Search Results (3,088)

Background: COVID-19 remains a substantial public health challenge in the Netherlands. Next-generation COVID-19 vaccine, mRNA-1283, is approved in the European Union, with potential for higher relative vaccine efficacy compared with originally licensed COVID-19 vaccines. Methods: The potential public health and economic impact of mRNA-1283 in adults ≥ 60 years and high-risk adults aged 18–59 years was modeled versus no vaccination and originally licensed mRNA-1273 and BNT162b2, adapting a published static Markov model with a 1-year time horizon. COVID-19 burden reflected two full post-pandemic seasons. Vaccine efficacy versus mRNA-1273 was based on pivotal phase 3 NextCOVE trial data; efficacy versus BNT162b2 was derived from an indirect treatment comparison. The economically justifiable price (EJP) of mRNA-1283 versus no vaccination and price premiums over existing vaccines were determined at a willingness-to-pay threshold of €50,000/quality-adjusted life-year (QALY) gained. Results: Without COVID-19 vaccination, an estimated 460,000 infections, 23,800 hospitalizations, and 5300 deaths would occur. With current coverage, mRNA-1283 was estimated to prevent 68,000 infections, 5400 hospitalizations, and 1200 deaths, saving 9667 QALYs and over €66.5 million in treatment costs. The EJP was €238 versus no vaccination. Compared with mRNA-1273 and BNT162b2, mRNA-1283 was estimated to prevent additional burden (e.g., 1309 and 1679 hospitalizations, respectively) and was cost-effective at an incremental EJP of €62 versus mRNA-1273 and €80 versus BNT162b2. Conclusions: The results support continued COVID-19 vaccination to mitigate the ongoing health and societal burden of SARS-CoV-2 in the Netherlands. The comparative analyses indicate that mRNA-1283 may be associated with substantial health benefits over originally licensed mRNA vaccines; consequently, its use may further improve health outcomes and economic efficiency within COVID-19 vaccination programs. Full article

Power battery enterprises are a key link in the new energy vehicle (NEV) industry chain. However, studies analyzing the investment layout of power battery enterprises from a micro perspective are relatively scarce. This study takes Contemporary Amperex Technology Co. Limited (CATL) as a case and employs various spatial analysis methods and an optimal parameter-based geographical detector (OPGD) to analyze the spatiotemporal evolution and driving mechanisms of its investment layout from 2020 to 2024. The results indicate that CATL’s investment center has shifted from Jiangxi to Hubei, and the spatial expansion axis has changed from a northwest–southeast to a southwest–northeast direction. The investment layout has evolved from a “one core with two secondary cores” structure to a “provincial dual core, multi-core outside the province” structure and, ultimately, to a nationwide networked pattern. By 2024, CATL’s investment network covered the southeastern coast, the Yangtze River Delta (YRD), the Pearl River Delta (PRD), central China, and southwestern regions. County-level spatial autocorrelation analysis shows that the investment agglomeration effect has continuously strengthened (with the global Moran’s I increasing from 0.006 to 0.025). High–high agglomeration areas gradually expanded from the southeastern coast to Xiamen and several provinces in central and western China, while high–low agglomeration areas, as early signals of investment diffusion, initially expanded and then contracted. The driving mechanism analysis reveals that fiscal support (q = 0.668), industrial structure upgrading (q = 0.585), tax burden (q = 0.543), and economic development (q = 0.536) are the primary factors driving investment layout, with significant synergistic effects between these factors. The synergy between industrial structure upgrading and clean energy supply stands out as particularly prominent. These findings contribute to optimizing the spatial layout of the NEV industry and promoting regional economic development. Full article

The replacement of synchronous generators (SGs) with inertia-less renewable energy sources (RESs) poses a significant challenge to grid stability due to the reduction of system inertia. To prevent grid instability, energy storage systems (ESSs) with frequency-derivative controls are used to emulate inertia. However, the limited lifetime of ESSs, along with their maintenance requirements, large footprint, and high cost, imposes an additional economic burden on microgrids. This paper proposes an enhanced grid-frequency support approach by coordinating two inertia-emulation mechanisms in parallel: (i) inertia support derived from DC-link capacitor dynamics and (ii) inertia support enabled by operating the PV plant with a power reserve. The proposed method enhances the grid support capacity of the PV energy system and energy sustainability through the efficient utilization of available support resources. Moreover, the DC-link voltage is restored smoothly and naturally to its rated value without the need for a complex control algorithm. The dynamic performance of the proposed system is evaluated under different disturbance conditions and different parameter settings. Simulation results using MATLAB/Simulink R2023a show that, under a 7% load increase, the proposed controller improves the frequency nadir by 0.04 Hz and decreases RoCoF by 10% compared with the baseline controller. Full article

Domestic and family violence (DFV) is a key driver of women’s homelessness and financial insecurity. In Australia, Safe at Home (SAH) programs have emerged as an innovative, wrap-around service response that increases victim-survivors’ safety by implementing a range of strategies and tools that enables them to remain in their home or a home of their choice. SAH responses represent one strategy that effectively prevents homelessness and mitigates the financial, social, and emotional disruption associated with housing relocation after leaving a violent and abusive relationship. This paper examines the implementation of SAH responses in Australia through a critical synthesis of national policy documents and published literature. The paper outlines the four nationally endorsed pillars of SAH (maximising safety, integrated responses, homelessness prevention, and economic security) and examines how these pillars shape service design and outcomes. Evidence from evaluations and outcome studies indicate that SAH can enhance women’s sense of safety, support housing stability, and reduce the financial burden of leaving a violent partner. Access and effectiveness vary depending on the design of the response and location. Challenges include limited affordable housing supply, inconsistent perpetrator accountability, and structural barriers to long-term economic security. Sustained investment in SAH programs, robust data collection mechanisms, and stronger integration of housing and economic supports are ultimately needed to ensure SAH can fulfil its potential as a core component of Australia’s DFV service system. Full article

Introduction: Cow’s milk protein allergy (CMPA) is one of the most common food allergies in early infancy and poses important clinical and economic challenges for affected children, their families, and healthcare systems. In Latin America, variability in diagnostic and therapeutic approaches remains substantial. Objective: We aim to systematically review the available evidence on CMPA, with emphasis on clinical characteristics, diagnosis, management, and economic impact, and to provide a complementary cost analysis of specialized formulas in the Colombian context. Methods: A systematic review was conducted according to PRISMA guidelines to synthesize current evidence on CMPA in pediatric populations. Studies published between 2010 and 2023 were screened using predefined eligibility criteria, and 46 studies were included in the qualitative synthesis. A complementary cost analysis was also performed to estimate the six-month costs associated with specialized infant formulas in Colombia, based on average age-specific formula consumption and standardized 2025 market prices. Results: The reviewed evidence confirms that CMPA is a heterogeneous condition with variable clinical manifestations and persistent diagnostic challenges, particularly in non-IgE-mediated presentations. Elimination of cow’s milk protein followed by oral food challenge remains the reference diagnostic approach. Breastfeeding with maternal dairy exclusion is consistently recommended as the preferred first-line strategy, whereas extensively hydrolyzed and amino-acid-based formulas are used when breastfeeding is not feasible or is insufficient. Estimated six-month costs ranged from COP 4,337,640 to COP 14,480,700 (approximately USD 1100–3600), depending on formula type. Conclusions: CMPA requires early recognition, careful clinical evaluation, individualized nutritional management, and improved access to effective and affordable treatment strategies. Full article

Antimicrobial resistance (AMR) has become one of the top ten global public health threats. Many countries have recognized the societal and economic burden of AMR. AMR has reduced the effectiveness of antimicrobial therapies, and this results in high mortality, morbidity, and health care expenditure. Like all the other developing countries, South Africa (SA) falls under the same ambiguous management system of antimicrobials. A lot of research focused on the global public health threat “AMR”. However, studies on AMR in wastewater are not yet enough, even though they are beginning to gain momentum. This paper highlights the imperatives of surveying AMR pathogens in wastewater since wastewaters are consecrated as hotspots for the dissemination and propagation of AMR genes. RNA was extracted from the untreated wastewater samples collected from the Tshwane district in Gauteng province, SA. Metatranscriptomics analysis was proposed for the analysis and profiling of AMR genes present in the wastewater. A total of 39 AMR gene families and 39 AMR drug classes were detected across 17 samples. The Metatranscriptomics approach discussed in this paper demonstrates the importance of wastewater surveillance, as it can be used as an early detecting system for communicable diseases and for monitoring wastewater. Full article

Though the European Commission has repeatedly stated that the necessary energy transition in Europe should leave “no one behind”, this paper describes a building refurbishment case that has entailed economic hardships for the low-income families involved. The project is located in the area of P. D. Orcasitas in southern Madrid, led by a grassroots neighbours’ movement, comprising one hundred and seven housing blocks, containing more than 2000 dwellings. The main source of funding for the operation consists of subsidies granted by the Madrid City Council; however, Spanish legislation requires the state Agency of Tax Administration to classify these subsidies as capital gains derived from lucrative transfers. Based on the tax data of vulnerable beneficiaries, the conclusion is that the recipients have ended up returning part of the subsidies to the State through their Income Tax Return. In addition, the Spanish Social Security Institute requires the return of social benefits associated with non-contributory retirement pensions and the Minimum Living Income. Apart from tax accounting, regulations are revised to draw conclusions. Unlike most actuations of this kind, in this case the negative effects are obvious. Although intended to alleviate fuel poverty, the initiative has exacerbated vulnerability due to the impact of the imposed penalties on household income. In conclusion, unless preventive measures are implemented, the mandatory refurbishment of inefficient buildings may place an undue burden on vulnerable low-income occupants and hinder the effective implementation of energy-efficiency regulations. Full article

Background/Objectives: Stroke generates 157 million disability-adjusted life-years (DALYs) annually, making it the leading neurological cause of global disease burden. Artificial intelligence (AI) and machine learning (ML) have emerged as transformative technologies across the stroke care continuum. This narrative review maps the trajectory of AI in stroke medicine over the decade from 2015 to 2025. Methods: We conducted a narrative review with a structured, pre-specified search strategy across eight pre-specified thematic clusters using PubMed/MEDLINE (January 2015–December 2025), identifying 8549 records and including 1335 studies after screening. Inclusion criteria encompassed primary research articles, systematic reviews, meta-analyses, and RCTs reporting quantitative performance metrics or clinical outcome data for AI/ML in stroke. Results: Stroke imaging AI is the most commercially mature domain, with over 30 FDA-cleared tools. Automated ASPECTS scoring reduced radiologist reading time by 74.8% (AUC 84.97%; 95% CI: 83.1–86.8%). The only triage AI RCT demonstrated an 11.2 min reduction in door-to-groin time without significant improvement in 90-day functional independence (OR 1.3, 95% CI 0.42–4.0). Brain–computer interface rehabilitation showed significant upper limb recovery in a 17-center RCT (FMA-UE mean difference +3.35 points, 95% CI 1.05–5.65; p = 0.0045). AF detection AI is FDA-cleared and RCT-validated. LLMs and federated learning are pre-regulatory but growing exponentially. Conclusions: AI in stroke has achieved diagnostic maturity but therapeutic immaturity. Bridging algorithmic performance to patient outcomes, addressing equity gaps, and building the economic evidence base for scalable deployment are the defining challenges of the next decade. Full article

Background: The aim of this study was to estimate the economic burden of radiotherapy (RT) from the perspectives of payers, the healthcare system, patients, and society, and to assess associated quality-of-life (QoL) outcomes. The analysis examined direct medical and non-medical costs, as well as QoL, before, during, and up to six months after RT. Given the inclusion of multiple cancer types, the study reflects a heterogeneous real-world population. An exploratory comparison across RT techniques was also conducted to provide contextual economic insight. Methods: This analysis included data from 301 cancer patients undergoing RT using various techniques, including two-dimensional radiotherapy (2D), 3D conformal radiotherapy (3D-CRT), volumetric-modulated arc therapy (VMAT), and intensity-modulated radiotherapy (IMRT), at the University General Hospital of Heraklion, Crete, Greece. Clinical and cost data were collected retrospectively, while QoL data were collected prospectively using validated instruments at baseline, end of treatment, and six months post-treatment. Quality-adjusted life years (QALYs) were estimated. The primary analysis compared RT with a hypothetical “no RT” comparator derived from published evidence, while comparisons across RT techniques were conducted as exploratory analyses. Costs and QALYs were evaluated over a 6-month time horizon; therefore, discounting was not applied. Incremental cost-effectiveness ratios (ICERs) were calculated, and probabilistic sensitivity analysis was performed to account for parameter uncertainty. Results: The cost per QALY gained with RT compared with the hypothetical “no RT” comparator varied substantially across techniques and cancer types. In the primary analysis, 2D radiotherapy yielded the lowest ICER (€13,043.27/QALY), while VMAT demonstrated an ICER of €29,945.12/QALY. In contrast, IMRT was associated with a substantially higher ICER (€135,529.51/QALY), suggesting limited cost-effectiveness under commonly accepted willingness-to-pay thresholds, whereas 3D-CRT was found to be dominant. Subgroup analyses revealed marked heterogeneity, with ICERs ranging from €3234.45 to €30,232.50 per QALY gained across cancer types. In certain subgroups, RT was either cost-saving or dominant, particularly in breast cancer (cost-saving with similar QALYs) and in skin cancer and sarcoma (dominant strategies). Sensitivity analyses highlighted considerable uncertainty, especially for 2D radiotherapy, primarily driven by small sample sizes and variability in QALY estimates. Conclusions: This study provides short-term, real-world evidence on the cost-effectiveness and quality-of-life outcomes of radiotherapy in a Greek healthcare setting. While simpler techniques such as 2D radiotherapy may appear economically favorable, their limited effectiveness and substantial uncertainty may reduce their overall value. In contrast, advanced techniques—particularly VMAT—demonstrate a more consistent balance between cost and clinical outcomes, supporting their role within value-based, patient-centered oncology care. However, the findings should be interpreted with caution due to population heterogeneity, small subgroup sizes, the short (6-month) time horizon, and the use of a hypothetical comparator. Further research with longer follow-up and disease-specific analyses is warranted. Full article

Reducing and managing emissions of mine waters and the minerals dissolved in them, and above all, using these wastes as resources, is an important element of sustainable development in regions undergoing a gradual phase-out of fossil fuel extraction. This article examines selected aspects of mine water management and the mineral substances contained therein, using the Polish hard coal mining industry as a case study, providing valuable insights for both Poland and other mining regions reducing raw material extraction regarding the sustainability of social water demand, mining sector restructuring, and Sustainable Development Goals (SDGs). In Poland, underground hard coal mining remains a significant source of mine water and mineral salt emissions. Mine waters, discharged into the catchments of major rivers (approximately 200 million m³ per year) along with their dissolved mineral compounds (approximately 1.5 million Mg per year), have repeatedly contributed to serious environmental disruptions, e.g., the phenomena of so-called “fish kill”. This study analyzes both the scale of emissions and the economic utilization of mineralized mine waters discharged to the surface by underground hard coal mining in Poland. Key processes and potential causes for the observed increase in environmental burdens are discussed. Furthermore, the paper presents a current statistical assessment of the trends and scale of emission changes, which can serve as a basis for environmental management decision-making amidst the decarbonization of the economy. Utilizing potential water resources and mineral compounds from mine waters for internal use or within circular economy applications can reduce environmental pressure, support compliance with sustainable development policies, and mitigate long-term impacts on post-mining regions. Full article

To promote the resource recovery of phosphate mine tailings and alleviate the pressure caused by the growing scarcity of river sand, this study employs a research methodology combining macroscopic performance analysis with microscopic testing to systematically investigate the effects of three types of recycled sand containing varying proportions of phosphate mine tailings (flint (FS), phosphorite flint (PFS) and dolomitic limestone (DLS)) on the performance of mortar. The study focused on assessing the impact of recycled sand on the workability of mortar, water absorption, mechanical properties, pore structure, cement hydration characteristics, and environmental safety, and conducted a comprehensive evaluation of the project’s feasibility in conjunction with a cost analysis. The effect of DLS was most pronounced in terms of setting time. Water absorption tests show that when the proportions of FS, PFS, and DLS are all 25%, the mortar’s water absorption reaches its minimum value. In terms of mechanical properties, DLS showed a more pronounced increase in early-stage flexural strength, whilst PFS and FS demonstrated a more significant increase in later-stage strength. In terms of compressive strength improvement, PFS outperformed both FS and DLS. XRD and TG-DTA test results show that the three kinds of recycled sand have no adverse effect on cement hydration. SEM and MIP results confirmed that compared with river sand, the porosity of mortar mixed with FS was smaller and the pore structure was denser. Environmental safety assessments have shown that the heavy metal leaching concentrations in the mortar made from the three types of recycled sand are all significantly below the national limits, indicating good environmental compatibility. An economic analysis indicates that the “25% river sand + 75% FS” alternative offers the best economic benefits, resulting in cost savings of 93.27 CNY per cubic metre. In summary, the use of recycled sand derived from phosphate ore tailings as a substitute for river sand in the preparation of mortar is feasible from technical, environmental, and economic perspectives. This approach facilitates the recovery of solid waste resources, conserves natural resources, reduces the environmental burden, and promotes cost optimisation. Full article

Pediatric pneumonia remains a major cause of morbidity and mortality in low- and middle-income countries (LMICs), imposing both health and financial burdens. While the clinical aspects of pediatric pneumonia are well-studied, less attention has been paid to its economic implications for households, particularly regarding out-of-pocket (OOP) expenditure. This paper synthesizes current evidence from Kenya, India, Bangladesh, and Vietnam and introduces a proposed econometric framework designed to identify cost determinants and model policy interventions. The framework integrates microeconomic data, identifies cost determinants, and models the effects of clinical and policy factors (e.g., intensive care, vaccination, insurance coverage) on household expenditures. Simulated results illustrate potential findings from such an approach. Existing studies show substantial variability in hospitalization costs, with OOP payments ranging from US$30 to US$250 per episode, often exceeding 20% of monthly household income. Econometric modeling using generalized linear models (GLMs) and difference-in-differences (DiD) can disentangle the impact of hospital practices, disease severity, and policy interventions. Simulated regression results demonstrate that length of stay, intensive care admission, and absence of insurance significantly increase household costs, while pneumococcal conjugate vaccine (PCV) introduction reduces both admissions and financial burden. Hospitalization for pediatric pneumonia imposes significant OOP costs on households in LMICs. An econometric framework provides rigorous tools to estimate cost drivers, evaluate policy impacts, and guide equitable health financing reforms. Full article

Morocco’s recent legalization of industrial and medicinal cannabis has created a rapidly expanding seed-oil sector whose sustainability has yet to be fully assessed. This study applies an environmental life cycle assessment (LCA) in accordance with ISO 14040:2006 and ISO 14044:2006, complemented by a qualitative social responsibility assessment based on ISO 26000:2010, aiming to evaluate the life cycle sustainability of Moroccan cannabis seed oil. Three representative processing chains, traditional artisanal presses, producer cooperatives and regulated industrial plants are compared using a functional unit of 1 kg of cold-pressed oil packaged for local distribution. Inventory data were drawn from field measurements and interviews and were modeled in OpenLCA with background datasets from Ecoinvent 3.8 and Agribalyse v3.1. Impact assessment used the ReCiPe 2016 (H) method at the midpoint level across nine categories (climate change, fossil resource scarcity, water use, freshwater eutrophication, terrestrial acidification, land occupation, carcinogenic, non-carcinogenic human toxicity, and fine particulate matter formation). Sensitivity analyses varied seed yield, electricity mix and transport distances by ±20% to gauge uncertainty. Results show that the cooperative scenario achieves the lowest impacts across nearly all categories because of higher extraction yields (3 kg seed per kg oil), lower energy use (0.54 kWh kg⁻¹ oil) and more effective co-product recovery. In contrast, artisanal extraction requires approximately 1 kg of additional seed input per functional unit compared to optimized scenarios, significantly increasing upstream environmental burdens and causing upstream agricultural burdens to multiply. Industrial facilities perform comparably to cooperatives if powered by renewable electricity. Integrating a semi-quantitative social responsibility assessment reveals that legalization has markedly improved organizational governance, labor conditions, consumer protection and community involvement. Cooperatives display the most balanced social performance, whereas industrial plants excel in governance and quality control. A set of recommendations, including drip irrigation, cultivar improvement, co-product valorisation, renewable energy adoption, eco-designed packaging and cooperative governance, is proposed to enhance the environmental and socio-economic sustainability of Morocco’s emerging cannabis seed-oil industry. Full article

As rural residents face the dual challenges of transforming dietary structures and addressing nutritional health burdens, establishing a resilient food consumption system for rural households has become an urgent priority. Drawing on micro-level data from the China Land Economic Survey (CLES) for the period 2020–2022, this study employs two-way fixed effects models, an instrumental variable (IV) approach, and seemingly unrelated regression (SUR) techniques to examine the impact of agricultural production diversity on household food expenditure and dietary diversity, as well as the underlying mechanisms. The results reveal that agricultural production diversity yields a significant and robust dual-dividend effect within household food consumption systems: it not only reduces per capital food expenditure but also enhances dietary diversity. Mechanism analysis indicates that diversified production increases food self-sufficiency, thereby reducing cash outflows for essential food items, while simultaneously improving dietary diversity through increased agricultural income and greater agricultural commercialization. Heterogeneity analysis further shows that these effects are more pronounced in villages lacking rural industrial support and among non-ageing households. These findings suggest that, in contexts where market mechanisms remain underdeveloped, the uncritical pursuit of absolute agricultural specialization may not align with the livelihood and nutritional needs of rural residents. From the perspective of fostering a healthy and resilient food system, China should adopt differentiated agricultural support policies, encourage rural households to maintain an appropriate degree of production diversity, and strengthen local agricultural market infrastructure. Full article

Operating multi-unit combined heat and power (MUCHP) plants involves determining unit commitment (UC) and coupled heat and power dispatch under demand uncertainty and progressive equipment degradation. This paper proposes a reinforcement learning approach to jointly optimize UC, dispatch, and preventive maintenance (PM). Specifically, we develop a Proximal Policy Optimization (PPO)-based policy that shifts the computational burden to offline training, enabling near-real-time decisions during operation. The trained agent is evaluated on an hourly five-unit CHP system model based on operational data from a district heating plant in the Republic of Korea, using a full-year simulation. The robustness of the proposed method is assessed against demand forecast noise and structural system shifts covering reduced, expanded, homogeneous, and heterogeneous unit configurations. The experiments indicate that the proposed approach reduced the total operating cost by 4.69 to 8.35 percent compared to three heuristic baselines across the evaluated scenarios. Moreover, it mitigates supply shortages during high-volatility seasons through proactive pre-commitment and preserves asset health by distributing production loads evenly. These results indicate that integrating PM into operational planning improves both the economic efficiency and operational stability of MUCHP systems. Full article