral Monte Carlo in a discrete variable representation with Gibbs sampling: Dipolar planar rotor chain.

In this work, we propose a path integral Monte Carlo approach based on discretized continuous degrees of freedom and rejection-free Gibbs sampling. The ground state properties of a chain of planar rotors with dipole-dipole interactions are used to illustrate the approach. Energetic and structural properties are computed and compared to exact diagonalization and numerical matrix multiplication for N ≤ 3 to assess the systematic Trotter factorization error convergence. For larger chains with up to N = 100 rotors, Density Matrix Renormalization Group calculations are used as a benchmark. We show that using Gibbs sampling is advantageous compared to traditional Metropolis-Hastings rejection importance sampling. Indeed, Gibbs sampling leads to lower variance and correlation in the computed observables.

Evaluating complementaries among urban water, energy, infrastructure, and social Sustainable Development Goals in China.

Urban areas' performance in water, energy, infrastructure, and socio-economic sectors is intertwined and measurable through Sustainable Development Goals (SDGs) 6-13. Effective synergy among these is critical for sustainability. This study constructs an indicator framework that reflects progress towards these urban SDGs in China. Findings indicate underperformance in SDGs 8-11, suggesting the need for transformative actions. Through network analysis, the research reveals complementarities among these SDGs. Notably, the SDG space divides into socio-economic and ecological clusters, with SDG 6 (Clean Water and Sanitation) central to both. Additionally, SDG 8 (Decent Work and Economic Growth) and SDG 9 (Industry, Innovation, and Infrastructure) act as bridges, while greater synergies exist between SDG 12 (Responsible Consumption and Production) and SDG 13 (Climate Action). An in-depth view at the indicator-level shows a core-periphery structure, emphasizing indicators like SDG 6.2 (Wastewater Treatment Rate) and SDG 6.6 (Recycled Water Production Capacity per capita) as pivotal. This study confirms the urban SDG space's stability and predictiveness, underscoring its value in steering well-aligned policy decisions for sustainable growth.

Smartphone video imaging: A versatile, low-cost technology for food authentication.

This study presents a low-cost smartphone-based imaging technique called smartphone video imaging (SVI) to capture short videos of samples that are illuminated by a colour-changing screen. Assisted by artificial intelligence, the study develops new capabilities to make SVI a versatile imaging technique such as the hyperspectral imaging (HSI). SVI enables classification of samples with heterogeneous contents, spatial representation of analyte contents and reconstruction of hyperspectral images from videos. When integrated with a residual neural network, SVI outperforms traditional computer vision methods for ginseng classification. Moreover, the technique effectively maps the spatial distribution of saffron purity in powder mixtures with predictive performance that is comparable to that of HSI. In addition, SVI combined with the U-Net deep learning module can produce high-quality images that closely resemble the target images acquired by HSI. These results suggest that SVI can serve as a consumer-oriented solution for food authentication.

Emerging deep eutectic solvents for food waste valorization to achieve sustainable development goals: Bioactive extractions and food applications.

Food waste, accounting for about one-third of the total global food resources wasted each year, is a substantial challenge to global sustainability, contributing to adverse environmental impacts. The utilization of food waste as a valuable source for bioactive extraction can be facilitated through the application of DES (Deep Eutectic Solvents). Acknowledging the significant need to tackle this issue, the United Nations integrated food waste management into its Sustainable Development Goals, hence, the present review explores the role of DES in bioactive compounds extraction from food waste. Various extraction processes using the DES system are thoroughly studied and the application of bioactive components as antioxidants, antimicrobials, flavourings, nutraceuticals, functional ingredients, additives, and preservatives is investigated. Most importantly, regulatory considerations and safety aspects of DES in food applications are discussed in-depth along with consumer perception and acceptance of DES in the food sector. The key hypothesis of the review is to evaluate emerging DES systems for their efficiency in bioactive extraction technologies and various food applications. Overall, this review provides a comprehensive understanding of utilizing DES for synthesizing valuable food waste-derived bioactive components, offering a sustainable approach to waste management and the development of high-value products.

The Contribution of Noncommunicable and Infectious Diseases to the Effect of Depression on Mortality: A Longitudinal Causal Mediation Analysis.

BACKGROUND: The increased prevalence of physical diseases among individuals with mental illness contributes to their increased risk of mortality. However, the mediating role of specific diseases in the effect of mental illness on mortality is not well understood. METHOD: We conducted a longitudinal causal mediation analysis using data from beneficiaries of a South African medical insurance scheme from 2011 to 2020. We estimated the overall effect of major depressive disorder (MDD) on mortality and evaluated reductions in this overall effect through hypothetical interventions on the risks of mediating physical diseases using an interventional effects approach. Monte Carlo simulation-based g-computation was used for estimation. RESULTS: Among 981,540 individuals, 143,314 (14.6%) were diagnosed with MDD. Mortality risk after 8 years was 6.5% under MDD, and 5.3% under no MDD (risk ratio 1.23, 95% CI = 1.19, 1.26). Overall, 43.4% of this disparity could be attributed to higher rates of physical comorbidities due to MDD. Cardiovascular diseases accounted for 17.8%, followed by chronic respiratory diseases (8.6%), cancers (7.5%), diabetes and chronic kidney disease (5.8%), tuberculosis (4.3%), and HIV (2.7%). CONCLUSION: Within the privately insured population of South Africa, MDD is associated with increased mortality. We found that noncommunicable diseases, rather than infectious diseases, are important mediators of the effect of MDD on mortality.

Design of a Low-cost Radiation Weather Station.

ABSTRACT: Combining a traditional weather station with radiation monitors draws the public's attention to the magnitude of background radiation and its typical variation while providing early indications of unplanned radiological releases, such as nuclear power plant accidents or terrorist acts. Several networks of combined weather and radiation monitoring sensors exist, but these fail to be affordable for broad distribution. This work involves creating an affordable system to accumulate data from multiple locations into a single open-source database. The data collected should thus serve as a friendly database for high school students. The system is designed around an inexpensive sensor package featuring a cup anemometer, wind direction vane, and tip bucket rain gauge. A Raspberry Pi 4 microcomputer interfaces through RJ11 and RJ45 connectors to these and other sensors. Custom-designed circuits were implemented on printed circuit boards supporting sensor chips for temperature, pressure, humidity, and air electrical resistance. The outdoor board communicates with ultraviolet light, soil moisture, and temperature sensors, relaying data using wired connections indoors where a Raspberry Pi 4 and indoor circuit board are located. The indoor board employs wireless internet protocol to communicate with a homemade Geiger-Mueller counter and a consumer-grade temporal radon monitor. The system employs an internet connection to transfer data to a cloud-based storage system. This enables a website with continuously updated pages dedicated to each established system to display collected data. Weatherproofed fused filament fabricated indoor and outdoor cases were designed. Sensor functions were tested for functionality and accuracy.

Referral to a Functional Seizures Clinic Reduces Inpatient and Emergency Department Health Care Utilization and Costs.

Background and Objectives: People with functional seizures (FSs) experience high health care utilization and costs revolving around the emergency department (ED). Overall, appropriate treatment of FS is underused, and better care pathways are associated with lower ED reattendance. Our objective was to assess changes in total ED and inpatient visits and costs before and after referral to a specialized, comprehensive FS treatment clinic. Methods: We collected data from 100 consecutive patients referred to the University of Colorado (CU) FS Clinic between July 2019 and December 2021. Hospital account data were obtained directly from the electronic health record. Total ED and inpatient visits, charges, and payments 1 year before and 1 year after referral were collected and analyzed using the Wilcoxon signed-rank test. Results: Ninety-four patients were included for analysis. 79% were female, 52% were on Medicaid, and the mean age was 41 (SD 13) years. Total visits after referral (ED and inpatient) were significantly reduced compared with total visits before referral (mean = 1.44 (SD 3.52) vs 1.83 (SD 3.52), p = 0.045). The same test was performed for total charges after and before referral ($15,551 (SD $38,712) vs $30,257 (SD $81,589), p = 0.03) and for total payments after and before referral ($2,469 (SD $6,682) vs $5,199 (SD $15,084), p = 0.02). Discussion: Referral to a specialized FS clinic is associated with reduced health care utilization and costs. This proof-of-concept study reveals that hospitals should implement policies to support efficient care pathways to comprehensive FS treatment programs with potential for cost savings.

Return on Investment With Health Care Simulation.

Delivering simulation across a health system can engage the entire workforce by moving beyond traditional educational delivery and focusing on broader organizational needs specific to a particular organization. The commonly known use of simulation as a form of life support education has progressed to include fully immersive simulation experiences focusing on team-based communication, leadership, fellowship, and clinical care. It continues beyond this point with the inclusion of patient safety strategies, root cause analysis investigation, leadership, and management training, and recently, it has included environments that catalyze innovation in complex healthcare systems. The focus on pure fiscal elements of simulation-based approaches does not give a health system the accurate nontangible benefits simulation can provide, and importantly, acknowledging that each location has differing needs is essential when considering what investment should be made and where. A small community hospital will have vastly different needs from specialty hospitals that deliver specialist care. It must also be understood that every simulation center, to some extent, will always be unique, as it should. The commonly quoted statement "when you have seen one simulation center, you have seen one simulation center" really does reflect the reality of this established and rapidly growing specialty. In this article, we reflect on the traditional use of simulation and discuss some wider uses that may engage a wider audience and, importantly, provide a greater return on investment for your facility, making the case for investment more reasonable and impactful to each part of a busy health system.