Food insecurity and diabetes management among adults of African descent: A systematic review.

AIMS: This systematic review explores the established causal link between food insecurity and cardiometabolic conditions among adults of African descent. Specifically, this study examined the relationship between food insecurity and the management of type 2 diabetes, highlighting the prevalence of food insecurity among individuals of African descent with type 2 diabetes. METHODS: Original English papers were meticulously searched in databases including PubMed, CINAHL, PsycINFO, Medline, Cochrane, Embase and Web of Science. The Cochrane Risk of Bias Tool for quantitative studies and COReQ for qualitative studies were employed to assess biases. Three independent reviewers meticulously evaluated and synthesized results, reaching a consensus. RESULTS: Among the 198 studies identified, 14 met the inclusion criteria for data extraction and analysis, which were conducted independently by three reviewers. The findings indicate that individuals of African descent are more likely to experience food insecurity compared to their White counterparts and are also more prone to diabetes risk factors or the presence of diabetes. CONCLUSIONS: This study underscores a higher prevalence of food insecurity and type 2 diabetes among adults of African descent, suggesting that ethnicity and food insecurity play significant roles in diabetes management. Future research should prioritize interventions aimed at reducing these disparities.

Economic losses due to foot-and-mouth disease (FMD) in Ethiopian cattle.

Ethiopia's cattle population is among the largest in Africa and is burdened by frequent foot-and-mouth disease (FMD) outbreaks. FMD is caused by several distinct and highly contagious viral strains that can result in acute disease in cattle, causing losses in productivity and impeding international trade. This economic simulation study considered four main sources of losses due to FMD in cattle: reduced milk yield, draft power yield, fertility, and increased mortality. Economic losses were estimated per case across age-sex strata in 89 Ethiopian administrative zones for the years 2010-2021 using a wide range of data to estimate distributions for 30 input variables in a series of Monte Carlo simulations. It was estimated that an average case of FMD in Ethiopian cattle results in losses (mean values reported followed 95 % confidence intervals in brackets) of US dollars (USD) 11 (USD 7-USD 16) per case. Losses resulting from an average outbreak were estimated to be USD 2300 (USD 1400-USD 3300), while national annual losses were estimated to be USD 0.9 Mil. (USD 0.2 Mil.-USD 2.3 Mil.). Per cow-year, based on a national cow population of approximately 39 Mil. head, these estimated annual losses are equivalent to losses of only USD 0.02 (USD 0.01-USD 0.06). Nationally, these losses were significantly less than previously estimated in the literature, with currently estimated losses more accurately reflecting the economic burden of FMD in Ethiopian cattle over the past decade. The relatively small estimated losses suggest that control efforts based on widespread vaccination in countries with primarily extensive cattle production systems, such as Ethiopia, are unlikely to be economically sound. Sensitivity analyses suggested losses would be far greater in intensive systems, and that certainty surrounding incidence rates is paramount to the formulation of economically sound animal healthpolicy in regions with endemic FMD.

Unveiling Afghanistan's wind and hydrogen potential: a comparative study.

Given the detrimental environmental impacts of fossil fuels, there is a gradual worldwide shift towards renewable energy sources. Wind power, renowned for its cost-effectiveness and simplicity, has been widely embraced. Despite Afghanistan facing significant challenges in its energy sector, its considerable wind energy potential offers a chance to mitigate some of these issues. This study employed a multi-criteria decision-making approach to evaluate potential wind-hydrogen project sites in Afghanistan, encompassing economic, technical, social, risk, and environmental considerations. Five criteria and sub-criteria for wind-hydrogen project implementation were analyzed using the Step-wise Weight Assessment Ratio Analysis (SWARA) method. The Weighted Aggregated Sum Product Assessment (WASPAS), Additive Ratio Assessment (ARAS), Evaluation based on Distance from Average Solution (EDAS), and Technique of Order Preference Similarity to the Ideal Solution (TOPSIS) methods were then applied to prioritize provinces for wind-hydrogen project implementation. The analysis found that the Duration of the Payback Period and Levelized Cost of Electricity (LCOE) with weight of 6.6% and 5.6% were critical sub-criteria. Farah, Herat, and Nimroz emerged as Afghanistan's most promising provinces for wind-hydrogen energy development. In Farah, utilizing 900-kW turbines, it is feasible to generate 2679.8 MWh of electricity and produce 43.4 tons of hydrogen annually, with a Levelized Cost of Electricity of 0.0690 $/kWh and Levelized Cost of Hydrogen of 1.747 $/kg.

Temporal Trends in Tobacco Smoking Prevalence During the Period 2010-2020 in Vietnam: A Repeated Cross-Sectional Study.

Objectives: This study used repeated cross-sectional data from three national surveys in Vietnam to determine tobacco smoking prevalence from 2010 to 2020 and disparities among demographic and socioeconomic groups. Methods: Tobacco smoking temporal trends were estimated for individuals aged 15 and over and stratified by demographic and socioeconomic status (SES). Prevalence estimates used survey weights and 95% confidence intervals. Logistic regression models adjusted for survey sample characteristics across time were used to examine trends. Results: Tobacco smoking prevalence dropped from 23.8% in 2010 to 22.5% in 2015 and 20.8% in 2020. The adjusted OR for 2015 compared to 2010 was 0.87, and for 2020 compared to 2010 was 0.69. Smoking decreased less for employed individuals than unemployed individuals in 2020 compared to 2010. Smoking was higher in the lower SES group in all 3 years. Higher-SES households have seen a decade-long drop in tobacco use. Conclusion: This prevalence remained constant in lower SES households. This highlights the need for targeted interventions to address the specific challenges faced by lower-SES smokers and emphasizes the importance of further research to inform effective policies.

Rethinking counterfeit medical supply chains: A critical review of the current literature.

The medical device and pharmaceutical industries include a range of drugs, machines, instruments, and apparatuses used to prevent, diagnose, treat disease and illness, or aid in rehabilitation for patients, and are expected to grow substantially in the coming years. However, they are often targets of criminal organizations who manufacture and profit from fraudulent products, infiltrating the market with counterfeit medical supply chains. In this paper, we discuss and analyze the extent and nature of this problem and make suggestions for mitigation and prevention of this worldwide challenge. Ultimately, we argue that a holistic approach is essential to addressing this problem, including the creation and dissemination of reliable and good quality data, developing healthcare systems to be more robust, establishing/enhancing intra- and international cooperation around this issue, and employing effective technological solutions, such as digital tracing.

Infant, Neonatal, and Post-neonatal Mortality in Greece: A Nationwide Time-Trend Analysis.

INTRODUCTION: Infant mortality is a crucial perinatal measure and is also regarded as an important public health indicator. This study aimed to comprehensively present time trends in infant, neonatal, and post-neonatal mortality in Greece. METHODS: The annual infant mortality rate (IMR), the neonatal mortality rate (NMR), and the post-neonatal mortality rate (PNMR) were calculated based on official national data obtained from the Hellenic Statistical Authority, spanning 67 years from 1956 to 2022. The time trends of the mortality rates were evaluated using joinpoint regression analysis, and the annual percent changes (APC) and the overall average annual percent change (AAPC) were calculated with a 95% confidence interval (95% CI). RESULTS: The IMR exhibited accelerating declines over more than 50 years, with an APC of -1.9 (-2.8 to -1.0) from 1956 to 1968, -5.4 (-5.6 to -5.2) from 1968 to 1999, and -7.3 (-8.9 to -5.7) between 1999 and 2008. In 2008, IMR reached its all-time low of 2.7 per 1,000 live births, down 16.6-fold from its peak at 44.1 per 1,000 live births in 1957. This improving trend was reversed following the onset of the economic crisis in the country, leading to a 57% increase in IMR from 2008 to 2016, with an upward trend APC of 3.4 (1.2 to 5.5). In the recent period 2016-2022, there was an improvement with an APC of -3.7 (-6.2 to -1.1), resulting in an IMR of 3.1 per 1,000 live births in 2022. The decrease in IMR was estimated to have prevented 209,109 infant deaths in the country from 1958 to 2022. From 1956 to 2022, the IMR decreased with an AAPC of -3.9 (-4.3 to -3.4), while the PNMR saw a decline with an AAPC of -4.5 (-5.1 to -3.9) and the NMR with an AAPC of -3.2 (-3.7 to -2.6). CONCLUSION: Greece achieved an impressive decrease in infant mortality rates, but this progress was halted and completely reversed during the economic crisis. Although there have been some recent improvements after the country's economic recovery, the rates have yet to reach pre-crisis levels.

Cost-benefit analysis of haemodialysis in patients with end-stage kidney disease in Abuja, Nigeria.

BACKGROUND: Significant gaps in scholarship on the cost-benefit analysis of haemodialysis exist in low-middle-income countries, including Nigeria. The study, therefore, assessed the cost-benefit of haemodialysis compared with comprehensive conservative care (CCC) to determine if haemodialysis is socially worthwhile and justifies public funding in Nigeria. METHODS: The study setting is Abuja, Nigeria. The study used a mixed-method design involving primary data collection and analysis of secondary data from previous studies. We adopted an ingredient-based costing approach. The mean costs and benefits of haemodialysis were derived from previous studies. The mean costs and benefits of CCC were obtained from a primary cross-sectional survey. We estimated the benefit-cost ratios (BCR) and net benefits to determine the social value of the two interventions. RESULTS: The net benefit of haemodialysis (2,251.30) was positive, while that of CCC was negative (-1,197.19). The benefit-cost ratio of haemodialysis was 1.09, while that of CCC was 0.66. The probabilistic and one-way sensitivity analyses results demonstrate that haemodialysis was more cost-beneficial than CCC, and the BCRs of haemodialysis remained above one in most scenarios, unlike CCC's BCR. CONCLUSION: The benefit of haemodialysis outweighs its cost, making it cost-beneficial to society and justifying public funding. However, the National Health Insurance Authority requires additional studies, such as budget impact analysis, to establish the affordability of full coverage of haemodialysis.

The impact of ASEAN economic community, firm characteristics and macroeconomics on firm performance and firm value: An investigation of Shariah-compliant firms in Indonesia.

The ASEAN Economic Community (AEC) presents both opportunities and challenges to Shariah-compliant firms (SCF) that have particular rules concerning business activities and financial ratios following Islamic principles. The SCF has to maintain the ratio of interest-based debt to total assets as well as non-permissible income, where these restrictions may impact both firm performance and firm value, particularly in the AEC era. Therefore, the SCF has to utilize internal factors to strengthen the firm while also considering the external factor of macroeconomics. The purpose of this paper is to examine the internal factors-firm age, size and efficiency (FASE), financial leverage, foreign ownership- and macroeconomics affecting financial performance and firm value of SCFs, including the effects both pre- and post-AEC. This study applies structural equation modelling-partial least square (SEM-PLS) to analyze 103 non-financial firms that were continuously listed on the Islamic Shariah Stock Index (ISSI) from 2011 to 2020. The results showed that FASE and macroeconomics had a significant positive influence on firm performance. Moreover, financial leverage, foreign ownership and the AEC participation showed a negative effect on firm performance. In addition, there was a positive relationship between FASE and firm value, as well as firm performance and firm value of SCFs. Finally, the findings from this study may help stakeholders determine policies that involve both internal and macroeconomic situations, as well as the potential effect of the AEC on the enhancement of firm performance and firm value.

Curosurf surfactant application on preterm babies with respiratory complications-health-economic benefits.

Background: The implementation of surfactant for respiratory syndrome approbates the therapy as a revolutionary method in intensive neonatal therapy and respiratory resuscitation. It is important to investigate the costs of this treatment. Objective: The aim of the study is to analyze the data by the application of the surfactant Curosurf to preterm babies with respiratory complications and describe the treatment costs, healthcare resource utilization and evaluate economic benefits of surfactant use in the treatment of neonates with respiratory distress syndrome (RDS) and hyaline-membrane disease (HDM). Methods: A retrospective survey was performed covering 167 babies based on respiratory complications due to preterm birth and the necessity to apply a surfactant therapy. A documentary method was implemented and for each patient, an individual research protocol was filled out - a questionnaire created specifically for the purposes of the study. Results and discussion: An analysis of the data from the application of CUROSURF was made and the obtained therapeutic results were compared to expenditures for the therapy, short-term therapeutic effect, benefits and consequences of the therapy of preterm newborns with respiratory complications. The application of CUROSURF to babies with RDS resulted in the realization of net savings due to the elimination of the necessity of conducting several diagnostic and therapeutic procedures as well as their duration reduction of hospital stay, thus defining its health-economic benefits. Conclusions: The models of evaluation of cost effectiveness reveal that the medicinal product is expensive but effective from the aspect of short-term therapeutic results.

Emission characteristics and health effects of PM2.5 from vehicles in typical areas.

Introduction: Vehicle emissions have become an important source of urban air pollution, and the assessment of air pollution emission characteristics and health effects caused by specific pollution sources can provide scientific basis for air quality management. Methods: In this paper, vehicle PM2.5 pollution in typical urban agglomerations of China (the Beijing-Tianjin-Hebei urban agglomeration (BTHUA), the triangle of the Central China urban agglomeration (TCCUA) and the Chengdu-Chongqing urban agglomeration (CCUA)) were used as research samples to evaluate the emission characteristics, health effects and economic losses of vehicle PM2.5 pollution based on the emission inventory, air quality model and exposure-response function from 2010 to 2020. Results: The results indicated that PM2.5 emissions from vehicles in the three urban agglomerations during 2010-2020 first showed an upward yearly trend and then showed a slow decrease in recent years. Heavy-duty trucks and buses are the main contribution vehicles of PM2.5, and the contribution rates of light-duty vehicles to PM2.5 is increasing year by year. The contribution rate of PM2.5 in Beijing decreased significantly. In addition to capital cities and municipalities directly under the central Government, the emission of pollutants in other cities cannot be ignored. The evaluation results of the impact of PM2.5 pollution from vehicles on population health show that: the number of each health endpoint caused by PM2.5 pollution from vehicles in the BTHUA and CCUA showed an overall upward trend, while the TCCUA showed a downward trend in recent years. Among them, PM2.5 pollution from vehicles in the three major urban agglomerations cause about 78,200 (95% CI: 20,500-138,800) premature deaths, 122,800 (95% CI: 25,600-220,500) inpatients, and 628,400 (95% CI: 307,400-930,400) outpatients and 1,332,400 (95% CI: 482,700-2,075,600) illness in 2020. The total health economic losses caused by PM2.5 pollution from vehicles in the three major urban agglomerations in 2010, 2015 and 2020 were 68.25 billion yuan (95% CI: 21.65-109.16), 206.33 billion yuan (95% CI: 66.20-326.20) and 300.73 billion yuan (95% CI: 96.79-473.16), accounting for 0.67% (95% CI: 0.21-1.07%), 1.19% (95% CI: 0.38%-1.88%) and 1.21% (95% CI: 0.39%-1.90%) of the total GDP of these cities. Discussion: Due to the differences in vehicle population, PM2.5 concentration, population number and economic value of health terminal units, there are differences in health effects and economic losses among different cities in different regions. Among them, the problems of health risks and economic losses were relatively prominent in Beijing, Chengdu, Chongqing, Tianjin and Wuhan.

Direct healthcare costs in the first 2 years of life: A comparison of screened and clinically diagnosed children with cystic fibrosis - The Irish comparative outcomes study of CF (ICOS).

BACKGROUND: In July 2011, Cystic Fibrosis (CF) was added to the Newborn Bloodspot Screening Programme in Ireland. The Irish Comparative Outcomes Study (ICOS) is a historical cohort study established to compare outcomes between clinically-detected and screen-detected children with CF. Here we present the results of economic analysis comparing direct healthcare costs in the first 2 years of life of children born between mid-2008 and mid-2016, in the pre-CF transmembrane conductance regulator modulator era. METHODS: Healthcare resource use information was obtained from Cystic Fibrosis Registry of Ireland (CFRI), medical records and parental questionnaire. Hospital admissions, emergency department visits, outpatient appointments, antibiotics and maintenance medications were included. Costs were estimated using the Health Service Executive Casemix, Irish Medicines Formulary and hospital pharmacy data, adjusted for inflation using Consumer Price Index data from the Central Statistics Office. A Negative Binomial regression was used, with time in the study as an offset. RESULTS: Overall participation was 93 %. After exclusion of those with meconium ileus, data from 139 patients, with follow-up to 2 years of age, were available. 72 (51.8 %) were from the clinically diagnosed cohort. In the final model (n=105), clinically diagnosed children had 2.62-fold higher costs per annum (p<0.0001), when adjusted for confounders, including homozygous ΔF508 or G511D mutation, socio-demographic factors and time between diagnosis and first CFRI interaction. CONCLUSIONS: There are few studies evaluating economic aspects of newborn screening for CF using routine care data. These results imply that the benefits of newborn screening extend to direct healthcare costs borne by the State.

Eye care following pre-school vision screening: Data from the Growing Up in New Zealand study.

AIM: This study aimed to determine adherence with follow-up from the New Zealand pre-school vision screening programme. The study also examined associations between pre-school vision screening outcomes and cognitive measures assessed at the 54-month follow-up in the Growing Up in New Zealand study cohort. METHODS: A cross-sectional retrospective record review of pre-school vision screening outcomes and hospital ophthalmology records with linkage to Growing Up in New Zealand cohort study data. RESULTS: Of 176 children referred from vision screening, 21.6% did not attend a referral appointment. Of 138 children who attended a referral appointment, 21.0% did not attend one or more follow-up appointments. Ethnic differences were observed in attendance at referral appointments (attended Maori 13%, Pacific 22.5%, European/Other 64.5%; not attended Maori 26.3%, Pacific 28.9%, European/Other 44.7%; P = 0.04) and follow-up appointments (attended Maori 11.9%, Pacific 15.6%, European/Other 72.5%; not attended Maori 17.2%, Pacific 48.3%, European/Other 34.5%; P = 0.001). Vision screening outcome was significantly associated with letter naming fluency scores (P = 0.01) but not name and numbers scores (P = 0.05). CONCLUSIONS: Non-attendance at referral and follow-up appointments limits the efficacy of vision screening, particularly for children of Maori and Pacific ethnicity. Children referred from vision screening achieve lower scores on letter naming fluency, a key predictor of reading ability in later childhood. Equity-based improvements are required to ensure that all children referred from vision screening receive appropriate follow-up eye care.

The Modeled Cost-Effectiveness of a Prevention Program Targeting Both Eating Disorders and High BMI.

OBJECTIVE: Prevention programs for eating disorders (EDs) and high body index mass (BMI) have the potential to reduce the onset of these interconnected public health concerns. However, it remains unclear whether routine implementation of such programs would be cost-effective. This study aims to determine the cost-effectiveness of an intervention that aims to prevent both ED and high BMI. METHOD: A Markov model was developed to evaluate the incremental cost-effectiveness of a targeted school-based program, Healthy Weight, that aims to prevent both EDs and high BMI among Australian adolescents with body image concerns (aged 15-18 years), versus a "no intervention" comparator. A cost-utility analysis was conducted from a "healthcare and education" sector perspective with costs (measured in 2019 Australian dollars) and health impacts modeled over the lifetime of the target population. An incremental cost-effectiveness ratio (ICER), expressed as cost per health-adjusted life year (HALY) gained, was calculated. Sensitivity analyses were done to test model assumptions. RESULTS: The mean intervention cost and HALYs gained were AUD$2.13 million (95% CI, AUD$1.83-2.43 million) and 146 (95% CI, 90-209), respectively. With healthcare cost-savings (AUD$3.97 million) included, the intervention was predicted to be cost-saving (AUD$1.83 million; 95% CI, AUD$0.51-3.21 million). Primary findings were robust to extensive sensitivity analyses. DISCUSSION: The Healthy Weight intervention is likely to represent good value-for-money. To ensure the successful implementation of this program at the population level, further research on its feasibility and acceptability among schools and the wider community is required.

Caregiver preferences for physically harsh discipline of children in rural Uganda.

Purpose: Physically harsh discipline is associated with poor developmental outcomes among children. These practices are more prevalent in areas experiencing poverty and resource scarcity, including in low- and middle-income countries. Designed to limit social desirability bias, this cross-sectional study in rural Uganda estimated caregiver preferences for physically harsh discipline; differences by caregiver sex, child sex, and setting; and associations with indicators of household economic stress and insecurity. Method: Three-hundred-fifty adult caregivers were shown six hypothetical pictographic scenarios depicting children whining, spilling a drink, and kicking a caregiver. Girls and boys were depicted engaging in each of the three behaviors. Approximately half of the participants were shown scenes from a market setting and half were shown scenes from a household setting. For each scenario, caregivers reported the discipline strategy they would use (time out, beating, discussing, yelling, ignoring, slapping). Results: Two thirds of the participants selected a physically harsh discipline strategy (beating, slapping) at least once. Women selected more physically harsh discipline strategies than men (b = 0.40; 95% confidence interval [CI], 0.26 to 0.54). Participants shown scenes from the market selected fewer physically harsh discipline strategies than participants shown scenes from the household (b = -0.51; 95% CI, -0.69 to -0.33). Finally, caregivers selected more physically harsh discipline strategies in response to boys than girls. Indicators of economic insecurity were inconsistently associated with preferences for physically harsh discipline. Conclusions: The high prevalence of physically harsh discipline preferences warrant interventions aimed at reframing caregivers' approaches to discipline.

Environmental, socioeconomic, and health factors associated with gut microbiome species and strains in isolated Honduras villages.

Despite a growing interest in the gut microbiome of non-industrialized countries, data linking deeply sequenced microbiomes from such settings to diverse host phenotypes and situational factors remain uncommon. Using metagenomic data from a community-based cohort of 1,871 people from 19 isolated villages in the Mesoamerican highlands of western Honduras, we report associations between bacterial species and human phenotypes and factors. Among them, socioeconomic factors account for 51.44% of the total associations. Meta-analysis of species-level profiles across several datasets identified several species associated with body mass index, consistent with previous findings. Furthermore, the inclusion of strain-phylogenetic information modifies the overall relationship between the gut microbiome and the phenotypes, especially for some factors like household wealth (e.g., wealthier individuals harbor different strains of Eubacterium rectale). Our analysis suggests a role that gut microbiome surveillance can play in understanding broad features of individual and public health.

Private management of African protected areas improves wildlife and tourism outcomes but with security concerns in conflict regions.

Protected areas can conserve wildlife and benefit people when managed effectively. African governments increasingly delegate the management of protected areas to private, nongovernmental organizations, hoping that private organizations' significant resources and technical capacities actualize protected areas' potential. Does private sector management improve outcomes compared to a counterfactual of government management? We leverage the transfer of management authority from governments to African Parks (AP)-the largest private manager of protected areas in Africa-to show that private management significantly improves wildlife outcomes via reduced elephant poaching and increased bird abundances. Our results also suggest that AP's management augments tourism, while the effect on rural wealth is inconclusive. However, AP's management increases the risk of armed groups targeting civilians, which could be an unintended outcome of AP's improved monitoring and enforcement systems. These findings reveal an intricate interplay between conservation, economic development, and security under privately managed protected areas in Africa.

Environmental regulation and marine economic resilience: An institutional synergy perspective.

Growing economic and industrial activities have put a large strain on the marine environment and ecosystem, presenting the marine economy with a tradeoff between economic expansion and environmental conservation. Though the Porter hypothesis depicts a win-win situation, it is crucial to consider the conditions under which environmental regulations generate positive effects. This paper is to study how the synergy between market-based and government-based environmental regulations affects marine economic resilience, whereas maintaining economic resilience is a prerequisite for promoting innovation and productivity. The findings indicate that each 1 % increase in the synergistic level of environmental regulations resulted in a 0.234 % improvement in marine economic resilience. The heterogeneity tests indicate that the relationship is still significant if the marine economy characterizes high industrial diversity, high industrial upgrading, and large scale, while environmental regulation in coastal provinces that marine industrial structure is not advanced negatively affects marine economic resilience.

Estimated Annual Healthcare Costs After Acute Pulmonary Embolism: Results From a Prospective Multicentre Cohort Study.

OBJECTIVE: Patients surviving acute pulmonary embolism (PE) necessitate long-term treatment and follow-up. However, the chronic economic impact of PE on European healthcare systems remains to be determined. METHODS AND RESULTS: We calculated the direct cost of illness during the first year after discharge for the index PE, analyzing data from a multicentre prospective cohort study in Germany. Main and accompanying readmission diagnoses were used to calculate DRG-based hospital reimbursements; anticoagulation costs were estimated from the exact treatment duration and each drug's unique national identifier; and outpatient post-PE care costs from guidelines-recommended algorithms and national reimbursement catalogues. Of 1017 patients enrolled at 17 centres, 958 (94%) completed ≥ 3-month follow-up; of those, 24% were rehospitalized (0.34 [95% CI 0.30-0.39] readmissions per PE survivor). Age, coronary artery, pulmonary and kidney disease, diabetes, and (in the sensitivity analysis of 837 patients with complete 12-month follow-up) cancer, but not recurrent PE, were independent cost predictors by hurdle gamma regression accounting for zero readmissions. Estimated rehospitalization cost was €1138 (95% CI 896-1420) per patient. Anticoagulation duration was 329 (IQR 142-365) days, with estimated average per-patient costs of €1050 (median 972; IQR 458-1197); costs of scheduled ambulatory follow-up visits amounted to €181. Total estimated direct per-patient costs during the first year after PE ranged from €2369 (primary analysis) to €2542 (sensitivity analysis). CONCLUSIONS: By estimating per-patient costs and identifying cost drivers of post-PE care, our study may inform decisions concerning implementation and reimbursement of follow-up programmes aiming at improved cardiovascular prevention. (Trial registration number: DRKS00005939).

The core tendencies underlying prosocial behavior: Testing a person-situation framework.

OBJECTIVE AND BACKGROUND: According to a recently proposed theoretical framework, different personality traits should explain pro-social behavior in different situations. We empirically tested the key proposition of this framework that each of four "core tendencies" (i.e., the shared variance of related traits) specifically predicts pro-social behavior in the presence of a different situational affordance. METHODS: We used a large-scale dataset (N = 2479) including measures of various personality traits and six incentivized economic games assessing pro-social behavior in different social situations. Using bifactor modeling, we extracted four latent core tendencies and tested their predictive validity for pro-social behavior. RESULTS: We found mixed support for the theoretically derived, preregistered hypotheses. The core tendency of beliefs about others' pro-sociality predicted pro-social behavior in both games involving dependence under uncertainty, as expected. Unconditional concern for others' welfare predicted pro-social behavior in only one of two games providing a possibility for exploitation. For conditional concern for others' welfare and self-regulation, in turn, evidence relating them to pro-social behavior in the presence of a possibility for reciprocity and temporal conflict was relatively weak. CONCLUSION: Different features of social situations may activate different personality traits to influence pro-social behavior, but more research is needed to fully understand these person-situation interactions.

A Novel Sustainable and Self-Sufficient Biotechnological Strategy for Directly Transforming Sewage Sludge into High-Value Liquid Biochemicals.

Sewage sludge, as a carbon-rich byproduct of wastewater treatment, holds significant untapped potential as a renewable resource. Upcycling this troublesome waste stream represents great promise in addressing global escalating energy demands through its wide practice of biochemical recovery concurrently. Here, we propose a biotechnological concept to gain value-added liquid bioproducts from sewage sludge in a self-sufficient manner by directly transforming sludge into medium-chain fatty acids (MCFAs). Our findings suggest that yeast, a cheap and readily available commercial powder, would involve ethanol-type fermentation in chain elongation to achieve abundant MCFA production from sewage sludge using electron donors (i.e., ethanol) and acceptors (i.e., short-chain fatty acids) produced in situ. The enhanced abundance and transcriptional activity of genes related to key enzymes, such as butyryl-CoA dehydrogenase and alcohol dehydrogenase, affirm the robust capacity for the self-sustained production of MCFAs. This is indicative of an effective metabolic network established between yeast and anaerobic microorganisms within this innovative sludge fermentation framework. Furthermore, life cycle assessment and techno-economic analysis evidence the sustainability and economic competitiveness of this biotechnological strategy. Overall, this work provides insights into sewage sludge upgrading independent of additional carbon input, which can be applied in existing anaerobic sludge fermentation infrastructure as well as to develop new applications in a diverse range of industries.