Global patterns of allochthony in stream-riparian meta-ecosystems.

Ecosystems that are coupled by reciprocal flows of energy and nutrient subsidies can be viewed as a single "meta-ecosystem." Despite these connections, the reciprocal flow of subsidies is greatly asymmetrical and seasonally pulsed. Here, we synthesize existing literature on stream-riparian meta-ecosystems to quantify global patterns of the amount of subsidy consumption by organisms, known as "allochthony." These resource flows are important since they can comprise a large portion of consumer diets, but can be disrupted by human modification of streams and riparian zones. Despite asymmetrical subsidy flows, we found stream and riparian consumer allochthony to be equivalent. Although both fish and stream invertebrates rely on seasonally pulsed allochthonous resources, we find allochthony varies seasonally only for fish, being nearly three times greater during the summer and fall than during the winter and spring. We also find that consumer allochthony varies with feeding traits for aquatic invertebrates, fish, and terrestrial arthropods, but not for terrestrial vertebrates. Finally, we find that allochthony varies by climate for aquatic invertebrates, being nearly twice as great in arid climates than in tropical climates, but not for fish. These findings are critical to understanding the consequences of global change, as ecosystem connections are being increasingly disrupted.

Subsidized gestational diabetes mellitus screening and management program in rural China: a pragmatic multicenter, randomized controlled trial.

BACKGROUND: The increasing prevalence of gestational diabetes mellitus (GDM) is a major challenge, particularly in rural areas of China where control rates are suboptimal. This study aimed to evaluate the effectiveness of a GDM subsidy program in promoting GDM screening and management in these underserved regions. METHODS: This multicenter, randomized controlled trial (RCT) was conducted in obstetric clinics of six rural hospitals located in three provinces in China. Eligible participants were pregnant women in 24-28 weeks' gestation, without overt diabetes, with a singleton pregnancy, access to a telephone, and provided informed consent. Participants were randomly assigned in a 1:1 ratio to either the intervention or control groups using an internet-based, computer-generated randomization system. The intervention group received subsidized care for GDM, which included screening, blood glucose retesting, and lifestyle management, with financial assistance provided to health care providers. In contrast, the control group received usual care. The primary outcomes of this study were the combined maternal and neonatal complications associated with GDM, as defined by the occurrence of at least one pre-defined complication in either the mother or newborn. The secondary outcomes included the GDM screening rate, rates of glucose retesting for pregnant women diagnosed with GDM, dietary patterns, physical activity levels, gestational weight gain, and antenatal visit frequency for exploratory purposes. Primary and secondary outcomes were obtained for all participants with and without GDM. Binary outcomes were analyzed by the generalized linear model with a link of logistic, and odds ratios (OR) with 95% confidence intervals (CIs) were reported. Count outcomes were analyzed by Poisson regression, and incidence rate ratios with 95% CIs were reported. RESULTS: A total of 3294 pregnant women were randomly assigned to either the intervention group (n = 1649) or the control group (n = 1645) between 15 September 2018 and 30 September 2019. The proportion of pregnant women in the intervention group who suffered from combined maternal and/or neonatal complications was lower than in the control group with adjusted OR = 0.86 (0.80 to 0.94, P = 0.001), and a more significant difference was observed in the GDM subgroup (adjusted OR = 0.66, 95% CI 0.47 to 0.95, P = 0.025). No predefined safety or adverse events of ketosis or ketoacidosis associated with GDM management were detected in this study. Both the intervention and control groups had high GDM screening rates (intervention: 97.2% [1602/1649]; control: 94.5% [1555/1645], P < 0.001). Moreover, The intervention group showed a healthier lifestyle, with lower energy intake and more walking minutes (P values < 0.05), and more frequent blood glucose testing (1.5 vs. 0.4 visits; P = 0.001) compared to the control group. CONCLUSION: In rural China, a GDM care program that provided incentives for both pregnant women and healthcare providers resulted in improved maternal and neonatal health outcomes. Public health subsidy programs in China should consider incorporating GDM screening and management to further enhance reproductive health. TRIAL REGISTRATION: China Clinical Trials Registry ChiCTR1800017488. https://www.chictr.org.cn/.

The Healthy Start scheme in England "is a lifeline for families but many are missing out": a rapid qualitative analysis.

BACKGROUND: Healthy Start (HS) is a government scheme in England, Wales and Northern Ireland that offers a financial payment card and free vitamins to families experiencing low income. Pregnant women and families with children < 4 years can use the HS card to buy fruit, vegetables, cow's milk, infant formula and pulses. HS was fully digitalised in March 2022. While digitalisation has improved the user experience for many families, in the context of the cost-of-living crisis and increasing dietary inequalities, it is important to understand why HS is not reaching more families. This study aimed to (i) assess the perceptions and experiences of HS from stakeholders across the system including those who promote, implement and are eligible for HS, and (ii) identify recommendations to improve the scheme's effectiveness and uptake. METHODS: The study design was a post-implementation rapid qualitative evaluation using stakeholder interviews. Data were collected between January and June 2023 via semi-structured interviews (50% online; 50% in person) with 112 stakeholders, including parents (n = 59), non-government organisations (n = 13), retailers (n = 11) and health and community professionals (n = 29) at national and local levels. Findings were confirmed by a sub-sample of participants. RESULTS: Six core themes cut across stakeholders' perceptions and experiences, and stakeholders collectively outlined seven recommendations they felt could be acted upon to maximise uptake and efficiency of HS, with actions at both national and local levels. A novel finding from this study is that raising awareness about HS alone is unlikely to result automatically or universally in higher uptake rate. Recommendations include: continuing to provide this scheme that is universally valued; the need for many families to be provided with a helping hand to successfully complete the application; reframing of the scheme as a child's right to food and development to ensure inclusivity; improved leadership, coordination and accountability at both national and local levels. CONCLUSIONS: HS provides benefits for child development and family wellbeing. The study's recommendations should be actioned by national and local governments to enable all families eligible for the scheme to benefit from this nutritional safety net.

Two distinct host-parasite associations mediate seasonal ecosystem linkages.

Nematomorph parasites manipulate terrestrial arthropods to enter streams where the parasites reproduce. These manipulated arthropods become a substantial prey subsidy for stream salmonids, causing cross-ecosystem energy flow. Diverse nematomorph-arthropod associations underlie the energy flow, but it remains unknown whether they can mediate the magnitude and temporal attributes of the energy flow. Here, we investigated whether distinct phylogenetic groups of nematomorphs manipulate different arthropod hosts and mediate seasonal prey subsidy for stream salmonids. The results of our molecular-based diagnoses show that Gordionus and Gordius nematomorphs infected ground beetle and orthopteran hosts, respectively. The presumable ground beetle hosts subsidized salmonid individuals in spring, whereas the presumable orthopteran hosts did so in autumn. Maintaining the two distinct nematomorph-arthropod associations thus resulted in the parasite-mediated prey subsidy in both spring and autumn in the study streams. Manipulative parasites are common, and often associated with a range of host lineages, suggesting that similar effects of phylogenetic variation in host-parasite associations on energy flow might be widespread in nature.

Well-being Effects of a Subsidy Retention Fund for Renovation of Dwellings of Locked-in Owners in Ghent.

With its subsidy retention fund, the city of Ghent targets homeowners, who live in a dwelling of bad quality and do not have the resources to renovate or move out. Being in this no-choice situation, they are locked-in homeowners. Through this innovative policy instrument, Ghent aims to improve the quality of its housing stock targeting households who may not take up other renovation-encouraging instruments. To reach the households who would otherwise not be able to renovate, important efforts in outreaching and offering technical and social guidance accompany the renovation subsidy. Guidance activities substantially increase the cost of the instrument, but in reaching the households living in bad-quality houses, it has the potential to create major benefits not only technically but also socially as housing quality is related to well-being. Generally, the identification of a causal relationship is difficult as well-being and its mediators are complex matters. This case offered a unique opportunity to collect information from the beneficiaries on a range of well-being domains both before the renovation of their dwelling and after the renovation. Even though the research was restricted to short-term effects, the results suggest that improvements in different domains of well-being can be linked to the improvement of housing quality. These improvements in well-being in Ghent show that (local) government spending in housing renovation of locked-in homeowners can be an instrument to achieve social progress.

Inter- and intrapopulation resource use variation of marine subsidized western fence lizards.

Marine resource subsidies alter consumer dynamics of recipient populations in coastal systems. The response to these subsidies by generalist consumers is often not uniform, creating inter- and intrapopulation diet variation and niche diversification that may be intensified across heterogeneous landscapes. We sampled western fence lizards, Sceloporus occidentalis, from Puget Sound beaches and coastal and inland forest habitats, in addition to the lizards' marine and terrestrial prey items to quantify marine and terrestrial resource use with stable isotope analysis and mixing models. Beach lizards had higher average δ13C and δ15N values compared to coastal and inland forest lizards, exhibiting a strong mixing line between marine and terrestrial prey items. Across five beach sites, lizard populations received 20-51% of their diet from marine resources, on average, with individual lizards ranging between 7 and 86% marine diet. The hillslope of the transition zone between marine and terrestrial environments at beach sites was positively associated with marine-based diets, as the steepest sloped beach sites had the highest percent marine diets. Within-beach variation in transition zone slope was positively correlated with the isotopic niche space of beach lizard populations. These results demonstrate that physiography of transitional landscapes can mediate resource flow between environments, and variable habitat topography promotes niche diversification within lizard populations. Marine resource subsidization of Puget Sound beach S. occidentalis populations may facilitate occupation of the northwesternmost edge of the species range. Shoreline restoration and driftwood beach habitat conservation are important to support the unique ecology of Puget Sound S. occidentalis.

A theory of coverage rate differences for hearing aids around the world based on correlational observation and analysis.

OBJECTIVE: Our objective was to ascertain likely reasons for explaining variation in coverage rates for hearing aids (HAs) among various countries around the world. DESIGN: A retrospective analysis of past coverage rates and their association to demographic and economic variables of apriori logical consideration. STUDY SAMPLE: Data was obtained on macroeconomic conditions from 37 countries in the OECD and estimated coverage rates for HAs using recent actual sales data. RESULTS: Two variables were identified with a very strong correlation (R = 0.97, R2 = 0.95) to coverage rates. The first variable was the level of subsidy provided for the citizens to obtain HAs. The second variable was the GNI/capita which reflects the income available to citizens to make the purchase of HAs. CONCLUSION: In countries where subsidy for HAs are made available through either public or private health service/insurance, an increase in coverage rates is likely to occur. The effect of subsidy is likely to surpass any effect of OTC HAs that has been demonstrated to date. Where and when feasible, subsidy presence and encouraging income generation among able citizens of a country should be sought in tandem - a complex interplay of improving coverage rates for HAs with economics.

Improving new energy subsidy efficiency considering learning effect: A case study on wind power.

Subsidy policies are instrumental in driving the development of new energy. However, the effective allocation of new energy subsidies over time is challenging given fiscal constraints. This study addresses this challenge by considering the learning effect associated with the new energy industry. A two-stage dynamic programming model is proposed to capture the investment decision-making process of companies under new energy subsidy policies and government subsidy setups. Theoretical findings suggest that company investment decisions in new energy are influenced by a guiding principle: The subsidy rate should be negatively correlated with the variation rate of production scale increment (VRPSI). We calibrate this investment decision principle using wind power data from 14 countries. According to this principle, excessive subsidy rates may result in a low VRPSI, thereby diminishing future investment profitability in the new energy industry and leading to subsidy inefficiency. Upon investigating the efficiency of annual subsidy allocation, we find that the subsidy rates were potentially set too high in 2014, 2016, and 2017. Furthermore, the government should exercise caution regarding an inefficient subsidy pattern whereby companies invest in new energy only when the subsidy rate exceeds a certain threshold, neglecting traditional power sources. It is crucial to note that although this study uses wind power industry data for calibration and simulation, the theoretical model can be broadly applied to other new energy industries and emerging industries with increasing marginal net profit.

The impacts of China's dual carbon policy on green innovation: Evidence from Chinese heavy-polluting enterprises.

Encouraging enterprises to engage in green innovation is a potent strategy for reducing carbon emissions from production. As one of the largest carbon emitters, China has launched a series of policies to achieve carbon peaking and neutrality collectively referred to as China's dual carbon policy. However, existing research on the impact of China's dual carbon policy on green innovation by heavy-polluting enterprises is insufficient. To fill this gap, this study constructed a theoretical model to draw hypotheses about the impact of the dual carbon policy on enterprises' green innovation and verified this impact using a difference-in-differences model to conduct a quasi-natural experiment based on data from 2010 to 2022 from Chinese A-share-listed enterprises. The results indicate that the dual carbon policy had a significantly positive influence on green innovation in heavy-polluting enterprises. Moreover, environmental tax mediated this effect, while enterprises' total costs and subsidies positively moderated it. Additionally, the impact exhibited variations based on several key factors, including green patent type, carbon emissions, enterprise ownership structure, and Environmental, Social, and Governance ratings. This study supplements related research on the effects of environmental policy on green innovation and provides both theoretical and empirical support for adapting subsequent environmental policies.

A stochastic dynamic programming model for the optimal policy mix of the carbon tax and decarbonization subsidy.

Carbon tax and decarbonization subsidy are an effective policy mix in reducing carbon emissions. However, there is a research gap between the deterministic and static analysis related to carbon reduction policy instruments and the dynamic green transition influenced by stochastic factors. This research investigates the optimal dynamic carbon reduction strategies that develop green technologies, increase abatement inputs, and reduce carbon emissions by applying the stochastic optimal control theory. Firms that are incentivized by decarbonization subsidies and regulated by carbon tax choose optimal closed-loop control strategies of abatement inputs to achieve profit-maximizing objectives with carbon reduction constraints. The explicit solutions of the optimal carbon tax and decarbonization subsidy are provided. The simulation results illustrate that the optimal policy mix is feasible in the effective period when the carbon emission decreases significantly, which indicates that the abatement policy mix can effectively promote carbon reduction. Our results reveal that the dynamic optimal policy mix is conducive to achieving carbon abatement goals with capital uncertainty. The government should implement a dynamic carbon tax and decarbonization subsidy policy mix simultaneously associated with optimal closed-loop carbon reduction strategies. Firms with asymmetric decarbonization efficiency can transfer progressively into a cleaner productive pattern.

High contribution of an invasive macroalgae species to beach wrack CO2 emissions.

Accumulations of macroalgal wrack are important for adequate functioning of the beach ecosystem. However, the sudden beaching of seaweed masses smothers the coastline and forms decomposing piles on the shore, harming tourism-based economies, but also affecting the beach ecosystem metabolism. The decomposition of sudden pulses of wrack can modify the biogeochemistry of beach sands and increase greenhouse gas (GHG) emissions. The presence of invasive species in the wrack deposits can superimpose harmful effects on the beach functioning. We quantified the wrack biomass of Rugulopteryx okamurae, an invasive species of extreme impact, on five sandy beaches from the Atlantic coast of the Strait of Gibraltar (Spain), and we tested the effects on in situ respiratory CO2 fluxes using an infrared gas analyser. All the beaches showed massive accumulations of Rugulopteryx wrack deposits. However, the biomass changed significantly between beaches, ranging (mean ± SE) from 968.3 ± 287.7 kg m-1 to 9210 ± 1279.4 kg m-1 of wet weight. Wrack supported high respiration rates, with CO2 fluxes averaging (±SE) 19.15 ± 5.5 µmol CO2 m-2 s-1 across beaches, reaching astounding maximum peaks of 291 µmol CO2 m-2 s-1. The within-beach variability was related to the distance of the wrack deposits from the shoreline, as the average metabolic rates tended to increase significantly from the swash to the drift line. Thicker wrack and a more degraded algae stage showed significantly higher CO2 fluxes. We estimated that the annual CO2 flux of R. okamurae in our study area ranged between 0.39 (±0.01) and 23.30 (±11.33) kg C m-2 y-1. We suggest that massive amounts of beach wrack can become a globally significant contributor to GHG emissions that can offset any potential carbon-sink capacity of macroalgal forests. However, the piles of wrack located several meters above the drift line showed non-measurable CO2 efflux. Transferring beach wrack from swash to drier upper-beach areas, a common practice in many coastal regions suffering from massive wrack accumulations, might help reduce GHG emissions while removing the wrack stockpiles from the intertidal. However, this practice is not necessarily suitable for all beaches and can create ecological and conservation problems in the dune system. There is an urgent need to implement practical and sustainable management practices for massive wrack deposits capable of presenting various solutions to achieve a balance between conservation and recreation actions, answering the consequences of a problem that links both, environmental and economic issues.

Quality matters: Stoichiometry of resources modulates spatial feedbacks in aquatic-terrestrial meta-ecosystems.

Species dispersal and resource spatial flows greatly affect the dynamics of connected ecosystems. So far, research on meta-ecosystems has mainly focused on the quantitative effect of subsidy flows. Yet, resource exchanges at heterotrophic-autotrophic (e.g. aquatic-terrestrial) ecotones display a stoichiometric asymmetry that likely matters for functioning. Here, we joined ecological stoichiometry and the meta-ecosystem framework to understand how subsidy stoichiometry mediates the response of the meta-ecosystem to subsidy flows. Our model results demonstrate that resource flows between ecosystems can induce a positive spatial feedback loop, leading to higher production at the meta-ecosystem scale by relaxing local ecosystem limitations ('spatial complementarity'). Furthermore, we show that spatial flows can also have an unexpected negative impact on production when accentuating the stoichiometric mismatch between local resources and basal species needs. This study paves the way for studies on the interdependency of ecosystems at the landscape extent.

Seasonal ecosystem linkages contribute to the maintenance of migratory polymorphism in a salmonid population.

The influence of resource subsidies on animal growth, survival and reproduction is well understood, but their ultimate effects on life history have been less explored. Some wild species have a partially migratory life history, wherein migration is dictated based upon threshold traits regulated in part by the seasonal availability of resources. We conducted a large-scale field manipulation experiment where we provided a terrestrial invertebrate subsidy to red-spotted masu salmon. Individuals in stream reaches that received a subsidy had, on average, a 53% increase in growth rate relative to those in control reaches. This increased growth resulted in a greater proportion of individuals reaching the threshold body size and smolting in the autumn. Consequently, 19-55% of females in subsidized reaches became migratory, whereas 0-14% became migratory in the control reaches. Our findings highlight seasonal ecosystem linkage as a key ecosystem property for maintaining migratory polymorphism in partially migratory animals.

Carbon Trading in China Reduces the Dependence of Household Waste Electrical and Electronic Equipment Recycling on Government Subsidies.

China's enterprises of waste electrical and electronic equipment (WEEE) recycling suffer from low profitability that is highly dependent on government subsidies. This low economic gain impedes the sustainable growth of China's WEEE-recycling sector and also adds to the government's financial burden. Prior life-cycle studies have approved the carbon reduction potentials or net carbon credit of recycling WEEE. However, policymakers fail to know whether the revenue from selling carbon credits can offset the government's financial subsidy. We performed life-cycle and cost-benefit analyses for a case recycling enterprise that processes six categories of household appliances. The results show that the reduction potentials of greenhouse gases range from 930-3450 kgCO2e by recycling per ton of household appliances and materials substitution. The recycling enterprise would gain extra revenue ranging from 32 to 160 RMB per ton of appliance if the carbon credits were sold at China's current carbon price, i.e., 45-60 RMB tCO2e-1. Recycling waste refrigerators exhibits the highest carbon revenue, offsetting 6-17% of the government's financial subsidy. Microcomputers, by contrast, indicate the lowest carbon revenue, equivalent to 1-3% of its highest government subsidy. For each household appliance category, when the carbon price reaches 270-600 RMB tCO2e-1, selling carbon credits can fully offset the government's financial subsidy. Constrained by the processing capacity of the case enterprise, optimizations for appliance-recycling composition contribute a 15-25% profit growth to the current economic gains. Interpreting the specific profit depends on the predefined scenarios of carbon price and the substitution rate of the regenerated materials for the virginal ones. Our findings show that raising the profitability of WEEE recycling enterprises through the carbon trading policy contributes to the sustainable growth of China's WEEE-recycling sector while alleviating the government's financial burden.

The impact of government subsidy programs on equity in health financing.

BACKGROUND: Iran government implemented the targeted subsidy plan in December 2010 to reduce energy consumption and inequality. In addition, the Health Transformation Plan was implemented by the Ministry of Health to reduce out-of-pocket payments. This study aimed to examine the impact of these two government subsidy programs on equity in health financing. METHOD: In this study, data on 528,046 households were collected using household surveys during 14 years (2007-2020). The Fairness in Financial Contribution index and Catastrophic Health Expenditures index were calculated. Also, a Logistic regression model was performed by the applied software of Stata V.14 to examine the effects of the two mentioned policies and other socioeconomic characteristics of households on their exposure to Catastrophic Health Expenditures. RESULTS: The FFC index was 0.829 and 0.795 respectively in 2007 and 2020. The trend analysis did not show significant changes in the FFC index between 2007 and 2020. TSP and HTP implementations do not reduce households' exposure to CHE significantly. Crowded households with more elder people, belonging to low-income deciles, without houses, and living in rural areas and deprived provinces, are more likely to be at risk of CHE. Health insurance coverage did not protect households from CHE. Highly educated and employed households were exposed to less CHE. CONCLUSION: The government subsidy programs have not been effective in improving FFC and reducing CHE indices. None of them has been able to realize the goal of the 6th National Development Plan of reducing CHE to 1%. The government should devise support packages for target households (households with more elderly people, lower incomes, without private houses, crowded, rural, and inhabited in deprived provinces), so they can protect households against CHE. Modifying and improving the quality of insurance coverage is strongly recommended due to its inefficiency.

Experiences and perceived outcomes of a grocery gift card programme for households at risk of food insecurity.

OBJECTIVE: This study explored programme recipients' and deliverers' experiences and perceived outcomes of accessing or facilitating a grocery gift card (GGC) programme from I Can for Kids (iCAN), a community-based programme that provides GGC to low-income families with children. DESIGN: This qualitative descriptive study used Freedman et al's framework of nutritious food access to guide data generation and analysis. Semi-structured interviews were conducted between August and November 2020. Data were analysed using directed content analysis with a deductive-inductive approach. PARTICIPANTS: Fifty-four participants were purposively recruited, including thirty-seven programme recipients who accessed iCAN's GGC programme and seventeen programme deliverers who facilitated it. SETTING: Calgary, Alberta, Canada. RESULTS: Three themes were generated from the data. First, iCAN's GGC programme promoted a sense of autonomy and dignity among programme recipients as they appreciated receiving financial support, the flexibility and convenience of using GGC, and the freedom to select foods they desired. Recipients perceived these benefits improved their social and emotional well-being. Second, recipients reported that the use of GGC improved their households' dietary patterns and food skills. Third, both participant groups identified programmatic strengths and limitations. CONCLUSION: Programme recipients reported that iCAN's GGC programme provided them with dignified access to nutritious food and improved their households' finances, dietary patterns, and social and emotional well-being. Increasing the number of GGC provided to households on each occasion, establishing clear and consistent criteria for distributing GGC to recipients, and increasing potential donors' awareness of iCAN's GGC programme may augment the amount of support iCAN could provide to households.

Experience of a demand-side subsidy scheme for residential long-term care: perspectives of elderly and their carers.

BACKGROUND: Vouchers, which are demand-side subsidies to targeted groups, are a type of consumer-led near-cash social transfer for specified benefits that have been used in education, health and other sectors. To provide better access to residential care services and an additional choice for elderly people in need, a novel means-tested residential care service voucher has been introduced in Hong Kong for elderly people to purchase places in the private sector to enable consumer-directed care. The objectives of this paper are to analyze the perspectives of voucher users and their carers toward the voucher scheme and to identify key elements in the design that will contribute to meeting the scheme's objectives. METHODS: An exploratory sequential mixed method design was adopted with initial explorative qualitative data collection of the perspectives of elderly people and their carers (Phase 1), which informed the design of the subsequent questionnaire survey (Phase 2). Thirty carers in 5 focus groups and 20 individual interviews with elderly people were conducted between April and May 2018. A total of 401 respondents (373 carers and 28 elderly people) completed the survey questionnaire. Findings from both phases were integrated both narratively and via a joint display. RESULTS: Five key themes summarized the features in two main elements of the design and implementation of the voucher scheme: awareness, meaning that inadequate knowledge and understanding of voucher schemes hinder participation; service needs and types, indicating that the urgent need for residential care services is the key reason for participation; shared responsibility, meaning that a high copayment level discourages participation; choice and flexibility, reflecting appreciation of the additional choices provided by voucher schemes although the availability of residential care beds limits choices; and service quality, indicating mixed perceptions of service quality and the impact of the voucher scheme. Voucher users believe that the voucher scheme is more helpful for relieving the financial burden (98.7%), reducing carers' stress (97.0%) and reducing the waiting time for subsidized homes for elderly people (89.0%) than for increasing choice and flexibility (78.1%) and improving service quality (62.1%). CONCLUSIONS: This study demonstrates how the design of a voucher scheme affects its take-up by targeted beneficiaries. When a voucher scheme is implemented in a long-term care system, it must consider the congruence with existing policies in long-term care provision and financing. The voucher scheme in Hong Kong has been able to generate the utilization of nonsubsidized places in homes for elderly people that were underutilized, but its effectiveness is limited by inadequate knowledge and understanding of the voucher scheme and the availability of residential care places. Giving the purchasing power and choice of providers to beneficiaries has the potential to enhance the quality of services, which will contribute to meeting the objectives. The study findings carry significant implications for long-term care policies and provide insights into the key features of the voucher scheme for residential care services and how to best design and implement a voucher scheme for elderly people in the context of policy objectives and a long-term care policy.

Evaluating the relative impact of multiple healthy food choice interventions on choice process variables and choices.

Fiscal tools-taxes and/or subsidies-are increasingly used to address diet-related health problems. However, some studies have found that these tools are markedly more effective if attention is drawn to the tax or subsidy, suggesting that the price change alone may go unnoticed in the complex food environments that consumers face. Interventions that prompt individuals to consider health during choice show promise for promoting healthy food choices in both simple laboratory settings and complex, real-world markets. In this pre-registered study, I examine the impact of dietary fiber health prompts and/or dietary fiber subsidies on the per-serving fiber content of foods chosen, the documented set of products considered, and (self-reported) nutrition information use by participants in an online supermarket setting. Participants were randomized to one of four conditions: 1) control, 2) subsidy, 3) fiber prompt, and 4) fiber prompt + subsidy. Results show that both the prompt and prompt + subsidy conditions significantly increase fiber content of foods chosen (with the latter having a larger effect). While all three interventions influence the probability of using nutrition information during food choice and affect the set of products that respondents consider relative to the control condition, the effects were larger for the prompt and prompt + subsidy conditions. A multiple mediation analysis illustrates that both direct and indirect (through the set of products considered and the use of fiber information during choice) pathways lead to the significant overall increase in fiber content of selected foods.

Effect of influenza vaccine subsidies for older adults on vaccination coverage and mortality before and during the COVID-19 pandemic: an ecological study in Japan.

OBJECTIVE: We aimed to determine how municipal subsidies for seasonal influenza vaccines for the elderly affected vaccination coverage and health outcomes and how responses to vaccine prices changed during the COVID-19 pandemic. STUDY DESIGN AND METHODS: This ecological study includes 1245 municipalities in Japan between 2019 and 2020. Fixed-effects regression analysis was performed to evaluate the effect of influenza vaccine cost subsidy for people aged 65 years or older on vaccination coverage, all-cause mortality, and influenza-related mortality. RESULTS: The vaccination rate increased when patients' copayments decreased, and reducing the copayment by 1000 Japanese Yen (JPY) was estimated to increase the vaccination rate by 6.3% (95% confidence interval [CI] 4.5-8.2%) in the adjusted model. When examining the additional effect of a zero price compared to a nearly zero price, we found that a zero price increased the immunization rate by 6.4% (95% CI 1.4-11.5%). The effect of copayment on the increase in vaccination coverage was significantly lower during the pandemic than in the pre-pandemic period. The municipal and prefectural analyses found no association between influenza vaccine copayments and all-cause, influenza, or pneumonia mortality. CONCLUSION: Cost subsidies and the zero-price effect were shown to increase vaccination coverage but were not associated with relevant mortality measures. Although the impact was attenuated under pandemic conditions, cost subsidy effectively increases the vaccination rate.

UAV Trajectory Optimization in a Post-Disaster Area Using Dual Energy-Aware Bandits.

Over the past few years, with the rapid increase in the number of natural disasters, the need to provide smart emergency wireless communication services has become crucial. Unmanned aerial Vehicles (UAVs) have gained much attention as promising candidates due to their unprecedented capabilities and broad flexibility. In this paper, we investigate a UAV-based emergency wireless communication network for a post-disaster area. Our optimization problem aims to optimize the UAV's flight trajectory to maximize the number of visited ground users during the flight period. Then, a dual cost-aware multi-armed bandit algorithm is adopted to tackle this problem under the limited available energy for both the UAV and ground users. Simulation results show that the proposed algorithm could solve the optimization problem and maximize the achievable throughput under these energy constraints.