Cost-benefit Research Articles

Chickpea (Cicer arietinum)-based intercropping systems in Rajasthan’s Hadoti region: Productivity and economic viability

A study was carried out during three successive winter (rabi) seasons (2018–19 to 2020–21) at the Agricultural Research Station in Ummedganj, Kota, Rajasthan to determine the productivity and economic viability of intercropping systems based on chickpea (Cicer arietinum L.) in the Hadoti region of Rajasthan. Nine various chickpeabased intercropping systems, viz. Sole chickpea; Sole linseed (Linum usitatissimum L.); Sole coriander (Coriandrum sativum L.); Sole wheat (Triticum aestivum L.); Sole mustard [Brassica juncea (L.) Czern.]; Chickpea + linseed (6:2); Chickpea + coriander (6:2); Chickpea + wheat (6:2); and Chickpea + mustard (6:2) were investigated in a randomized block design (RBD) with three replications. According to combined statistics, the chickpea + mustard intercropping system had the highest chickpea grain yield and equivalent yield (1,865 kg/ha and 2,574 kg/ ha, respectively) when compared to all other intercropping systems. Results of competitive indices revealed that compared to rest of the intercropping system, chickpea + mustard (6:2) recorded significantly higher LER (1.25), MAI (18,462) and SPI (2912 kg/ha), while the lowest land equivalent ratio (LER), monetary advantage index (MAI), system productivity index (SPI) and production efficiency (PE) were recorded in the chickpea + wheat intercropping system. The chickpea + mustard intercropping system yielded values of competition ratio (3.56), aggressivity (-0.05), system profitability index (2912), relative crowding coefficient (13.2), and area time equivalent ratio (1.24), that were sustainable and producible in comparison to other treatments. In terms of economics, compared to all other intercropping and solo crops, the chickpea + mustard intercropping system yielded the chickpea’s most significant net returns (`93,681/ha) and benefit cost (B:C) ratio (3.11). So, for south-eastern Rajasthan, the mustard and chickpea intercropping system is a productive and sustainable system.

A cost-benefit analysis of mass prostate cancer screening

BackgroundProstate cancer (PCa) causes a substantial health and financial burden worldwide, underscoring the need for efficient mass screening approaches. This study attempts to evaluate the Net Cost-Benefit Index (NCBI) of PCa screening in Iran to offer insights for informed decision-making and resource allocation.MethodThe Net Cost-Benefit Index (NCBI) was calculated for four age groups (40 years and above) using a decision-analysis model. Two screening strategies, prostate-specific antigen (PSA) solely and PSA with Digital Rectal Examination (DRE), were evaluated from the health system perspective. A retrospective assessment of 1402 prostate cancer (PCa) patients’ profiles were conducted, and direct medical and non-medical costs were calculated based on the 2021 official tariff rates, patient records, and interviews. The monetary value of mass screening was determined through Willingness to Pay (WTP) assessments, which served as a measure for the benefit aspect.ResultThe combined PSA and DRE strategy of screening is cost-effective, yields up to $3 saving in costs per case and emerges as the dominant strategy over PSA alone. Screening for men aged 70 and above does not meet economic justification, indicated by a negative Net Cost-Benefit Index (NCBI). The 40–49 age group exhibits the highest net benefit, $13.81 based on basic information and $13.54 based on comprehensive information. Sensitivity analysis strongly supports the cost-effectiveness of the combined screening approach.ConclusionThis study advocates prostate cancer screening with PSA and DRE, is economically justified for men aged 40–69. The results of the study recommend that policymakers prioritize resource allocation for PCa screening programs based on age and budget constraints. Men’s willingness to pay, especially for the 40–49 age group which had the highest net benefit, leverages their financial participation in screening services. Additionally, screening services for other age groups, such as 50–54 or 55–59, can be provided either for free or at a reduced cost.

Differential analysis of histopathological and genetic markers of cancer aggressiveness, and survival difference in EBV-positive and EBV-negative prostate carcinoma

Several studies have shown an association between prostate carcinoma (PCa) and Epstein-Barr virus (EBV); however, none of the studies so far have identified the histopathological and genetic markers of cancer aggressiveness associated with EBV in PCa tissues. In this study, we used previously characterized EBV-PCR-positive (n = 39) and EBV-negative (n = 60) PCa tissues to perform an IHC-based assessment of key histopathological and molecular markers of PCa aggressiveness (EMT markers, AR expression, perineural invasion, and lymphocytic infiltration characterization). Additionally, we investigated the differential expression of key oncogenes, EMT-associated genes, and PCa-specific oncomiRs, in EBV-positive and -negative tissues, using the qPCR array. Finally, survival benefit analysis was also performed in EBV-positive and EBV-negative PCa patients. The EBV-positive PCa exhibited a higher percentage (80%) of perineural invasion (PNI) compared to EBV-negative PCa (67.3%) samples. Similarly, a higher lymphocytic infiltration was observed in EBV-LMP1-positive PCa samples. The subset characterization of T and B cell lymphocytic infiltration showed a trend of higher intratumoral and tumor stromal lymphocytic infiltration in EBV-negative tissues compared with EBV-positive tissues. The logistic regression analysis showed that EBV-positive status was associated with decreased odds (OR = 0.07; p-value < 0.019) of CD3 intratumoral lymphocytic infiltration in PCa tissues. The analysis of IHC-based expression patterns of EMT markers showed comparable expression of all EMT markers, except vimentin, which showed higher expression in EBV-positive PCa tissues compared to EBV-negative PCa tissues. Furthermore, gene expression analysis showed a statistically significant difference (p < 0.05) in the expression of CDH1, AR, CHEK-2, CDKN-1B, and CDC-20 and oncomiRs miR-126, miR-152-3p, miR-452, miR-145-3p, miR-196a, miR-183-3p, and miR-146b in EBV-positive PCa tissues compared to EBV-negative PCa tissues. Overall, the survival proportion was comparable in both groups. The presence of EBV in the PCa tissues results in an increased expression of certain oncogenes, oncomiRs, and EMT marker (vimentin) and a decrease in CD3 ITL, which may be associated with the aggressive forms of PCa.

Dual purpose barley (Hordeum vulgare) for better remunerations through higher fodder and grain production under different cutting schedules

A field experiment was conducted during the winter (rabi) seasons of 2019–20 and 2020–21 at the research farm of Chaudhary Charan Singh Haryana Agricultural University, Hisar, Haryana to evaluate the dual purpose barley for higher remunerations through increased production of fodder and grain under different cutting schedules. The experiment was conducted in a split-plot design with 5 fodder cutting management practices, viz. No fodder cut; Fodder cutting at 50–60 DAS (days after sowing) above 5 cm cutting height; Fodder cutting at 50–60 DAS above 10 cm cutting height; Fodder cutting at 60–70 DAS above 5 cm cutting height; Fodder cutting at 60–70 DAS above 10 cm cutting height in main plot and 4 dual purpose barley varieties, viz. ‘BH 393’, ‘BH 946’, ‘RD 2552’ and ‘RD 2715’ under sub-plots, replicated thrice. On the mean basis of 2 years experiment, maximum plant height, tillers/m2 and GFY (green fodder yield) were recorded with fodder cutting at 60–70 DAS irrespective of their cutting heights. Maximum GFY of 8.19 t/ha was found in variety ‘RD 2715’. At grain harvest, maximum effective tillers/m2 (415.2), no. of grains/ear-head (48.11), grain yield (4.82 t/ha) and straw yield (7.43 t/ha) were recorded in fodder cut at 50–60 DAS above 10 cm height. Among the varieties, ‘BH 946’ exhibited maximum effective tillers/m2 (416), test weight (45.51 g), grain yield (5.25 t/ha) and straw yield (7.62 t/ha). Highest benefit cost (B:C) ratio was fetched with the grain production after taking fodder cut at 50–60 DAS above 10 cm height (2.36) and barley variety ‘BH 946’ (2.61) among the tested dual-purpose barley varieties.

51 Application of an energy and nutrient matrix to a mixed cereals-based diet supplemented with a novel phytase and xylanase–β-glucanase achieved a production benefit from wean-to-finish in pigs

Abstract The effect of a novel consensus bacterial 6-phytase variant (PhyG) without or with a xylanase–β-glucanase (XB) when added to an energy and nutrient-reduced diet on growth performance and production benefit was evaluated in pigs from wean-to-finish. A total of 192 weaned pigs [DanBred x Pi; initial body weight (BW) 7.18 ± 0.38 kg] were randomized to 4 treatments with 12 (4 piglets/pen) and 24 pens (2 pigs/pen) per treatment (1:1 male to female) for nursery and grow-finish phases, respectively. Diets were wheat-corn-barley-rye-soybean meal-based and fed in 5 phases (pre-starter, 7–11 kg, starter, 11–25 kg, grower I, 25–55 kg, grower II, 55–85 kg and finisher, 85–110 kg BW). Treatments comprised: 1) a nutritionally adequate positive control (PC); 2) a negative control (NC1) without added inorganic phosphate, reduced (based on specific PhyG dose) in net energy (NE), calcium (Ca), digestible amino acids (AA) and sodium (Na) vs. PC, supplemented with PhyG at 1,000, 1000, 750, 500 and 500 FTU/kg during pre-starter, starter, grower I, II and finisher phase, respectively (NC1+PhyG ‘low’); 3) a negative control (NC2) without added inorganic phosphate, supplemented with PhyG at 2,000, 2,000, 1,000, 750 and 750 FTU/kg in each phase with reduction in NE, Ca, dig AA and Na vs. PC based on the specific PhyG dose (NC2+PhyG ‘high’); and 4) a negative control (NC3) that was similar to 2) but supplemented with XB to provide 2,400 U/kg xylanase and 304 U/kg β-glucanase, with additional reduction in NE and dig AA based on the contribution of XB vs NC1 (NC3+PhyG ‘low’+XB). Data were analyzed by ANOVA, and means separation was by Tukey’s HSD test. Growth performance in all enzyme-supplemented diets was maintained or improved compared with PC. The NC3+PhyG ‘low’+XB treatment significantly improved performance vs. PC; average daily gain (ADG) and BW were greater vs. PC in starter (620 g and 28.2 kg vs. 557 g and 26.4 kg) and grower I (859 g and 65.1 kg vs. 777 g and 60.0 kg) respectively; feed conversion ratio (FCR) was reduced in grower II vs. PC (2.10 vs. 2.25; P &amp;lt; 0.05). The final BW was 114.5, 114.8, 115.6 and 116.7 kg in PC, NC1+PhyG ‘low’, NC2+PhyG ‘high’ and NC3+PhyG ‘low’+XB, respectively (P &amp;gt; 0.05). Carcass parameters were unaffected by treatments. Compared with PC, NC1+PhyG ‘low’, NC2+PhyG ‘high’ and NC3+PhyG ‘low’+XB conferred a 3.8 to 5.8% reduction in total feed cost (ingredients price, October 2023)/kg BWG and 4.4 to 6.8% reduction in the total carbon footprint (FeedPrint, WUR, The Netherland, CO2 eq., g)/kg BWG. The results confirm the appropriacy of the applied matrix values with PhyG supplementation, with or without XB, in mixed cereal diets from wean-to-finish and highlight the potential feed cost and sustainability benefit of using the phytase alone or in combination with the carbohydrase enzymes.

Enhancing Wind Farm Reliability: A Field of View Enhanced Convolutional Neural Network-Based Model for Fault Diagnosis and Prevention

Wind farms play a crucial role in renewable energy generation, but their reliability is often compromised by complex environmental and equipment conditions. This study proposes a field of view enhanced convolutional neural network (CNN) model for fault diagnosis and prevention in wind farms. The model is developed by collecting and processing wind farm fault data and compared with support vector machine (SVM) and k-nearest neighbor (KNN) models. The results showed that the proposed CNN model outperformed the other models in terms of convergence speed (17 iterations to reach the minimum loss), fault diagnosis accuracy (99.3% and 99.2% for inner and outer circle faults, respectively), and stable power output improvement. The model’s application to maintenance scheduling and economic benefit analysis in a real wind farm case demonstrated its high consistency and accuracy in fault prediction and maintenance optimization. The proposed approach has the potential to enhance wind farm reliability, efficiency, and economy by enabling accurate fault diagnosis, early warning, and preventive maintenance.

Is faster really better? The impact of digital transformation speed on firm financial distress: Based on the cost-benefit perspective

Based on the cost–benefit perspective, this study theoretically analyzes and empirically examines the influence of digital transformation speed on firm financial distress. We find that digital transformation speed has a U-shaped relationship with firm financial distress. In addition, after considering the moderating effect of CEO IT background, we find that not only does the effect of digital transformation speed on firm financial distress but, more importantly, their relationship also undergoes a shape-flip from the original U-shape to an inverted U-shape. Finally, we find that CEO power weakens the moderating effect of CEO IT background on the relationship between digital transformation speed and firm financial distress. Our research not only helps to advance theoretical and empirical research on digital transformation but also provides important empirical insights for understanding the economic consequences of accelerating digital transformation, which can be beneficial for digital transformation firms’ managers, investors, and other stakeholders.

Cucumber under Controlled Environment Polyhouse: A Step Forward to Enhance Farmers Income

Present study was conducted to see profitability of cucumber crop when grown under polyhouse. Controlled environment crops have greater consistency and production is more reliable than uncontrolled open field crops. Technology is used to manage and manipulate the growing conditions to reduce uncertainty and optimise crop growth. Particularly, cucumber crop was uneconomical when grown under open field conditions due to its climate sensitiveness. Present study was conducted in cucumber which was being cultivated in environment-controlled poly house. The cost return analysis showed that the total cost of cultivation per 1000 m2 area was Rs. 307746 with an output value of Rs.888960 resulted in Benefit Cost Ratio of 2.89. As the poly house involves initial establishment costs besides maintenance costs every year. This component was amortized to be included in Total Fixed Cost component (TFC) of cost analysis. Similarly, the bed prepared for cucumber sowing also amortized as it lasts for five years once prepared. As most of the farmers were facing initial capital issues for establishing polyhouse, majority of farming fraternity till unable tap the full benefits of cucumber crop. By utilizing the policies of government, cucumber cultivation under poly house is economically beneficial.

Cost-effectiveness of genetic testing of endocrine tumor patients using a comprehensive hereditary cancer gene panel.

Heterogenous clinical manifestations, overlapping phenotypes and complex genetic backgrounds are common in patients with endocrine tumors. There are no comprehensive recommendations for genetic testing and counselling of these patients compared to other hereditary cancer syndromes. The application of multigene panel testing is common in clinical genetic laboratories, but their performance for patients with endocrine tumors has not been assessed. As a national reference center, we prospectively tested the diagnostic utility and cost-efficiency of a multigene panel covering 113 genes representing genetic susceptibility for solid tumors. 1279 patients (including 96 cases with endocrine tumors) were evaluated between October 2021 and December 2022 who were suspected to have hereditary tumor syndromes. The analytical performance of the hereditary cancer panel was suitable for diagnostic testing. Clinical diagnosis was confirmed in 24% (23/96); incidental findings in genes not associated with the patient's phenotype were identified in 5% (5/96). A further 7% of pathogenic/likely pathogenic variants were detected in genes with potential genetic susceptibility roles but currently no clear clinical consequence. Cost-benefit analysis showed that the application of a more comprehensive gene panel in a diagnostic laboratory yielded a shorter turnaround time and provided additional genetic results with the same cost and workload. Using comprehensive multigene panel results in faster turnaround time and cost-efficiently identifies genetic alterations in hereditary endocrine tumor syndromes. Incidentally identified variants in patients with poor prognoses may serve as a potential therapeutic target in tumors where therapeutic possibilities are limited.

The Role of Medical Schools in Enhancing the Quality of Health Facility Services: A Doctoral Perspective: A Brief Review

This article explores the pivotal role of doctoral-level medical education in enhancing the quality of health facility services. Through a comprehensive examination of Doctoral programs, it underscores their significance in shaping competent healthcare professionals. Emphasizing clinical training, interprofessional education, research, and continuous professional development, Doctoral programs prepare doctors to deliver patient-centered, evidence-based care. The article suggests further research avenues including assessing learning methodologies' impact, evaluating healthcare service performance post-educational interventions, comparative analyses of international programs, examining emerging technology's influence, developing innovative curriculum models, and conducting cost-benefit analyses. These efforts aim to deepen understanding and advance healthcare delivery globally.

Effect of Different Quantities of Bio Stimulant on Chilli Growth, Quality and Yield

A present investigation was carried out with title “Effect of different quantities of bio stimulant on chilli growth, quality and yield” at the central research farm, Department of Horticulture, Naini Agricultural Institute, Sam Higginbottom University of Agriculture Technology and Sciences, Prayagraj, Uttar Pradesh during kharif, 2023-24 with a view to identify the effects of different doses of bio stimulant and its role in growth, yield and quality of Chilli variety NS-1701. The experiment was laid in the randomized block design with 9 treatments and 3 replications with different combination of different quantities of bio stimulant. The treatment T7 (3.0 L/hac. Amalgerol essence) performed best in terms of plant height (79.68), number of branches (8.53), days to first flower initiation (79.30), number of fruits per plant (122.36), fruit length (7.81), individual fruit weight (2.90gm), fruit yield per plant (258.13gm). The highest benefit cost ratio was found at 3.69 in the same treatment.

Abstract PO1-04-05: Effectiveness and safety of inetetamab + pyrotinib + vinorelbine in ≥second-line treatment of HER2-positive metastatic breast cancer

Abstract Background: In real-world settings, Patients with HER2-positive metastatic breast cancer (MBC) who cannot receive antibody-drug conjugates (ADCs) as standard second-line therapy due to cost–benefit ratios and who have no preferred options as ≥third-line regimen by NCCN guidelines, require new regimens to meet their clinical needs. This study aims to explore the effectiveness and safety of inetetamab + pyrotinib + vinorelbine for ≥second-line treatment of HER2-positive MBC. Methods: Patients with HER2-positive MBC who received ≥second-line treatment at our hospital from June 2020 to December 2022 were enrolled. Progression-free survival (PFS), objective response rate (ORR), clinical benefit rate (CBR) and adverse reactions were assessed. Patients received inetetamab + pyrotinib + vinorelbine until disease progression or unacceptable toxicity were evaluated every two cycles according to the RECIST 1.1 criteria. Results: 89 patients were included based on the inclusion and exclusion criteria. Among them, 45 patients received second-line treatment who couldn't use T-DM1 or T-DXd, and 44 patients received ≥third-line treatment. The median PFS of the second-line treatment subgroup was 17months, the ORR and CBR were 60.0% and 86.7%, respectively, which were significantly higher than those in the ≥third-line treatment subgroup and numerically superior to T-DM1 as a second-line treatment option. Additionally, the ORR and CBR of patients with baseline brain metastasis who did not receive radiotherapy were 27.3% and 72.7%, respectively. The most common adverse events observed were leukopenia (37.1%), neutropenia (42.7%), anemia (34.8%) and diarrhea (67.4%). The incidence of grade 3-4 leukopenia, neutropenia, anemia and diarrhea were 11.2%, 15.7%, 55.6% and 27.0%, respectively. A total of 8 patients (8.9%) discontinued medication due to adverse reactions. Conclusions: Inetetamab + pyrotinib + vinorelbine demonstrates good efficacy and controllable toxicity as a second-line treatment for HER2-positive MBC. This therapeutic regimen provides a viable alternative option for patients who are unable to receive ADCs as the second-line treatment. Citation Format: Fan Wu, Mulan Chen, Weiwei Huang, Lili Wang, Nani Li, Xiufeng Wu, Xinhua Chen, Yi Hong, Lin Lin, Kan Chen, Jian liu. Effectiveness and safety of inetetamab + pyrotinib + vinorelbine in ≥second-line treatment of HER2-positive metastatic breast cancer [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO1-04-05.

Analysis of scale problem using acidizing stimulation in field Z Kalrez Petroleum (Seram) LTD.

The annual decrease in production at well Z occurs due to scale deposits that impede fluid flow. Scale is a production problem due to the mixing of two types of water with different properties so that the solubility limit of the compound in the formation water is exceeded. To overcome the scale, stimulation is carried out with an acidizing method using a type of acid (HCL 10%). Evaluation was conducted to determine the effect of acidizing stimulation on scale based on productivity index (PI), inflow performance relationship (IPR) curve and comparison of stimulation methods. Evaluation of test results after acidizing stimulation of well Z experienced an increase in production. Productivity Index increased from 4.748 bpd/psi to 9.036 bpd/psi. Based on the IPR curve before acidizing, the maximum flow rate (Q max) = 324.107 bpd, increased to Qmax = 769.021 bpd. Based on the Cost Benefit Analysis (CBA), the Acidizing Stimulation method (10% formic Acid) was chosen to overcome the scale problem because the B/C ratio >1 or 1.9 means that for every 1 US$ invested in the Acidizing Stimulation method (10% formic Acid), a savings ratio of 1.9 will be obtained. So it is very reasonable to decide that the Acidizing Stimulation method (10% formic Acid), is feasible and more useful and efficient.

Ökologischer Umbau von Wirtschaft und Gesellschaft: Kosten und Nutzen

Abstract This article weighs up the costs and benefits of the expansion of renewable energy technologies for electricity generation in Germany. According to calculations of the German Ministry of Economic Affairs, this expansion has cost electricity consumers almost 300 billion euros since the introduction of the Renewable Energy Sources Act (EEG) in 2000. Moreover, payment obligations of a similar magnitude are already in place for the next two decades. However, with the accelerated expansion of renewables following Russia’s attack on Ukraine, politicians are accepting costs well in excess of this approximately 600 billion. Given the costs already incurred, a cost-benefit analysis is imperative, not least because further costs in the three-digit billion range are not included in the 600 billion figure, such as the costs for grid expansion, which would not be necessary to the same extent without the expansion of renewables. Against this backdrop, strict attention should be paid to cost discipline in the further expansion of renewables by ensuring that the Federal Network Agency only issues technology-neutral rather than technology-specific tenders for the expansion of renewables in future. This means that only the most cost-efficient renewable technologies will be installed. Consequently, there will be budgetary scope for future investments that could boost the growth potential of the German economy more than the expansion of renewable energies. Contrasting with the high costs, the benefits of expanding renewable energies are modest. For example, the share of renewables in primary energy consumption in 2022 was only around 17 %. With such a low share, achieving greenhouse gas neutrality in 2045 with renewables alone appears to be a tremendous challenge.

Cost-benefit analysis with return on investment of clinical pharmacists in the Military Health System.

The Defense Health Agency comprises more than 700 military medical, dental, and veterinary facilities and provides care to more than 9.6 million beneficiaries. As medication experts, pharmacists identify opportunities to optimize medication therapy, reduce cost, and increase readiness to support the Defense Health Agency's mission. The Tripler Pilot Project and the Army Polypharmacy Program were used to establish a staffing model of 1 clinical pharmacist for every 6,500 enrolled beneficiaries. No large-scale cost-benefit study within the military health care system has been done, which documents the number of clinical interventions and uses established cost-avoidance (CA) data, to determine the cost-benefit and return on investment (ROI) for clinical pharmacists working in the medical treatment facilities. To validate the patient-centered medical home staffing model across the military health care system using the Tripler Pilot Project results to provide a cost-benefit analysis with an ROI. The secondary goal is to describe the interventions, staffing levels, and US Department of Defense-specific requirements impacting the provision of clinical pharmacy. A retrospective analysis of 3 years of encounters by clinical pharmacists in which an intervention was documented in the Tri-Service Workflow (TSWF) form as part of the electronic health record was completed. The analysis used 6 steps to assign CA intervention types and to prevent duplication and overestimation of the ROI. The absolute number of clinical pharmacists was determined using workload criteria defined as at least 20 encounters per month for at least 3 months of each calendar year. The number of clinical pharmacist full-time employees (FTEs) was determined by dividing the number of total active months by 12 months. Attrition was calculated comparing the presence of a unique provider identification between calendar years. The ROI range was calculated by dividing the CA by the total cost of clinical pharmacists using the variables' raw and extrapolated CA based on percentage of documentation template usage and the active clinical pharmacist calculation (absolute and FTE-based). Between January 1, 2017, and December 31, 2019, a total of 1,069,846 encounters by clinical pharmacists were documented in the electronic health record. The TSWF Alternative Input Method form was used by pharmacists to document 616,942 encounters. Forty-three percent of TSWF documented encounters had at least 1 CA intervention. The absolute number of clinical pharmacists associated with a documented encounter in any medical treatment facility ranged from 404 in 2017 to 374 in 2018 and the clinical pharmacist FTEs ranged from 324 in 2017 to 314 in 2019. Annual attrition rates for clinical pharmacists ranged from 15% to 20% (58 to 81 clinical pharmacists) annually. The total CA range was $329,166,543-$534,014,494. The ROI range was between $2 and $4 per dollar spent. This analysis demonstrated that ambulatory care clinical pharmacists in the Military Health System bring value through a positive ROI. Our study also identified a potential shortage of clinical pharmacists within the Air Force and Navy branches impacting medication management. This can have a negative impact on the readiness of service members, one of the leading priorities of the US Department of Defense.

Ensuring Neonatal Human Milk Provision: A Framework for Estimating Potential Demand for Donor Human Milk

Using donor human milk (DHM) for preterm infants, where the mother's milk is unavailable, protects infants against potentially fatal necrotising enterocolitis. When used optimally, DHM can support mothers to establish breastfeeding. Understanding the relationship between clinical choices for DHM provision and the resulting demand is important. For policymakers, it informs decision-making around the provision of DHM based on cost-benefit analyses. For milk banks, it helps plan for required capacity, donor recruitment and supply-side collections. This study presents a framework for estimating DHM potential demand for infants born preterm, which allows for various sources of secondary population data, different feeding protocols and policy options for DHM provision. A Monte Carlo Simulation (MCS) is developed which follows the framework, simulating annual births (based on historical data) and incorporating uncertainty related to infant and maternal populations. A case study on human milk banking serves as the basis for the application of the framework and the modelling approach. Our model estimates the overall demand for DHM in England and Wales, the local level demand for NHS Trusts in England and provides an indication of the associated uncertainties. Our study provides a useful tool to enrich the strategic and operational level decision making environment, benefitting both policymakers and milk bankers by providing a better understanding of the impact of policy decisions on the future development of the milk bank infrastructure.

Cost-effectiveness of erosion mitigation to meet water clarity targets in the Manawatū-Whanganui Region of New Zealand

Soil erosion is a significant environmental issue worldwide. It affects water quality, biodiversity, and land productivity. New Zealand government agencies and regional councils work to mitigate soil erosion through policies, management programmes, and funding for soil conservation projects. Information about cost-effectiveness is crucial for planning, targeting, and implementing erosion mitigation to achieve improvements in sediment-related water quality. While there is a good understanding of the costs of erosion mitigation measures, there is a dearth of literature on their cost-effectiveness in reducing sediment loads and improving water quality at the catchment level. In this study, we estimate the cost-effectiveness of erosion mitigation measures in meeting visual water clarity targets. The analysis utilizes the spatially explicit SedNetNZ erosion process and sediment budget modelling in the Manawatū-Whanganui Region and region-specific mitigation costs. The erosion mitigation measures considered in the analysis include afforestation, bush retirement, riparian retirement, space-planted trees, and gully tree planting. We modelled two scenarios with on-farm erosion mitigation implemented across the region from 2021 to 2100, resulting in a 48% and 60% reduction of total sediment load. We estimate the marginal costs to achieve the visual national bottom line for water clarity, as assessed by the length of waterways that meet the clarity targets. We also estimate the marginal costs of improving average water clarity, which can be linked with non-market valuation studies when conducting a cost-benefit analysis. We find that gully tree planting and space-planted trees are the most cost-effective mitigation measures and that riparian retirement is the least cost-effective. Moreover, cost-effectiveness is highly dependent on current land use and the biophysical features of the landscape. Our estimates can be used in cost-benefit analysis to plan and prioritize soil erosion mitigation at the catchment and regional levels.

Risk-based life cycle cost–benefit analysis for progressive collapse design of RC frame structures

Progressive structural collapse is a typical low-probability high-consequence event. Progressive collapse design can effectively improve the robustness of structures against accidental local damage and reduce the probability of collapse. However, progressive collapse design also increases the construction cost of buildings. Hence, it is necessary to conduct cost-benefit analyses for the progressive collapse design of building structures. This study first designs a reinforced concrete (RC) frame based on a progressive collapse design program that simultaneously optimizes material consumption and structural resistance. Then, the structural failure probability is quantified using an alternative path (AP) method-based fragility analysis that considers the structural uncertainties. Based on this, the life cycle costs and benefits of the structure designed with different design load factors are investigated. A four-story RC frame is used as an example. By considering the time value of money and threat probability, the break-even points and optimized design load factors for the progressive collapse design of the RC frame are analyzed. These research outcomes can help promote progressive collapse design in engineering practice and provide references for proposing scientific and reasonable design load factors.

Assessment of Project Baseline Effect on Performance of Rwanda Education Funded Projects: A Case of Pan African Education Empowerment Project in Rwanda

A project's baseline is the research conducted at the commencement of the project to identify the current state of the project via data collecting, providing a benchmark against which subsequent modifications may be evaluated. The general objective of the study was the assessment of project baselines on performance of Rwanda education funded projects. A case of Pan African Education Empowerment Project in Rwanda and the specific objectives were to evaluate the influence of stakeholder’s participation as an effective baseline-survey on performance of education funded project of Pan African Education Empowerment Project in Rwanda, to examine the effect of project team competency as an effective baseline-survey on performance of education funded projects of Pan African Education Empowerment Project in Rwanda and to determine the effect of project costs as an effective baseline-survey on performance of education funded project of Pan African Education Empowerment Project in Rwanda. The study guided by the following theories: Stakeholder’s participation theory, project team competency theory, Project Costs Effectiveness theory and Expected Quality Standard theory. Project coordinators, PAEE project officers, District Education Officers in the Nyarugenge District, and project beneficiaries in the Nyarugenge District made up the target population of this descriptive research that used both quantitative and qualitative methods. In all there were 2689 from which a sample size of 348 was picked, the sample size calculated by Yamane formula. Researchers utilized a basic random sample strategy to choose participants from the whole population of interest, and a stratified sampling strategy to divide those participants into manageable subsets. Questionnaires, interviews, and records were used to compile the information needed for the study. Frequency tables, percentages, means, and standard deviations were generated using SPSS version 21 when data processing is complete. The predictors (Project cost effectiveness, Project team competency, and Stakeholders' engagement) and the Performance of education sponsored project of Pan African Education Empowerment Project in Rwanda are well correlated (R value of 0.807). There is a 0.221 coefficient for stakeholders' engagement (t = 3.938, p = 0.000), a 0.398 coefficient for project team competency (t = 8.381, p = 0.000), and a 0.254 coefficient for project cost effectiveness (t = 4.286, p = 0.000). This means that the performance of the Pan African Education Empowerment Project -funded education initiative in Rwanda improves in direct correlation with the level of each of these factors. These coefficients have important statistical significance and major roles in contributing to the success of the education financed project of Pan African Education Empowerment Project in Rwanda, since their p-values are considerably below the normal significance threshold of 0.05. Pan African Education Empowerment Project in Rwanda is recommended to strengthen stakeholder engagement, providing comprehensive training, investing in project team competency through professional development, conducting cost-benefit analyses, and implementing strong monitoring mechanisms to optimize financial resources and enhance the success of education funded projects.

The effect of education expenditure on air pollution: Evidence from China

Education expenditure is essential in mitigating air pollution, but the relationship between education expenditure and air pollution lacks in-depth discussion. Utilizing data at the county level in China during 2007–2021, this study estimates the effect of education expenditure from local governments on air pollution. Our findings demonstrate that education expenditure significantly and negatively affects air pollution, which remains robust after addressing endogeneity. The mechanism analysis presents that education expenditure reduces air pollution through the composition, technique, and income effects. The heterogeneity analysis indicates that the impact of education expenditure exhibits marked regional heterogeneity. Specifically, the role of education expenditure is significant in strong regulation, key, eastern, and central regions. By considering interaction terms, we identify the moderating effects of human capital, economic development, infrastructure construction, and public service for education expenditure. The cost-benefit analysis emphasizes that education expenditure improves social welfare. Our findings can inspire local governments to place more emphasis on air quality and public education expenditure.