Cost-effectiveness Considerations Research Articles

Cost-effectiveness and other considerations for different research techniques applied in ancient DNA analysis.

Ancient DNA (aDNA) analysis has developed rapidly since it first emerged in the 1980s, becoming an almost indispensable tool in anthropological and archaeological sciences. Earlier aDNA study was based on the polymerase chain reaction (PCR) technique, with which, unfortunately, modern DNA contamination and other authenticity issues were often incurred. These technical hurdles were soon overcome by application of advancements in the forms of the next generation sequencing (NGS) technique and others. However, since NGS requires money, time, and, in the case of large projects, manpower as well, genetic analysis of some ancient samples considered to be insignificant is commonly delayed or, in the worst cases, neglected entirely. We acknowledge that as a diagnostic tool in aDNA analysis, PCR is less accurate than NGS and more easily affected by modern DNA contamination; but it also has advantages, such as simplicity, time-saving, and greater ease of interpretation, among others. The role of PCR in aDNA analysis, then, should be reconsidered.

Comparative analysis on the hydrodynamic characteristics of offshore floating photovoltaic systems based on membrane structures under different mooring configurations

In the context of rapidly increasing global energy demand, solar energy is considered one of the most promising alternatives due to its ubiquity and sustainability. Floating photovoltaics, which do not occupy land and offer higher power generation efficiency, are becoming increasingly popular. As a novel type of floating photovoltaic, membrane structures are drawing more attention due to their lightweight nature, easy installation, and cost-effectiveness. Based on the Ocean Sun's floating photovoltaic membrane prototype as a reference, this study designed and fabricated a 1:40 scale model for laboratory experiments. The research investigated the influence of different mooring configurations and lengths on the hydrodynamic characteristics of membrane structures. The conclusions indicate that structures with more anchor chains exhibit smaller amplitudes in various movements and mooring forces. As the mooring length decreases, the amplitudes of various structural movements decrease, but mooring forces increase. Compared to regular wave conditions, mooring has a more significant impact on structural motion responses under irregular waves. In practical engineering, a comprehensive consideration of structural safety and cost-effectiveness is necessary for design. The selection of appropriate mooring configurations and lengths plays a crucial role in ensuring the safe operation and sustainability of membrane structures.

Health Technology Assessment of Nailfold Capillaroscopy and Digital Retina Imaging in Diabetes Screening

AimThis study aims to identify the criteria for the evaluation of medical technologies in diabetes screening and then perform health technology assessment (HTA) for two technologies: digital retina imaging (DRI) and Nailfold Capillaroscopy (NFC). MethodsA multicriteria decision-making tool measuring attractiveness using a categorical-based evaluation technique (MACBETH) was used to calculate and compare alternatives. A focus group of ten decision-makers with more than ten years of experience in health technology was used for the decision-making. The Delphi Method was used to get a consensus about comparing criteria and alternatives to these criteria. The sampling method used in the study was the nonprobability purposive sampling method. ResultsThe study concluded that clinical efficacy (0.42) is the most important criterion for evaluating medical technologies, followed by cost-effectiveness (0.27). At the same time, ethical considerations were found to be less important (0.03). The sensitivity analysis concluded that the decision is sensitive to clinical efficacy and cost-effectiveness changes. The study found that none of the alternatives dominates others as an option for early detection of diabetes through vascular changes. LimitationsThis study primarily uses systemic literature review methods to identify criteria for evaluating alternatives. There may be additional criteria for evaluation. ConclusionThis study provides an approach for a multicriteria comparison of medical devices. The study findings are useful for public health professionals and health policymakers. Plain Language SummaryThis study assesses nailfold capillaroscopy (NFC) as a substitute for digital retina imaging (DRI) in diabetes screening using the MACBETH multicriteria decision-making tool. The research identifies five key evaluation criteria: clinical efficacy, cost-effectiveness, patient needs, user safety, and ethical considerations. A focus group of experienced health technology decision-makers was used to compare NFC and DRI. Results indicate that clinical efficacy and cost-effectiveness are the most critical factors, with NFC showing potential but not significantly outperforming DRI. Sensitivity analyses highlight the need for further research to validate NFC as an effective diabetes screening tool.

Comparative Analysis of Bispecific Antibodies and CAR T-Cell Therapy in Follicular Lymphoma.

The treatment landscape for relapsed/refractory follicular lymphoma (RR-FL) is marked by a pivotal debate between chimeric antigen receptor T-cell (CAR-T) therapy and bispecific antibodies (BsAbs). While both CAR-T therapy and BsAbs target similar immunobiology and molecular markers, their efficacy comparisons are hindered by the lack of direct clinical trial comparisons. Key trials, such as the ZUMA-5 study, underscore axicabtagene ciloleucel (axi-cel)'s efficacy in treating RR-FL, achieving a 79% complete response rate with a median duration of response exceeding 3 years. Similarly, lisocabtagene maraleucel (liso-cel) in the TRANSCEND FL study reports a 94% complete response rate, emphasizing robust outcomes in heavily pretreated patients. Among BsAbs, mosunetuzumab showed promise in the GO29781 trial, with a 62% overall response rate in heavily pretreated RR-FL patients. Thus, CAR-T therapy offers potential curative benefits with a single infusion. However, its efficacy is tempered by significant adverse events such as cytokine release syndrome (CRS), neurotoxicity, and cytopenias, requiring specialized management and patient monitoring. In contrast, BsAbs provide a more tolerable treatment option counterbalancing by lower response rates and frequent dosing requirements. Personalized treatment strategies are crucial because of these distinct efficacy and safety profiles. When considering cost-effectiveness, both therapies need to be evaluated in the context of their clinical outcomes and quality of life improvements. Cost-effectiveness considerations are essential; while CAR-T therapies incur higher initial costs, their potential for long-term remission may mitigate expenses associated with repeated treatments or hospitalizations. Future research into resistance mechanisms and optimal therapeutic sequencing will further refine RR-FL management strategies.

A Twin Transition in Regulatory Toxicology-moving towards Chemicals 2.0 and phasing out animal testing.

The European regulatory framework on chemicals is at a crossroads. There are calls for the framework to be more effective, by better protecting people and the environment. There is also room for it to be more efficient and cost-effective, by harmonising assessment practices across sectors and avoiding the need for unnecessary testing. At the same time, there is a political commitment to phase out animal testing in chemical safety assessments. In this commentary, we argue that these needs are not at odds with other. On the contrary, the roadmap to phase out animal testing could also be the transition pathway to a more efficient, effective and sustainable regulatory ecosystem. Central to our proposal is a framework based on biological reasoning in which biological questions can be answered by a choice of methods, with non-animal methods progressively becoming the only choice. Within this framework, a tiered approach to testing and assessment allows for greater efficiency and effectiveness, while also introducing considerations of proportionality and cost-effectiveness. Testing strategies, and their component methods, should be developed in tandem and judged in terms of their outcomes, the protection levels they inform, rather than their ability to predict the outputs of animal tests.

Photon-counting detector computed tomography in cardiac imaging.

Photon-counting detector computed tomography (PCD-CT) has emerged as arevolutionary technology in CT imaging. PCD-CT offers significant advancements over conventional energy-integrating detector CT, including increased spatial resolution, artefact reduction and inherent spectral imaging capabilities. In cardiac imaging, PCD-CT can offer amore accurate assessment of coronary artery disease, plaque characterisation and the in-stent lumen. Additionally, it might improve the visualisation of myocardial fibrosis through qualitative late enhancement imaging and quantitative extracellular volume measurements. The use of PCD-CT in cardiac imaging holds significant potential, positioning itself as avaluable modality that could serve as aone-stop-shop by integrating both angiography and tissue characterisation into asingle examination. Despite its potential, large-scale clinical trials, standardisation of protocols and cost-effectiveness considerations are required for its broader integration into clinical practice. This narrative review provides an overview of the current literature on PCD-CT regarding the possibilities and limitations of cardiac imaging.

Tonsillectomy Under the Microscope: Is Routine Histopathological Analysis Necessary?

Introduction Tonsillectomy is the most common surgery in otorhinolaryngology worldwide, with many indications in adults and children. Traditionally, all tonsillectomy specimens are routinely submitted for histopathological examination, even in the absence of clinical suspicion of malignancy. This practice has been debated due to its resource implications and the low yield of malignancy in routine cases. In this study, we aim to determine the prevalence of occult malignancy in our population and assess the necessity of histopathology examination after routine tonsillectomies. Methodology This retrospective chart review was conducted on patients who underwent tonsillectomy between January 2018 and December 2019 at a single tertiary care center. The patients were divided into two groups: those undergoing routine tonsillectomy without clinical suspicion of malignancy and those with suspected malignancy based on preoperative evaluation. Results A total of 1857 tonsillectomy cases were analyzed, comprising 1839 routine cases with no suspicion of malignancy and 18 cases where malignancy was suspected. Among the routine cases, 1609 (87.5%) were pediatric patients, and 230 (12.5%) were adult patients. All cases in the suspected malignancy group were adults. In the routine tonsillectomy group, recurrent tonsillitis was the most common indication for surgery, observed in 821 (51.1%) pediatric patients and 160 (69.6%) adult patients. Reactive lymphoid hyperplasia was the most common histopathological finding, present in 1589 (98.8%) pediatric cases and 187 (81.3%) adult cases. No unexpected malignancies were identified in the routine tonsillectomy group (0%). In the suspected malignancy group, reactive lymphoid hyperplasia was identified in 13 cases (72.2%), lymphoma in four cases (22.2%), and squamous cell carcinoma (SCC) in one case (5.6%). All patients diagnosed with lymphoma presented with visible tonsillar lesions and palpable neck lymph nodes, three (75%) exhibited tonsillar asymmetry, and two (50%) reported weight loss. The single patient with SCC had asymmetrical tonsils, a visible tonsillar lesion, and palpable neck lymph nodesand experienced weight loss. Conclusion The study findings demonstrated no cases of unexpected malignancy in routine tonsillectomy specimens, reinforcing the argument that routine histopathological examination may not be necessaryin the absence ofclinical suspicion of malignancy. These results, along with considerations of cost-effectiveness and resource optimization, suggest that histopathological analysis maybe reserved only for cases with clinical indicators of malignancy.

Cost-effectiveness and algorithmic decision-making

AbstractWe argue that there are cases in which it is morally permissible to replace medical practitioners with machine learning algorithms. Our argument appeals to the uncontroversial view that it is sometimes morally permissible to make medical decisions based on cost-effectiveness considerations. For example, it is generally morally permissible to prescribe a treatment that is as effective as its alternatives but much cheaper. If this is so, we argue, then similar cost-effectiveness considerations can explain why it is sometimes morally permissible to replace human practitioners with algorithms. To reject our argument, one needs to show that when it comes to algorithmic medical decision-making, there are special considerations that would always override cost-effectiveness considerations. We go through a range of candidate considerations and argue that none of them is weighty enough to tip the balance in favor of human practitioners.

Considering the Cost-Effectiveness of Accredited Continuing Medical Education: A Landscape Analysis of Economic Concepts in Continuing Medical Education Research.

In health care, cost-effectiveness analysis evaluates changes in health outcomes as a function of costs. The cost-effectiveness of continuing professional development for health care providers has not been historically well characterized despite substantial investment. This literature review identified publications considering the costs and cost-effectiveness of accredited continuing medical education activities. Searches were conducted for English language records in PubMed and the gray literature using a 10-year lookback period from March 10, 2023. Search terms included concepts related to continuing medical education, cost, effect, and utilization. One reviewer conducted title/abstract screening, full-text review, and data extraction, with direction and adjudication of search and screening concepts provided by the lead advisor. Publications were categorized as related to costs of an educational intervention (Concept 1) and/or the impact of education on health care costs (Concept 2). Results were summarized using descriptive statistics. A total of 668 database records were screened, 125 (19%) underwent full-text review, and 25 of 125 (20%) were accepted; 7 of 351 (2%) gray literature sources were accepted for a total of 32 included records. The most common reason for rejection was not being an accredited activity. Of the 32 records, 27 (84%) were related to Concept 1 only, 3 (9%) to Concept 2 only, and 2 (6%) to both Concepts 1 and 2. Approximately half (n = 19, 59%) mentioned costs without supporting data. These findings show that considerations of cost and cost-effectiveness are rare in the accredited continuing medical education literature, which may limit how the value of continuing medical education is characterized.

Microwave biosensors utilizing metamaterial enhancement: Design and application

Microwave sensing technology has become increasingly widely applied in the biomedical field, playing a significant role in medical diagnosis, biological monitoring, and environmental warning. In recent years, the introduction of metamaterials has brought new possibilities and opportunities to microwave biosensors. This paper aims to explore the applications of microwave sensors in biosensing, with a particular emphasis on analyzing the crucial role of metamaterials in enhancing sensor performance and sensitivity. It provides a thorough examination of the fundamental principles, design strategies, fabrication techniques, and applications of microwave biosensors leveraging metamaterial enhancement. Moreover, it meticulously explores the latest applications spanning biomedical diagnostics, environmental monitoring, and food safety, shedding light on their transformative potential in healthcare, environmental sustainability, and food quality assurance. By delving into future research directions and confronting present challenges such as standardization and validation protocols, cost-effectiveness and scalability considerations and exploration of emerging applications, the paper provides a roadmap for advancing microwave biosensors with metamaterial enhancement, promising breakthroughs in multifaceted bioanalytical realms.

Exploring versatile applications of a vacuum-assisted bone harvester in orthopedic surgery

BackgroundOrthopedic procedures often require removing bone or pathological tissue, with traditional methods involving instruments like curettes and rongeurs. However, these methods can be time-consuming and lead to increased blood loss. To mitigate these side effects, vacuum-assisted tools have been developed to aid in tissue removal. These devices enable surgeons to suction tissue without discarding it, potentially improving outcomes in conditions such as osteomyelitis or tumor removal while enabling collection of the material for downstream applications. Despite limited research, vacuum-assisted devices show promise beyond bone marrow harvesting. This study assesses infection and clearance rates, estimated blood loss, and total procedure time associated with the use of vacuum-assisted tissue removal, with a goal to understand if these devices can be used for tissue removal across a variety of pathologic conditions.MethodsA retrospective cohort study was conducted on patients undergoing orthopedic procedures with the Avitus® Bone Harvester repurposed from its original design from December 1, 2021, to July 1, 2023. Procedures were categorized into oncology, and debridement for infection cases. Infection cases were further categorized into those secondary to trauma and those involving primary infections (osteomyelitis and periprosthetic joint infection). Clinical variables, including demographics, intraoperative details, complications, and follow-up, were reviewed. Statistical analysis included descriptive statistics computed with R Studio.ResultsThe study included 44 patients, with debridement for infection cases being the most common (primary infection: 45.5%; infection secondary to trauma: 18.1%), followed by oncology cases (36.4%). In all oncology cases, a definitive diagnosis was established using the device, and no post-operative infections were reported. The infection clearance rate was 85.0% for primary infection cases and 50.0% for cases of infection following trauma. Across the entire cohort, the average blood loss was 314.52 mL (sd: 486.74), and the average total procedure time was 160.93 min (sd: 91.07). The overall reoperation rate was 47.7%, with an unplanned reoperation rate of 11.4%.ConclusionThe vacuum-assisted bone harvester was effectively utilized in a wide range of debridement and curettage procedures across diverse orthopedic surgeries. In oncology cases, the device enabled effective tissue removal with comparable recurrence rates, demonstrating its potential to minimize contamination while preserving tissue for accurate diagnoses. Additionally, a high rate of osteomyelitis eradication was observed in debridement for primary infection cases (85%). Despite the relatively high reoperation rate of 47.7%, it is crucial to interpret this figure within the context of the varied reasons for reoperation. Many of these reoperations were planned as part of a staged approach to treatment or were unrelated to the device's performance. It is crucial to acknowledge that isolating the device's contribution to these results can be difficult. The utilization of the device should be guided by considerations of cost-effectiveness and patient-specific risk factors.

Optimizing size and evaluating Techno-Enviro-Economic Feasibility of hybrid renewable energy to power RO/Well unit

The present investigation focuses on the Techno-Enviro-Economic assessment of a hybrid renewable energy system employing Homer software to identify an optimal system to power the Reverse Osmosis/Well (RO/Well) unit, with a capacity of 500 m3/d in the Salbukh region of Riyadh, Kingdom of Saudi Arabia (KSA). The proposed system encompasses photovoltaics (PV), a wind turbine (WT), fuel cells (FCs), a reformer (RF), an electrolyzer (Elec), a hydrogen tank (HT), and a battery (BT). The hybrid system, comprising 325 PV, 6 WT, 100 kW FCs, and a reformer that produces 6 kg of hydrogen (H2)/h, emerges as the most cost-effective and efficient solution, with a cost of energy (COE) amounting to $0.135/kWh. This configuration offers a balanced approach to energy generation, ensuring a more consistent energy supply, and enhancing system reliability. Although the 9 kg H2/hr RF-148 kW FCs system offers the lowest COE ($0.100/kWh), it relies entirely on fossil fuels, namely natural gas (NG). Conversely, the system is powered exclusively by renewable energy derived from PV planes, and WT records the highest COE ($0.199/kWh). The investigation provides valuable insights into developing sustainable energy solutions while taking cost-effectiveness, efficiency, and environmental considerations into account.

Multifaceted approach to successful management of pediatric acute liver failure: High-volume plasma exchange as a pivotal intervention

Abstract: Pediatric acute liver failure (pALF) poses a formidable clinical challenge characterized by rapid hepatocyte necrosis and pro-inflammatory events. The urgency of pALF necessitates advanced therapeutic modalities, prompting the exploration of high-volume plasma exchange (HVPE) as a sophisticated intervention. This case report delves into the intricate management of a 16-year-old female with hyperacute liver failure secondary to hepatitis A, highlighting the critical need for nuanced and multidisciplinary approaches. The case unfolds through a detailed description of symptoms, clinical decision-making, and the therapeutic journey. The management includes a calculated deferral of liver transplantation in favor of HVPE, with a focus on the rationale for choosing HVPE over continuous renal replacement therapy. Technical aspects of the procedure, such as blood volume calculations and procedural details, are meticulously outlined. Laboratory investigations track the patient’s progress, showcasing the profound impact of HVPE on clinical and laboratory recovery. The patient’s response to HVPE is evident in the comprehensive clinical and laboratory recovery observed after the intervention. The resolution of encephalopathy, successful extubation, and eventual discharge highlight the positive outcomes achieved through the judicious application of HVPE. However, the procedure is not without challenges, as the emergence of hypertension during the second and third cycles and a lone episode of seizure require swift and careful management. The management of pALF demands a sophisticated and multidimensional approach, especially when liver transplantation is not immediately feasible. This case report underscores the nuanced decision-making involved in selecting extracorporeal therapies, with a focus on the successful application of HVPE. HVPE, as recommended by the American Society for Apheresis, emerges as a promising intervention in the context of pALF, offering a viable option when liver transplantation is deferred due to advanced encephalopathy. The favorable outcomes and considerations of cost-effectiveness and procedural simplicity further accentuate the potential of HVPE as a cornerstone in the critical care of pediatric patients with acute liver failure.

Exploring the conservation of historic avian corridors under urbanization threats in China: A case study of egrets in the Greater Bay Area

This study explores the conservation of historic flyway corridors for egret in the Greater Bay Area (GBA), with a focus on habitat connectivity and dynamic corridors. To address the gaps in previous research, we used field observations, bio-climatic data and landcover information spanning three decades. Our approach involves MaxENT modeling and the Linkage Mapper method. The results showed that the MaxENT model effectively simulated the egret habitats at different levels, with coastlines and riverbanks emerging as primary habitat zones. Moreover, bio-climatic factors, particularly Bio 19 and Bio 8, played a dominant role, accounting for 90 % of the habitat suitability in 2020. Other factors contributed rather minimally. Through the utilization of resistance surface and corridor extraction methods, noteworthy alterations in the flyway networks emerged post-2000, followed by a gradual return to normal. Connectivity analyses highlighted a critical 30 km threshold for the egret preservation. Corridor widths should be determined based on cost-effective considerations. We conclude that combining MaxENT with the Linkage Mapper method, even with limited egret observations and integrating multi-source data, such as land cover, might simulate potential suitable habitats and flyway dynamics for waterbirds such as egrets. This study provides valuable insights for the egret conservation and the preservation of their habitats in the GBA, contributing to a global waterbird diversity and habitat quality.

Probabilistic Techno-Economic Assessment of Medium-Scale Photoelectrochemical Fuel Generation Plants.

Photoelectrochemical (PEC) systems are promising approaches for sustainable fuel processing. PEC devices, like conventional photovoltaic-electrolyzer (PV-EC) systems, utilize solar energy for splitting water into hydrogen and oxygen. Contrary to PV-EC systems, PEC devices integrate the photoabsorber, the ionic membrane, and the catalysts into a single reactor. This integration of elements potentially makes PEC systems simpler in design, increases efficiency, offers a cost advantage, and allows for implementation with higher flexibility in use. We present a detailed techno-economic evaluation of PEC systems with three different device designs. We combine a system-level techno-economic analysis based on physical performance models (including degradation) with stochastic methods for uncertainty assessments, also considering the use of PV and EC learning curves for future cost scenarios. For hydrogen, we assess different PEC device design options (utilizing liquid or water vapor as reactant) and compare them to conventional PV-EC systems (anion or cation exchange). We show that in the current scenario, PEC systems (with a levelized cost of hydrogen of 6.32 $/kgH2 ) located in southern Spain are not yet competitive, operating at 64% higher costs than the PV-driven anion exchange EC systems. Our analysis indicates that PEC plants' material and size are the most significant factors affecting hydrogen costs. PEC designs operating with water vapor are the most economical designs, with the potential to cost about 10% less than PV-EC systems and to reach a 2 $/kgH2 target by 2040. If a sunlight concentrator is incorporated, the PEC-produced hydrogen cost is significantly lower (3.59 $/kgH2 in the current scenario). Versions of the concentrated PEC system that incorporate reversible operation and CO2 reduction indicate a levelized cost of storage of 0.2803 $/kWh for the former and a levelized cost of CO of 0.546 $/kgCO for the latter. These findings demonstrate the competitiveness and viability of (concentrated) PEC systems and their versatile use cases. Our study shows the potential of PEC devices and systems for hydrogen production (current and future potential), storage applications, and CO production, thereby highlighting the importance of sustainable and cost-effective design considerations for future advancements in technology development in this field.

Is a larger patient benefit always better in healthcare priority setting?

When considering the introduction of a new intervention in a budget constrained healthcare system, priority setting based on fair principles is fundamental. In many jurisdictions, a multi-criteria approach with several different considerations is employed, including severity and cost-effectiveness. Such multi-criteria approaches raise questions about how to balance different considerations against each other, and how to understand the logical or normative relations between them. For example, some jurisdictions make explicit reference to a large patient benefit as such a consideration. However, since patient benefit is part of a cost-effectiveness assessment it is not clear how to balance considerations of greater patient benefit against considerations of severity and cost-effectiveness. The aim of this paper is to explore the role of a large patient benefit as an independent criterion for priority setting in a healthcare system also considering severity and cost-effectiveness. By taking the opportunity cost of new interventions (i.e., the health forgone in patients already receiving treatment) into account, we argue that patient benefit has a complex relationship to priority setting. More specifically, it cannot be reasonably concluded that large patient benefits should be given priority if severity, cost-effectiveness, and opportunity costs are held constant. Since we cannot find general support for taking patient benefit into account as an independent criterion from any of the most discussed theories about distributive justice: utilitarianism, prioritarianism, telic egalitarianism and sufficientarianism, it is reasonable to avoid doing so. Hence, given the complexity of the role of patient benefit, we conclude that in priority practice, a large patient benefit should not be considered as an independent criterion, on top of considerations of severity and cost-effectiveness.

Comprehensive Study on Design and Construction Methodology of Precast Box-Type Minor Bridge

Abstract: Bridges are crucial elements in modern transportation infrastructure, facilitating connectivity across different points on roads. In areas with challenging topography and site conditions, such as rivers or streams, it becomes essential to construct structures that allow for the unobstructed flow of water. These structures, commonly known as bridges and culverts, are vital for maintaining natural water flow. The flow rate through these water bodies is a key consideration in the design of bridges, culverts, and other drainage structures. This study focuses on the design of precast box type minor bridge, exploring alternative design modules that incorporate fixed and hinged end condition for both top and bottom slabs of single and double box cells. The objective is to determine the optimal design configuration for box Type Minor Bridge components, balancing considerations of functionality, efficiency, and cost-effectiveness.

Development of Macrotexture Test Method for Dense-Graded Asphalt Mixtures

The design and construction of pavements necessitate careful consideration of longevity, cost-effectiveness, sustainability, and safety, with a focus on enhancing the durability and lifespan of dense-graded asphalt (DGA) surface mixtures. This paper discusses a research project the Federal Highway Administration (FHWA) initiated to assess the macrotexture characteristics of DGA mixture pavement—particularly concerning safety at higher speeds. The project aims to develop an efficient testing procedure for measuring macrotexture during mixture design and field-testing processes, striking a balance between longevity, cost-effectiveness, sustainability, and safety in pavement design and construction. The study began with a comprehensive review of existing practices, leading to the selection and testing of a unique laser texture scanner capable of noncontact macrotexture measurement. The subsequent phase involved validating the suggested macrotexture measurement system through data collected from State-sponsored projects under the FHWA Mobile Asphalt Technology Center program. Macrotexture measurements were collected from field cores and laboratory-compacted specimens from various State departments of transportation projects and analyzed. Preliminary analysis of the limited dataset to date revealed a positive correlation between average macrotexture measurements from gyratory specimens’ top surface and field core macrotexture measurements. The FHWA developed a draft test method for measuring macrotexture on laboratory specimens and field cores, thereby aiming to reduce procedural variability. Interlaboratory macrotexture test results demonstrated good reproducibility, with an average coefficient of variation of approximately 20%. Overall, this research project seeks to advance the understanding and measurement of macrotexture in DGA mixture pavements and thereby contribute to the development of safe pavements.

Exploring the potential of ammonia and hydrogen as alternative fuels for transportation

Abstract This study investigates the potential of hydrogen and ammonia, as alternatives for transportation fuels to tackle urgent issues concerning greenhouse gas emissions and air quality in the worldwide transportation sector. By examining studies and technological progresses, we evaluate the feasibility of transitioning to these energy options. Through an investigation of production methods, energy efficiency, environmental consequences, and infrastructure requirements, we present both the advantages and disadvantages of using hydrogen and ammonia as fuel substitutes. We spotlight production techniques such as electrolysis and renewable energy sources that could significantly decrease carbon emissions and air pollutants. Nonetheless, key challenges such as expanding infrastructure, cost-effectiveness, and safety considerations need to be resolved for adoption. Drawing on findings from research and industry developments, this article contributes to publications on transportation solutions while proposing avenues for research efforts and policy initiatives. Existing challenges and limitations are also discussed in details. In conclusion, this research underscores the significance of research endeavors and policy backing to unlock the potential of hydrogen and ammonia as sustainable transportation fuels underscoring their role in mitigating environmental impacts and promoting global sustainability objectives.

Pharmacologic Treatments in Adults With Type 2 Diabetes: Cost-Effectiveness and Comorbidity Considerations.

Pharmacologic Treatments in Adults With Type 2 Diabetes: Cost-Effectiveness and Comorbidity Considerations.