Budget Analysis Research Articles

Response of Shallow-Water Temperature and Significant Wave Height to Sequential Tropical Cyclones in the Northeast Beibu Gulf

Using shallow-water buoy observations, reanalysis data, and numerical models, this study analyzes the variations in sea temperature and significant wave height (SWH) caused by two sequential tropical cyclones (TCs) ‘Lionrock’ and ‘Kompasu’ in October 2021 in the northeast Beibu Gulf, South China Sea. The results show that the sea surface temperature (SST) cooling of the nearshore waters was larger than the offshore water in the basin of the gulf, with the cooling amplitude and rate decreasing and the cooling time lagging behind wind increasing from coast to offshore. The near-surface temperature at the buoy station had a maximum decrease of 2.8 °C after ‘Lionrock’, and the decrease increased slightly to 3 °C after the stronger wind of ‘Kompasu’. The total decrease of 4.6 °C indicates that the sequential TCs had a superimposed effect on the cooling of the Beibu Gulf. The heat budget analysis revealed that the sea surface heat loss and the Ekman pumping rate in the nearshore waters during ‘Kompasu’ (−535 W/m2 and 5.8 × 10−4 m/s, respectively) were significantly higher than that (−418 W/m2 and 4 × 10−4 m/s) during ‘Lionrock’. On the other hand, the SST cooling (−1.2 °C) during the second TC is smaller than (−1.6 °C) the first weaker TC in the gulf basin, probably due to the deepening of the mixed layer. During the observation period, the waves in the Beibu Gulf were predominantly wind-driven. The maximum SWHs reached 1.58 m and 2.3 m at the bouy station near shore during the two TCs, and the SWH variation was highly correlated to the wind variation with a correlation of 0.95. The SWH increases from the nearshore to offshore waters during the TCs. The SAWN and ARCIRC coupled model results suggest that wave variations in the Beibu Gulf are primarily influenced by water depth, bottom friction, and whitecapping. Two days after the TCs, sea surface cooling and high waves appeared again due to a cold air event.

Budget impact analysis of continuous glucose monitoring in individuals with type 2 diabetes on insulin treatment in England

IntroductionIn 2022, updated guidance from NICE expanded the options for self-monitoring of blood glucose for patients with type 2 diabetes (T2DM), to include continuous glucose monitoring (CGM). In this budget impact analysis, the cost impact of CGM was compared with traditional self-monitoring of blood glucose (SMBG) in adults with T2DM over 1 year from the commissioner perspective in England.Research Design and methodsThe NICE-eligible T2DM cohort was split into 4 subgroups to enable nuanced costing by insulin administration frequency: basal human insulin, premixed insulin, basal-bolus insulin and bolus insulin. The model’s cost components comprised mild and severe hypoglycaemia (SH), diabetic ketoacidosis (DKA), consumables and healthcare resource utilisation in primary and secondary care.ResultsThe introduction of CGM is estimated to be cost additive by approximately £4.6 million in the basecase, driven by increased spending on the CGM device. Overall, healthcare activity was reduced by approximately 20,000 attendances, due to fewer SH and DKA episodes in the CGM arm. General Practitioner (GP) practice-based activity is expected to drop after the first year as patients requiring CGM training is reduced. The budget impact could be neutralised if the CGM sensor was discounted by 13.2% (£29.76 to £25.83).ConclusionsCGM may result in increased spending in the NICE-eligible T2DM cohort but is expected to reduce demand on secondary care services and GP time. These findings may be of interest to local decision-makers who wish to resolve the COVID-19 backlog with transformational investment in primary care to reduce secondary care activity.

Wind Distribution in the Eye of Tropical Cyclone Revealed by a Novel Atmospheric Motion Vector Derivation

AbstractObservations of wind distribution in the eye of tropical cyclones (TCs) are still limited. In this study, a method to derive atmospheric motion vectors (AMVs) for TCs is developed, where selection from multiple local rotation speeds is made by considering continuity among neighboring grid points. The method is applied to 2.5‐min interval image sequences of three TCs, Lan (2017), Haishen (2020), and Nanmadol (2022), observed by the Himawari‐8 satellite. The results are compared with AMVs derived from research‐based 30‐s Himawari‐8 special observations conducted for Haishen and Nanmadol, as well as with in‐situ dropsonde observations conducted for Lan and Nanmadol. In these storms, the AMVs obtained from the 2.5‐min interval images in the eye are found to be in good agreement with the dropsonde observations. Examinations of AMVs in the eye reveal transient azimuthal wavenumber‐1 features in all three TCs. These features are consistent with algebraically growing wavenumber‐1 disturbances, which transport angular momentum inward and accelerate the eye rotation. In the case of Lan, the angular velocity in the eye increased by approximately 1.5 times within 1 hr. This short‐term increase is further examined. Visualization of low‐level vorticity in the eye and angular momentum budget analysis suggest that angular momentum transport associated with mesovortices played an important role in the increase of tangential wind and the homogenization of angular velocity in the eye of Lan.

Pharmacoeconomic evaluation of first-line combination therapy with immunotherapy drugs and platinum-containing chemotherapy in adult patients with metastatic non-squamous non-small cell lung cancer

Objective: to evaluate the pharmacoeconomic efficacy of “atezolizumab + bevacizumab + paclitaxel + carboplatin” drug combination compared to “pembrolizumab + pemetrexed + carboplatin” combination in adult patients with non-small cell lung cancer (NSCLC) in the first line of therapy.Material and methods. The modeling was applied for cost minimization analyzis of using compared therapy regimens with comparable efficacy, and to estimate the impact on the healthcare budget when increasing the proportion of patients in the target population receiving “atezolizumab + bevacizumab + paclitaxel + carboplatin” combination. Published adjusted indirect comparison data were used in modeling. The calculations were based on the registered prices according to the state register of maximum selling prices.Results. The use of “atezolizumab + bevacizumab + paclitaxel + carboplatin” combination instead of “pembrolizumab + pemetrexed + carboplatin” combination will decrease the direct medical costs of therapy per 1 patient for 2 years by 28,165.00 rubles (–0.4%). The budget impact analysis showed that an increase in the proportion of patients receiving “atezolizumab + bevacizumab + paclitaxel + carboplatin” combination from 50% (current therapy practice) to 100% (considered therapy practice) will reduce the budget load for the population of 6,240 patients over 2 years by 256.1 million rubles (–0.64%).Conclusion. The results of pharmacoeconomic analysis demonstrated that the use of “atezolizumab + bevacizumab + paclitaxel + carboplatin” combination in first-line therapy for metastatic NSCLC is economically feasible and reduces the load on the budget compared to “pembrolizu- mab + pemetrexed + carboplatin” scheme.

Clinical and economic implications of using daratumubab with lenalidomide in the 1st and 2nd lines of therapy for multiple myeloma patients

Objective: to assess clinical and economic implications of adding daratumumab (Dara) to the “lenalidomide + dexamethasone” (Rd) treatment program in early lines of therapy for patients with multiple myeloma (MM) ineligible for high-dose chemotherapy (HDCT) with subsequent autologous hematopoietic stem cell transplantation (autoHPSCT).Material and methods. Partitioned survival model was developed to compare overall survival in the treatment programs of MM patients in the 1st to 3rd lines of therapy. The following treatment options were included in the analysis: 1st line – Dara+Rd; 2nd line – “carfilzomib + lenalidomide” (K+Rd) or “ixazomib + lenalidomide” (Ixa+Rd) triplets; 3rd line – pomalidomide (Pom+dex) and Rd+(Dara+Rd)+(Pom+dex) versus Rd+(K/Ixa+Rd)+(Pom+dex/Dara). Probabilities of transition between health states (progression-free, progressed disease, and death) were based on published clinical data. Lifetime direct healthcare costs and incremental cost-effectiveness ratios (ICERs) per 1 life year gained were calculated from a Russian health care perspective. The indicator of the difference in costs between current and expected practice was used in budget impact analysis.Results. Dara+Rd combination increased life expectancy by 1.04 years (+16.05%) and 0.95 years (+14.57%) per patient, and in the target population (n=955) by 995.48 and 903.40 years for (Dara+Rd)+(K+Rd)+(Pom+dex) and (Dara+Rd)+(Ixa+Rd)+(Pom+dex) treatment programs, respectively, compared to Rd use in the 1st line. The ICER per 1 life year gained for Dara+Rd in 1st line therapy was 8.95 mln rubles for (Dara+Rd)+(K+Rd)+(Pom+dex) and 8.41 mln rubles for (Dara+Rd)+(Ixa+Rd)+(Pom+dex). It's lower than the median ICER of 13.64 million per 1 life year gained for antitumor drugs used to treat cancer of lymphatic and hematopoietic tissues (reference ICER). Dara+Rd triplet is used in 2nd line therapy after Rd, the number of life years gained in the target population due to greater efficacy is higher by 291.50 years compared with K+Rd and by 203.93 years compared with Ixa+Rd. The ICER per 1 life year gained for Dara+Rd is also lower than the ICER reference value: 9.25 mln rubles versus 13.64 mln rubles. The budget impact analysis showed that using Dara in early stages of MM therapy does not increase drug provision costs in the target population.Conclusion. The obtained results allowed to conclude that it is economically feasible to add Dara to the 1st and 2nd lines of therapy in lenalidomide treatment programs for MM patients who are not candidates for HDCT with autoHPSCT.

Budget Impact Analysis of Circulating Tumor DNA Testing for Colon Cancer in Commercial Health and Medicare Advantage Plans

In a randomized clinical trial, treatment guided by tumor-informed circulating tumor (ct)DNA testing reduced adjuvant chemotherapy use without compromising recurrence-free survival in patients with stage II colon cancer. The potential effects of adopting ctDNA testing into routine patient care is unknown. To compare the total cost of patient care scenarios with and without the adoption of ctDNA testing. This budget impact analysis was conducted from the perspectives of US commercial health and Medicare Advantage payers. A decision-analytical model was populated with age-specific incidence of colon cancer, use of adjuvant chemotherapy, and use of single-agent or multiagent regimens. Total cost was estimated with the costs of ctDNA testing, drug acquisition, administration, surveillance, and adverse events. The analysis was conducted from September 2023 to January 2024. The adoption of ctDNA testing. The incremental cost in the first year following the adoption of ctDNA testing, where testing will affect patient treatment and costs. In hypothetical plans with 1 million individuals covered, 35 commercial health plan members and 102 Medicare Advantage members aged 75 years and younger were eligible for ctDNA testing. In the base case with a 50% adoption rate, total cost savings were $221 684 (equivalent to $0.02 per member per month [PMPM]) for a commercial payer and $116 720 (equivalent to $0.01 PMPM) for a Medicare Advantage payer. Cost savings were robust to variations in assumptions of all parameters in the commercial population but sensitive to variations in assumptions of adjuvant chemotherapy use rates in the Medicare Advantage population. The number needed to test to avoid 1 patient receiving adjuvant chemotherapy was 4 in the commercial population and 10 in the Medicare Advantage population. The budget-neutral cost for ctDNA testing was $16 202 for a commercial payer and $5793 for a Medicare Advantage payer. Use of tumor-informed ctDNA testing to guide adjuvant chemotherapy in postsurgery patients with stage II colon cancer was projected to result in cost savings for both commercial and Medicare Advantage payers. Adoption of ctDNA testing is therefore advantageous from a budgetary perspective.

Farm Partial Budget Analysis of Onion (Allium Cepa L.) for the Application of Nitrogen and Spacing in Southern Tigray, Ethiopia

This study aimed to assess the economic viability of onion production under varying nitrogen fertilizer rates and intra-row spacing in the study area using partial budget analysis. The experiment employed a factorial arrangement in a randomized complete block design, conducted at Alamata Agricultural Research Center in Kara Adishabo in 2020. Experimental treatments included nitrogen fertilizer rates (0, 23, 46, 69, and 92 Kg N ha-1) and intra-row spacing (5, 10, and 15 cm) with three replications. The partial budget analysis indicated that the treatment combination of 69 kg N ha-1 and 5 cm intra-row spacing yielded the highest net benefit of birr 642602.3. However, based on the marginal rate of return, the recommendation of 46 Kg N ha-1 and 15 cm intra-row spacing, which had a lower net benefit, was rejected after residual analysis. Consequently, the recommended treatment combination is 69 Kg N ha-1 and 5 cm of intra-row spacing, contrary to the previous recommendation. Onion cultivation is a significant economic activity in the southern zone, playing a crucial role in the livelihoods of smallholder farmers. Consequently, understanding the production costs and analyzing the financial profitability of this on-farm business is essential in the study area to enhance crop productivity.

How Economists Could Help Inform Economic and Budget Analysis Used by the US Congress

The US Congress uses economic and budgetary projections, cost estimates for proposed legislation, and other analyses provided by the Congressional Budget Office (CBO) as part of its legislative process. CBO makes assessments based on an understanding of federal programs and revenue sources, reading the relevant research literature, analysis of data, and consultation with outside experts—and often relies on economic research. This article begins with a discussion of the role of the Congressional Budget Office and then discusses how economists could conduct research that would help inform the Congress by improving the quality of the analysis and parameter estimates that CBO uses. It gives overall context and specific examples in seven areas: credit and insurance, energy and the environment, health, labor, macroeconomics, national security, and taxes and transfers.

Economic Evaluation of an Integrated Care Program Compared to Conventional Care for Patients With Chronic Kidney Disease in Rural Communities of Thailand

IntroductionAn integrated care program for chronic kidney disease in Thailand has shown its effectiveness in delaying the decline in kidney function, as evidenced by the ESCORT-1 randomized control trial and the ESCORT-2 prospective cohort study. Designed for sustainability within the primary healthcare system, the program optimizes the use of the existing workforce by fostering collaboration among local multidisciplinary care teams and community care networks. MethodsA Markov model with a lifetime horizon was used to conduct a cost-utility analysis from a societal perspective. Individual participant level data from ESCORT studies, national registries, and relevant literature were used to estimate model parameters. A budget impact analysis from the payer’s perspective was also assessed over a five-year period. ResultsThe integrated care program yielded a dominant result with 1.84 QALYs gained with “less” lifetime cost, resulting in a negative incremental cost-effectiveness ratio. Probabilistic analysis showed that the intervention being cost-effective almost 100% of the time at the local willingness-to-pay threshold. The intervention maximized cost-effectiveness when delivered as early as possible, both in terms of age and stage. The budget impact analysis estimated that the introduction of the intervention could save about 7% of the Thai government's total health expenditure or 205 billion Thai-Baht ($5.9 billion) over five years with cost savings beginning from the third year onwards. ConclusionThe integrated care program for CKD offers potential benefits and cost savings for patients, caregivers, and payers. Future efforts should focus on the screening and implementation processes across various regions and healthcare settings.

Cost-Effectiveness and Budget Impact Analysis of the Implementation of Differentiated Service Delivery Models for HIV Treatment in Mozambique: a Modelling Study.

In 2018, the Mozambique Ministry of Health launched guidelines for implementing differentiated service delivery models (DSDMs) to optimize HIV service delivery, improve retention in care, and ultimately reduce HIV-associated mortality. The models were fast-track, 3-month antiretrovirals dispensing, community antiretroviral therapy groups, adherence clubs, family approach and three one-stop shop models: adolescent-friendly health services, maternal and child health, and tuberculosis. We conducted a cost-effectiveness analysis and budget impact analysis to compare these models to conventional services. We constructed a decision tree model based on the percentage of enrolment in each model and the probability of the outcome (12-month retention in treatment) for each year of the study period-three for the cost-effectiveness analysis (2019-2021) and three for the budget impact analysis (2022-2024). Costs for these analyses were primarily estimated per client-year from the health system perspective. A secondary cost-effectiveness analysis was conducted from the societal perspective. Budget impact analysis costs included antiretrovirals, laboratory tests and service provision interactions. Cost-effectiveness analysis additionally included start-up, training and clients' opportunity costs. Effectiveness was estimated using an uncontrolled interrupted time series analysis comparing the outcome before and after the implementation of the differentiated models. A one-way sensitivity analysis was conducted to identify drivers of uncertainty. After implementation of the DSDMs, there was a mean increase of 14.9 percentage points (95% CI: 12.2, 17.8) in 12-month retention, from 47.6% (95% CI, 44.9-50.2) to 62.5% (95% CI, 60.9-64.1). The mean cost difference comparing DSDMs and conventional care was US$ -6 million (173,391,277 vs. 179,461,668) and -32.5 million (394,705,618 vs. 433,232,289) from the health system and the societal perspective, respectively. Therefore, DSDMs dominated conventional care. Results were most sensitive to conventional care interaction costs in the one-way sensitivity analysis. For a population of 1.5 million, the base-case 3-year financial costs associated with the DSDMs was US$550 million, compared with US$564 million for conventional care. DSDMs were less expensive and more effective in retaining clients 12 months after antiretroviral therapy initiation and were estimated to save approximately US$14 million for the health system from 2022 to 2024.

The Role of Atmospheric Stabilities and Moisture Convergence in the Enhanced Dry Season Precipitation over Land from 1979 to 2021

Abstract Between 1979 and 2021, global ocean regions experienced a decrease in dry season precipitation, while the trend over land areas varied considerably. Some regions, such as southeastern China, the Maritime Continent, eastern Europe, and eastern North America, showed a slight increasing trend in dry season precipitation. This study analyzes the potential mechanisms behind this trend by using the fifth major global reanalysis produced by ECMWF (ERA5) data. The analysis shows that the weakening of downward atmospheric motions played a critical role in enhancing dry season precipitation over land. An atmospheric moisture budget analysis revealed that larger convergent moisture fluxes lead to an increase in water vapor content below 400 hPa. This, in turn, induced an unstable tendency in the moist static energy profile, leading to a more unstable atmosphere and weakening downward motions, which drove the trend toward increasing dry season precipitation over land. More water vapor in the low troposphere is because of higher moisture convergence and moisture transport from ocean to land regions. In summary, this study demonstrates the intricate elements involved in altering dry season rainfall trends over land, which also emphasizes the importance of comprehending the spatial distribution of the wet-get-wetter and dry-get-drier paradigm. Significance Statement This study found that global land precipitation during the dry season slightly increased from 1979 to 2021, while precipitation over oceans declined. Moist static energy analysis showed a trend toward less stability in areas with increased dry season precipitation and the opposite trend in regions with declining precipitation. Water vapor content trends and dynamic components were the primary controlling mechanism for precipitation trends. Furthermore, the hotspots with pronounced increases or decreases in dry season precipitation reflect local circulation changes influenced by anthropogenic or natural factors.

Supercells and Tornado‐Like Vortices in an Idealized Global Atmosphere Model

AbstractWe investigate the representation of individual supercells and intriguing tornado‐like vortices in a simplified, locally refined global atmosphere model. The model, featuring grid stretching, can locally enhance the model resolution and reach cloud‐resolving scales with modest computational resources. Given a conditionally unstable sheared environment, the model can simulate supercells realistically, with a near‐ground vortex and funnel cloud at the center of a rotating updraft reminiscent of a tornado. An analysis of the Eulerian vertical vorticity budget suggests that the updraft core of the supercell tilts horizontal vorticity into the tornado‐like vortex, which is then amplified through vertical stretching by the updraft. Results suggest that the simulated vortex is dynamically similar to observed tornadoes, as well as those simulated in modeling studies at much higher horizontal resolution. Lastly, we discuss the prospects for the study of cross‐scale interactions involving supercells.

Feasibility Assessment of a Small-Scale Agrivoltaics-Based Desalination Plant with Flywheel Energy Storage—Case Study: Namibia

As climate change and population growth threaten rural communities, especially in regions like Sub-Saharan Africa, rural electrification becomes crucial to addressing water and food security within the energy-water-food nexus. This study explores social innovation in microgrid projects, focusing on integrating micro-agrovoltaics (APV) with flywheel energy storage systems (FSSs) and small-scale water desalination and purification plants. Employing a mixed-methods approach to assess the economic viability of FSS and APV-powered desalination, we believe that social innovation could serve as a significant tool for rural development, requiring collaboration between governments, the private sector, and nonprofit organizations. While FSS technology for microgrids has not been entirely developed, it holds promise as an alternative energy storage solution. Our capital budgeting analysis, presented within the context of social innovation, reveals positive Net Present Values (NPV) and a short payback period over the project’s 20-year lifespan.

The influence of atmospheric deposition and climate change driven catchment internal processes on the recovery from acidification of high-altitude Alpine lakes

The impact of atmospheric deposition and environmental factors on catchment processes and water chemistry of 20 high-altitude Alpine lakes in Southern Switzerland was investigated over four decades. Through the analysis of input-output budgets of sulphur (S), nitrogen (N), base cations and alkalinity significant trends emerged. Notably, S and N input concentrations significantly declined since the 1980s, by approximately 78 % and 22 %, respectively, with N primarily declining after 2000. Recovery from acidification was slightly delayed, likely due to the increased release of S, possibly originating from legacy S pools, alongside the simultaneous reduction in leaching of base cations from exchange sites. Catchments heavily impacted by thawing cryospheric features increasingly released S and base cations due to enhanced weathering processes, with hardly any impact on the recovery process, as evidenced by the balanced releases of S and base cations. N output concentrations followed the decrease of N input concentrations, while the relative N retention in the catchments remained relatively stable. Recently, both input concentrations of S and N have stabilised, while output concentrations of base cations began to increase across all catchments. The trend likely arises from the stabilisation of S and N input concentrations and/or the ongoing increase in weathering rates induced by climate change. Consequently, there was a consistent rise in alkalinity output concentrations even after the stabilisation of the S and N input concentrations. Ion ratio analysis suggests that carbonation primarily drives weathering processes in catchment areas unaffected by thawing cryosphere, while in areas impacted by thawing cryosphere, sulphide oxidation (or sulphate dissolution) is the dominant process. Further recovery depends on future N deposition and the effects of climate change.

The Use of Precision Epigenetic Methods for the Diagnosis and Care of Stable Coronary Heart Disease Reduces Healthcare Costs.

The cost of secondary prevention of coronary heart disease (CHD) is continuing to increase, with a substantial portion of this acceleration being driven by the expense of confirmatory diagnostic testing. Conceivably, newly developed precision epigenetic technologies could drive down these costs. However, at the current time, their impact on overall expense for CHD care is poorly understood. We hypothesized that the use of a newly developed, highly sensitive, and specific epigenetic test, PrecisionCHD, could decrease the costs of secondary prevention. To test this hypothesis, we constructed a budget impact analysis using a cost calculation model that examined the effects of substituting PrecisionCHD for conventional CHD diagnostic tests on the expenses of the initial evaluation and first year of care of stable CHD using a 1-year time horizon with no discounting. The model projected that for a commercial insurer with onemillion members, full adoption of PrecisionCHD as the primary method of initial CHD assessment would save approximately $113.6million dollars in the initial year. These analyses support the use of precision epigenetic methods as part of the initial diagnosis and care of stable CHD and can meaningfully reduce cost. Real-world pilots to test the reliability of these analyses are indicated.

Chickpea (Cicer arietinum L.) growth, nodulation, and yield as affected by varieties, Mesorhizobium strains, and NPSB fertilizer in Southern Ethiopia.

A significant legume crop in Ethiopia, chickpeas (Cicer arietinum L.) have several advantages, including high nutritional value and the capacity to improve soils deficient in nitrogen through biological nitrogen fixation using several endosymbiotic Mesorhizobium spp. strains. However, the host variety, the soil's capacity to hold nutrients, and the endosymbiont's innate physiological traits all affect how efficient the strains are. The primary obstacles to its cultivation in the research area are inadequate agronomic methods and low soil fertility [low nitrogen (N), low soil organic matter (OM), low accessible phosphorous (P), sulfur (S), and boron (B)], which results in ineffective nodulation. To evaluate the effects of NPSB fertilization and inoculation, a field experiment was carried out in Buchach Kebele's Cheha area during the primary cropping season of 2021/22. The trial included two chickpea kinds (Local and Arerti), two NPSB levels (zero and 121 kg NPSB ha-1), and four levels of Mesorhizobium strains (CP-M41, CP-EAL 029, CP-M20b, and un-inoculated control). A randomized complete block design (RCBD) was used to organize the treatments in a factorial form with three replications. In comparison to the single application and the control, the interaction impact of strains, NPSB fertilizer, and variety greatly increased nodulation parameters, growth parameters, yield, and yield components. The Arerti variety combined with the CP-M41 Mesorhizobium strain and NPSB fertilizer had the maximum grain production (3177.16 kg ha-1). It yielded 15.96%, 24.06%, and 37.93% more than the Arerti with CP-M41 strain, Arerti with NPSB, and the control treatments, respectively. The partial budget analysis of the study treatments showed that the Arerti variety with the combined application of 121 kg NPSB ha-1 and Mesorhizobium strain CP-M41 inoculation produced the highest net return (102,092.6 ETB ha-1) with an acceptable marginal rate of return (618%). It has been found that the CP-M41 strain and the Arerti variety, when combined with 121 kg NPSB ha-1 application, is a suitable treatment combination to achieve increased chickpea crop yield and profit in the studied area. However, the results need further validation in the farmer's field before recommending to farmers.

Water Budget for Lake Trafford, a Natural Subtropical Lake in South Florida: An Example of Enhanced Groundwater Influx in a Subtropical Lake Subsequent to Organic Sediment Dredging

A very detailed water budget analysis was conducted on Lake Trafford in South Florida. The inflow was dominated by surface water influx via five canals (61%), with groundwater influx constituting 12% and direct rainfall constituting 27%. Lake discharge was dominated by sheet flow (69%) and evapotranspiration (30.5%), with groundwater recharge of the hydraulically connected unconfined aquifer accounting for only 0.5%. The removal of 30 M tons (4.4 × 106 m3) of organic sediment impacted the groundwater influx, causing enhanced groundwater flow into the deeper parts of the lake and mixed flow along the banks, creating a rather unusual pattern. The large number of groundwater seepage meters used during this investigation led to a very reliable set of measurements with occasional failure of only a few meters. A distinctive relationship was found between the wet-season lake stage, heavy rainfall events, and pulses of exiting sheet flow from the lake. Estimation of the evapotranspiration loss using data collected from a weather station on the lake allowed the use of three different models, which, when averaged, produced results comparable to Lake Okeechobee (South Florida). A limitation of this investigation was the inability to directly measure sheet-flow discharges, which had to be estimated as a residual within the calculated water budget.

Health and economic impact of dapagliflozin for type 2 diabetes patients who had or were at risk for atherosclerotic cardiovascular disease in the Italian general practitioners setting: a budget impact analysis

AimIn 2022, in Italy, general practitioners (GPs) have been allowed to prescribe SGLT2i in Type 2 Diabetes (T2D) under National Health Service (NHS) reimbursement. In the pivotal clinical trial named DECLARE-TIMI 58, dapagliflozin reduced the risk of hospitalization for heart failure, CV death and kidney disease progression compared to placebo in a population of T2D patients. This study evaluated the health and economic impact of dapagliflozin for T2D patients who had or were at risk for atherosclerotic cardiovascular disease in the Italian GPs setting.MethodsA budget impact model was developed to assess the health and economic impact of introducing dapagliflozin in GPs setting. The analysis was conducted by adopting the Italian NHS perspective and a 3-year time horizon. The model estimated and compared the health outcomes and direct medical costs associated with a scenario with dapagliflozin and other antidiabetic therapies available for GPs prescription (scenario B) and a scenario where only other antidiabetic therapies are available (scenario A). Rates of occurrence of cardiovascular and renal complications as well as adverse events were captured from DECLARE-TIMI 58 trial and the literature, while cost data were retrieved from the Italian tariff and the literature. One-way sensitivity analyses were conducted to test the impact of model parameters on the budget impact.ResultsThe model estimated around 442.000 patients eligible for the treatment with dapagliflozin in the GPs setting for each simulated year. The scenario B compared to scenario A was associated with a reduction in the occurrence of cardiovascular and renal complication (−1.83%) over the 3 years simulated. Furthermore, the scenario A allowed for an overall cost saving of 102,692,305€: 14,521,464€ in the first year, 33,007,064€ in the second and 55,163,777€ in the third. The cost of cost of drug acquisition, the probability of cardiovascular events and the percentage of patients potentially eligible to the treatment were the factor with largest impact on the results.ConclusionsThe use of dapagliflozin in GPs setting reduce the number of CVD events, kidney disease progression and healthcare costs in Italy. These data should be considered to optimize the value produced for the T2D patients who had or were at risk for atherosclerotic cardiovascular disease.

The business case for hospital mobility programs in the veterans health care system: Results from multi-hospital implementation of the STRIDE program.

To conduct a business case analysis for Department of Veterans Affairs (VA) program STRIDE (ASsisTed EaRly MobIlization for hospitalizeD older VEterans), which was designed to address immobility for hospitalized older adults. This was a secondary analysis of primary data from a VA 8-hospital implementation trial conducted by the Function and Independence Quality Enhancement Research Initiative (QUERI). In partnership with VA operational partners, we estimated resources needed for program delivery in and out of the VA as well as national implementation facilitation in the VA. A scenario analysis using wage data from the Bureau of Labor Statistics informs implementation decisions outside the VA. This budget impact analysis compared delivery and implementation costs for two implementation strategies (Replicating Effective Programs [REP]+CONNECT and REP-only). To simulate national budget scenarios for implementation, we estimated the number of eligible hospitalizations nationally and varied key parameters (e.g., enrollment rates) to evaluate the impact of uncertainty. Personnel time and implementation outcomes were collected from hospitals (2017-2019). Hospital average daily census and wage data were estimated as of 2022 to improve relevance to future implementation. Average implementation costs were $9450 for REP+CONNECT and $5622 for REP-only; average program delivery costs were less than $30 per participant in both VA and non-VA hospital settings. Number of walks had the most impact on delivery costs and ranged from 1 to 5 walks per participant. In sensitivity analyses, cost increased to $35 per participant if a physical therapist assistant conducts the walks. Among study hospitals, mean enrollment rates were higher among the REP+CONNECT hospitals (12%) than the REP-only hospitals (4%) and VA implementation costs ranged from $66 to $100 per enrolled. STRIDE is a low-cost intervention, and program participation has the biggest impact on the resources needed for delivering STRIDE. ClinicalsTrials.gov NCT03300336. Prospectively registered on 3 October 2017.

Effects of fertilizer levels and varieties on fodder yield productivity, nutrient use efficiency, and profitability of oat (Avena sativa L.) in the central highlands of Ethiopia

This study aimed to assess the effect of fertilizer rates on agro-morphological traits, nutrient uptake and use efficiency, and economic feasibility of fodder yield in oat. The study was carried out using a factorial arrangement of eight fertilizer rates (0, 25, 50, 75, 100, 125, 150, and 175 %) and three oat varieties (CI-8251, SRCPX80Ab2291, and Sorataf) in a randomized complete block design with three replications. The results revealed that variety, fertilizer, and year had a significant effect on fodder yield. The fodder yield increased up to 175 % of the blanket recommended fertilizer and application of 100, 125, 150, and 175 % produced fodder yield of 14.0, 15.6, 15.8, and 15.9 t/ha, respectively. The fodder type oat (CI-8251) and dual type oat (SRCPX80Ab2291) variety had 15.4 and 10.6 % fodder yield advantages over grain type oat (Sorataf), respectively. Significantly higher fodder yield was obtained in 2021 than 2020 cropping season. Moreover, the interaction effect of variety by fertilizer by year was significant for nitrogen and phosphorus concentrations, nitrogen and total nutrient uptake, partial factor productivity, internal utilization efficiency, agronomic efficiency, and agro-physiological efficiency. The Pearson correlation analysis indicated that the number of tillers per plant, yields of morphological fractions (leaf, stem, and panicle), forage yield production rate, nutrient concentration, and uptake had significant positive associations with fertilizer levels and fodder yield. In contrast, all nutrient use efficiency except agro-physiological efficiency had inverse associations with fertilizer levels and fodder yield. The combined partial budget analysis for the three oat varieties showed that the application of 125 % fertilizer produced a higher net benefit (83,440 ETB) and marginal rate of return (12,635.6 %). Therefore, the blanket recommended fertilizer rate of 125 % (51.3 kg N + 25 kg P/ha) could increase fodder yield and farm profitability in the study area.