Comprehensive economic evaluation of enhanced recovery after surgery in hepatectomy.

BACKGROUND: Enhanced recovery after surgery (ERAS) is attracting extensive attention and being widely applied to reduce postoperative stress and accelerate recovery. However, the economic benefits of ERAS are less clarified at the social level. We aimed to assess the economic impact of ERAS in hepatectomy from the perspectives of patients, hospitals and society, as well as identify the approach to create the economic benefits of ERAS. METHODS: By combining the literature and national statistical data, the cost-effectiveness framework was clarified, and parameter values were determined. Cost-effectiveness analysis, cost-benefit analysis and cost-minimisation analysis were used to compare ERAS and conventional treatment from the perspectives of patients, hospitals and society. The capital flow diagram was used to analyse the change between them. RESULTS: ERAS significantly reduced the economic burden of disease on patients ($8935.02 vs $10,470.02). The hospital received an incremental benefit in ERAS (the incremental benefit cost ratio value is 1.09), and the total social cost was reduced ($5958.67 vs $6725.80). Capital flow diagram analysis demonstrated that the average daily cost per capita in the ERAS group increased ($669.51 vs $589.98), whereas the benefits depended on the reduction of hospital stay and productivity loss. CONCLUSION: The mechanism by which ERAS works is to reduce the average length of stay, thereby reducing the economic burden and productivity loss on patients and promoting the hospital bed turnover rate. Therefore, ERAS should further focus on accelerating the rehabilitation process, and more economic support (such as subsidies) should be given to hospitals to carry out ERAS.

The Austerity of Lone Motherhood: Discrimination Law and Benefit Reform.

The austerity-motivated reforms of the UK benefit system have had a devastating and disproportionate impact on vulnerable groups. Lone mothers are challenging these regulations as discriminatory. Their claims raise an under-theorised question: how should courts adjudicate claims for status equality in the realm of fiscal policy? The courts are adopting a fragmented model of equality that artificially divides status and economic inequalities. This approach fails to fully account for the multiple dimensions of disadvantage at stake in these claims. Using a substantive equality framework, this article uncovers the intertwined status and economic inequalities perpetuated by the benefit reforms. It then proceeds to evaluate how the courts' fragmented approach to equality distorts the justification evaluation. Substantive equality can enrich the justification analysis in a manner that both respects the institutional limits of the court and holds the government to account for discrimination in social benefits.

Limits of the social-benefit motive among high-risk patients: a field experiment on influenza vaccination behaviour.

BACKGROUND: Influenza vaccine uptake remains low worldwide, inflicting substantial costs to public health. Messages promoting social welfare have been shown to increase vaccination intentions, and it has been recommended that health professionals communicate the socially beneficial aspects of vaccination. We provide the first test whether this prosocial vaccination hypothesis applies to actual vaccination behaviour of high-risk patients. METHODS: In a field experiment at a tertiary care public hospital in Istanbul, Turkey, we compare the effects of two motivational messages for promoting vaccination. Using a between-subjects single-blind experimental design patients were randomly assigned to frames emphasizing the vaccine's benefits to self (n = 125) or social benefits (n = 119). Free influenza vaccination was offered to each patient. RESULTS: Among 222 patients who were not vaccinated for the season prior to the study (72% medically assessed to be at high risk), 42% in the self-benefit frame chose to receive a vaccination compared with 34% in the social-benefits frame, but the difference was not statistically significant (aOR = 1.63, 95% CI 0.90 to 2.95, p = 0.108). Reasons for vaccination focused primarily on self-benefit (67%) rather than social-benefit (5%). Exploratory analysis showed that the effect of messages depended on patient perception of risk group membership (aORHigh / aORLow = 5.59, 95% CI 1.30 to 24.05, p = 0.021). In particular, emphasis on self-benefit was more influential among patients who perceived themselves to be in the risk group (aOR = 6.22, 95% CI 1.69 to 22.88, p = 0.006). CONCLUSIONS: In contrast to the literature observing intentions of low-risk populations, we found no evidence that social-benefit motivates actual vaccination behaviour among a high-risk patient population. Instead, those who self-categorize as being in the high risk group are more motivated by the self-benefit message. Our results suggest that a stratified approach can improve coverage: even if an emphasis on social-benefit could be effective among low-risk groups, an emphasis on self-benefit holds more promise for increasing vaccination in medical organizational settings where high-risk groups are prevalent. TRIAL REGISTRATION: ClinicalTrials.gov NCT04230343 Retrospectively registered on the 13th January 2020.

Which Benefits Are Mentioned Most Often in Drug Development Publications?

OBJECTIVES: The aim was to identify theoretically expected as well as actually reported benefits from drug development and the importance of individual patient benefits compared to the collective benefits to society in general. BACKGROUND: Ethical guidelines require that clinical research involving humans offer the potential for benefit. A number of characteristics can be applied to define research benefit. Often benefit is categorized as being either direct or indirect. Indirect benefits can involve collective benefits for society rather than any benefits to the trial patient or subject. The purpose of this review was to examine which potential individual and societal benefits were mentioned as being expected in publications from government experts and which were mentioned in publications describing completed drug development trial results. METHODS: Literature on research benefit was first identified by searching the PubMed database using several combinations of the key words benefit and clinical research. The search was limited to articles published in English. A Google search with the same combinations of key words but without any language limitation was then performed. Additionally, the reference lists of promising articles were screened for further thematically related articles. Finally, a narrative review was performed of relevant English- and German-language articles published between 1996 and 2016 to identify which of several potential benefits were either theoretically expected or which were mentioned in publications on clinical drug development trial results. RESULTS: The principal benefits from drug development discussed included 2 main types of benefit, namely individual benefits for the patients and collective benefits for society. Twenty-one of an overall total of 26 articles discussing theoretically expected benefits focused on individual patient benefits, whereas 17 out of 26 articles mentioned collective benefits to society. In these publications, the most commonly mentioned theoretically expected individual patient benefit was the chance to receive up-to-date care (38.1%). A general increase in knowledge about health care, treatments, or drugs (70.6%) was the most commonly mentioned theoretically expected benefit for society. In contrast, all 13 publications reporting actual benefits of clinical drug development trials focused on personal benefits and only 1 of these publications also mentioned a societal benefit. The most commonly mentioned individual benefit was an increased quality of life (53.9%), whereas the only mentioned collective benefit to society was a general gain of knowledge (100.0%). CONCLUSIONS: Both theoretically expected and actually reported benefits in the majority of the included publications emphasized the importance of individual patient benefits from drug development rather than the collective benefits to society in general. The authors of these publications emphasized the right of each individual patient or subject to look for and expect some personal benefit from participating in a clinical trial rather than considering societal benefit as a top priority. From an ethical point of view, the benefits each individual patient receives from his or her participation in a clinical trial might also be seen as a societal benefit, especially when the drug or device tested, if approved for marketing, would eventually be made available for other similar patients from the country in which the clinical trial was conducted.

Mitigating and adapting to climate change: multi-functional and multi-scale assessment of green urban infrastructure.

In order to develop climate resilient urban areas and reduce emissions, several opportunities exist starting from conscious planning and design of green (and blue) spaces in these landscapes. Green urban infrastructure has been regarded as beneficial, e.g. by balancing water flows, providing thermal comfort. This article explores the existing evidence on the contribution of green spaces to climate change mitigation and adaptation services. We suggest a framework of ecosystem services for systematizing the evidence on the provision of bio-physical benefits (e.g. CO2 sequestration) as well as social and psychological benefits (e.g. improved health) that enable coping with (adaptation) or reducing the adverse effects (mitigation) of climate change. The multi-functional and multi-scale nature of green urban infrastructure complicates the categorization of services and benefits, since in reality the interactions between various benefits are manifold and appear on different scales. We will show the relevance of the benefits from green urban infrastructures on three spatial scales (i.e. city, neighborhood and site specific scales). We will further report on co-benefits and trade-offs between the various services indicating that a benefit could in turn be detrimental in relation to other functions. The manuscript identifies avenues for further research on the role of green urban infrastructure, in different types of cities, climates and social contexts. Our systematic understanding of the bio-physical and social processes defining various services allows targeting stressors that may hamper the provision of green urban infrastructure services in individual behavior as well as in wider planning and environmental management in urban areas.

Advancing Transportation Equity and Safety Through Autonomous Vehicles.

Motor vehicle crashes are a leading cause of death in the United States, and disproportionately impact communities of color. Replacing human control with automated vehicles (AVs) holds the potential to reduce crashes and save lives. The benefits of AVs, including automated shuttles, buses, or cars could extend beyond safety to include improvements in congestion, reductions in emissions, and increased access to mobility, particularly for vulnerable populations. However, AVs have not attained the level of public trust that has been expected, given their potential to save lives and increase access to mobility. Public opinion surveys have highlighted safety and security concerns as reasons for this lack of confidence. In this study, we present the findings of an experiment we conducted to actively shift mindsets on AVs toward advancing health equity. We demonstrate through a nationally representative sample of 2265 U.S. adults that the public support for AVs can be improved by expanding their scope of application to include advancing social benefit. The survey began with questions on respondent's support for AVs based on a priori knowledge and beliefs. Consistent with prior surveys, baseline support (strong support and some degree of support) was low at 26.4% (95% confidence interval 24.0-29.0). After introducing information about how AVs could be used to provide mobility for older adults, those with limited income, or the vision-impaired, respondents were asked to reassess their support for AVs. Support significantly increased to include the majority of respondents. By prioritizing the deployment of AVs to serve individuals and communities in greatest need of mobility, AVs would not only demonstrate compelling social value by reducing disparities but would also gain widespread public support among the U.S. public.

Equal allocation, demand priority or negotiated allocation? How to allocate water resources in the Tigris and Euphrates River Basin efficiently.

The Tigris and Euphrates River Basin is an important water supply, but it suffers from water scarcity. It is necessary to carry out reasonable allocation of water resources in this region. Since water resources issues in this region are of multinational interest, international cooperative distribution efforts are needed. Common water resources allocation modes include equal allocation, demand priority or negotiation allocation. In order to derive the applicable range of various water resources allocation modes, this article constructs three differential game models and compares and analyzes the equilibrium results obtained by the models. Finally, the study shows that when the cost of developing water resources is small and the revenue obtained from developing water resources is large, the water-scarce region can obtain the maximum benefit by adopting the demand priority mode. Otherwise, the water-scarce region can obtain the maximum benefit by adopting the negotiation allocation mode. This study can inform the allocation, strategic interaction and cooperation of dynamic water resources in the two river basins.

Building Blocks Towards a Proportionate Chemicals Policy With a Focus on the Netherlands.

In this contribution, we propose that 'sound' government policy should be characterised by a proportionate, integral vision with due consideration to tradeoffs between social costs and benefits. This principle also applies to government policy regarding the protection of workers from exposure to chemicals. It should be taken into account that having a job is a huge health benefit. Less educated people are statistically likely to enjoy ten additional healthy years, if employed. Although there is no debate about the risks of exposure to high doses of chemicals, there is most certainly debate on the magnitude, nature and possible cumulative effects of low-dose exposure to chemicals. These are established by model-based assumptions. The current advisory structure in which the Health Council of the Netherlands restricts its focus to the immediate health benefits for workers on the basis of risk avoidance models, and the Social and Economic Council of the Netherlands which focuses primarily on policy costs for trade and industry, is hardly a sound basis for well-considered decision making. The challenge for the scientific experts is to provide political administrators with an insightful social cost-benefit analysis, including all the concomitant uncertainties.

Effects of Self-Rated Health Status on Residents' Social-Benefit Perceptions of Urban Green Space.

Urban green spaces (UGS) provide many social benefits and improves residents' wellbeing. Studying residents' perceptions of UGS's social benefits and driving factors could promote public health and environmental justice. A questionnaire survey of 432 Beijing residents and statistical tests assessed the impacts of residents' living environments and self-rated health status on UGS perceptions. The results showed: (1) perceptions of UGS' physical health benefits were subdued, with an inclination towards other social benefits. Respondents more highly perceived accelerating patient recovery and reducing morbidity and mortality rates. Perceptions of bearing larger-head babies with higher weight were relatively low. For other social benefits, perceptions of improving the environment and life quality were higher, but reducing anger outbursts and resolving conflicts were lower. (2) Childhood living environments did not affect perceptions of social benefits, but current living environments did. Suburb residents understood reducing pain-relief medication demands and bearing larger-head babies better than city residents. City residents understood UGS' investments considerable and sustained returns better than village residents. City residents agreed with accelerating patient recovery higher than village ones. (3) Respondents with "poor" self-rated health status had better perceptions of other social benefits. Those with "excellent" ratings did not fully understand UGS' physical health benefits. "Poor" ratings understood improving a city's image and making cities livable and sustainable better than "good" or "fair" ratings. "Excellent" ratings had less understanding of larger-head babies than "good" or "fair" ratings. The study could enhance appreciation of UGS' social benefits to facilitate planning and management to meet residents' expectations.

Beyond the 3 Rs to a More Comprehensive Framework of Principles for Animal Research Ethics.

We have produced a framework of general moral principles for animal research ethics in a book, Principles of Animal Research Ethics, which is forthcoming with Oxford University Press in fall 2019. This book includes a detailed statement and defense of our framework along with critical commentaries on our work from seven eminent scholars: Larry Carbone, Frans de Waal, Rebecca Dresser, Joseph Garner, Brian Hare, Margaret Landi, and Julian Savulescu. In the present paper, we explain the motivation for our project and present our framework of principles. The first section explains why a new framework is both needed and timely, on the basis of six important developments in recent decades. The second section challenges assertions of an unbridgeable gulf dividing the animal-research and animal-protection communities on the issue of animal research. It does so, first, by indicating common ground in the core values of social benefit and animal welfare and, then, by presenting and briefly defending our framework: three principles of social benefit and three principles of animal welfare. These six principles, we argue, constitute a more suitable framework than any other that is currently available, including the canonical 3 Rs advanced in 1959 by William M. S. Russell and Rex L. Burch.