Nonrestorative sleep (NRS) refers to the subjective experience of not feeling refreshed after sleeping. Although associations between NRS and mental and physical health have been reported, their relationship with long-term healthcare costs has not been examined. This study investigated whether NRS is associated with increased long-term healthcare costs using a large-scale cohort dataset from Japan. We analyzed the annual health screening and medical claims data of 117,049 individuals enrolled in a health insurance association for civil engineering and construction workers. NRS was assessed in the 2018 health screening using a single item: "Do you feel refreshed after a typical night's sleep?" Annual healthcare costs were calculated using medical claims data from fiscal years (FY) 2018 to 2023. Mixed-effects models for repeated measures, including interaction terms, were used to examine the association between NRS and healthcare costs over time. Sex-stratified analyses were also performed. At baseline, 45.7% of participants reported NRS. From FY 2020 onward, healthcare costs were significantly higher in the NRS group than in the restorative sleep (RS) group. In FY 2023, the cost difference was JPY 18,468 (95% CI: 7,306 to 29,630). Interaction analysis revealed that the cost gap between the NRS and RS groups widened significantly over time. Similar trends were observed in the sex-stratified analysis. NRS is significantly associated with increased long-term healthcare costs, suggesting an important medical and economic impact. Screening for NRS during routine health checkups and providing early interventions may be beneficial in reducing healthcare costs.

Canine parvovirus (CPV-2) is one of the most important viral diseases affecting domestic dogs worldwide, particularly in unvaccinated and poorly managed canine populations. Despite its major veterinary and economic impact, epidemiological information regarding canine parvovirus remains scarce in Guinea, especially in the urban commune of Labé. This study aimed to determine the prevalence of canine parvovirus and identify factors associated with infection among dogs in the study area. A descriptive, analytical, cross-sectional study was conducted between September and November 2024 among 102 dogs selected from seven neighborhoods of the urban commune of Labé. Rectal swab samples were collected from dogs after owner consent and analyzed using real-time polymerase chain reaction (qPCR) for the detection of CPV-2 genetic material. Epidemiological and management data were collected using structured questionnaires administered to dog owners and breeders. Statistical analyses were performed using logistic regression to evaluate potential associations between infection and selected risk factors. The overall prevalence of canine parvovirus was 10.8% (11/102), confirming active viral circulation in the study area. Higher prevalence rates were observed in male dogs (11.9%) and free-roaming dogs (11.5%) compared with female dogs and caged dogs, respectively. Dogs aged 6-10 years showed the highest prevalence (20.0%). However, no statistically significant association was identified between infection and the investigated factors (p > 0.05). In addition, the survey revealed low owner awareness of canine parvovirus and limited vaccination practices. These findings indicate that canine parvovirus remains an important animal health concern in the urban commune of Labé. Strengthening vaccination programs, improving owner awareness, promoting responsible dog management, and reinforcing epidemiological surveillance are necessary to reduce viral transmission and associated canine health losses.

Enhanced recovery protocols for pediatric colorectal surgery demonstrate cost-effectiveness: An economic analysis to support programmatic development.

Post-liver transplant complications-cancer, infections, and renal dysfunction-impose substantial clinical and economic impact on recipients. This study evaluated clinical impacts and cost-effectiveness of adding everolimus (EVR) to a calcineurin inhibitor (CNI)-based regimen in liver transplant recipients, aiming to identify how co-occurring major complications affect cost-effectiveness. We conducted a cohort analysis and a cost-utility analysis, dividing recipients into CNI with and without EVR groups. We calculated adjusted hazard ratios (HRs) for the risk of cancer and posttransplant infection with EVR combination therapy using a Cox regression model. A Markov model that captured the co-occurrence of liver disease, infection, and renal dysfunction was constructed to estimate costs and quality-adjusted life years (QALYs) and compare the incremental cost-effectiveness ratio (ICER) of adding EVR to CNI. A hypothetical cohort of 10 000 liver transplant recipients aged 55 y was simulated during 30 y. The addition of EVR significantly reduced the risk of cancer (HR 0.435; 95% confidence interval 0.279-0.678) while increasing the infection risk in subsequent years (HR 1.468; 95% confidence interval 1.053-2.045). Cost-utility analysis demonstrated the CNI with EVR strategy was cost-effective, with an ICER of US$5298/QALY, well below the $25 000/QALY threshold. In analyses quantifying how co-occurring events shift value, the ICER was $9307/QALY when limited to liver disease, decreased to $4363/QALY with renal dysfunction included, and increased to $10 464/QALY when infection was added. Overall, CNI with EVR regimen in liver transplant remained cost-effective across co-occurring outcomes and perspectives, supporting risk-benefit balancing across cancer, posttransplant infection, and renal function.

Impact of firework restrictions on emergency plastic surgery cases: A five-year comparison of restricted vs. non-restricted New Year's Days and Easter Sunday (2021-2025).

Health, economic, and equity impact of a COVID-19 mobile vaccine clinic program in US: a cost-effectiveness analysis.

The economic feasibility and environmental impacts of simultaneous levulinic acid (LV) and hydrochar synthesis from cassava rhizome (CR) using H 2 SO 4 and HCl catalysts were investigated. In this study, CR was initially delignified with a KOH solution at 120 °C for 1 h, followed by conversion into LV and hydrochar using 0.1–0.7 M H 2 SO 4 at 175–225 °C for 1–3 h. The highest LV yield (15.34 wt.%) and selectivity (84.60%) were achieved at 225 °C for 2 h using a 0.4 M H 2 SO 4 . Characterization of the resulting hydrochar revealed fuel properties comparable to coal, indicating its potential as a coal substitute. Notably, the HCl-catalyzed process demonstrated superior economic feasibility, with an internal rate of return (IRR) of 55.76% and a minimum selling price of $21.98/kg LV, attributed to its higher LV yield. Furthermore, LV produced via the HCl system exhibited a lower environmental impact (96.75 kg CO 2 eq./kg LV), highlighting the critical influence of catalyst selection on productivity, economic viability, and environmental sustainability. • Levulinic acid (LV) and hydrochar were produced from cassava rhizome (CR). • H 2 SO 4 catalytic hydrothermal process of CR achieved the highest LV yield of 15.34%. • TEA and LCA of the LV production using either H 2 SO 4 or HCl were compared. • HCl-catalyzed process had superior economic and environmental feasibility. • Catalyst selection affected LV productivity, economic, and environmental impacts.

Axillary management in early-stage breast cancer is increasingly shifting toward de-escalation. While sentinel lymph node biopsy (SLNB) remains standard, evidence suggests axillary ultrasound (AUS) may safely replace SLNB in selected patients. The SOUND trial demonstrated noninferior oncologic outcomes with AUS-based staging among clinically node-negative patients with small (≤ 2 cm), unifocal invasive breast cancers and negative preoperative AUS. However, the economic and health system impact of implementing this strategy in routine practice remains unclear. We conducted a retrospective cohort analysis of 221 SOUND-eligible patients who underwent breast-conserving surgery with SLNB at four affiliated hospitals between January and June 2023. Costs were modeled using 2025 Medicare reimbursement rates, comparing the observed SLNB pathway with a theoretical AUS-only approach. Estimates included procedural, anesthesia, pathology, and complication-related costs, analyzed from both hospital and patient perspectives. Total estimated hospital costs were $1192,159.56 for SLNB versus $111,825.65 for AUS-only staging, a 90.6% reduction. Mean patient out-of-pocket costs decreased similarly (from $1078.88 to $101.20 per patient). SLNB added an average of 15.1 min of operative time and increased pathology workload owing to lymph node processing. In SOUND-eligible patients, axillary staging with ultrasound alone provides substantial reductions in cost, operative time, and resource utilization while supporting a less invasive, value-based approach to breast cancer care. Together with existing evidence, these findings support broader implementation of the SOUND strategy in appropriately selected populations, particularly postmenopausal patients over 50 years undergoing breast-conserving surgery for cT1N0, ER-positive, HER2-negative invasive ductal carcinoma with a negative AUS.

ASO Visual Abstract: Economic and Health System Impact of Implementing the SOUND Trial Approach in Early-Stage Breast Cancer.

Psoriatic disease, including psoriasis and psoriatic arthritis, is associated with increased risk of comorbidities (cardiovascular disease, mental health disorders, type 2 diabetes mellitus and obesity), placing substantial burden on patients and health systems. We aimed to quantify the lifetime economic burden of these four comorbidities in populations with moderate-to-severe psoriasis and psoriatic arthritis. We subsequently estimated the potential comorbidity-related gross cost offsets from timely systemic therapy across three diverse country settings (Denmark, the USA and Vietnam). We conducted a literature review to identify data on prevalence, comorbidity risk, treatment-associated risk reduction and cost inputs, followed by development of a static cohort-based economic model from a societal perspective. The model compared untreated/undertreated moderate-to-severe psoriasis/psoriatic arthritis; and systemic treatment scenarios (conventional systemic disease-modifying antirheumatic drugs [csDMARDs]; biologic DMARDs [bDMARDs]; and targeted synthetic DMARDs [tsDMARDs]) over a lifetime horizon in Denmark, the USA and Vietnam, reporting total comorbidity cost offsets across direct (healthcare) and indirect (societal) costs. Systemic treatment reduced lifetime comorbidity-related direct and societal costs across settings. In the USA, patients with moderate-to-severe psoriasis incurred annual direct costs of approximately 4.6 billion USD (indirect 0.6 billion USD), and untreated lifetime burden of about 153.0 billion USD. Treating all patients with bDMARDs yielded an estimated cost offset of 62.9 billion USD in the direct costs and an offset of 8.1 billion USD in the societal costs compared with a fully undertreated population. Equivalent analyses in Denmark and Vietnam reflected similar effects on comorbidity-related costs. The model shows that early systemic therapy yields substantial effect on the direct and societal costs via reduced comorbidity incidence. Timely and efficacious systemic treatment of psoriatic disease can significantly reduce lifetime economic burden of comorbidities across diverse healthcare settings. These findings underscore the value of early, proactive management of psoriatic disease and highlight the need for further cost-effectiveness research, including treatment uptake and real-world comorbidity prevention.

Superiority of ultrasound-DSP fusion over CT guidance for percutaneous nephrostomy in complex hydronephrosis: a propensity-matched multicenter cohort study demonstrating enhanced procedural efficiency and secondary ureteroscopy success.

In this study, we address the inventory decision problem of ameliorating goods by explicitly incorporating a demand spillover effect between product categories – an interaction that has received little attention in operations management. We first empirically demonstrate the existence of this spillover using multi-year sales data from 11 Port wine brands across 86 markets. Building on these insights, we integrate the spillover effect into a stochastic inventory decision model for a (Port) wine seller who must decide whether to sell existing inventory or continue aging it to offer higher-quality products in the future. The problem is formulated as a Markov Decision Process and solved using a forecast-based Deterministic Lookahead (DLA) approach and a Proximal Policy Optimization (PPO) algorithm. Our results show that accounting for the spillover effect can increase profits by up to 1.31%, and that both proposed solution methods outperform the myopic strategy currently applied by producers. While the DLA policy performs best under high forecast accuracy, the PPO algorithm proves more robust when uncertainty is high. The study contributes to bridging marketing and operations perspectives by quantifying the economic impact of spillover effects and providing decision-support tools for managing aged inventory under demand uncertainty.

Leaf bleaching is associated with extensive transcriptional reprogramming in avocado trees with sunblotch disease.

Long-term sequelae after tick-borne encephalitis in Germany: a nationwide claims-based matched cohort study.

Molar Incisor Hypomineralization (MIH) is a dynamic condition in which demarcated opacities can progress to post-eruptive enamel breakdown, increasing the risk of dental caries. This study aimed to evaluate the clinical and economic impact of late diagnosis of MIH. A total of 803 children aged 6-11years were examined, of whom 172 were diagnosed with MIH and classified into 2 groups based on age at diagnosis: early diagnosis (under 8years) and late diagnosis (8years or older). A treatment plan was developed according to the severity and clinical presentation of MIH in each child, and the associated financial costs were calculated. Children in the late-diagnosis group presented more severe MIH, with a higher prevalence of demarcated opacities, atypical carious lesions, and atypical restorations. Although the estimated overall financial cost of treatment did not differ significantly between groups, a 2-year delay in MIH diagnosis led to more severe clinical presentations and higher expenses from the more complex interventions required. In conclusion, a 2-year delay in the diagnosis of MIH was associated with a more severe clinical presentation, necessitating more complex restorative treatments and leading to increased financial costs related to these treatments.Research Ethics Committee: CAAE 12161019.2.0000.5419, date 29.04.2019.

Development of an ELISA as a complement to MAT for swine leptospirosis diagnosis.

Glucagon-like peptide-1 receptor agonists (GLP-1RAs) have transformed obesity and diabetes management, with rapidly expanding indications and use among U.S. adults. Despite their promise, key questions remain about optimal treatment pathways, long-term safety, effectiveness across diverse populations, adherence, and economic impact. Real-world evidence (RWE) derived from electronic health records, claims, and other data sources could address these gaps, but unique challenges complicate its use, such as inconsistent insurance coverage, high discontinuation rates, medication shortages, compounded formulations, and off-label prescribing. To explore these issues, the National Institute of Diabetes and Digestive and Kidney Diseases convened a workshop in May 2025 with experts from regulatory agencies, guideline committees, payers, and academia. Discussions focused on identifying knowledge gaps in GLP-1RA use, evaluating how RWE informs practice, assessing limitations of real-world data, and strategies to reduce bias in RWE. Presentations emphasized RWE's potential to complement randomized trials by capturing rare adverse events, long-term outcomes, and effectiveness in routine care. However, persistent challenges include data reliability, confounding, and incomplete capture of medication use and outcomes, particularly in pediatric and underserved populations. Coverage decisions remain heterogeneous across Medicare, Medicaid, and private payers and across time, underscoring the need for rigorous cost-benefit analyses. The workshop concluded that robust RWE is essential for developing value-based coverage policies and optimizing GLP-1RA use. Continued investment in high-quality data infrastructure and analytic methods will be critical to inform regulatory, clinical, and economic decisions as utilization expands.

Clinical and economic impact on the primary care system of respiratory syncytial virus infection in children under 5 years.

Forest wellness tourism is an emerging form of nature-based tourism that leverages forest ecosystem services for health promotion while contributing to regional sustainable development. Although the integration of Strengths-Weaknesses-Opportunities-Threats (SWOT) analysis and the Analytic Hierarchy Process (AHP) has been applied in tourism planning, their combination with quantitative strategic positioning remains underexplored in the context of forest wellness tourism development in emerging economy mountain regions. This study applies an integrated SWOT-AHP strategic positioning framework to assess the sustainable development of forest wellness tourism in Shangluo City, Qinling Mountains, China. Through multi-round Delphi consultation (n = 46 for factor identification;n = 28 for AHP pairwise comparisons), 18 factors were identified across four SWOT dimensions. AHP weighting revealed that the Strengths dimension received the highest overall weight (dimension weight = 0.3652), with ecological resource quality ranking as the highest-weighted individual factor (composite weight = 0.1175), followed by policy support frameworks (0.0985) and traditional wellness culture (0.0871). Infrastructure deficits constituted the most prominent weakness (composite weight = 0.0647, representing 53.96% of total Weaknesses weight). Four-quadrant strategic positioning yielded coordinates P(0.2454, 0.1706), an intensity coefficient ρ = 0.2989, and an azimuth angle θ = 34.82°, placing Shangluo in Quadrant I (Strengths-Opportunities) and suggesting a competitive strategy that leverages internal advantages to capitalise on external opportunities. Sensitivity analysis confirmed the robustness of this positioning across all tested scenarios (ρ ranging from 0.2632 to 0.3489; Quadrant I maintained throughout). All findings should be interpreted as expert-perceived strategic priorities derived from structured expert judgment, rather than as objectively verified empirical outcomes of actual tourism demand, ecological measurement, or economic impact assessment.The findings provide case-based insights into how ecological resource endowment and institutional capacity are perceived by domain experts to jointly shape tourism development priorities in China's western mountain regions, and illustrate one contextually grounded approach to reconciling economic development with ecological conservation in comparable mountain destination contexts.

Varicella vaccination is not currently included in Portugal's childhood national immunization program. We modeled the clinical and economic impact of a two-dose universal varicella vaccination (UVV) program in Portugal. A dynamic transmission model was adapted to Portugal to assess the impact of UVV over a 50-year time horizon. Two two-dose UVV strategies (first dose at 12 months, second dose at 5 years) were compared to no vaccination. Clinical outcomes included varicella and herpes zoster incidence rates, cases, deaths, quality-adjusted life years (QALYs) lost, and varicella-related health care resource use. Costs were assessed from the payer perspective (direct costs of treatment) and societal perspective (direct costs plus indirect costs of lost workdays). Both UVV strategies reduced total varicella cases by 79.4-85.3%, outpatient visits by 78.9-84.8%, and varicella hospitalizations by 69.3-71.3% compared to no varicella vaccination. Herpes zoster cases were reduced by 2.4-2.9%. These strategies resulted in the gain of 5977-6094 QALYs and cost savings of €12.0 million (M)-15.9M from the payer perspective and €84.2M-93.9M from the societal perspective. A two-dose UVV program is estimated to substantially reduce the burden of varicella disease in Portugal and to be cost-saving from both the payer and societal perspectives.