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.

Benefits and costs of measures to tackle the outbreak of African swine fever in Sweden.

A common rule in many countries for mitigating the damage caused by African swine fever (ASF) is to eradicate the virus at the outbreak in order to prevent its dispersal and the associated social costs of depopulating infected domestic pigs. The economic performance of this practice, as measured by five different evaluation criteria (net present value, benefit-cost ratio, rate of return, internal rate of return, and payback time), depends on the type of control cost and the spatial and dynamic allocation of benefits, i.e. avoided losses from infected domestic pig farms. The present paper calculates the direct and indirect costs of immediate control measures during an ASF outbreak in wild boars in Mid Sweden. The direct costs include expenses incurred for surveillance, laboratory tests, depopulation of wild boar etc., while the indirect costs are borne by firms and people in the area in relation to movement restrictions. The calculations showed that the total cost of control measures amounted to 28 million euros, with indirect costs making up 40 % of this figure. The benefits were greatly dependent on the speed of ASF dispersal and assumptions about pig farmers' investment responses, which implied large variations in each of the five evaluation criteria.

Erratum: Assessing the credibility of a drug's effects: identification and judgment of uncertainty by the Dutch Medicines Evaluation Board.

[This corrects the article DOI: 10.3389/fmed.2024.1409259.].

The effect of two speech and language approaches on speech problems in people with Parkinson's disease: the PD COMM RCT.

Background: Speech impairments are common with Parkinson's disease (reported prevalence 68%), increasing conversational demands, reliance on family and social withdrawal. Objective(s): The PD COMM trial compared the clinical and cost-effectiveness of two speech and language therapy approaches: Lee Silverman Voice Treatment LOUD and National Health Service speech and language therapy for the treatment of speech or voice problems in people with Parkinson's disease to no speech and language therapy (control) and against each other. Design: PD COMM is a phase III, multicentre, three-arm, unblinded, randomised controlled trial. Participants were randomised in a 1 : 1 : 1 ratio to control, National Health Service speech and language therapy or Lee Silverman Voice Treatment LOUD via a central computer-generated programme, using a minimisation procedure with a random element, to ensure allocation concealment. Mixed-methods process and health economic evaluations were conducted. Setting: United Kingdom outpatient and home settings. Participants: People with idiopathic Parkinson's disease, with self-reported or carer-reported speech or voice problems. We excluded people with dementia, laryngeal pathology and those within 24 months of previous speech and language therapy. Interventions: The Lee Silverman Voice Treatment LOUD intervention included maximum effort drills and high-effort speech production tasks delivered over four 50-minute therapist-led personalised sessions per week, for 4 weeks with prescribed daily home practice. National Health Service speech and language therapy content and dosage reflected local non-Lee Silverman Voice Treatment speech and language therapy practices, usually 1 hour, once weekly, for 6 weeks. Trained, experienced speech and language therapists or assistants provided interventions. The control was no speech and language therapy until the trial was completed. Main outcome measures: Primary outcome: Voice Handicap Index total score at 3 months. Secondary outcomes: Voice Handicap Index subscales, Parkinson's Disease Questionnaire-39; Questionnaire on Acquired Speech Disorders; EuroQol-5D-5L; ICEpop Capabilities Measure for Older Adults; Parkinson's Disease Questionnaire - Carers; resource utilisation; and adverse events. Assessments were completed pre-randomisation and at 3, 6 and 12 months post randomisation. Results: Three hundred and eighty-eight participants were randomised to Lee Silverman Voice Treatment LOUD (n = 130), National Health Service speech and language therapy (n = 129) and control (n = 129). The impact of voice problems at 3 months after randomisation was lower for Lee Silverman Voice Treatment LOUD participants than control [-8.0 (99% confidence interval: -13.3, -2.6); p = 0.001]. There was no evidence of improvement for those with access to National Health Service speech and language therapy when compared to control [1.7 (99% confidence interval: -3.8, 7.1); p = 0.4]. Participants randomised to Lee Silverman Voice Treatment LOUD reported a lower impact of their voice problems than participants randomised to National Health Service speech and language therapy [99% confidence interval: -9.6 (-14.9, -4.4); p < 0.0001]. There were no reports of serious adverse events. Staff were confident with the trial interventions; a range of patient and therapist enablers of implementing Lee Silverman Voice Treatment LOUD were identified. The economic evaluation results suggested Lee Silverman Voice Treatment LOUD was more expensive and more effective than control or National Health Service speech and language therapy but was not cost-effective with incremental cost-effectiveness ratios of £197,772 per quality-adjusted life-year gained and £77,017 per quality-adjusted life-year gained, respectively. Limitations: The number of participants recruited to the trial did not meet the pre-specified power. Conclusions: People that had access to Lee Silverman Voice Treatment LOUD described a significantly greater reduction in the impact of their Parkinson's disease-related speech problems 3 months after randomisation compared to people that had no speech and language therapy. There was no evidence of a difference between National Health Service speech and language therapy and those that received no speech and language therapy. Lee Silverman Voice Treatment LOUD resulted in a significantly lower impact of voice problems compared to National Health Service speech and language therapy 3 months after randomisation which was still present after 12 months; however, Lee Silverman Voice Treatment LOUD was not found to be cost-effective. Future work: Implementing Lee Silverman Voice Treatment LOUD in the National Health Service and identifying alternatives to Lee Silverman Voice Treatment LOUD for those who cannot tolerate it. Investigation of less costly alternative options for Lee Silverman Voice Treatment delivery require investigation, with economic evaluation using a preference-based outcome measure that captures improvement in communication. Study registration: This study is registered as ISRCTN12421382. Funding: This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 10/135/02) and is published in full in Health Technology Assessment; Vol. 28, No. 58. See the NIHR Funding and Awards website for further award information.

Most people with Parkinson's disease develop difficulties with their speech and voice. Communicating becomes difficult. This affects their relationships, work, social life and how they feel about themselves. Our PD COMM trial compared two types of speech and language therapy to find out if they helped the speech and voice problems people with Parkinson's have. We measured changes in the way their voice and speech problems affected their lives and how much therapy cost the National Health Service and families. Everyone taking part had speech or voice problems because of their Parkinson's disease. People could not take part if they had dementia, evidence of laryngeal pathology or previous laryngeal surgery or received speech and therapy for Parkinson's disease in the last 2 years. People who agreed to take part joined one of three groups, which were alike except for the therapy they received. A computer decided which group they joined by chance. National Health Service speech and language therapy Lee Silverman Voice Treatment LOUD No speech and language therapy for 12 months The 388 people who took part came from 41 outpatient clinics in Scotland, England and Wales. Most were older men. The people that received Lee Silverman Voice Treatment LOUD felt better about their speech and voice after 3 months compared to people in the other groups. A year later, they still felt better about it. People that received National Health Service therapy had no benefit compared to people with no access to therapy. Analysis of cost-effectiveness indicated that Lee Silverman Voice Treatment LOUD did not offer value for money and the intervention cost more because more speech and language therapy time was needed to deliver it. Our next question is to ask how we can provide Lee Silverman Voice Treatment LOUD in a way that costs less, for example, using therapy assistants and computer packages or at home. Clear speech and language therapy approaches for people with Parkinson's disease and speech or voice problems should be tested in trials that measure changes in people's lives.

Transperineal biopsy devices in people with suspected prostate cancer - a systematic review and economic evaluation.

Background: People with suspected prostate cancer are usually offered either a local anaesthetic transrectal ultrasound-guided prostate biopsy or a general anaesthetic transperineal prostate biopsy. Transperineal prostate biopsy is often carried out under general anaesthetic due to pain caused by the procedure. However, recent studies suggest that performing local anaesthetic transperineal prostate biopsy may better identify cancer in particular regions of the prostate and reduce infection rates, while being carried out in an outpatient setting. Devices to assist with freehand methods of local anaesthetic transperineal prostate may also help practitioners performing prostate biopsies. Objectives: To evaluate the clinical effectiveness and cost-effectiveness of local anaesthetic transperineal prostate compared to local anaesthetic transrectal ultrasound-guided prostate and general anaesthetic transperineal prostate biopsy for people with suspected prostate cancer, and local anaesthetic transperineal prostate with specific freehand devices in comparison with local anaesthetic transrectal ultrasound-guided prostate and transperineal prostate biopsy conducted with a grid and stepping device conducted under local or general anaesthetic. Data sources and methods: We conducted a systematic review of studies comparing the diagnostic yield and clinical effectiveness of different methods for performing prostate biopsies. We used pairwise and network meta-analyses to pool evidence on cancer detection rates and structured narrative synthesis for other outcomes. For the economic evaluation, we reviewed published and submitted evidence and developed a model to assess the cost-effectiveness of the different biopsy methods. Results: We included 19 comparative studies (6 randomised controlled trials and 13 observational comparative studies) and 4 single-arm studies of freehand devices. There were no statistically significant differences in cancer detection rates for local anaesthetic transperineal prostate (any method) compared to local anaesthetic transrectal ultrasound-guided prostate (relative risk 1.00, 95% confidence interval 0.85 to 1.18) (n = 5 randomised controlled trials), as was the case for local anaesthetic transperineal prostate with a freehand device compared to local anaesthetic transrectal ultrasound-guided prostate (relative risk 1.40, 95% confidence interval 0.96 to 2.04) (n = 1 randomised controlled trial). Results of meta-analyses of observational studies were similar. The economic analysis indicated that local anaesthetic transperineal prostate is likely to be cost-effective compared with local anaesthetic transrectal ultrasound-guided prostate (incremental cost below £20,000 per quality-adjusted life-year gained) and less costly and no less effective than general anaesthetic transperineal prostate. local anaesthetic transperineal prostate with a freehand device is likely to be the most cost-effective strategy: incremental cost versus local anaesthetic transrectal ultrasound-guided prostate of £743 per quality-adjusted life-year for people with magnetic resonance imaging Likert score of 3 or more at first biopsy. Limitations: There is limited evidence for efficacy in detecting clinically significant prostate cancer. There is comparative evidence for the PrecisionPoint™ Transperineal Access System (BXTAccelyon Ltd, Burnham, UK) but limited or no evidence for the other freehand devices. Evidence for other outcomes is sparse. The cost-effectiveness results are sensitive to uncertainty over cancer detection rates, complication rates and the numbers of core samples taken with the different biopsy methods and the costs of processing them. Conclusions: Transperineal prostate biopsy under local anaesthetic is equally efficient at detecting prostate cancer as transrectal ultrasound-guided prostate biopsy under local anaesthetic but it may be better with a freehand device. local anaesthetic transperineal prostate is associated with urinary retention type complications, whereas local anaesthetic transrectal ultrasound-guided prostate has a higher infection rate. local anaesthetic transperineal prostate biopsy with a freehand device appears to meet conventional levels of costeffectiveness compared with local anaesthetic transrectal ultrasound-guided prostate. Study registration: This study is registered as PROSPERO CRD42021266443. Funding: This award was funded by the National Institute for Health and Care Research (NIHR) Evidence Synthesis programme (NIHR award ref: NIHR134220) and is published in full in Health Technology Assessment Vol. 28, No. 60. See the NIHR Funding and Awards website for further award information.

A prostate biopsy can help determine if a person has prostate cancer. The main ways of performing a prostate biopsy involve taking small samples of the prostate out through the rectum (back passage) or through the perineum ­ the skin area between the anus and the scrotum (testicles). Both methods use ultrasound images from a probe inserted into the rectum to help the clinician see what they are doing. Taking samples through the rectum is usually carried out under local anaesthetic, whereas taking samples through the perineum is usually carried out under general anaesthetic. We wanted to find out if taking samples through the perineum under local anaesthetic (instead of general anaesthetic) would be equally effective at detecting prostate cancer as the other biopsy methods and whether there was any improvement or change in the sorts of side effects people may have. We also wanted to know if people found the biopsy painful or not. We carried out searches of computer research databases to find relevant clinical and cost-effectiveness studies and compared the effectiveness of the different biopsy methods they used. We read and summarised the results of the studies we found in our search. Our findings showed that taking biopsy samples through the perineum under local anaesthetic had rates of detecting prostate cancer similar to those of the other biopsy methods. But if the clinician also used a freehand device that helps guide the biopsy needle as part of the procedure, then this may be a better method for detecting cancer. The studies we found agreed that performing this prostate biopsy under local anaesthetic was not too painful for most people. Our economic estimates suggest that using a freehand device for local anaesthetic perineal (through the skin of the perineum) biopsy may be a cost-effective use of National Health Service resources.

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.

Bio-organic substitution in tobacco (Nicotiana tabacum L) cultivation: Optimum strategy to lower carbon footprint and boost net ecosystem economic benefit.

The partial substitution of organic manure for chemical nitrogen fertilizers, known as organic substitution, is widely regarded as a cleaner and more sustainable production strategy. However, few studies have quantified greenhouse gas emissions, product income and net ecosystem economic benefit (NEEB) using a life cycle assessment (LCA) approach, particularly for typical tobacco (Nicotiana tabacum L.) production. Here, we quantified the yield and quality of a typical tobacco production in Qujing, Yunnan, China, through field experiments and calculated its carbon footprint and NEEB using the LCA approach. Four organic substitution strategies were established with equal nitrogen inputs, including synthesized chemical fertilizer (SN), farmyard organic manure (NF), commercial organic manure (NC), and bio-organic (Trichoderma viride Pers.) manure (NT), each substituting 15% of synthesized nitrogen fertilizer. Compared to the SN strategy, the NT strategy significantly increased yield and income by 10.3% and 9.6%, respectively. In contrast, the NF strategy significantly reduced income, while the NC strategy showed no significant difference. Both the NC and NT strategies significantly reduced N2O cumulative emissions (by 15.9% and 8.0%, respectively), increased δSOC (by 38.4% and 15.0%, respectively), and decreased carbon footprint compared to the SN strategy. However, the NF strategy significantly increased the income-scaled carbon footprint, even though it also notably reduced N2O cumulative emissions (by 22.6%) and increased δSOC (by 7.9%). The NT strategy achieved a win-win scenario of low environmental risk and high economic returns of tobacco production with significantly increased NEEB (by 10.6%) compared to the SN strategy (37.60 × 103 CNY yr-1). This suggests that the bio-organic Trichoderma manure substituting 15% synthesized nitrogen fertilizer is the best organic substitution strategy for sustainable tobacco production.

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.

Risk-benefit assessment of foods and its role to inform policy decisions: outcome of an international workshop.

Policy decisions in public health require consideration and evaluation of trade-offs for which transparency and science-based evidence is needed. Improvement of decision-support tools is essential to help guide food policy decisions that promote healthy diets and meet the challenges of food systems without compromising food security, food safety, and sovereignty. Risk-benefit assessment of foods (RBA) is an established methodological approach designed to inform policy decisions within the area of nutrition and food safety. Despite methodological developments, translation of RBA findings into policies is still limited. In this context, a stakeholder workshop held in May 2023 gathered RBA experts and food regulators from Europe to identify the challenges, obstacles and opportunities in using evidence generated through RBAs to inform food policy decisions. A structured process was implemented to collect their views through online surveys, breakout groups, and plenary discussions. As a secondary objective, food regulators' views on other approaches for holistic risk assessment fit for food systems analysis were also explored. This paper summarizes the main findings of the workshop and discusses policy implications and future perspectives to improve the area of RBA and its role in food policymaking.

Effects of integrated fertilizer application on selected soil properties and yield attributes of common bean (Phaseolus vulgaris L.) on different soil types.

In Ethiopia, common bean (Phaseolus vulgaris L.) productivity remains low because of low soil fertility. However, both plant production and soil fertility benefit from integrated application of fertilizers. Thus, this study investigates the effect of integrated application of inorganic, organic and biofertilizers on selected soil properties and yield components of common bean. A field experiment was conducted at three sites in southern Ethiopia, under two consecutive cropping season (2021 and 2022). The experiment was conducted using a randomized complete block design (RCBD) with three replications. The treatments included three levels of inorganic fertilizer (Triple Superphosphate, TSP), applied at 0, 42.5, and 85 kg TSP ha⁻1 for Kokate; 0, 29, and 58 kg TSP ha⁻1 for Hawassa; and 0, 35.5, and 71 kg TSP ha⁻1 for Alage, tailored to the specific conditions of each site. Additionally, the experiment incorporated three levels of organic inputs 0, 5 t biochar ha⁻1, and 5 t compost ha⁻1 as well as Rhizobium inoculation (HB-429) applied at 500 g ha⁻1. These treatments were designed to assess the combined effects of inorganic, organic and biofertilizers on soil health and crop performance. Results showed that the integrated application of inorganic, and organic fertilizers significantly (p ≤ 0.05) improved soil pH, soil organic carbon, and available P compared with the sole fertilizer application plots. Similarly, the integrated use of inorganic, organic and biofertilizers increased nodule numbers, seed weight, grain yield, and biomass yield. We also found that 23 and 24 % higher grain yield were achieved with integrated applications of TSP fertilizer with compost on Hawassa and Alage sites than sole inorganic fertilizer application. On the other hand, the integrated application of TSP fertilizer with biochar increased by 18 % grain yield on Kokate over the sole application of inorganic fertilizer. The highest economic benefit of 69,460 and 63,250 ETB was obtained from the integrated application of TSP fertilizer with compost at Hawassa and Alage sites, respectively. The highest economic benefit for the Kokate site was 53,583 ETB at TSP fertilizer with biochar application. Overall, the study confirms that site-specific integrated soil fertility management appears to be a prerequisite for sustainable and profitable common bean production over sole fertilizer application in southern Ethiopia.

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.

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.

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.

Public health impact and return on investment of the pediatric national immunization program in Italy.

OBJECTIVES: We conducted a cost-benefit analysis of the pediatric National Immunization Program (NIP) in Italy. METHODS: An economic model evaluated the benefit-cost ratio (BCR) of the Italian pediatric NIP, including 10 pathogens for mandatory vaccines and 4 pathogens for recommended vaccines for children aged 0-10 years from the healthcare-sector and societal perspectives. Separate decision trees were used to model each vaccine-preventable disease (VPD). The 2020 birth cohort (n = 420,084) was followed over their lifetime; the model projected and compared discounted disease cases, life-years, quality-adjusted life-years (QALYs), and costs (2021 euros) with and without immunization (based on current and pre - vaccine era disease incidence estimates, respectively). RESULTS: The pediatric NIP was estimated to prevent 1.8 million cases of VPDs and 3,330 deaths, resulting in 45,900 fewer life-years lost and 57,000 fewer QALYs lost. Vaccination costs of €285 million were offset by disease cost savings of €1.6 billion, resulting in a BCR of 5.6 from a societal perspective (BCR = 1.7 from a healthcare-sector perspective). When QALYs gained were valued, the BCR increased to 15.6. CONCLUSIONS: The benefits of the Italian pediatric NIP, including averted disease-related morbidity, mortality, and associated costs, highlight the value of continued investment in pediatric immunization.

[Health is a serious matter : so let's play ! Part 1 : an overview of «serious gaming¼ in physical medicine and rehabilitation]. / La médecine du futur. La santé est un sujet sérieux : alors jouons ! Première partie : un aperçu du «serious gaming¼ en médecine physique et réhabilitation.

The lack of physical activity is widespread among our populations affecting all age groups from youngsters to older adults, heavily impacting health in general (physical as well as mental health). The main objective of serious gaming is not simply providing entertainment and fun. It aims at achieving specific health-related goals in an efficient and pleasant way. This article will take stock of the general interest of this approach in physical medicine and rehabilitation, while trying to illustrate the barriers and limits. Even if the concept seems effective, more efforts are required based on scientific sound and rational approaches, using standardized methods, to answer multiple existing and persistent questions.

Le manque d'activité physique est ubiquitaire, tant au niveau de nos populations vieillissantes que chez nos jeunes. Et pourtant c'est un des facteurs les plus importants pour le maintien d'une bonne santé (dans sa définition holistique, donc y compris sa dimension mentale). L'objectif principal du jeu sérieux est autre que simplement procurer du divertissement au joueur. Il a pour but d'atteindre des objectifs de santé spécifiques et ce, de façon efficace et agréable. Nous allons faire le point sur l'intérêt de cette approche en médecine physique et réhabilitation, tout en essayant d'illustrer les barrières et les limites. De façon générale, le concept semble bel et bien efficace, mais il mérite une attention plus scientifique et standardisée, afin de répondre à de multiples questions existantes et persistantes.

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.

Using Machine Learning on MRI Radiomics to Diagnose Parotid Tumours Before Comparing Performance with Radiologists: A Pilot Study.

The parotid glands are the largest of the major salivary glands. They can harbour both benign and malignant tumours. Preoperative work-up relies on MR images and fine needle aspiration biopsy, but these diagnostic tools have low sensitivity and specificity, often leading to surgery for diagnostic purposes. The aim of this paper is (1) to develop a machine learning algorithm based on MR images characteristics to automatically classify parotid gland tumours and (2) compare its results with the diagnoses of junior and senior radiologists in order to evaluate its utility in routine practice. While automatic algorithms applied to parotid tumours classification have been developed in the past, we believe that our study is one of the first to leverage four different MRI sequences and propose a comparison with clinicians. In this study, we leverage data coming from a cohort of 134 patients treated for benign or malignant parotid tumours. Using radiomics extracted from the MR images of the gland, we train a random forest and a logistic regression to predict the corresponding histopathological subtypes. On the test set, the best results are given by the random forest: we obtain a 0.720 accuracy, a 0.860 specificity, and a 0.720 sensitivity over all histopathological subtypes, with an average AUC of 0.838. When considering the discrimination between benign and malignant tumours, the algorithm results in a 0.760 accuracy and a 0.769 AUC, both on test set. Moreover, the clinical experiment shows that our model helps to improve diagnostic abilities of junior radiologists as their sensitivity and accuracy raised by 6 % when using our proposed method. This algorithm may be useful for training of physicians. Radiomics with a machine learning algorithm may help improve discrimination between benign and malignant parotid tumours, decreasing the need for diagnostic surgery. Further studies are warranted to validate our algorithm for routine use.

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.

Benefit-Cost Analysis for Earthquake-Resilient Building Design and Retrofit: State of the Art and Future Research Needs.

This paper reviews the state of the art in using benefit-cost analysis (BCA) to inform earthquake risk reduction decisions by building owners and policymakers. The goal is to provide a roadmap for the application and future development of BCA methods and tools for earthquake risk reduction. Our review covers three earthquake risk reduction measures: adopting up-to-date building codes for new construction, designing new buildings to exceed code requirements, and retrofitting deficient existing buildings. We highlight the factors that influence the cost-effectiveness of building design and retrofit, as well as tactics for increasing the cost-effectiveness of risk reduction strategies. We also present BCA results, methods, and data sources used in the literature to help researchers and practitioners design and conduct a reliable and robust BCA study. In the process, we develop a set of opportunities and challenges for applying BCA to new areas of research, as well as key gaps and limitations in current BCA approaches, including further investigation of above-code design, incorporation of code implementation and enforcement into BCA, quantification of environmental benefits of seismic retrofits, and optimization of seismic retrofits with energy upgrades. Overall, our review provides practical guidance and useful insights into BCA with the goal of increasing the earthquake resilience and economic efficiency of buildings in the United States.