The European Union's Biodiversity Strategy sets an ambitious goal to increase the area of protected land and sea to 30% with 10% devoted to strict protection by 2030. The large land areas required to fulfil the conservation target and the quick schedule of implementation challenge both the current policy instruments and public funding for conservation. We introduce a deferrence mechanism for forest conservation by using procurement auctions. Deferring the conservation payments allows the government to conserve large areas in a quicker schedule, reduce the irreversible biodiversity loss due to harvesting risks and distribute the financial burden of conservation cost for a longer period of time. The deferred payments are paid an interest. The interest earning and an auction mechanism for downpayments strengthens the incentives for landowners to take part in conservation. We characterize the general properties of the mechanism and run numerical simulations to find that the deferrence mechanism facilitates a quick conservation of stands and thereby minimizes the loss of ecologically valuable sites caused by harvesting risks. The analysis suggests that keeping the lending period no longer than 10 years and paying a 3% interest rate provides a compromise that works rather well and outperforms the up-front mechanism regardless the payments being determined by the conservation programme or by an auction. • The EU Biodiversity Strategy requires large-scale conservation efforts by 2030. • Current payments entail slow conservation and thus irreversible biodiversity losses. • Deferred payments allow quick large-scale conservation and removes harvest risks. • We build an auction model for downpayments and instalments. • Numerical simulation shows that deferrence leads to higher net benefits.

Type 1 diabetes (T1D) is a chronic autoimmune disease that results in loss of insulin-secreting pancreatic β-cells in the islets of Langerhans. A diagnosis of T1D is typically associated with children and adolescents, yet half of all diagnoses of T1D are made in adults. In children and adolescents, T1D is often first recognized following hospitalization for diabetic ketoacidosis (DKA), which occurs in approximately 20%-50% of new-onset T1D for people younger than 18 years of age in Europe. For adults with new-onset T1D, DKA rates of up to 24% are estimated. Early-stage T1D, during the asymptomatic period, can be detected through screening for multiple islet autoantibodies in blood samples, including capillary and venous samples, and such programs are made more popular by the availability of disease-modifying therapies for early-stage T1D. For individuals who screen positive for early-stage T1D, participation in monitoring programs can greatly reduce the incidence of DKA once symptomatic hyperglycemia develops, as well as reducing severity of symptoms of T1D at onset. Education and awareness of the clinically relevant features of symptomatic T1D can also support the psychological wellbeing of people with early-stage T1D and minimize distress at the point when insulin treatment is necessary. All of these consequences come with a predicted reduced burden of healthcare costs for managing T1D at a population level, and general population screening for islet autoantibodies is underway. In this European perspective, we discuss the imperatives and the components of implementation of general population screening for early-stage T1D.

Abstract X-ray Thomson scattering (XRTS) constitutes an essential technique for diagnosing material properties under extreme conditions, such as high pressures and intense laser heating. Time-dependent density functional theory (TDDFT) is one of the most accurate available ab initio methods for modeling XRTS spectra, as well as a host of other dynamic material properties. However, strong thermal excitations, along with the need to account for variations in temperature and density as well as the finite size of the detector significantly increase the computational cost of TDDFT simulations compared to ambient conditions. In this work, we present a broadly applicable method for optimizing and enhancing the efficiency of TDDFT calculations. Our approach is based on a one-to-one mapping between the dynamic structure factor and the imaginary time density–density correlation function, which naturally emerges in Feynman’s path integral formulation of quantum many-body theory. Specifically, we combine rigorous convergence tests in the imaginary time domain with a constraints-based attenuation of narrow-band fluctuations to improve the efficiency of TDDFT modeling without the introduction of any significant bias. As a result, we can report a speed-up by up to an order of magnitude, thus substantially reducing the burden of computational cost required for XRTS analysis.

Background Tuberculosis (TB) is a major public health challenge in developing countries, where patient satisfaction (PS) and perceived healthcare service quality influence treatment adherence and outcomes. This study assessed PS and perceived quality of healthcare services in public and private facilities. Methods An analytical cross-sectional study was conducted among 330 pulmonary TB patients (18-75 years) receiving treatment under the Directly Observed Treatment Short-course (DOTS) program in Lahore, Pakistan. Participants were recruited from four public hospitals, one private hospital, and three TB association centers. Data were collected through structured face-to-face interviews assessing professional competence, facility experience, accessibility, and medicine availability. Reliability was assessed using Cronbach's alpha. Exploratory factor analysis (EFA) and multiple linear regression were performed to identify determinants of PS. Results EFA extracted three factors: professional communication, facility competence, and accessibility/cost, explaining 72% of the total variance. Overall satisfaction was moderate to high, with no statistically significant difference between public and private facilities (p > 0.05). Regression analysis showed that facility experience (standardized β = 0.587, p < 0.001) and public sector facility services (β = 0.290, p < 0.001) were significant predictors of satisfaction, whereas cost burden was a significant negative predictor (β = -0.215, p = 0.001). The model explained 36% of the variance in satisfaction (R² = 0.36). Conclusion Facility experience and healthcare service quality are key determinants of TB satisfaction. Strengthening patient-centered care and reducing financial barriers may improve perceived healthcare quality and support adherence within the DOTS program.

ABSTRACT Historical manifestations of structural racism and discrimination (SRD; e.g. 1930s redlining) have been linked to current adverse health outcomes, yet less is known about linkages to present-day neighborhood conditions. We advance existing literature by linking historical and contemporary manifestations of SRD at the neighborhood-level across five metropolitan areas in North Carolina. Historical (Homeowner’s Loan Corporation [HOLC]) neighborhood classifications (ranging from A [green/“best”] to D [red/“hazardous”]) were spatially linked at the census-tract level to contemporary manifestations of SRD: multi-dimensional measures of residential segregation, racial disparity in mortgage denials, housing cost burden, and a gentrification index. We generated figures to descriptively represent the relationship between HOLC grades and contemporary manifestations of SRD and examine the change in neighborhood conditions over time. Across all metro areas, tracts previously graded C/D had the highest Black-non-Hispanic white residential segregation. Additionally, these tracts had wider Black-non-Hispanic-white mortgage lending disparities and higher housing cost burdens compared with areas formerly graded A/B. Most tracts deemed either “gentrified” or “intense gentrification” were formerly classified as Grade C, while the majority of formerly redlined (Grade D) tracts were considered “eligible, not gentrified.” These results indicate a persistent connection between historical and contemporary manifestations of SRD.

BackgroundPatient Safety Indicators (PSIs) are quality metrics developed by the Agency for Healthcare Research and Quality (AHRQ) to identify potentially preventable postoperative complications. The rate of PSIs after lung resection remains poorly defined.MethodsWe retrospectively reviewed our institutional database for all lung resection patients age ≥16 from 2014 to 2024. Patient Safety Indicators evaluated were PSI-9 (hemorrhage/hematoma), PSI-10 (acute kidney injury requiring dialysis), PSI-12 (peri-operative pulmonary embolism [PE] or deep vein thrombosis [DVT]), and PSI-13 (post-operative sepsis). The primary outcome was the incidence of preventable PSIs following lung resection. Secondary outcomes included clinical predictors of PSI, short-term outcomes by PSI status, and PSI-related costs.ResultsAmong 2701 lung resection patients, 35 (1.29%) experienced at least one PSI, totaling 43 PSI events (1.59%). Patient Safety Indicator patients were more often male (65.7% vs 48.3%, P = .04), had higher comorbidity burden (Charlson-Deyo 3+: 97.1% vs 73.5%, P = .02), and more frequently had prior lung cancer (80.0% vs 52.3%, P = .001). Patient Safety Indicator patients had higher 30-day mortality (11.4% vs 1.2%, P < .001). Logistic regression identified male sex (aOR 2.20 [1.08-4.46], P = .03) and prior lung cancer (aOR 2.95 [1.22-7.12], P = .02) as independent predictors of PSI. After review, 37 PSIs were classified as preventable or possibly preventable (1.37%), generating an estimated cost burden of $983,059 and largely driven by PSI-13 sepsis events.ConclusionAlthough PSIs after lung resection are infrequent, focus on preventing post-operative adverse outcomes should remain paramount. Targeted strategies to prevent these preventable complications can help improve outcomes and provide a significant cost-saving opportunity.

Chronic kidney disease (CKD)-mineral bone disorder (MBD) is a prevalent and serious complication in patients with advanced CKD, particularly in Southeast Asia where the disease burden is high. This condition significantly increases the risk of cardiovascular events and mortality. This review synthesizes mechanistic insights, clinical trial evidence, guideline recommendations, and expert perspectives to evaluate the role of sevelamer, a non-calcium-based phosphate binder, in the management of CKD-MBD. Regional epidemiological and clinical practice data from Southeast Asia were also examined. Sevelamer effectively controls hyperphosphatemia without exacerbating hypercalcemia or vascular calcification. Beyond phosphate binding, it offers pleiotropic benefits including improvements in lipid profile, reductions in vascular inflammation, and potential survival advantages. Despite challenges such as higher cost and pill burden, long-term safety and efficacy have been consistently demonstrated, particularly in high-risk CKD populations. Sevelamer represents a preferred therapeutic option in the management of CKD-MBD due to its efficacy and favorable safety profile. Insights from Southeast Asia highlight the need for improved accessibility, physician education, and supportive health policies to optimize its use in real-world practice.

Mobility is central to aging in place, yet older adults’ transportation experiences are shaped by the interaction of housing conditions, transportation systems, and functional capacity. Drawing on person–environment exchange perspectives in environmental gerontology, this study examines how housing-related cost pressures and transportation disadvantage jointly influence transportation dependence and realized mobility among adults aged 55 and older. Using survey data, we estimate multivariable regression models and test moderation and mediation pathways to clarify underlying mechanisms. Transportation disadvantage—defined as the cumulative presence of car unavailability, lack of smartphone access, and reliance on assistance for travel—emerges as a strong and consistent predictor of reliance on dependent transportation modes and destination-specific mobility. Greater transportation disadvantage is associated with increased medical trip-making and reduced social participation, while grocery trip frequency shows no independent association once access constraints are accounted for. In contrast, combined housing and transportation cost burden and housing tenure exhibit no direct, conditional, or indirect effects on mobility outcomes. These findings highlight the central role of proximal access constraints in shaping mobility in later life and underscore the limits of cost-based affordability measures for understanding everyday transportation experiences among older adults.

This study aims to analyze the impact of green economy variables on Foreign Direct Investment (FDI) in 10 ASEAN member countries from 2000 to 2020. The primary issue investigated is the energy transition paradox, where sustainability policies potentially become a cost burden for foreign investors. The research methodology employs a quantitative approach using panel data regression with the Fixed Effect Method (FEM), enhanced by Clustered-Robust Standard Error to address classical assumption issues. The results indicate that Renewable Energy Consumption (REC), CO2 emissions, and Natural Resource Depletion (NRD) simultaneously have a significant effect on FDI. Partially, only the REC variable shows a significant negative impact, where every one percent increase in renewable energy consumption decreases FDI by 0.159% of GDP. In contrast, CO2 emissions and NRD do not exhibit statistically significant effects. These findings confirm the efficiency-seeking motives of investors who perceive the energy transition as an additional compliance cost due to the absence of adequate fiscal support. Consequently, a fiscal buffering strategy is required through the synchronization of tax incentives and the implementation of carbon taxes to maintain investment competitiveness amidst the global energy transition.

ABSTRACT Introduction Racial differences in exposure to area-level social determinants of health (SDoH) may contribute to distinct vulnerability profiles among people living with dementia. Methods This cross-sectional study used data from the OCHIN Community Health Equity Database to examine SDoH factors among patients with dementia and mild cognitive impairment. SDoH measures encompassed social, environmental, and climate vulnerability factors. We trained Random Forest classifiers to identify the most influential SDoH features distinguishing racial groups. Results Common SDoH factors – those ranking among the top features across multiple racial groups – included percentage of minority populations, limited English proficiency, exposure to diesel particulate matter or fine particulate matter, impaired watershed, and frequency of extreme heat and wildfire smoke days. Distinct SDoH factors – those identified as top-ranked for only one or two groups – included unemployment and disability rates in ZIP codes where American Indian and/or Alaska Native patients lived; lack of walkability in areas where Asian patients resided; hurricane occurrences in ZIP codes where Black patients lived; low educational attainment in Native Hawaiian or other Pacific Islander communities; and housing cost burden, lack of internet access, and older housing stock in areas where Multiracial patients lived. Discussion These findings highlight the importance of incorporating multidimensional SDoH measures when assessing structural contexts in dementia research.

Hemophilia is an inherited bleeding disorder caused by deficiencies in coagulation factor VIII (FVIII) or factor IX (FIX), leading to impaired thrombin generation and recurrent bleeding episodes. For decades, prophylactic factor replacement therapy has been the mainstay of hemophilia management; however, its limitations-including treatment burden, inhibitor development, and incomplete bleeding control-have required the development of alternative therapeutic strategies. Non-factor therapies represent a major paradigm shift in hemophilia care by restoring hemostatic balance through mechanisms independent of FVIII or FIX replacement. These approaches include bispecific antibodies that mimic FVIII cofactor activity and rebalancing strategies that enhance thrombin generation by inhibiting anticoagulant pathways such as tissue factor pathway inhibitor or antithrombin. Clinical studies have demonstrated that non-factor therapies provide stable and predictable prophylactic efficacy, significantly reduce bleeding rates, and improve quality of life in people with hemophilia A or B, irrespective of inhibitor status. Despite these advances, important challenges remain. Non-factor therapies modify physiological coagulation pathways and may be associated with thrombotic events due to imbalance between procoagulant and anticoagulant mechanisms, particularly for rebalancing agents. In addition, the lack of standardized laboratory assays for assessing global coagulation potential, uncertainties regarding combination therapy during breakthrough bleeding or surgery, and concerns about long-term safety and cost burden could limit optimal implementation. This review summarizes the mechanisms of action, clinical evidence, and safety considerations of currently available and emerging non-factor therapies for hemophilia. We also discuss unmet clinical needs, patient management considerations, and future perspectives aimed at optimizing the safe and sustainable use of non-factor therapies into routine hemophilia care.

In alignment with the World Health Organization's goal of eliminating hepatitis C, this study assessed the current treatment status and reasons for non-treatment among patients with hepatitis C in Jeonbuk State, Republic of Korea, to inform strategies for improving care engagement. Among 311 individuals diagnosed with hepatitis C and reported through the National Notifiable Infectious Disease Surveillance system between January 2023 and June 2024, 208 patients were surveyed after excluding those who had died or could not be contacted. Statistical analyses included the chi-square test, the Cochran-Armitage test for trend, and logistic regression. Overall, 116 participants (55.8%) reported having received antiviral therapy. Among the 92 untreated individuals, the most common reason for non-treatment was the absence of symptoms (n=23; 25.0%), followed by the burden of drug costs (n=21; 22.8%). These findings highlight suboptimal treatment uptake and key barriers that may hinder progress toward hepatitis C elimination. Expanding screening and strengthening linkage-to-care strategies, while addressing financial barriers, will be essential to achieving national elimination targets.

Heart failure (HF) hospitalization readmissions are associated with a high mortality rate and strain the health care system. Both clinical factors and social determinants of health (SDOH) predict HF readmissions, but the optimal approach to incorporating area-level SDOH data remains unclear. We merged census tract- and county-level SDOH measures with electronic health record data in a retrospective cohort of 33 579 Black and White patients with HF (Emory Healthcare, 2010-2018). Six combinations of electronic health record data with 752 area-level SDOH were evaluated using multiple machine learning models (logistic regression, random forest, XGBoost) to predict 30-day HF readmission. Models were assessed for predictive performance using area under the receiver operating characteristic curve and algorithmic fairness across race using the equalized odds ratio. Expanded SDOH predictor sets improved predictive performance and algorithmic fairness compared with traditional SDOH indices. The XGBoost model using expanded SDOH alongside clinical predictors provided better predictive performance (area under the receiver operating characteristic curve, 0.671) and improved algorithmic fairness across patient race (equalized odds ratio, 0.437) than models with traditional indices (area under the receiver operating characteristic curve, 0.632; equalized odds ratio, 0.329). Feature-importance analysis revealed that specific environmental predictors (housing cost burden, air quality) ranked among top predictors alongside clinical biomarkers. County-level SDOH outperformed census tract-level SDOH and matched prediction performance of clinical predictors alone. Including hundreds of individual SDOH indicators rather than traditional composite indices improves machine learning models' ability to predict 30-day HF readmissions. While performance gains are modest, inclusion of specific environmental factors may provide greater clinical utility and improved equity across racial groups than composite SDOH measures for guiding further research and preventive interventions.

• Amending WtE with CCS reduces CO 2 -eq emissions by 73–174 % per ton waste. • Introducing advanced sorting technology increases material recovery by 15–34 %. • Energy output is reduced by 23–55 % from WtE depending on the scenario. • Cost increases for treating 1 ton waste increase by 20–98 %. • Current Norwegian policy is inconsistent with the waste hierarchy and the polluter-pays-principle. Greenhouse gas emissions from waste incineration has been characterized as hard to abate process-based emissions due to the consistent generation of residual waste, which contains significant levels of embedded fossil carbon. Policy enacted by the Norwegian government takes aim at reducing these emissions via implementing carbon capture and storage (CCS) or reducing the flow of residual waste to incineration by incentivizing advanced centralized waste sorting. The enacted policy tool used for achieving this is a tax directed at incineration plant fossil carbon emissions. The emission (CO2-equivalents), material, energy, and cost consequences of these amendments to existing waste management are modelled and assessed via LCA and LCC scenarios, considering various waste compositions and technology levels for the treatment of 1 ton residual waste. Model results show considerable environmental improvements in terms of emission mitigation via CCS and increased recycling (23–160% reduction), with a considerable trade-off with energy recovery (23–55% reduction) and costs (20–90% increase). The failure of national policy to incorporate the intricacies of the existing system in conjunction with moral considerations regarding cost burdens are discussed in the context of societal acceptance. Adoption of clearer and more active governing frameworks to avoid socializing the cost of the circular economy transition are highlighted, and the consistency of current policy with governing principles such as ‘ the polluter pays ’ is questioned.

Asthma is a chronic disease that requires careful management, and its exacerbations can be life-threatening. The aim of this study was to ascertain whether inhaled corticosteroids (ICS)-containing inhaler in combination with oral montelukast and levocetirizine could lessen the exacerbation of asthma in comparison to inhaler alone. Among 437,915 asthma patients receiving ICS-containing inhaler, 91,122 participants were included. Treatment groups were categorized as (1) ICS-containing inhalers (ICS with or without long-acting β-2 agonist (LABA)), and (2) ICS-containing inhalers used in combination with both oral montelukast and levocetirizine, and (3) severe exacerbation of asthma (visit of emergency room or hospitalization). After 1:1 propensity score matching of treatment groups, survival analysis utilizing Cox regression was conducted for estimating the effect of treatment on asthma exacerbation. We found that the inhaler plus montelukast and levocetirizine group exhibited a lower crude incidence rate and was associated with a lower risk of all-cause death and moderate to severe exacerbation. Specifically, the adjusted hazard ratios (HRs) were 0.71 (p=0.006) for all-cause death, 0.57 (p<0.001) for moderate exacerbation. For severe exacerbations, the adjusted HRs were 0.59 for emergency room visits and 0.66 for hospitalizations (p = 0.018 and 0.011, respectively), compared to the ICS-only group, demonstrating a statistically significant reduction. Treatment with ICS-containing inhaler plus oral montelukast and levocetirizine was significantly associated with a lower risk of exacerbations in asthma patients. Alongside the growing burden of healthcare utilization and costs in South Korea, consideration of the treatment of ICS with montelukast and levocetirizine may serve as an effective treatment option for patients with severe, uncontrolled asthma, potentially improving disease management and reducing healthcare costs.

Adaptive trials and new designs.

Prior studies link intimate partner violence (IPV) to poor mental health, especially among those with low socioeconomic status or limited support. However, few have explored how housing conditions may moderate these psychological effects. This study investigates the relationship between IPV and psychological well-being, with a particular focus on two outcomes: depressive symptoms and life satisfaction. It also examines whether housing conditions amplify or mitigate individuals' psychological responses to IPV. Data were drawn from the 2008 to 2022 Korea Welfare Panel Study (n = 14,350 married individuals). We employed an individual fixed-effects model to examine the relationship between IPV and psychological well-being. Housing physical conditions, housing tenure, and housing cost burden were evaluated as potential moderators. IPV is strongly associated with increased depressive symptoms and decreased life satisfaction. The impact of IPV on depressive symptoms is particularly pronounced among IPV survivors who live in inadequate housing conditions, rent their homes, and experience a housing cost burden. However, we did not find evidence that housing physical conditions or housing tenure moderate the association between IPV and life satisfaction; only housing cost burden showed a moderating effect. Our findings demonstrate that IPV significantly decreases psychological well-being among individuals facing housing-related challenges. These results underscore the importance of interventions that address both IPV and housing instability to improve mental health outcomes, highlighting the critical role of stable, safe, and affordable housing for survivors. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

26-A-14564-ACC REAL-WORLD INCIDENCE AND COST BURDEN OF MEDICAL EVENTS IN MEDICARE MEMBERS WITH OBSTRUCTIVE HYPERTROPHIC CARDIOMYOPATHY

The paper discusses the relation between Environmental, Social and Governance (ESG) performance and financial performance of the both the industries which are highly polluting in regards to profitability, market value, cost burden and risk reduction. It is analyzed in a quantitative form which is based on secondary data and the firms are divided into high, medium and low ESG performers. The results indicate that the percentage of high, medium and low ESG companies is 38, 42 and 20 respectively that implies that the industries are in a transitional stage of environmental scanning with ESG. The results indicate that there is a positive correlation between the ESG performance and profitability with the high ESG firms that reported an average of 18 proportion of profit margin compared to 14 and 10 proportion of profit margin of medium and low ESG firms respectively. Similarly, high ESF companies (22) relative to medium (16) and low (11) have greater growth in market values because of the preference of sustainable companies by investors. However, the realization of ESG is associated with the high-cost burden because ESG related costs increase by 26 percent that is greater than the revenue increase in the short term of 19%. The paper also mentions that, ESG plays a role in risk management, with high ESG firms having a smaller risk (30 percent) when compared to medium and low ESG firms (22 and 14 percent, respectively). In addition, the ESG ranks with a long-term financial impact (24) that is two times as much as its short-term impact (12), and this will serve to demonstrate its strategic importance. Overall, the findings suggest that, despite the fact that ESG investments may create short-term profitability, it has much to offer to the long-term financial performance, growth, and minimization of risks in highly polluting sectors.

Academic credential fraud and the inefficiencies of manual, paper based verification procedures continue to weaken trust in educational records and enforce significant time and cost burdens on institutions, employers, and graduates. Current blockchain-based approaches demonstrate that distributed ledgers can provide tamper evident, auditable storage and quick validation of certificates, yet many solutions lack a comprehensive tokenisation model and fine-grained access control tailored to heterogeneous academic ecosystems. This paper offers a blockchain based tokenisation framework for secure academic certificate verification, in which each credential is represented as a unique, verifiable digital token governed by smart contracts. The framework defines procedures for certificate issuance, ownership transfer, and withdrawal, along with role based permission mechanisms to ensure that only authorized institutions can mint or modify academic tokens while verifiers can efficiently validate their authenticity. To preserve privacy, the model combines on chain token metadata with selectively disclosed off chain certificate data, thereby preventing exposure of sensitive student information while maintaining endwise verifiability. A theoretical planning and orientation work flow are presented to validate incorporation with present institutional information systems, highlighting how the proposed framework can reduce verification potential, mitigate imitation, and support interoperable, cross institutional credential exchange at scale.