Deceased Donor Program in India: Listing and Allocation Practices and the Legal Process With Respect to Liver Transplantation.

India is the country with the third largest transplantation activity in the world but has one of the lowest deceased donation rates. The Transplantation of Human Organs Act was first enacted as law 29 years ago, its implementation has been non-uniform and growth in deceased donation has been slow and heterogenous. This review discusses the concept of brain death, ethics of deceased donation and organ allocation, Indian legislation in this area and the regulatory structure of the National Organ transplantation program. We also discuss current status of deceased donation and deceased donor liver transplantation in the country, identify variation in liver allocation policies across Indian states and identify areas of need and potential solutions.

Optimizing sustainable development in arid river basins: A multi-objective approach to balancing water, energy, economy, carbon and ecology nexus.

The ongoing water crisis poses significant threats to the socioeconomic sustainability and ecological security of arid and semi-arid river basins. Achieving Sustainable Development Goals (SDGs) within a complex socio-ecological nexus requires effective and balanced resource management. However, due to the intricate interactions between human societies and environmental systems, the tradeoffs and synergies of different SDGs remain unclear, posing a substantial challenge for collaborative management of natural resources. Here we introduce a gray fractional multi-objective optimization (GFMOP) model to balance multi-dimensional SDGs through a novel water-energy-economy-carbon-ecology nexus perspective. The model was applied to a typical arid river basin in Northwest China, where thirty-two scenarios were explored, considering factors such as shared socioeconomic pathways, carbon removal rates, water conveyance efficiencies, and ecological requirements. The results reveal a strong tradeoff between marginal benefit and carbon emission intensity, indicating that improving the economic efficiency of water use can simultaneously reduce emissions and protect the environment. Given the immense power generation potential, wind power development should be prioritized in the future, with its share in the energy structure projected to increase to 23.3% by 2060. Furthermore, promoting carbon capture technologies and expanding grassland coverage are recommended to achieve regional carbon neutrality, contributing 39.5% and 49.1% to carbon absorption during 2021-2060, respectively. Compared with traditional single-objective models, GFMOP demonstrates a superiority in uncovering interrelationships among multiple SDGs and identifying compromised alternatives within the compound socio-ecological nexus. The model also provides detailed strategies for resource allocation and pollutant control, offering valuable guidance to policymakers and stakeholders in pursuing sustainable and harmonious watershed management.

Stable Isotope Labelling Reveals Water and Carbon Fluxes in Temperate Tree Saplings Before Budbreak.

Despite considerable experimental effort, the physiological mechanisms governing temperate tree species' water and carbon dynamics before the onset of the growing period remain poorly understood. We applied 2H-enriched water during winter dormancy to the soil of four potted European tree species. After 8 weeks of chilling, hydrogen isotopes in stem, twig and bud water were measured six times during 2 consecutive weeks of forcing conditions (Experiment 1). Additionally, we pulse-labelled above-ground plant tissues using 2H-enriched water vapour and 13C-enriched CO2 7 days after exposure to forcing conditions to trace atmospheric water and carbon uptake (Experiment 2). Experiment 1 revealed soil water incorporation into the above-ground organs of all species during the chilling phase and significant species-specific differences in water allocation during the forcing conditions, which we attributed to differences in structural traits. Experiment 2 illustrated water vapour incorporation into all above-ground tissue of all species. However, the incorporation of carbon was found for evergreen saplings only. Our results suggest that temperate trees take up and reallocate soil water and absorb atmospheric water to maintain sufficient above-ground tissue hydration during winter. Therefore, our findings provide new insights into the water allocation dynamics of temperate trees during early spring.

A novel two-stage network data envelopment analysis model for kidney allocation problem under medical and logistical uncertainty: a real case study.

Organ transplantation is one of the most complicated and challenging treatments in healthcare systems. Despite the significant medical advancements, many patients die while waiting for organ transplants because of the noticeable differences between organ supply and demand. In the organ transplantation supply chain, organ allocation is the most significant decision during the organ transplantation procedure, and kidney is the most widely transplanted organ. This research presents a novel method for assessing the efficiency and ranking of qualified organ-patient pairs as decision-making units (DMUs) for kidney allocation problem in the existence of COVID-19 pandemic and uncertain medical and logistical data. To achieve this goal, two-stage network data envelopment analysis (DEA) and credibility-based chance constraint programming (CCP) are utilized to develop a novel two-stage fuzzy network data envelopment analysis (TSFNDEA) method. The main benefits of the developed method can be summarized as follows: considering internal structures in kidney allocation system, investigating both medical and logistical aspects of the problem, the capability of expanding to other network structures, and unique efficiency decomposition under uncertainty. Moreover, in order to evaluate the validity and applicability of the proposed approach, a validation algorithm utilizing a real case study and different confidence levels is used. Finally, the numerical results indicate that the developed approach outperforms the existing kidney allocation system.

Integrated municipal solid waste management using ArcGIS tools: A case of akaki-kality sub-city, addis ababa, ethiopia.

This study aimed to optimize the solid waste collection and transportation system using ArcGIS Network Analyst and location-allocation tools. The generated solid waste was characterized by proximate analysis. The generation rate and composition were determined according to standard methods. The average solid waste generation rates for households, commercial sites, institutions, and recreational places were 0.48 kg/c/day, 15.03 kg/fac/day, 9.32 kg/fac/day, and 22.8 kg/fac/day, respectively. The estimated total generation rate of the sub-city is 207,004.03 kg/day and 712.13 m3/day as discarded base. Composition analysis revealed that food waste is the major component of municipal solid waste, with estimated weight and volume of 134,696.08 kg and 299.46 m3, respectively. Proximate analysis indicated that food and textile wastes have relatively high moisture content and fixed carbon. Candidate pre-collection bin allocations were optimized based on factors such as road network, distribution of solid waste generators, and existing temporary dumping sites, resulting in 1052 potential bin locations. Transfer station allocation was optimized by considering land use-land cover, slope, and geology. Twelve transfer routes and four transport routes were established to efficiently serve the bins and final waste destinations. In conclusion, the study demonstrates that ArcGIS Network Analyst and location-allocation tools can effectively optimize the municipal solid waste collection and transportation system, providing a robust framework for improving waste management efficiency. However, further research is recommended to validate these findings through field application.

Rice plants treated with biochar derived from Spirulina (Arthrospira platensis) optimize resource allocation towards seed production.

The use of biofertilizers is becoming an economical and environmentally friendly alternative to promote sustainable agriculture. Biochar from microalgae/cyanobacteria can be applied to enhance the productivity of food crops through soil improvement, slow nutrient absorption and release, increased water uptake, and long-term mitigation of greenhouse gas sequestration. Therefore, the aim of this study was to evaluate the stimulatory effects of biochar produced from Spirulina (Arthrospira platensis) biomass on the development and seed production of rice plants. Biochar was produced by slow pyrolysis at 300°C, and characterization was performed through microscopy, chemical, and structural composition analyses. Molecular and physiological analyses were performed in rice plants submitted to different biochar concentrations (0.02, 0.1, and 0.5 mg mL-1) to assess growth and productivity parameters. Morphological and physicochemical characterization revealed a heterogeneous morphology and the presence of several minerals (Na, K, P, Mg, Ca, S, Fe, and Si) in the biochar composition. Chemical modification of compounds post-pyrolysis and a highly porous structure with micropores were observed. Rice plants submitted to 0.5 mg mL-1 of biochar presented a decrease in root length, followed by an increase in root dry weight. The same concentration influenced seed production, with an increase of 44% in the number of seeds per plant, 17% in the percentage of full seeds per plant, 12% in the weight of 1,000 full seeds, 53% in the seed weight per plant, and 12% in grain area. Differential proteomic analyses in shoots and roots of rice plants submitted to 0.5 mg mL-1 of biochar for 20 days revealed a fine-tuning of resource allocation towards seed production. These results suggest that biochar derived from Arthrospira platensis biomass can stimulate rice seed production.

The effect of dual training on the hazard response and attention allocation of novice drivers when driving with advanced driver assistance system.

To ensure traffic safety when driving with an advanced driving assistance system (ADAS), drivers are still required to take over control of the vehicle in case of emergency. Drivers' takeover performance jointly relies on their capability to anticipate the potential hazards in traffic scenarios and an appropriate understanding of ADAS capabilities. However, previous research mostly focused on strengthening drivers' understanding of ADAS capabilities but ignored drivers' hazard perception capabilities when using ADAS - the latter is especially weak among novice drivers. This study proposed and evaluated three training methods for novice drivers, i.e., ADAS training only (AD training), hazard perception training only (HP training), and AD+HP training. Their effectiveness on drivers' attention allocation strategies and responses to hazardous scenarios when handling hazardous scenarios with different levels of complexity were evaluated among 32 novice drivers in a driving simulator study. Results show that the proposed AD+HP training outperformed AD training and HP training in terms of attention allocation strategies (i.e., wider distribution of attention) and responses in hazardous scenarios (i.e., quicker and more attention to cues of importance and larger minimum time gap). However, the effectiveness of all kinds of training was weakened in more complex scenarios. Findings from this study provide insights into driver training in the context of driving automation.

Models for malaria control optimization-a systematic review.

BACKGROUND: Despite advances made in curbing the global malaria burden since the 2000s, progress has stalled, in part due to a plateauing of the financing available to implement needed interventions. In 2020, approximately 3.3 billion USD was invested globally for malaria interventions, falling short of the targeted 6.8 billion USD set by the GTS, increasing the financial gap between desirable and actual investment. Models for malaria control optimization are used to disentangle the most efficient interventions or packages of interventions for inherently constrained budgets. This systematic review aimed to identify and characterise models for malaria control optimization for resource allocation in limited resource settings and assess their strengths and limitations. METHODS: Following the Prospective Register of Systematic Reviews and Preferred reporting Items for Systematic Reviews and Meta-Analysis guidelines, a comprehensive search across PubMed and Embase databases was performed of peer-reviewed literature published from inception until June 2024. The following keywords were used: optimization model; malaria; control interventions; elimination interventions. Editorials, commentaries, opinion papers, conference abstracts, media reports, letters, bulletins, pre-prints, grey literature, non-English language studies, systematic reviews and meta-analyses were excluded from the search. RESULTS: The search yielded 2950 records, of which 15 met the inclusion criteria. The studies were carried out mainly in countries in Africa (53.3%), such as Ghana, Nigeria, Tanzania, Uganda, and countries in Asia (26.7%), such as Thailand and Myanmar. The most used interventions for analyses were insecticide-treated bed nets (93.3%), IRS (80.0%), Seasonal Malaria Chemoprevention (33.3%) and Case management (33.3%). The methods used for estimating health benefits were compartmental models (40.0%), individual-based models (40.0%), static models (13.0%) and linear regression model (7%). Data used in the analysis were validated country-specific data (60.0%) or non-country-specific data (40.0%) and were analysed at national only (40.0%), national and subnational levels (46.7%), or subnational only levels (13.3%). CONCLUSION: This review identified available optimization models for malaria resource allocation. The findings highlighted the need for country-specific analysis for malaria control optimization, the use of country-specific epidemiological and cost data in performing modelling analyses, performing cost sensitivity analyses and defining the perspective for the analysis, with an emphasis on subnational tailoring for data collection and analysis for more accurate and good quality results. It is critical that the future modelling efforts account for fairness and target at risk malaria populations that are hard-to-reach to maximize impact. TRIAL REGISTRATION: PROSPERO Registration number: CRD42023436966.

The OPTN Expeditious Task Force: Improved Organ Utilization and Efficiency to Drive Transformational Growth in Solid Organ Transplant in the United States.

The Organ Procurment and Transplant Network (OPTN) Expeditious Task Force (ETF) was conceived and initiated in response to a need to move quickly to greatly expand successful deceased-donor transplant across the U.S. The ETF, using data from the top 20% of transplant programs ranked by ability to manage successful growth in transplant volume, came up with a bold aim of facilitating 60,000 successful transplants by 2026 to save more lives. In order to achieve this transformational growth, the ETF will use a data-driven approach, partnering with key stakeholders across the transplant system to secure commitments, reduce barriers, obtain data, align metrics, evaluate new technologies, and run short trials that will better inform future policy developments. To achieve this growth, the two primary aims of the ETF are increasing system efficiency and improving organ and donor utilization. The initial ETF workstreams will focus on 6 areas that include assessments of organ non-utilization (where donors are consented but organs not recovered) and non-use (where organs are recovered but not transplanted), facilitating community events to address challenges in utilization and efficiency; hosting transplant growth collaboratives focused on securing resources needed for transformational growth; creating tools for patient empowerment; evaluating OPTN policies to remove barriers; and designing short trials of rescue pathways for organs at risk for non-use.

[Possibilities of the utilization of trauma networks of the German Society for Trauma Surgery using digital solutions]. / Möglichkeiten der Nutzung von TraumaNetzwerken DGU unter Verwendung von digitalen Lösungen.

This paper describes the use of digital solutions to improve the care of trauma patients in Germany. The focus is on the trauma networks of the German Society for Trauma Surgery (Deutsche Gesellschaft für Unfallchirurgie, DGU). The use of digital solutions includes quality assurance through the TraumaRegister, which enables comprehensive data analysis as well as preregistration and resource utilization through programs such as the interdisciplinary proof of treatment IVENA eHealth, Rescuetrack and Rescue-Net. In addition, Predictive Hospital Resource Planning is presented, which optimizes resource forecasting using artificial intelligence (AI). Telemedical services such as Medgate and teleradiology solutions (Nexus/Chili) offer additional support, especially in rural areas. The paper shows how the digitalization of medical care is crucial to improving the efficiency and quality of treatment of trauma patients. In addition, the paper shows possible developments in the field of clinical decision making through AI.

[Utilization of registers to create an evidence-based approach in catastrophes and civil defence]. / Nutzung von Registern zur Schaffung eines evidenzbasierten Vorgehens im Katastrophen- und Zivilschutzfall.

Medical data registers are a key instrument of medical care research and a valuable tool for medical quality assurance. The structured plausibility tested documentation of large case numbers on a longitudinally oriented time axis with different points in time of data acquisition enables statements to be made on numerous relevant outcomes, not only the mortality of patients. For incidents outside the daily routine care in trauma surgery, such as natural disasters, accidents with multiple casualties and nonmilitary treatment of the domestic population in defence situations, such registers can provide data-based recommendations for action. These data, mainly obtained from routine traumatological treatment, enable a targeted resource management in the abovenamed incidents, which are associated with mass casualties. Due to the utilization of registers from the military field or from international registers, the perspective is additionally extended with respect to treatment strategies and injury patterns. Whether data can also be generated in a suitable manner for the abovenamed registers in specific disaster situations and can provide a direct gain of knowledge from the incident, must be critically discussed. The maintenance of the register datasets is time-consuming and has been subjected to a more stringent regulation at least since May 2018, when the European Union General Data Protection Regulation (EU-GDPR) came into force. The future Register Act in Germany will hopefully achieve greater simplification in the documentation of routine data.

Associations Among Circle-Based Kidney Allocation, Center Waiting Time, and Likelihood of Deceased-Donor Kidney Transplantation.

RATIONALE & OBJECTIVE: The kidney allocation system (KAS250), using circle-based distribution, attempts to address geographic disparities through broader sharing of deceased-donor kidney allografts. This study sought to evaluate the association between KAS250 and likelihood of deceased-donor kidney transplantation (DDKT) among waitlisted candidates, and whether the policy has differentially affected centers with shorter vs. longer waiting time. STUDY DESIGN: Retrospective cohort study. SETTING: & Participants: 160,941 candidates waitlisted at 176 transplant centers between 3/2017-3/2024. EXPOSURE: KAS250 allocation policy. OUTCOME: Rate of DDKT. ANALYTICAL APPROACH: Multivariable Cox regression, modeling KAS250 as a time-dependent variable. RESULTS: KAS250 was not independently associated with likelihood of DDKT overall (HR=1.01 vs. pre-KAS250, 95% C.I. 0.97-1.04). KAS250's association with likelihood of DDKT varied across centers from HR=0.18 (DDKT less likely after KAS250) to HR=17.12 (DDKT more likely) and varied even among neighboring centers. KAS250 was associated with decreased DDKT at 25.6% and increased DDKT at 18.2% of centers. Centers with previously long median waiting times (57+ months) experienced increased likelihood of DDKT after KAS250 (HR=1.20, 95% C.I. 1.15-1.26), whereas centers with previously short median waiting times (6-24mo.; HR=0.88, 0.84-0.92) experienced decreased likelihood of DDKT. LIMITATIONS: Retrospective study of allocation policy changes, confounded by multiple changes over the study timeframe. CONCLUSION: Association between KAS250 and DDKT varied across centers. For one-in-four centers, DDKT was less likely after KAS250 relative to pre-KAS250 trends. Candidates at centers with previously long waiting times experienced increased likelihood of DDKT after KAS250. Thus, broader distribution of kidneys may be associated with improved equity in access to DDKT, but additional strategies may be needed to minimize disparities between centers.

Personal responsibility for health in Bulgarian public health law and social legislation.

BACKGROUND: In the last decades all health systems have experienced a lack of resources. Against this background, the idea of ​​applying personal responsibility of the patient as a criterion for allocation of resources (PRCAR) is gaining increasing attention. Bulgarian healthcare reform has been marked by the implementation of many new strategies, that grounded our scientific interest towards investigating PRCAR in Bulgarian public health law and social legislation. METHODS: Through a search of national legal databases 7 documents were selected and subjected to content analysis. RESULTS: Prospective responsibility was found in two and retrospective responsibility - in three documents, two of which imposed explicit penalties on the patient. Two documents did not distinguish between the types of patient responsibility. PRCAR was found to be controversial through the prism of the social justice principle. The discussion was conducted through the perspectives of evidence translation of research to law, particularities of social cohesion in Bulgaria, and the interpretation of principles of public health ethics. CONCLUSION: Although PRCAR was traceable in Bulgarian legislation, no supporting arguments for its introduction were deduced. The applicability of PRCAR should be further studied and wider public debate should be initiated.

Greater impact of COVID-19 on peer-supported addiction services than government-owned services for addiction in Japan: A nationwide 3-year longitudinal cohort study.

Aim: This study aims to investigate how the coronavirus disease (COVID-19) pandemic impacted service provision of peer-supported addiction services, such as self-help groups or recovery houses and government-owned addiction healthcare services, in Japan, as well as the quality of their interaction. Methods: An online survey was distributed to all 69 public regional healthcare facilities (Mental Health and Welfare Centers [MHWCs]) across the 47 prefectures of Japan annually from 2021 to 2023, totaling three surveys. The survey asked about: (1) the current status of addiction healthcare services at each center, (2) the current status of peer-supported addiction services within each center's area, and (3) changes in connectivity between centers and peer-supported addiction services. Results: All 69 centers participated in the survey each year. Following the second year of the pandemic, both MHWCs and peer-supported services experienced service closures and restrictions; however, peer-supported services were notably more affected nationwide, such as downsizing of services, decreased number of users, shortage of operation funds, and inability to connect with other services being widely reported (p < 0.0001). Despite the easing of most restrictions by the fourth year, MHWCs in 18 out of 47 prefectures reported at least one sustained negative impact on their service provision, while peer-supported services struggled to recover, with 40 out of 47 prefectures still observing difficulties. Conclusion: The COVID-19 pandemic significantly affected both types of service, with peer-supported services facing greater challenges in recovery. Additional support is essential to restore these services to normal operation.

The balance between alleviating copper damage and maintaining root function during root pruning with excessive copper.

Coating high concentrations of copper (Cu) on the inner wall of containers can efficiently inhibit root entanglement of container-grown seedlings. However, how the protective and defensive responses of roots maintain root structure and function during Cu-root pruning is still unclear. Here, Duranta erecta seedlings were planted in the containers coated with 40 (T1), 80 (T2), 100 (T3), 120 (T4), 140 (T5), and 160 (T6) g L-1 Cu(OH)2 with containers without Cu(OH)2 as the control. Although T5 and T6 produced the best inhibitory effect on root entanglement, root anatomy structure was damaged. T1 and T2 not only failed to completely control root circling, but also led to decreased root activity and stunted growth. Cu(OH)2 treatments significantly increased lignin concentration of roots with the highest values at T3 and T4. Compared with T3, seedlings at T4 had higher height, biomass, and root activity and no significant root entanglement. Excessive Cu accumulation in Cu(OH)2 treatments changed the absorption of other mineral nutrients and their allocation in the roots, stems, and leaves. Overall, Ca was decreased while Mg, Mn, Fe, and K were increased, especially K and Mn at T4 which is related to defense capacity. The results indicate that there is a Cu threshold to balance root entanglement control, defense capacity, and nutrient uptake function under excessive Cu for container-grown D. erecta seedlings.

Analyzing Online Conversations on Reddit: A Study of Stress and Anxiety Through Topic Modeling and Sentiment Analysis.

This study analyses the topic of stress and anxiety in 3,765 Reddit posts to determine key themes and emotional undertones using natural language processing (NLP) techniques. Five major category topics are identified from the posts using the latent Dirichlet allocation (LDA) algorithm. The topics identified are general discontent and lack of direction; panic and anxiety attacks; physical symptoms of anxiety, stress, and mental health concerns; and seeking help for anxiety. Sentiment analysis with the help of TextBlob showed a neutral score, for the most part: an average polarity score of 0.009 and a subjectivity score of 0.494. Several kinds of visualizations, including word clouds, bar charts, and pie charts, have been used to show the distribution and importance of these topics. These findings underscore the important role played by online communities in extending their support to those in distress because of mental health problems. This information is very important to mental health professionals and researchers. This study shows the effectiveness of using a combination of topic modeling and sentiment analysis to identify problems related to mental health discussed on social media. These results direct the possibilities for future research in using advanced NLP techniques and expanding to larger datasets.

Public Perceptions of Enuresis: Insights From Online Communities in South Korea and the United States.

PURPOSE: To establish a foundation for raising awareness and disseminating accurate information about enuresis-one of the most challenging conditions to discuss openly-this paper examines public perceptions of enuresis. METHODS: This paper collected title and text data from posts related to enuresis on the top popular online platforms such Naver Cafe in South Korea and Reddit in the United States (US). The data along with the thematic subcommunities where the posts were uploaded, was analyzed and visualized using word cloud, Latent Dirichlet Allocation (LDA) topic modeling, and pyLDAvis. RESULTS: The findings reveal both similarities and differences in how the patients from the 2 countries addressed enuresis online. In both countries, enuresis symptoms were a daily concern, and individuals used online platforms as a space to talk about their experiences. However, South Koreans were more inclined to describe symptoms within region-based communities or mothers' forums, where they exchanged information and shared experiences before consulting a doctor. In contrast, US patients with medical experience or knowledge frequently discussed treatment processes, lifestyle adjustments, and medication options. CONCLUSION: South Koreans tend to be cautious when selecting and visiting hospitals, often relying on others for advice and preparation before seeking medical attention. Compared to online communities in the US, Korean users are more likely to seek preliminary diagnoses based on nonprofessional opinions. Consequently, it is important to lower the barriers for patients to access professional medical advice to mitigate the potential harm of relying on nonprofessional opinions. Additionally, there is a need to raise awareness so that adults can recognize and address their symptoms in a timely manner.

Adjusting the risk-adjustment: Accounting for variation between organisations in the responsiveness of their expenditure to need.

There is concern that basing healthcare budgets on risk adjustment estimates derived from historical utilisation data may reinforce patterns of unmet need. We propose a method to avoid this, based on a measure of how closely local health organisations align resources to the needs of their populations. We refer to this measure as the 'responsiveness of expenditure to need' and estimate it using national person-level data on use of acute hospital and secondary mental health services in England. We find large variation in responsiveness in both services and show that higher expenditure responsiveness in mental health is associated with fewer suicides. We then re-estimate the national risk-adjustment model removing the data from the organisations with the lowest expenditure responsiveness to need. As expected, higher need individuals are estimated to have higher expenditure needs when less responsive organisations are removed from the estimation of the risk-adjustment. Removal of organisations with below-average responsiveness results in the neediest deciles of individuals having an extra £163 (7%) annual need for acute hospital care and an additional £79 (27%) annual need for mental health services. The application of this approach to risk adjustment would result in more resources being directed towards organisations serving higher-need populations.

Thinking like a mountain: A land ethical approach to healthcare resource.

Human activity is now having a defining influence on global systems. The Anthropocene epoch requires revisiting our ethical presuppositions to understand our relationship to the earth's life support systems. The Land Ethic of Aldo Leopold proposes an ethic that is diachronic, holistic, and biocentric, in contrast to the synchronic, individualist, and anthropocentric axioms of mainstream bioethics. I argue that these features of the Land Ethic make it more suitable to engage with the ethics of healthcare resource allocation in the Anthropocene; that understanding sustainability in a Land Ethical fashion requires that we view it as placing a side-constraint on all permissible healthcare resource use such that this use remains within planetary boundaries; and outline how this might re-shape debates around healthcare resource allocation.