Cost Barriers Research Articles

Assessing the Effectiveness of Local and International Food Safety Standards in Small and Medium‐Sized Enterprises (SMEs) of Pakistan

Pakistani small and medium‐sized enterprises (SMEs) have an important role and contribute less than other countries, yet their significance cannot be denied. The SME sector is confronted with multiple problems, including export issues because of the trust factor and least knowledge of the latest food safety standards, which have made it difficult to contribute to the GDP of the nation. Various standards such as Food Safety, HACCP, GGAP YUM GAP, MacDonald’s GAP, ISO 9001, and ISO 14001 are being implemented in Pakistan for decades. This study was designed to highlight the critical issues of Pakistani SMEs in adopting management systems, i.e., food safety management systems. Data from 107 SMEs from different fields (beverages, baking, meat, postharvest processing, etc.) of Pakistan were collected through a detailed questionnaire and fed to SPSS V 26.0 for statistical illustration and articulation of the results. In this study, SME company profiles were analyzed and showed that 43% had 6–20 employees, 78.5% were manufacturers, and 68.2% were in business for 7–15 years. The focus was on sales growth (35.5%), profit growth (38.3%), return on assets (42.1%), gross revenues (47.7%), net cash flow (46.7%), customer satisfaction (47.7%), and customer satisfaction relative to competitors (46.7%). A total of 21.5% of SMEs implemented local standards, 23.4% implemented international standards, and 54.2% implemented both local and international standards. Certification benefits included establishing an effective system (62.6% agreed), understanding roles and responsibilities (76.6% agreed), and more efficient documentation (60.7% agreed). However, 29.9% and 24.3% of respondents found international standards such as FSSC 22000 and BRC challenging to apply in local organizations due to language and cost barriers. Above all, the current study implies the dire need for the development of Pakistan’s food safety management system (PFSMS) standard. The PFSMS should be easy to understand, low in cost, and highly applicable in different sectors of the SMEs in Pakistan.

Uptake and Barriers of HPV Vaccine by 10-Year-Old School-Going Girls in Kisumu County, Kenya

Background: Cervical cancer is the most common gynaecological cancer and a significant cause of Disability-Adjusted Life Years (DALYs). It is estimated that 85% of cervical cancer cases are in low- and middle-income countries. Kenya became the 16th African country to introduce the HPV vaccine into its routine immunization schedule. The main hindrance was initially the cost, but even as the vaccine has been rolled out free of charge, we still have acceptability and uptake challenges. Objectives: To determine the uptake of the HPV vaccine by 10-year-old school-going girls in Kisumu County and to assess the factors associated with parental acceptability of the HPV vaccine in Kisumu County, using the Health Belief Model. Methods: We conducted a mixed-method analysis of the uptake of the HPV vaccine by 10-year-old school-going girls in Kisumu County and the factors affecting parental acceptability. The study’s first phase was a cross-sectional quantitative study, where secondary data of randomly sampled 384 girls, ten years of age, was collected from the school registry retrospectively between December 2019 and December 2021. A descriptive analysis was conducted. The results were presented in frequency and percentage. 34 parents purposively sampled for the FGDs. Transcripts were analyzed from the four focus groups in rural and urban Kisumu. Results: The average uptake of the HPV vaccine in Kisumu County was (252) 65.63% (n=384). Only (119) 30.98% were fully vaccinated, while 26.82% (103) were partially vaccinated. 34.37% were not vaccinated during the study period. Upon analysis of the qualitative data from the focused group discussion (FGDs), four main themes emerged as regards the HBM: the lack of knowledge and misinformation about Human Papillomavirus, cervical cancer, and the HPV vaccine, the fear of the HPV vaccine side effects, non-vaccine costs like transportation cost and institutional barriers like availability of the vaccine and proximity to a facility offering the vaccine services. Conclusion: The study confirms that the HPV vaccination uptake is low, especially for the two doses. The study findings indicate that many parents and guardians did not possess vital information regarding the HPV vaccine that would enable them to allow their daughters to receive the vaccine. Recommendations: It is, therefore, imperative that policymakers investigate and verify the efficacy of a single dose of the HPV vaccine and shift to one dose, and also employ other modalities of HPV vaccination campaigns to include door-to-door campaigns. Moreover, vital information regarding the causal relationship between the HPV cervical cancer and the HPV vaccine, and the side effects should be part of the disseminated information to the target groups.

Virtual Reality and Surgical Simulation Training for Orthopaedic Surgery Residents: A Qualitative Assessment of Trainee Perspectives.

The demonstrated benefits of virtual reality (VR) in orthopaedic surgical training are numerous. However, it is relatively unknown how best to implement VR into an already established orthopaedic resident education curriculum and how trainees will engage and use these technologies longitudinally. This was an exploratory, qualitative research study performed in accordance with Consolidated Criteria for Reporting Qualitative Research guidelines. Orthopaedic surgery residents at a single institution were recruited during the 2022 to 2023 academic year. Semistructured interviews were conducted. Data were analyzed through grounded theory methodology, beginning with open coding, followed by axial coding, and concluding with selective coding that describes orthopaedic surgery residents' current perceptions of VR as a training tool. Six residents participated in interviews before thematic saturation was achieved. Average interview length was 13:27 (±2:59) minutes. Residents felt that currently, VR is most useful for interns and junior residents as an educational adjunct for learning anatomy, surgical exposures, and the steps of a procedure in a risk- and judgment-free arena. There seems to be a "ceiling effect" with VR given current technological limitations, and residents remarked that there is an associated "opportunity cost" with using VR technology. Some residents may find it more time-efficient to study texts, videos, or surgical guides rather than use VR. Cost (limited number of headsets) and technological barriers (i.e., hardware, software, and Wi-Fi issues) were some of the described barriers to VR utilization. Residents felt that there needs to be dedicated technological support to help with these issues. At this time, given these limitations of VR, many preferred VR as an optional educational adjunct rather than as a required curricular tool or assessment of surgical competency. There is current utility for VR in orthopaedic surgical training. Future technological advances may make VR more central to resident education. This study describes resident perceptions about the technology and best use practices for the technology. Qualitative Study, Level V Evidence.

Problems in Veterinary Pathology: A Focus on Diagnosis

Veterinary pathology is a critical field in veterinary medicine, necessary for the diagnosis of diseases in animals. However, it is faced with numerous challenges that impact the accuracy and efficiency of diagnoses. This manuscript explores into the multifaceted issues within this field, and emphasised on diagnostic challenges. Key areas of concern include the complexity of differentiating between similar pathological conditions, the limitations of current diagnostic tools and techniques, and the variability in the manifestation of diseases across different species. Furthermore, the manuscript highlights the shortage of specialised pathologists, which exacerbates diagnostic delays and errors. Advanced diagnostic technologies, such as molecular pathology and digital imaging, are explored for their potential to enhance diagnostic precision, yet their high cost and limited accessibility present significant barriers. The integration of artificial intelligence and machine learning in veterinary diagnostics is also discussed as a promising avenue to overcome some of these obstacles. Case studies illustrating common diagnostic pitfalls and their consequences on animal health are provided, underscoring the need for continuous education and training in this rapidly evolving field. In conclusion, there is need for a concerted effort to standardise diagnostic procedures and improve collaboration among veterinary pathologists, clinicians, and researchers. By addressing these challenges, the veterinary pathology community can improve diagnostic accuracy, ultimately enhancing animal health outcomes.

Assessing the cost barrier for small and medium food processing businesses to meet Preventive Controls for Human Foods standards.

The Preventive Controls for Human Food Rule regulation under the Food Safety Modernization Act sets new food safety standards. Both food safety educators and small and medium sized food processing businesses that manufacture certain value-added or processed foods lack knowledge regarding costs to prepare, implement, and manage ongoing food safety practices under the new standards. Current food safety training materials do not acknowledge costs or provide content addressing potential costs, and food safety educators do not have information needed to guide development of relevant materials that address costs. We combine economics and food science principles and use mixed methods to identify and estimate cost barriers for food processing businesses through an interdisciplinary research and extension project in the Northeast U.S. We first modify Preventive Controls extension programming to acknowledge costs and test how modified programming improves self-reported knowledge about costs. Materials that acknowledge that costs are associated with meeting standards significantly increases participants' self-reported perceived knowledge of costs by 1.3 points on a 1-to-5-point Likert scale. Compared with programming areas in which detailed content is provided, however, improvements in knowledge of costs lags behind overall knowledge gains (3.2 for costs versus 4.1 for food safety content). To fill this content gap, we next conduct semi-structured group interviews with a subset of participants (N = 10), develop a costs analysis framework, and measure actual costs associated with Preventive Controls. We find that initial costs average $20,000 per business to plan, implement, and manage standards, and almost $8,000 in every subsequent year to manage. We demonstrate that even modest interventions can reduce cost barriers for businesses seeking to meet compliance standards. We provide food safety educators with concrete cost information to support businesses to pursue Preventive Controls standards. Study results imply that low-cost methods could improve food safety in mid-scale supply chains.

Managing diabetes and hypertension in western Kenya: A qualitative study of experiences of patients supported by the primary health integrated care for chronic conditions (PIC4C) model of care.

The Primary Health Integrated Care for Chronic Conditions (PIC4C) pilot project was launched in 2018 to strengthen prevention and control of four non-communicable conditions at primary health care level in western Kenya. We conducted a qualitative study to explore the extent to which PIC4C integrated services supported people with hypertension and/or diabetes towards timely diagnosis and referral, treatment, follow-up and adherence, from the perspective of those receiving care. Semi-structured interviews were conducted with a purposively sampled patient cohort at two time points, with the intention of capturing changes over time (total (n) = 43, completion of both interviews (n) = 37). We extracted existing survey data to describe socio-demographic characteristics and analyzed qualitative data thematically. We identified two cross-cutting contextual factors, individual's financial resources and their social situation, which shaped each stage of their interactions with PIC4C services. The PIC4C model successfully engaged people in accessing screening services to enable timely diagnosis and referred them to enter care. Free community level screening services and decentralization of care to lower level facilities reduced cost barriers for patients. However, retention in care and adherence to treatment were affected by the wider system context in which PIC4C was operating, including inconsistencies in medication availability and patients' limited financial capacity. Individually tailored advice from health care workers to work around some of these challenges supported self-management strategies. Further development of the service should focus on supporting health care workers to adopt flexible, contextually responsive approaches in order to support patients facing economic and other constraints to engage in (self) care.

Unmet need for primary health care and subsequent inpatient hospitalisation in Aotearoa New Zealand. A cohort study.

Introduction The inability to afford a consultation with a general practitioner may lead to delays in accessing care pathways. Aim This study aimed to explore the characteristics of people by their unmet need for a general practitioner consultation because of cost, and the characteristics of subsequent inpatient hospitalisations. Methods From the New Zealand Health Surveys (2013/14-2018/19), two groups were formed based on their unmet need for a general practitioner consultation due to cost. These groups were compared by socio-demographic factors and subsequent inpatient hospitalisation characteristics during follow-up. Time to an inpatient hospitalisation was the outcome in a proportional hazards regression model with need status as the key variable. The model was expanded to include confounding variables: sex, age group, ethnicity, the New Zealand Deprivation Index and self-rated health. Results The need group, characterised by having a higher proportion of females, younger adults, Māori, increased socioeconomic deprivation and poorer self-rated health experienced a greater chance of hospitalisation, a similar number of visits during follow-up, shorter stays and a quicker time to hospitalisation compared to the no-need group. Proportional hazards survival models gave a 28% higher hazard rate for the time to an inpatient hospitalisation for the need group compared to the no-need group. The inclusion of all the confounders in the model gave a similar hazard ratio. Discussion Although consultation fees vary across general practices, it is evident that this may not eliminate the cost barriers to accessing care for some groups. Needing multiple consultations may contribute to persistent unmet needs.

Driving the Future: Design and Implementation of an Advanced Smart Car Network Simulation Platform for Education

— Incorporating smart car network education into an academic setting often faces a substantial cost barrier. Traditionally, creating a realistic learning environment involved significant investments, such as procuring an actual smart car or specialized automotive-grade testing equipment. However, these approaches pose challenges, especially in resource-constrained educational contexts. This project addresses these challenges by introducing an innovative solution—a smart car education platform. Our objective is to design and implement this platform using a limited number of microcontrollers and components extracted from modern vehicles, enabling the creation of a lifelike simulation of genuine smart car networks. By adopting this approach, we enhance accessibility for students interested in gaining practical insights into automotive networks, offering a more pragmatic and cost-effective educational pathway.

Attitudes, subjective norms and perceived behavioural control factors influencing Canadian secondary school students' milk and milk alternatives consumption.

The research objectives were to evaluate factors that influence Canadian secondary school students' milk and milk alternatives (MMA) consumption and to explore associations through age and gender lenses. A qualitative design was used, consisting of semi-structured interviews and photo-elicitation methods. Analysis was guided by the Theory of Planned Behaviour (TPB). Deductive and inductive thematic analyses were used to generate themes, charting data based on attributes such as gender and age. Interviews were held virtually or via telephone. Participants were twenty-eight high school students from Ontario, Canada, diverse in terms of gender and age. Both desirable and undesirable beliefs about the health outcomes of consuming MMA were commonly discussed. These included health benefits such as strong bones, muscular strength, and growth, and health consequences like unwanted skin conditions, weight gain, and diseases. While boys and girls associated MMA consumption with muscular strength, boys predominantly considered this favourable, while girls discussed outcomes like unwanted skin conditions and weight gain more often. Adolescents' perspectives on taste/perceived enjoyment, environmentally friendly choices and animal welfare also influenced their MMA preferences. Parental influences were most cited among social factors, which appeared to be stronger during early adolescence. Factors involving cost, time and accessibility affected adolescents' beliefs about how difficult it was to consume MMA. Recommendations for shifting attitudes towards MMA are provided to address unfavourable beliefs towards these products. Interventions to increase MMA consumption among adolescents should include parents and address cost barriers.

Knowledge and intentions to use fertility preservation among urban Chinese cancer patients: A study from Hong Kong.

To assess the knowledge levels and fertility preservation (FP) intentions of urban Chinese cancer patients. A cross-sectional study was conducted on Hong Kong Chinese male and female cancer patients aged 18-54 years (N = 325) who were recruited by a local non-governmental organization for cancer patients between July 2020 to January 2021. Patients completed a self-administered questionnaire on knowledge, perceptions, and intentions to use FP services/seek FP-related information. Multivariable logistic regression was used to explore the correlates of intention to seek additional FP information and intention to undergo FP treatments. Although cancer patients demonstrated a good knowledge of the available FP treatment options, they were less knowledgeable about the legal restrictions of these procedures. Only one in seven cancer patients first became aware of FP through a health provider and the majority of cancer patients felt they did not have adequate knowledge about FP to make informed FP decisions at the current time. Yet, over one-third of cancer patients would consider FP options even if their cancer or cancer treatment had < 5% chance of causing infertility, and 13.4% of females and 14.6% of males would delay their cancer treatment by ≥ 3 months to undergo FP procedures. However, for both sexes, the main perceived barrier to obtaining FP was its financial cost. Patients with older-aged spouses were less likely to seek FP treatments or seek more information about FP. There is an unmet need for more FP information and FP services for reproductive-aged cancer patients in East Asian populations. Greater integration of FP services into cancer treatment requires a reduction of cost barriers, greater provision of timely FP information, and improved referral systems.

Research on the Development Path of Green Building Industry under the "Dual Carbon" Goal

The green building industry plays a crucial role in achieving the "dual carbon" goals by reducing carbon emissions. This article first explores the definition and significance of green buildings, and outlines their environmental, economic, and social benefits. Then the focus was on discussing the development path, including low-carbon strategies, sustainable materials, and integration of intelligent technologies. Finally, opportunities for market growth were explored, such as increasing environmental awareness and government support, as well as challenges, including cost barriers and a lack of skilled labor. By addressing these challenges, the green building industry can make significant contributions to a more sustainable and low-carbon future.

Abortion Clients’ Perceptions of Alternative Medication Abortion Service Delivery Options in Mississippi

ObjectivesWe assessed Mississippi abortion clients’ perceptions of alternative medication abortion service delivery options that were restricted under state law but available elsewhere. MethodsWe conducted in-depth interviews with medication abortion clients between November 2020 and March 2021 at Mississippi's only abortion facility. We described alternative service delivery models: telemedicine, medications by mail, and follow-up care in their community versus returning to the facility. We asked if participants would be interested in using any of these models, if available, and how use of each model would have changed their abortion experience. We used thematic analysis, organizing codes into common themes based on participants' preferences and concerns for each option. ResultsOf the 25 participants interviewed, nearly all (n = 22) expressed interest in at least one option and reported that, had they been available, these would have alleviated cost, travel, and childcare barriers. Many believed these options would further ensure privacy, but a minority thought abortion was too sensitive for telemedicine or were concerned about mailing errors. Participants not interested in the alternative options also feared missing valued aspects of face-to-face care. Most did not return to the facility for follow-up (n = 19), citing financial and logistical barriers. Largely, participants were not interested in obtaining follow-up care in their community, citing concerns about provider judgment, stigma, and privacy. ConclusionsMississippi abortion clients were interested in models that would make abortion care more convenient while ensuring their privacy and allowing for meaningful client-provider interaction. These features of care should guide the development of strategies aimed at helping those in restricted settings, such as Mississippi, to overcome barriers to abortion care following the implementation of abortion bans in many states following the overturn of Roe v. Wade.

(Invited) Leveraging Imaging Techniques to Accelerate the Advancement of Polymer Electrolyte Membrane Water Electrolyzers

Polymer electrolyte membrane water electrolyzers (PEMWEs) are critically needed to meaningfully incorporate clean renewable energy into our energy, transportation, and manufacturing sectors, for without this energy conversion mechanism, the intermittency of renewable energy will always pose a prohibitive cost barrier to practical use. However, in addition to overcoming the intermittency issue of renewable energy, energy storage also has the power to transform current energy infrastructure, particularly when plagued by older systems that lack modularity and flexibility. For example, electricity grids are often constrained to move electricity in and out of a jurisdiction with careful predictions based on past use and future needs. This comes at a cost when electricity must be sold at a loss to prevent a catastrophic surplus of electricity in the grid. While the potential for PEMWEs is tremendous, we must reduce their capital and operating costs in order to reach widespread adoption. In recent years, important work in the field has contributed to advancing PEMWEs in a variety of areas from new materials to flow field design; however, experimental validation, particularly spatially resolved, is necessary to take a fully informed approach to tailoring these materials and architectures.In this talk, I will discuss how we use X-ray and neutron imaging, both ex situ and operando, to provide high spatial and temporal resolution experimental performance and materials characterization for PEMWEs to inform our design process for new materials fabrication, new architectures, and operating parameters. We obtained nano-scale, 3D imaging of PEMWE catalyst layers to inform the stochastic simulations used to uncover the influence of pore size and ionomer distributions on electrical and ionic conductivities. We also used operando X-ray imaging to elucidate the influence of catalyst layer and porous transport layer interfacial conditions on liquid and gas transport behaviour. By applying neutron imaging, we elucidated the impact of temperature on the distribution heterogeneity of liquid water reactant at the catalyst layer. I will also discuss how we are using soft X-rays to perform synchrotron-based scanning transmission X-ray microscopy with absorption spectroscopy to uncover heterogeneity across performance and material characteristics for the PEMWE. Through these highly resolved techniques (in terms of time and space), we aim to advance our predictive models for designing next generation materials, interfaces, and flow configurations for high performance water electrolyzers.

(Invited) Durable and Highly Active Fe-N-C Catalysts for PEM Fuel Cells

Atomically dispersed and nitrogen-coordinated single iron sites (FeN4) embedded in carbon (Fe-N-C) catalysts are the most promising platinum group metal (PGM)-free catalysts. However, they have yet to match their Pt counterparts for oxygen reduction reaction (ORR) activity and stability in proton exchange membrane fuel cells (PEMFCs). Here, we developed viable Fe-N-C catalysts, which, for the first time, demonstrated competitive activity to that of Pt/C catalysts and dramatically enhanced stability and durability under practical PEMFC operating conditions. The most active Fe-N-C catalyst achieved a record half-wave potential (E1/2 = 0.915 V vs. RHE at 0.6 mgcatcm-2) and an ORR mass activity of 10.5 mA mgcat at 0.9 V in (RDE) tests, exceeding a Pt/C baseline catalyst (60 µgPt cm-2) by 40 mV in acidic electrolytes. This compelling activity of the Fe-N-C catalyst in aqueous acids on rotating disk electrode (RDE) was successfully transferred to fuel cell membrane electrode assembly (MEAs), generating an initial current density of 44.2 mA cm-2 exceeding the U.S. DOE 2025 target (i.e., 44 mA cm-2) at 0.9 VIR-free under O2. Under practical hydrogen-air conditions, record 151 mA cm-2 at 0.8 V and peak power density of 601 mW cm-2 were achieved. Importantly, we discovered that depositing nitrogen-carbon species on the catalyst surface via chemical vapor deposition (CVD) dramatically enhanced catalyst stability, evidenced by performance durability after accelerated stress tests (30 000 square-wave voltage cycles under H2/air) and long-term steady-state life tests (> 300 hours at 0.67 V). Innovative identical location-scanning transmission electron microscopy (IL-STEM) experiments confirmed that the CVD process leads to deposition of nitrogen-doped carbon onto the catalyst surfaces. Along with theoretical modeling, a reconstruction of the carbon structure adjacent to FeN4 sites leads to increased robustness against demetallation and carbon oxidation. This work opens new avenues for developing earth-abundant iron-based catalysts with extraordinary activity and stability, thus competing with Pt and addressing the cost barrier of current PEMFCs.

Highly Durable Electrocatalyst with Low-Loading Pt-Co Dispersed over Graphene Nanofiber for Oxygen Reduction Reaction Under PEMFC Condition

Proton exchange membrane fuel cell (PEMFC) has been demonstrated as a highly efficient energy conversion technology. The sluggish oxygen reduction reaction (ORR) at the fuel cell cathode requires 3 to 5 times more catalysts than the hydrogen oxidation reaction at the anode (1). Currently, platinum is still the catalyst material of choice. However, the heavy use of scarce Pt in the electrodes represents a major cost barrier to the commercialization of PEMFCs. Tremendous efforts have been dedicated to reduce or remove Pt usage through the development of Pt-transition metal catalysts, as highlighted recently by dealloyed PtNi (2), Mo-doped PtNi(3), and ordered PtCo (4); or through the development of transition metals-nitrogen-carbon based PGM-free catalysts (5, 6).In the fuel cell, catalysts should be highly dispersed over the electrode surface to be easily accessible by the reactants, especially at the high fuel cell current density where a large influx of O2 must be converted. For the Pt alloy catalyst of large crystallites, there won’t be enough crystallites available to spread over the electrode surface to encounter the incoming O2 if the total loading of platinum has to be maintained ultralow. Furthermore, unprotected Pt nano-alloys may lose their nanostructure and crystallinity from the dissolution and agglomeration during the ORR process. The PGM-free catalysts, on the other hand, have high catalytic site density with uniform distribution when prepared by homogenous precursors such as metal-organic framework or porous organic polymer, rendering them highly efficient in interacting with O2 flux. Their key drawback, however, is the poor stability operated under PEMFC condition.In this presentation, we will describe a method of preparing highly active yet stable electrocatalysts containing ultralow Pt content using polymer fiber containing cobalt zeolitic imidazolate framework as precursor. The new catalyst contains Pt-Co nanoparticels situated over the PGM-free catalystically active support (7,8). The ORR activities of the new catalyst was first tested in O2 saturated acidic electrolyte by rotating ring disk electrode (RRDE) before fabricated into the membrane electrode assembly (MEA) and evaluated under fuel cell operating condition. The synergistic catalysis between PtCo NPs and the PGM-free active substrate led to an unprecedented oRR performance in both RRDE and fuel cell. For example, the fuel cell test demonstrated a mess activity of 2.43 A/mgPt for the new catalysts and > 80% retention of the initial mass activity after 60000 continuous voltage cycles from 0.6 – 1.0 V.The characterizations of the fresh and the post-electrochemical test samples were investigated by x-ray photoelectron spectroscopy (XPS), x-ray diffraction (XRD), x-ray absorption near-edge structure (XANES), extended x-ray absorption fine structure (EXAFS), transmission electron microscopy (TEM), Raman spectroscopy and BET surface analysis. We also performed DFT calculation on the ORR thermodynamic barriers over both Pt-Co NPs and PGM-free site as the descriptors for reaction pathway. The results reveal that the synergistic interaction between Pt-Co and PGM active substrate contribute significantly to both activity and durability enhancements.Acknowledgments:This work was supported by Argonne National Laboratory through Maria Goeppert Mayer Fellowship, US; Overseas Outstanding Youth Fund project, shanghai Jiao Tong university, Shanghai, China, State Key Laboratory of Metal Matrix Composites, shanghai Jiao Tong university, Shanghai, China. The works performed at Argonne National Laboratory’s Center for Nanoscale Materials and Advanced Photo Source, and Hydrogen research center, shanghai Jiao Tong university.Reference: H. A. Gasteiger, N. M. Markovic, Just a Dream-or Future Reality? Science 324, 48-49 (2009).B. Han et al., Record activity and stability of dealloyed bimetallic catalysts for proton exchange membrane fuel cells. Energy & Environmental Science 8, 258-266 (2015).X. Huang et al., High-performance transition metal–doped Pt3Ni octahedra for oxygen reduction reaction. Science 348, 1230-1234 (2015).D. Wang et al., Structurally ordered intermetallic platinum-cobalt core-shell nanoparticles with enhanced activity and stability as oxygen reduction electrocatalysts. Nat Mater 12, 81-87 (2013).L. Chong et al., Investigation of Oxygen Reduction Activity of Catalysts Derived from Co and Co/Zn Methyl-Imidazolate Frameworks in Proton Exchange Membrane Fuel Cells. ChemElectroChem 3, 1541-1545 (2016).J. Shui, C. Chen, L. Grabstanowicz, D. Zhao, D. J. Liu, Highly efficient nonprecious metal catalyst prepared with metal-organic framework in a continuous carbon nanofibrous network. Proc Natl Acad Sci U S A 112, 10629-10634 (2015).L. Chong et al., Ultralow-loading platinum-cobalt fuel cell catalysts derived from imidazolate frameworks. Science, (2018).L. Chong et al., Highly durable fuel cell electrocatalyst with low-loading Pt-Co nanoparticles dispersed over single-atom Pt-Co-N-graphene nanofiber. Chem Catalysis 3, 100541.

Economic inequalities in health insurance subscription renewal: Evidence from Ghana's National Health Insurance Scheme

Ghana's national health insurance scheme (NHIS) is considered a major step towards achieving Universal Health Coverage (UHC) in the country. However, over the years the scheme has faced challenges, including subscription non-renewal, that threaten its sustenance. In this study, we estimate and analyse the nature of economic inequalities in NHIS subscription renewal and determine factors that contribute to the observed inequality. Data from the seventh round of the Ghana Living Standard Survey (GLSS) was used for the study. A sample of 40,170 ever insured individuals was included in the analysis comprising 18,066 males and 22,104 females. We computed concentration indices (CIs) and used linear regression techniques to decompose the CIs. The results show that NHIS renewal is pro-rich [CI = 0.126; P < 0.01] and favored males [CI = 0.110; P < 0.01] and urban dwellers [CI = 0.066; p < 0.01]. Major contributors to the observed inequality in subscription renewal include premium and processing fees payment, access to information, and economic wellbeing. The observed rural-urban and male-female differences in subscription renewal were explained by differences in premium and processing fee payments, education outcomes, employment status and access to information. The findings suggest that interventions that reduce cost barriers to NHIS subscription for the poor, improve physical access to healthcare and improve sensitization efforts should be encouraged.

Aquaponics: A Sustainable Path to Food Sovereignty and Enhanced Water Use Efficiency

This comprehensive review explores aquaponics as an environmentally friendly solution aligned with SDGs and food sovereignty, assessing various aspects from system design to automation, and weighing social, economic, and environmental benefits through literature and case studies. However, challenges persist in obtaining organic certification and legislative recognition, hindering its growth. Achieving remarkable water use efficiency, up to 90%, relies on adaptable fish species like Nile tilapia and carp. Nutrient-rich fish feeds notably benefit low-nutrient-demanding greens. Ensuring water quality and efficient nitrification are pivotal, supported by IoT systems. Despite its efficiency, integrating Industry 4.0 involves complexity and cost barriers, necessitating ongoing innovation. Economies of scale and supportive horticultural policies can bolster its viability. Aquaponics, known for its efficiency in enhancing crop yields while minimizing water use and waste, is expanding globally, especially in water-scarce regions. Aquaponics, pioneered by the University of the Virgin Islands, is expanding in Europe, notably in Spain, Denmark, Italy, and Germany. Asia and Africa also recognize its potential for sustainable food production, especially in water-limited areas. While it offers fresh produce and cost savings, challenges arise in scaling up, managing water quality, and meeting energy demands, particularly for indoor systems. Egypt’s interest in desert and coastal regions highlights aquaponics’ eco-friendly food production potential. Despite the associated high costs, there is a quest for practical and affordable designs for everyday integration. Research in arid regions and industry advancements are crucial for aquaponics’ global food production potential. Deeper exploration of intelligent systems and automation, particularly in large-scale setups, is essential, highlighting the industry’s promise. Practical application, driven by ongoing research and local adaptations, is a key to fully harnessing aquaponics for sustainable food production worldwide.

Framework for the design of seismically isolated National Building Code of Canada Part 9 structures

In Canada, most single-family wood-frame residential structures in seismically hazardous regions are constructed according to Part 9 of Division B of the National Building Code (or similar provincial standards) using nonengineering methods. These structures are expected to perform well during an earthquake regarding life safety but may sustain severe economic losses. Seismic isolation is an emerging technology that provides excellent life safety and economic performance. While this technology has proven effective at protecting structures from earthquakes, no nonengineering methodologies exist that are compatible with Part 9 methods. This limitation produces significant testing, design, and cost barriers that restrict the application of base isolation on vulnerable Part 9 structures. To eliminate or reduce these cost barriers, a program framework was developed to perform the engineering seismic design and analysis for a base-isolated Part 9 single-family residential structure. The proposed methodology further encourages the application of seismic isolation to Part 9 structures.

Understanding Renal Failure Mortality Trends and Determinants in the US (1999–2020): Impacts of the Affordable Care Act, Advancements, Disparities, and Challenges

Introduction: Renal failure, encompassing both acute and chronic forms, stands as a formidable public health challenge with far-reaching consequences for individual well-being and healthcare systems. This study delves into the mortality rates of renal failure in the United States over two transformative decades, from 1999 to 2020. Renal failure’s significance arises from its escalating prevalence, substantial healthcare costs, and the imperative to understand the multifaceted factors that influence its outcomes. Objectives: The primary objectives of this research are to analyze temporal trends in renal failure mortality rates, explore the impact of the Affordable Care Act (ACA) and advancements in renal care practices on mortality rates, and assess demographic disparities in mortality outcomes. Methods: Utilizing CDC WONDER’s multi-cause mortality data, we assessed mortality due to renal failure (ICD-10 Codes: N17–N19). Age-adjusted mortality rates (AAMRs) were collected and stratified by sex and race. The Joinpoint Regression Program analyzed trends, calculating annual percent change (APC) and significant average annual percent change (AAPC) from 1999 to 2020. Segmented line regression models were employed for parallel pairwise comparisons. Results: Renal failure mortality rates decreased for both sexes during the late 2000s. The ACA’s enactment in 2010 coincided with improved access to healthcare, possibly contributing to the decline. Demographic disparities highlighted variations in mortality rates across racial and gender groups. Advancements in renal care practices were evident, which were driven by innovations in treatment modalities and disease management. Significant temporal trends were observed by race, with varying periods of decrease or uptrend. Conclusions: The decline in renal failure mortality rates during the late 2000s was potentially influenced by the ACA and advances in renal care practices. Demographic disparities emphasize the need for equitable healthcare access and interventions. These findings underscore the significance of healthcare policies and medical advancements in reducing renal failure mortality rates and addressing disparities. Persistent efforts to mitigate challenges such as healthcare access, cost barriers, and disparities remain crucial to enhancing renal failure outcomes.

Out-of-Pocket Costs and Physician Payment Variations in Abdominal Contouring: Evidence From United States Claims Data

Background: Abdominal contouring after massive weight loss has positive impacts on quality of life. There are often cost and access barriers for patients who desire these procedures. Objectives: To examine levels of access to body contouring in the era of price transparency, this study aims to characterize the out-of-pocket expenses and physician/facility payments in abdominal contouring procedures. Setting: The IBM MarketScan Commercial Databases were queried to identify patients who underwent outpatient abdominal contouring surgeries in the United States in 2021. Methods: Financial variables of interest included gross payments to the provider (facility and/or physician) and out-of-pocket costs (total of coinsurance, deductible, and copayments). Univariate analysis and mixed-effects linear regression were utilized to study the variations in costs across regions, insurance plan types, and places of service. Results: A total of 1319 abdominal contouring episodes were identified. The average age was 44.7, and the majority of patients were female (91%) and in the South region (44%). Median out-of-pocket costs were low overall ($30, IQR $768) and median total physician/facility payments for abdominal contouring was $4982.47 (IQR $7392.46). Out-of-pocket costs were highest in the South ($105) and $0 in all other regions ( P &lt; .05). The highest physician/facility payments were in the Northeast ($6392) and the lowest was in the South ($3936). Conclusions: Patients undergoing abdominal contouring incur relatively low out-of-pocket costs overall, but there is a need for further reimbursement negotiation in regions where physician payments are lower and out-of-pocket costs are higher. Further study should explore reimbursement and payment gaps in procedural coverage.