Actual Benefits Research Articles

Becoming Eligible for Long-Term Care Insurance in China Brought More Ageing at Home: Evidence from a Pilot City

Abstract Person-centered long-term care systems, integral to healthy ageing, should empower older people to achieve ageing in place. Yet evidence on the impact of the design of long-term care systems on older people’s choice of places of ageing, especially that from developing countries, is limited. Taking the introduction of Long-Term Care Insurance (LTCI) in City X of China as a policy shock, we examined the impact of becoming eligible for LTCI on program beneficiaries’ choice of places of ageing—institution or home—before they started to receive any actual benefit. Based on our analysis of the administrative data of all LTCI applicants between July 2017 and September 2020 from City X, we found that becoming eligible for LTCI increased an older-person’s probability of choosing home as her place of ageing even before she received any benefit by around 16 percentage points, and this positive impact was larger for those insured of higher education level or of higher disability grade. By bring more ageing in place, the LTCI in City X promoted healthy ageing. Our study suggests that the specifics of the LTCI program like who could receive subsidies, family values, and family members’ engagement in labor market could all work together to shape the substitution pattern between home and institutional care.

The Oncological Stress Test of Neoadjuvant Therapy: A Systematic Review in Outcomes of Neoadjuvant Therapy Compared to Upfront Resection Approach for Borderline Resectable Pancreatic Adenocarcinoma.

Pancreatic adenocarcinoma, increasingly diagnosed in the United States, has a disheartening initial resection rate of 15%. Neoadjuvant therapy, particularly FOLFIRINOX and gemcitabine-based regimens, is gaining favor for its potential to improve resectability rates and achieving microscopically negative margins (R0) in borderline resectable cases, marked by intricate arterial or venous involvement. Despite surgery being the sole curative approach, actual benefit of neoadjuvant therapy remains debatable. This study scrutinizes current literature on oncological outcomes post-resection of borderline resectable pancreatic cancer. A MEDLINE/PubMed search was conducted to systematically compare oncological outcomes of patients treated with either neoadjuvant therapy with intent of curative resection or an "upfront resection" approach. A total of 1293 studies were initially screened and 30 were included (n = 1714) in this analysis. All studies included data on outcomes of patients with borderline resectable pancreatic adenocarcinoma being treated with neoadjuvant therapy (n = 1387) or a resection-first approach (n = 356). Patients treated with neoadjuvant therapy underwent resection 52% of the time, achieving negative margins of 43% (n = 601). Approximately 77% of patients who received an upfront resection underwent a successful resection, with 39% achieving negative margins. Neoadjuvant therapy remains marginally efficacious in treatment of borderline resectable pancreatic adenocarcinoma, as patients undergo an operation and successful resection less often when treated with neoadjuvant therapy. Rates of curative resection are comparable, despite neoadjuvant therapy being a primary recommendation in borderline resectable cases and employed more often than upfront resection. Upfront resection may offer improved resection rates by intention-to-treat, which can provide more patients with paths to curative resection.

Socioeconomic drivers of low value screening

Abstract Low-value care brings minimal or no benefit to the patient and is a growing concern for healthcare systems. In this presentation, we will discuss the issue of low-value cancer screening, its frequency, and how it is socially patterned. The general population, policymakers, and healthcare providers expect a lot from cancer screening, while the actual absolute benefits are generally relatively low. In addition, screening practice often does not follow recommendations regarding the frequency of testing or the ages at which to start and to stop, and many screenings providing no benefit are commonly performed. Addressing low-value screening is key for evidence-based population health management and prevention.

Harnessing nature-based solutions for economic recovery: A systematic review

Nature-based solutions (NbS) involve working with nature to address societal challenges in ways that benefit communities and biodiversity locally. However, their role supporting economic recovery from crises, such as those arising from conflicts or pandemics remains underexplored. To address this knowledge gap, we conducted a systematic review of 66 reviews on the economic impact of nature-based interventions. Most demonstrated positive outcomes for income and employment, though those with critical appraisal of underlying studies reported more mixed outcomes. These varied results were influenced by factors such as the balance between short-term and long-term gains, market conditions, regional effects, reliance on subsidies, and discrepancies between expected and actual economic benefits. National-scale economic growth assessments were scarce. Half of the cases featured nature-based food production investments, with much evidence from sub-Saharan Africa, East Asia and the Pacific. The few reviews comparing NbS with alternatives found that NbS delivered equal or better economic outcomes. NbS also provided broader benefits like food and water security, flood protection and community empowerment. We identified key factors influencing the delivery of benefits and trade-offs, finding that NbS must adhere to best practice standards, with community involvement being critical for equitable outcomes. Well-designed NbS can create diverse job opportunities at different skill levels, diversify income, and improve resilience, offering a rapid, flexible response to economic shocks that can be targeted at deprived communities. By integrating traditional, local and scientific knowledge, NbS can enable eco-innovation, and drive the transition to a clean and efficient circular economy, with high economic multipliers spreading benefits throughout economies. The evidence underscores the need to incorporate NbS in investment programs to concurrently address economic, environmental, and societal challenges. However, improved monitoring of economic, social and ecological outcomes and the development of comprehensive accounting systems are needed to better track public and private investments in NbS.

Is blockchain cost-effective in construction project management? A systematic review from the perspective of transaction cost

PurposeBlockchain technology (BCT) is considered a promising tool to improve the productivity of construction project management. Existing research has studied its potential costs and benefits for the construction industry. However, the potential costs and benefits of BCT failed to be compared as actual costs and benefits of specific applications for stakeholders. To fill this gap, this study seeks to analyze the cost-effectiveness of BCT-based applications in construction project management.Design/methodology/approachThis study is conducted with a customized systematic literature review based on transaction cost theory to enable qualitative comparison. With a deliberately designed structure confining extraneous variables, the costs and benefits of BCT-based applications are identified and compared. The inherent dependent relations of processes and the evolution relations of functions are identified. The cost-effectiveness of blockchain adoption is then analyzed.FindingsSeven functions and six challenges are identified within five processes. The result suggests all identified functions are cost-effective except for manual instruction (coding smart contracts manually). The smart contracts require explicit definition and logic to be effective. However, the construction projects essentially require the institution to be flexible due to unpredictability. The adoption of smart contracts and corresponding additional requirements can increase the transaction cost of bounded rationality.Research limitations/implicationsAs manual instruction is fundamental to realize other functions, and its advanced substitute relies on its broad adoption, its cost-effectiveness must be improved for applications to be acceptable to stakeholders. The establishment of a universal smart contract model and a universal, legitimate and efficient database structure are recommended to minimize the cost and maximize the effect of applications.Originality/valueThis study contributes to the knowledge by providing a comprehensive analysis of BCT adoption’s cost-effectiveness in construction project management. The adopted review structure can be extended to analyze the qualitative benefits and challenges of management automation in the early stages.

The Adoption and Applications of Earth Observations and Allied Geoinformation Systems for Environmental Management in Ghana

Earth Observations (EOs) and allied technologies were initially adopted and applied to inform sustainable environmental resource management in Ghana. This paper examines the initial adoption of EOs in the early 1990s and subsequent applications. It highlights the transformative potentials of EO technologies in addressing critical environmental issues while also identifying barriers to their widespread adoption and options for optimal up-scaling. Literature review, in-depth interview, and personal experiences of the author were analyzed. The initial optimism bias generated may have masked the need for establishing the necessary sustainability arrangements. The adoption of EOs was driven by the need to generate data to inform natural and environmental resource management in the mid-1990s. Initially, EOs facilities were established in public organizations, including the Council for Scientific and Industrial Research (CSIR), Survey Department, and the University of Ghana. Since then, EOs have been applied in various sectors for research and environmental resource management. Granted, there have been successes. Yet, challenges undermine the optimization and scaling-up of actual benefits. These include the misconceived technocentric view of EOs, which is a restricted domain for the technically initiated and map-making tool. Others, such as unfavourable organizational processes, unsustainable funding, and limitations in research and applications, have adversely contributed to suboptimal outcomes. Suboptimal institutionalization of EOs into management decisions has constrained EOs infrastructure acquisition, maintenance and data procurement. To sustainably enhance EOs applications in resource management, research, and governance, a shift from present misconceptions for effective mainstreaming and a leveraging of EOs as integral parts of decision-making processes are prerequisites. Decision-makers and management personnel should be educated on the relevance of EOs’ functionalities to the core strategies of environmental management.

Assessing the Risk of QT Prolongation in a Psychiatric Inpatient Cohort: A Retrospective Cross-Sectional Study.

QT prolongation is a potential serious adverse drug reaction, and assessing the risk of QT-prolonging drugs is routinely included in psychotropic medication reviews. However, the actual clinical benefits of such assessments are unknown. We investigate whether QT prolongation (QTc value > 480 ms) manifests in psychiatric inpatients at risk of QT prolongation as identified by assessing drug regimens. Secondly, we test the predictive value of well-known risk factors for QT prolongation. The median patient age was 49 years (IQR 34-64) for patients treated with a median of nine drugs (IQR 6-12) and a median QT-prolonging drug sum of three daily defined dosages (IQR 1.88-4.76). We extracted 290 ECGs for patients where pharmacist-led-medication reviews (PMRs) identified an increased risk of QT prolongation and 190 ECGs for patients with no such risk, identifying 33 cases of verified QT prolongation equally distributed between groups. Unadjusted regression analysis revealed that advanced age (OR 3.27 CI 95% 1.60-6.84) and cardiovascular comorbidity (OR 3.53 CI 95% 1.71-7.29) were associated with manifest QT prolongation, while the QT-prolonging drug load was not. We reviewed electronic health records (EHRs) of 799 psychiatric inpatients exposed to PMRs made from 1 September 2016 to 31 December 2018 in Region Zealand Denmark. Patients at risk of QT prolongation as identified by drug reviews rarely manifests with actual QT prolongation. Non-pharmacological risk factors seem to be better predictors for identifying patients with QT prolongation.

Towards a trusted genomics repository: Identifying commercialisation fears and preferred forms of governance across segments of the community.

A latent class analysis on a nationally representative Australian sample (N = 1000) identified four subgroups (i.e. classes), ranging from high to low concern about, and willingness to donate to, a national genomic repository under different forms of public and commercial management and access. The distribution of concerns and governance preferences across these classes was investigated. This added to previous research by indicating the degree to which extant concerns (e.g. corporate profiteering, discrimination by insurers) are held by different segments of the community. Based on the governance mechanisms that had widespread support across segments, the following recommendations are made to develop a trusted Australian genomic repository: the repository cannot be solely profit-driven; can utilise an access committee; protections (e.g. ensuring confidentiality of donors) may not require new legislation; data users cannot retain data for future research; the public should remain informed about the intended and/or actual benefits of research.

Demountable structures: evaluation of a circular design approach through life cycle assessment

Abstract The demand to reduce the use of raw materials, construction waste, and the negative environmental impacts of the construction sector is constantly increasing. New circular design strategies, such as Design for Disassembly, are intended to meet these challenges. Furthermore, circular strategies facilitate the easy and quick replacement of building components during end-of-life phases, as well as the efficient and waste-free deconstruction of entire buildings for subsequent reuse. However, building structures developed according to these strategies can have a higher environmental burden in the production or use phase of their life cycle. To confirm the actual environmental benefits of circular constructions, the paper utilizes the Life Cycle Assessment (LCA) method as a vital tool for the environmental evaluation of circular structures. As a case study, fully demountable and conventional masonry building façade systems with insulation are analyzed through a cradle-to-cradle approach over 2 life cycles. Several End-of-Life scenarios, as well as reuse and the benefits it provides, were considered during the assessment. Examining eight environmental indicators, the comparative analysis of linear and circular facade design approaches in the chosen case studies provides insights into efficient and environmentally friendly solutions.

Just in Time Port Call Optimisation: Preliminary Regulatory Compliance Evaluation and Environmental Performance Assessment

Abstract Just in Time (JIT) arrival, as an operational measure towards shipping decarbonisation, promises increased energy savings and reduced emissions. Integrated digital systems targeting the optimisation of the port call process allow vessels to adapt their speed to avoid the “hurry-up-and-wait” syndrome, and thus, reduce their fuel consumption at a certain extend. However, there are a lot of concerns and challenges ahead for a wide adoption of such a solution, that are either related to the regulatory and standardisation frameworks, or to the realisation of the actual benefits of a JIT optimisation system. Thus, this paper attempts to shed light on some of these challenges, by focusing on the maritime regulatory framework around JIT operations and on emission reduction potential from speed adaptation. Results provide a baseline for regulatory compliance evaluation for such a system, and a preliminary environmental performance assessment from JIT arrival applied on an actual ship case. These insights and early results will be further explored within the EU-funded MISSION project towards a full appreciation of the JIT concept benefits and regulatory compliance, which will lead to its wide implementation.

The Lamella Ostium Extent Mucosa (LOEM) system: a new classification for endoscopic sinus surgery.

In the last decades, various types of endoscopic sinus surgery (ESS) have emerged as treatments for chronic rhinosinusitis (CRS), particularly with the development of personalized, endotype-driven approaches targeting mucosal inflammation and remodeling (1). Despite these advancements, the literature reports heterogeneous and often divergent outcomes, leaving the actual benefit of more extensive surgical approaches in CRS control a matter of ongoing debate (2,3). This discrepancy stems from inconsistent definitions of surgical techniques, leading to variations in osseous and mucosal resections depending on patient phenotype, disease severity and surgeon preference (4). To address this inconsistency, the Japanese Rhinology Society introduced a classification based on procedure extent, but it lacks details on anatomical structures and mucosal treatment (5). Similarly, the ACCESS system measures ESS extent with postoperative CT-scans but overlooks mucosal interventions (6).

PIPAC Pharmacologic and Clinical Data.

Pressurized intraperitoneal aerosol chemotherapy (PIPAC) emerged as an innovative intraperitoneal chemotherapy delivery system to overcome the issue of limited efficacy of systemic therapies to induce response in peritoneal malignancies. Promising results for patients with mesothelioma peritonei and peritoneal metastasis from gastric, ovarian, colorectal, pancreatic, and hepatobiliary tumors origin are changing the landscape for patients otherwise just facing palliative treatment. Ongoing trials will shed more light on the actual benefits of PIPAC.

Sustainable Business Practices through IoT: Energy Efficiency and Cost Reductions

This is the age of industrial transformation that is being driven by the Internet of Things (IoT). It offers very unique chance to maximize productivity excellence and foster economic expansion while having the opportunity to meet environmental concerns. This comprehensive study looks into not only the IoT contribution to energy efficiency and cost reduction but also potential use in areas of administrative operations with the same objective of energy efficiency and cost reduction. With the aid of rigorous mixed methods research that brings together qualitative data from multiple industries, against the backdrop of carefully selected case studies showing the actual benefits of IoT installations, the paper seeks to give a clear picture of the practical advantages of IoT-powered organizations. The research presents information regarding how IoT technologies function to optimize energy applications, enhance processes, and cut down waste through their ability to collect data in real-time and manage systems. Besides, it will analyze the problems companies may run into while adding IoT solutions, such as technological complexity, initial expenditure, and security matters. On the other hand, the research also designs the tactical moves that the companies can opt for as an alternative to completely eradicate these barriers and successfully deploy the IoT technology. Through the systematic study of the role of the Internet of Things on green business practices policymakers, business leaders, and technologists will gain valuable insights which can be applied in whatever levels they are working from. This policy is based on a systematic approach to IoT adoption, which, inter alia, suggests the organization of the project, statistical analysis, and improvement of the present situation to get the best economic and environmental state of affairs. This will further the comprehension of the power of IoT technology in both developing sustainability and increasing profitability, all indications that it is not just a technological advantage but rather a basic instrument for the future sustainability of business practices.

On the analytical solution of the one-dimensional convection–conduction equation for packed-bed thermal energy storage systems

Temperature distribution modeling within packed-bed thermal energy storage (PBTES) systems is crucial to simulate its integration into heat sources and perform techno-economic analyses to assess the actual benefits associated with its use. This article proposes a one-dimensional convection–conduction equation to model a fluid–solid system by assuming volume-averaged properties for the energy balance and determines the analytic solution through Integral Transforms. The present study analyzes the applicability of this analytic solution considering different operational conditions of PBTES systems. The article revealed that the Péclet number (Pe) and the fluid-to-solid capacity ratio (κ) must be limited to obtain stable solutions, while the dimensionless time τ cannot be arbitrary despite computing an analytic solution. A sensitivity study of the solution for parameter a=κPe/2 defined the minimum dimensionless time required for the solution to be stable. This stability was assessed with existing experimental setups, indicating the solution’s feasibility for air–solid PBTES systems.

An Integrated Method Using a Convolutional Autoencoder, Thresholding Techniques, and a Residual Network for Anomaly Detection on Heritage Roof Surfaces

The roofs of heritage buildings are subject to long-term degradation, resulting in poor heat insulation, heat regulation, and water leakage prevention. Researchers have predominantly employed feature-based traditional machine learning methods or individual deep learning techniques for the detection of natural deterioration and human-made damage on the surfaces of heritage building roofs for preservation. Despite their success, balancing accuracy, efficiency, timeliness, and cost remains a challenge, hindering practical application. The paper proposes an integrated method that employs a convolutional autoencoder, thresholding techniques, and a residual network to automatically detect anomalies on heritage roof surfaces. Firstly, unmanned aerial vehicles (UAVs) were employed to collect the image data of the heritage building roofs. Subsequently, an artificial intelligence (AI)-based system was developed to detect, extract, and classify anomalies on heritage roof surfaces by integrating a convolutional autoencoder, threshold techniques, and residual networks (ResNets). A heritage building project was selected as a case study. The experiments demonstrate that the proposed approach improved the detection accuracy and efficiency when compared with a single detection method. The proposed method addresses certain limitations of existing approaches, especially the reliance on extensive data labeling. It is anticipated that this approach will provide a basis for the formulation of repair schemes and timely maintenance for preventive conservation, enhancing the actual benefits of heritage building restoration.

Prophylactic ICD Survival Benefit Prediction: Review and Comparison between Main Scores.

Current guidelines advocate for the use of prophylactic implantable cardioverter defibrillators (ICDs) for all patients with symptomatic heart failure (HF) with low ejection fraction (EF). As many patients will never use their device and some are prone to device-related complications, scoring systems for delineating subgroups with differential ICD survival benefits are crucial to maximize ICD benefit and mitigate complications. This review summarizes the main scores, including MADIT trial-based Risk Stratification Score (MRSS) and Seattle Heart Failure Model (SHFM), which are based on randomized trials with a control group (HF medication only) and validated on large cohorts of 'real-world' HF patients. Recent studies using cardiac MRI (CMR) to predict ventricular arrhythmia (VA) are mentioned as well. The review shows that most scores could not delineate sustained VA incidence, but rather mortality without prior appropriate ICD therapies. Multiple scores could identify high-risk subgroups with extremely high probability of early mortality after ICD implant. On the other hand, low-risk subgroups were defined, in whom a high ratio of appropriate ICD therapy versus death without prior appropriate ICD therapy was found, suggesting significant ICD survival benefit. Moreover, MRSS and SHFM proved actual ICD survival benefit in low- and medium-risk subgroups when compared with control patients, and no benefit in high-risk subgroups, consisting of 16-20% of all ICD candidates. CMR reliably identified areas of myocardial scar and 'channels', significantly associated with VA. We conclude that as for today, multiple scoring models could delineate patient subgroups that would benefit differently from prophylactic ICD. Due to their modest-moderate predictability, these scores are still not ready to be implemented into clinical guidelines, but could aid decision regarding prophylactic ICD in borderline cases, as elderly patients and those with multiple co-morbidities. CMR is a promising technique which might help delineate patients with a low- versus high-risk for future VA, beyond EF alone. Lastly, genetic analysis could identify specific mutations in a non-negligible percent of patients, and a few of these mutations were found to predict an increased arrhythmic risk.

Innovative Applications and Benefit Analysis of Financial Informationization and Intelligence in the Construction Industry

This paper explores the current status of the application of financial informationization and intelligence in the construction industry, analyzing the impact on improving financial management efficiency, reducing operational costs, and enhancing decision-making support capabilities. Through a case study of Huaxin Construction Engineering Group Co., Ltd., this paper evaluates the actual benefits of intelligent technology in financial process reengineering, risk management, and strategic planning.

Factors influencing agroforestry practices adoption in the central river Region of The Gambia

The world's multiple landscape crises have placed agroforestry among the cost-effective nature-based solutions with numerous ecological, social, and economic benefits. This study examined the farmer and land factors influencing the adoption of agroforestry practices in the Gambia's Central River Region. Stratified random sampling was used to collect primary data from 377 households using semi-structured questionnaires and farm-level walkabout observations. The study used purposive and snowball sampling methods to engage different key informants. The results indicated that the agroforestry adoption rate in the study area was 52.3 %. Significant differences between the means of agroforestry adopters and non-adopters were observed. Adopters held more land size 0.66ha vs. 0.55ha, owned more livelihood assets (private land and livestock), and had significantly more fenced lands. The binary regression model established that livelihood assets, land size, land fencing, and gender were positively associated with agroforestry adoption in the study area. Conclusively, land-related factors emerged as more predictable determinants of agroforestry adoption than farmer-related factors. Notably, age and education, though important socioeconomic attributes, remained relatively the same between adopters and non-adopters, and were not statistically significant. The study recommends cross-cutting farmer and land-related policies, as well as other interventions to boost agroforestry adoption. It further suggests a follow-up study to quantify the actual cost and benefits associated with agroforestry adoption in the area.

(Invited) 1D Oxides for Energy, Environment, and Biomedical Applications: Are They as Good as They Appear?

1D oxides demonstrate interesting optical, electronic, catalytic, and surface properties. They are interesting not only because they can be synthesized using cost effective methods but also appear to be useful in several technological processes. They are also amenable to doping, composite formation, and assembly as heterostructures with a variety of elements as well as pre-formed materials such as dyes, metals, and non-metals.This talk will feature representative examples of 1D oxides and their composites in the field of energy, environment, and biomedical applications. Key findings using Titanium dioxide as the compound of focus will be highlighted. Research in this field from our group will be presented. Specific focus will be on the work involving former and current collaborators associated with India This presentation will also look into examples of work in the area that suggest not so promising benefits of these 1D oxides, thus raising the question of its actual benefits.

Smart ArM: a customizable and versatile robotic arm prosthesis platform for Cybathlon and research

BackgroundIn the last decade, notable progress in mechatronics paved the way for a new generation of arm prostheses, expanding motor capabilities thanks to their multiple active joints. Yet, the design of control schemes for these advanced devices still poses a challenge, especially with the limited availability of command signals for higher levels of arm impairment. When addressing this challenge, current commercial devices lack versatility and customizing options to be employed as test-beds for developing novel control schemes. As a consequence, researchers resort to using lab-specific experimental apparatuses on which to deploy their innovations, such as virtual reality setups or mock prosthetic devices worn by unimpaired participants.MethodsTo meet this need for a test-bed, we developed the Smart Arm platform, a human-like, multi-articulated robotic arm that can be worn as a trans-humeral arm prosthesis. The design process followed three principles: provide a reprogrammable embedded system allowing in-depth customization of control schemes, favor easy-to-buy parts rather than custom-made components, and guarantee compatibility with industrial standards in prosthetics.ResultsThe Smart ArM platform includes motorized elbow and wrist joints while being compatible with commercial prosthetic hands. Its software and electronic architecture can be easily adapted to build devices with a wide variety of sensors and actuators. This platform was employed in several experiments studying arm prosthesis control and sensory feedback. We also report our participation in Cybathlon, where our pilot with forearm agenesia successfully drives the Smart Arm prosthesis to perform activities of daily living requiring both strength and dexterity.ConclusionThese application scenarios illustrate the versatility and adaptability of the proposed platform, for research purposes as well as outside the lab. The Smart Arm platform offers a test-bed for experimenting with prosthetic control laws and command signals, suitable for running tests in lifelike settings where impaired participants wear it as a prosthetic device. In this way, we aim at bridging a critical gap in the field of upper limb prosthetics: the need for realistic, ecological test conditions to assess the actual benefit of a technological innovation for the end-users.