Favorable Cost-benefit Ratio Research Articles

Incremental Cost Benefit Ratio (ICBR) of Poly House and Open Field Conditions in Cabbage (Brassica oleracea var. capitata) after Chemical Intervention

This study evaluates the Incremental Cost Benefit Ratio (ICBR) between Poly house and Open field conditions in cabbage cultivation chemical intervention. The research aimed to compare the economic feasibility of adopting poly house technology over traditional open field methods, considering costs and benefits associated with chemical inputs. A comparative cost analysis was conducted to assess production expenses like costs for insecticidal treatments and labor charges. Yield data from both environments were collected to determine output differences and subsequent economic returns. Results indicate that Incremental cost benefit ratio of cabbage heads yields to the cost of treatments in poly house and open field presented as there was a significant superior difference in ICBR ratio of poly house with 1: 0.946 as compared to open field with 1: 0.639 of cabbage heads. The economic analysis revealed that the higher yields and quality achieved in poly house conditions due to less dissipation and undisturbed environmental factors on insecticide applied. Resulting in a favorable incremental Cost benefit ratio compared to open field cultivation.

Benefits of early highly effective versus escalation treatment strategies in relapsing multiple sclerosis estimated using a treatment-sequence model

Background: Uncertainty about disproportionate impact on health care budgets limits implementation of early highly effective treatment (EHT) in multiple sclerosis (MS). Objective: To estimate cost-effectiveness of escalation versus EHT disease-modifying treatment (DMT) sequences. Methods: Using a health-economic approach, we analysed health benefits (relapse rate reduction, disability prevention), direct/indirect DMT and societal costs of escalation versus EHT DMT sequences. In scenario analyses, we allowed (1) earlier use of alemtuzumab (ALE) and (2) a single retreatment with cladribine (CLA). Results: In our model, we showed that the ratio between costs and quality-adjusted life years (QALYs) for the most cost-effective EHT and escalation sequence results into a similar net health benefit with higher costs and also higher QALYs associated with an EHT versus escalation strategy. Earlier use of ALE is more cost-effective than in later lines, even when aggravating the impact of its side-effects tenfold. Retreatment with CLA was more cost-effective in both escalation and EHT sequences. Conclusions: Certain EHT sequences are equally cost-effective to escalation sequences and are likely to result in more health at uncertain additional costs. The favourable cost–benefit ratio of CLA and ALE suggests that a wider application of affordable highly effective therapies could promote the cost-effectiveness both EHT and escalation approaches.

Impact of a complex health services intervention in long-term care nursing homes on 3-year overall survival: results from the CoCare study

BackgroundThe Coordinated medical Care (CoCare) project aimed to improve the quality of medical care in nursing homes by optimizing collaboration between nurses and physicians. We analyze the impact of the CoCare intervention on overall survival.MethodsThe effect of time-varying treatment on 3-year overall survival was analyzed with treatment as time-varying covariate within the entire cohort. To reduce bias due to non-random assignment to treatment groups, regression adjustment was applied. Therefore, age, sex, and level of care were used as potential confounders.ResultsThe study population consisted of 8,893 nursing home residents (NHRs), of which 1,330 participated in the CoCare intervention. The three-year overall survival was 49.8% in the entire cohort. NHRs receiving the intervention were associated with a higher survival probability compared to NHRs of the control group. In a univariable cox model with time-dependent treatment, the intervention was associated with a hazard ratio of 0.70 [95%CI 0.56–0.87, p = 0.002]. After adjustment for age, sex and level of care, the hazard ratio increased to 0.82 but was still significant [95%CI 0.71–0.96, p = 0.011].ConclusionThe analysis shows that optimizing collaboration between nurses and physicians leads to better survival of NHRs in Germany. This adds to the already published favorable cost-benefit ratio of the CoCare intervention and shows that a routine implementation of optimized collaboration between nurses and physicians is highly recommended.

Dos inseticidas ao controle biológico de pragas na cana-de-açúcar: uma experiência de meio século na Venezuela

Biological control has been established as a unique measure for managing borers of the genus Diatraea and the candelilla Aeneolamia spp., both of which are key pests of sugarcane in Venezuela. Optimal results have been achieved with the use of parasitoids and entomopathogens. Systematic releases of the Amazonian fly Lydella minense from the mid-20th century and the establishment of the braconid wasp Cotesia flavipes from 1987 led to effective control of borers. In the case of Aeneolamia varia, a pest formerly controlled with frequent insecticide applications, an efficient solution was the introduction of the entomopathogenic fungus Metarhizium anisopliae in 1977. This measure has been established as efficient in controlling adult Aeneolamia, though nymphs were less controlled. This issue was effectively addressed in 2004 with the introduction of the entomopathogenic nematode Heterorhabditis bacteriophora, which has been widely used as a biological measure to avoid the application of insecticides. To illustrate this, we can consider the case of Azucarera Río Turbio. Despite experiencing a reduction in cultivated areas in recent harvests due to various factors, this establishment has witnessed a significant decline in Diatraea infestations over the past 58 years. Infestation rates have decreased from 15% to 3.18%, resulting in a saving of 170,552.62 metric tons valued at USD 49,196,045. The cost of implementing biological control measures amounts to USD 1,187,189, translating into a favorable benefit-cost ratio of USD 41.44. Before the adoption of biological control methods, Aeneolamia infestations were exclusively controlled using chemical insecticides applied to both the foliage for adults and the soil for nymphs. Concurrently, since then, entomopathogenic fungus M. anisopliae, produced by national companies, has been deployed across 87,000 hectares between 1986 and 1990. Moreover, since 2004, the use of entomopathogenic nematodes to control Aeneolamia nymphs has been integrated into pest management practices.

Improvement of the Efficiency of Urban Management within the Concepts of Smart City and Sustainable Development (As Exemplified by Cities in Kazakhstan)

The idea of urban development corresponds to the concept of a smart city and is based on resource savings or more favorable benefit-cost ratios in the long term using a systematic approach to solving a specific problem. In addition, it is necessary to address such challenges in the interests of all city residents with due regard to the possibilities and level of management efficiency. The study aims to identify opportunities for improving the efficiency of managing an urban resource potential within the concept of a smart city. The article considers various approaches to the concept of smart city. In particular, it presents the 4T concept of urban resources based on the relationship between the development of a smart city and its resource potential. Based on the analysis of five large cities in the Republic of Kazakhstan, reporting and strategic documents of local government authorities, a survey of their residents, and targeted interviews with local government employees, the authors of the article have studied their perception of innovations, expectations from their implementation, and manifestations of smart management in these local government bodies. This allowed the authors to evaluate the results obtained within the concept of a smart city and the 4T resource potential.

Thermal and viscous irreversibilities in the heat exchanger of individually finned heat pipes using freon R404A as the working fluid

This work aims to apply a theoretical procedure to determine the performance of the heat exchanger of individually finned heat pipes used in an air conditioning system. The relevant physical quantities are defined and specified locally in the evaporator and condenser sections. The results obtained in the sections are associated with the theoretical determination of the global performance of the heat exchanger. Global theoretical results are compared with global experimental results. Thermal effectiveness, heat transfer rate, pressure drop, thermal and viscous irreversibilities, and thermodynamic Bejan number are determined at the evaporator, condenser, and heat exchanger. The relevant variables used to determine the results are the number of fins per heat pipe and rows of heat pipes. The theoretical-experimental comparison demonstrates that the localized model applied in the analysis is consistent and can be used as a design and comprehensive analysis tool for finessed heat exchangers. The performance of the heat exchanger demonstrated exceptionalness when comparing irreversibilities through the Bejan number, indicating a favorable cost-benefit ratio for the fins less than 30 and the number of heat pipes equal to 49. Bejan’s thermodynamic number, which uses results related to thermal and viscous irreversibilities, demonstrated that one should look for the relationship between thermal irreversibility versus total irreversibility and that fin numbers between 10 and 20 for heat pipes equal to 49 provide a better cost-benefit ratio. The absolute percentage errors obtained between theoretical and experimental values, for an experimental number of fins equal to 30, for the overall heat transfer rate and overall thermal effectiveness range from 2.0% to 42.1%.

How states deal with long-term destabilizing risks

Many risks of events with the potential to cause societal collapse either lie far in the future or have a low chance of materializing in any given year. However, optimal mitigation of these long-term destabilizing risks requires state action in the present. We provide a novel framework for understanding why states struggle to formulate a rational response to these risks. In our framework, insights from cognitive psychology, long-term governance and game theory in international relations are integrated. Cognitive biases limit state forecasting accuracy; political incentives and state structures are generally not aligned with tackling the important challenges of the long-term; and global cooperation, a necessary component of mitigation of long-term destabilizing risks, is constrained by suboptimal institutional design in the face of game-theoretical challenges to cooperation. We illustrate this framework by looking at the case of how states fared against epidemic risk in the pre-COVID-19 period. Using 2019 indices of pandemic preparedness, we show that, as a result of the challenges included in our framework, almost all countries failed to take low-cost, high-benefit measures for preventing and mitigating pandemic risk. This underinvestment was widely acknowledged at the time, and occurred in spite of the well-established favorable cost-benefit ratios of such measures. In addition, international cooperation failed to lead to adequate preventive, mitigative and response policies. We argue that, considering the stakes, deepening our knowledge of why states do not adequately mitigate long-term destabilizing risks should be a priority for the study of governance. We conclude with recommendations both for policy makers and researchers.

Barrier films for the prevention of acute radiation dermatitis in breast cancer: A systematic review and meta-analysis of randomised controlled trials.

Radiation dermatitis (RD) is the most common side effect of adjuvant whole-breast or chest wall irradiation, majorly impacting quality of life in numerous patients. The use of barrier films (polyurethane dressings such as Hydrofilm® and Mepitel® film remaining on the skin for the duration of the radiation treatment) has been investigated as a prophylactic measure in several prospective trials. Here, we critically appraise the available evidence behind preventive barrier film application in the context of breast cancer treatment. International literature was reviewed and high-quality randomised controlled trials (RCTs) were included in this meta-analysis. The results of 5 RCTs (663 patients; >90% Caucasian) were analysed. Overall, barrier films lead to improved clinician- and patient-reported outcomes: fewer grade ≥2 RD (11% vs. 42%; OR=0.16; p<0.001) and moist desquamation (2% vs. 16%; OR=0.12; p=0.006), as well as less patient-reported pain (standardised mean difference [SMD] -0.51; p<0.001), itching (SMD -0.52; p=0.001), burning (SMD -0.41; p=0.011), and limitations in daily activities (SMD -0.20; p=0.007). Furthermore, barrier films have a high acceptance rate among patients, as well as a favourable cost-benefit ratio. Possible side effects due to its application are mild and mostly self-limiting. Overall, there was a lack of information on the radiation treatment techniques used. The evidence presented in this meta-analysis suggests that barrier films are an excellent tool in the prevention of RD among Caucasian patients receiving whole-breast or chest wall irradiation. Its use should therefore be considered routinely in these patients.

Evaluación técnico-económica de consorcios bacterianos en el cultivo de fresa en dos sistemas de producción

Strawberry production is predominantly carried out in open fields, rendering it vulnerable to pest attacks, which can lead to reductions in yield. This susceptibility is further exacerbated by adverse climatic conditions. Another challenge is the high cost of inputs like fertilizers. Consequently, the aim of this study was to evaluate both technically and economically the impact of applying bacterial bio-fertilizers to strawberry crops under two production systems. The experimental design employed was a subdivided-plot arrangement in a randomized complete block, with the main plot focusing on the production system (either open field or macrotunnel), the subplot on plastic mulch (either with or without), and the sub-subplot on bacterial consortia treatments commercial. These were as follows: (a) control, which corresponded to traditional farmer management; (b) Bacillus subtilis, (c) consortium 1, comprising a mixture of humic acids and Rhodopseudomonas palustris, Bacillus subtilis, Bacillus amyloliquefaciens, Bacillus licheniformis; and (d) consortium 2, composed of Azospirillum brasilense, Azotobacter chroococcum, Lactobacillus acidophillus, Saccharomyces cerevisiae. The combination of macrotunnel production and plastic mulch, along with the application of bacterial consortium 2, yielded the best results in the second year, producing gross and net yields of 25.041 kg ha-1 and 17.330 kg ha-1, respectively. This was associated with the most favorable benefit-cost ratio of 1.41 in the second year.

Assessing 'no evidence of disease activity' status in patients with relapsing-remitting multiple sclerosis: a long-term follow-up.

Multiple Sclerosis (MS) is a chronic inflammatory demyelinating disease of the CNS with an autoimmune pathogenesis. Over the years, numerous disease-modifying therapies (DMTs) have proven effective in disease control; to date, there is a need to identify a personalized treatment effective in ensuring disease-free status or no evidence of disease activity (NEDA). identify clinical, demographic and treatment approach characteristics that affect the maintenance of NEDA-3 and the occurrence of clinical relapses during a 6-years follow-up. a retrospective study was conducted on a cohort of MS patients followed up with six-year period. All participants were treated with first- or second-line MS drugs.Clinical relapse, NEDA-3 at 6 years and sustained EDSS were assessed as disease activity outcomes. Patients with follow-up of less than 6 years and insufficient clinical and radiological data were excluded from the study. Two-hundred-eighty naive patients (mean age was 49.8 years, SD ± 11.35 years, 23-76, F/M 182/98), with MS were followed up for 6 years.The mean age at diagnosis was 34.3 years (SD ±11.5, 14-62 years), the mean EDSS score at the onset was 1.9 (±1.3), 76.8% of patients had an EDSS below or equal to 2.5 at diagnosis.In the cohort 37 (13.2%) directly received second-line treatment, 243 (86.8%) received first-line drugs.The analysis showed that second-line treatment from beginning had a protective effect for the achievement of NEDA-3 (p = 0.029), on the prevention of clinical relapse (p = 0.018) and on number of relapses (p = 0.010); this finding was confirmed by logistic regression analysis (p = 0.04) and Kaplan-Meier analysis (p = 0.034). The results of this study demonstrate the efficacy of targeted and early intervention so as to act in the right time window, ensuring a favorable outcome in both clinical and radiological terms; this could be decisive in reducing clinical relapse, disease progression and related disability. Therefore, prescribing highly effective drug in the early stages of the disease represents a leading strategy with the most favorable cost-benefit ratio.

Combined Di-Ammonium Phosphate and Straw Return Increase Yield in Sweet Corn

Straw returning is an environmentally friendly method to improve soil health and agricultural productivity by reusing organic waste products. However, fields are often also treated with inorganic fertilizers, and the effect of the interaction between phosphate fertilizer application and straw return on crop yield remains unclear. Therefore, a full-factorial, two-year field experiment was conducted on sweet corn (NARC-16 in late 2021 and Kashmeri-19 in early 2022) to explore how crop yield may be optimized by combining straw return with efficient phosphate fertilization. The experiment involved the application of DAP, SSP, and NP (three different types of phosphates) and the application of crop waste byproducts, namely the residual stover left after sorghum and maize harvesting. We compared control fields with no crop waste or phosphate addition (CR0 and PS0) to experimental plots treated with various phosphates and straw return. Growth parameters such as days to emergence, tasseling, silking and maturity, emergence rate (emergence m−2), height of plant, number of leaves, leaf area per plant, and yield were evaluated, and the influence of the treatment on the economic value of crops was estimated. Phosphorus and straw return were applied at rates of 90 kg per hectare and 5 tons per hectare, respectively. The best P-crop straw combination treatment involved DAP (90 kg ha−1) with the incorporation of 5 tons’ ha−1 of maize straw, which resulted in delayed tasseling (50 days), early silking (68 days), taller plants (178 cm), improved thousand-grain weight (233 g), maximum biological yield (11,349 kg ha−1) and grain yield (3760 kg ha−1). The application of DAP with maize straw return resulted in the highest plant height, biological yield, and grain yield of sweet corn during the second year of the experiment, despite the first year’s yield being influenced by a natural disaster. This combined management strategy (using either DAP or crop residuals) was found to have a more a favorable cost–benefit ratio (BCR) efficiency. In conclusion, increasing the use of crop residuals can help reduce the expensive application of synthetic mineral fertilizers like SSP and NP, while significantly increasing sweet corn production and improving profit margins. Considering the importance of environmental friendliness and sustainable agriculture, the combined use of DAP and straw return is considered a viable method.

Management of malignant pleural effusion in Italian clinical practice: a nationwide survey

BackgroundPleural disease (PD), particularly malignant pleural effusion (MPE), is a common cause of hospital admission and its prevalence is rising worldwide. Recent advances in diagnostic and therapeutic options, such as Indwelling Pleural Catheters (IPCs), have simplified PD treatment, allowing an effective outpatients management. Therefore, dedicated pleural services can improve PD care, guaranteeing specialized management and optimizing time and cost. We aimed to provide an overview on MPE management in Italy, mainly focused on distribution and characteristics of pleural services and IPCs use.MethodsA nationwide survey, endorsed by the Italian Thoracic Society, was distributed by email to members of selected subgroups in 2021.ResultsNinety (23%) members replied, most of whom being pulmonologists (91%). MPE resulted the most common cause of pleural effusion and was managed with heterogenous approaches, including talc pleurodesis via slurry (43%), talc poudrage (31%), repeated thoracentesis (22%) and IPCs insertion (2%). The setting of IPC insertion was inpatient care in 48% of cases, with a predominance of draining frequency every other day. IPC management mainly relied on caregivers (42%). The presence of a pleural service was reported by 37% of respondents.ConclusionsThe present study provides an extensive overview of MPE management in Italy, showing a highly heterogeneous approach, a scarce prevalence of out-patient pleural services, and a still limited adoption of IPCs, mainly due to lack of dedicated community care systems. This survey emphasizes the need of promoting a higher spreading of pleural services and an innovative healthcare delivery with more favourable cost-benefit ratio.

The labor market outcomes of bilinguals in the United States: Accumulation and returns effects.

At least half of the world population is bilingual, but lifetime financial gains from early exposure to multiple languages are largely unknown. In this study, we analyze individual earnings of bilinguals in the US using 15 years of Census data and an augmented wage model, accounting for cognitive, manual, and interpersonal skills derived from O*NET job task descriptors via sparse principal component method. Using unconditional quantile regression, we find evidence that language skills mostly benefit individuals at the lower end of the earnings distribution. While our analysis does not establish causality, it underscores the potential of early language acquisition to mitigate income inequality by enhancing the employment prospects of low-income individuals. We also highlight the favorable cost-benefit ratio of language acquisition in childhood, when learners face no monetary opportunity costs and can achieve greater levels of fluency.

The potential for stabilizing Amundsen Sea glaciers via underwater curtains.

Rapid sea level rise due to an ice sheet collapse has the potential to be extremely damaging the coastal communities and infrastructure. Blocking deep warm water with thin flexible buoyant underwater curtains may reduce melting of buttressing ice shelves and thereby slow the rate of sea level rise. Here, we use new multibeam bathymetric datasets, combined with a cost-benefit model, to evaluate potential curtain routes in the Amundsen Sea. We organize potential curtain routes along a "difficulty ladder" representing an implementation pathway that might be followed as technological capabilities improve. The first curtain blocks a single narrow (5 km) submarine choke point that represents the primary warm water inflow route towards western Thwaites Glacier, the most vulnerable part of the most vulnerable glacier in Antarctica. Later curtains cross larger and deeper swaths of seabed, thus increasing their cost, while also protecting more of the ice sheet, increasing their benefit. In our simple cost-benefit analysis, all of the curtain routes achieve their peak value at target blocking depths between 500 and 550 m. The favorable cost-benefit ratios of these curtain routes, along with the trans-generational and societal equity of preserving the ice sheets near their present state, argue for increased research into buoyant curtains as a means of ice sheet preservation, including high-resolution fluid-structural and oceanographic modeling of deep water flow over and through the curtains, and coupled ice-ocean modeling of the dynamic response of the ice sheet.

The impact of mechanical devices for lifting and transferring of patients on low back pain and musculoskeletal injuries in health care personnel-A systematic review and meta-analysis.

Heavy lifting in nursing is highly associated with low back pain (LBP) and musculoskeletal injuries (MSI). We aimed to evaluate the impact of mechanical devices used for patient lifting and transferring on risk of LBP and MSI of health care personnel. We conducted a systematic review and meta-analysis. The literature search was performed during 1st and 12th September 2021 using 17 electronic databases and handsearching of bibliographies of included studies. Twenty studies were included in the qualitative synthesis and eight studies with in total 2087 participants in the meta-analysis. Dependent on the study design, risk of bias was assessed by Cochrane RoB 2.0, EPOC, and MINORS. We conducted random-effects meta-analyses assessing Hedges's g and 95% CI of MSI rate, perceived LBP, and peak compressive spinal load. We calculated prediction intervals and conducted a cost-benefit analysis (CBA). All outcomes showed significant, adjusted pooled effect sizes (MSI rate: g = 1.11, 95% CI 0.914-1.299; perceived LBP: g = 1.54, 95% CI -0.016-3.088; peak compressive spinal load: g = 1.04, 95% CI -0.315 to 2.391). True effect sizes in 95% of all comparable populations fell in the following prediction intervals: MSI rate = -1.07-3.28, perceived LBP = -0.522-3.594, and peak compressive spinal load = -15.49 to 17.57. CBA revealed cost-benefit ratios of 1.2 and 3.29 between cumulative total savings and investment costs of intervention. Prediction intervals confirmed strong true effect sizes for MSI rate and perceived LBP in 95% of all comparable populations but not for peak compressive spinal load. Mechanical lifting and transferring devices displayed a favorable cost-benefit ratio and should be considered for clinical implementation.

Consolidated financial statement information and group reporting in the central government: a user-oriented approach

PurposeThis study aims to fill the research gap regarding the usability of group reporting information in the central government. It answers the question of how the consolidated information should be formed to benefit the real needs of governmental information users.Design/methodology/approachThe empirical research is based on a survey and interviews among key internal preparers and users in the central government sector in the case country, Finland.FindingsResults show that the private sector approach regarding consolidation is not appropriately transferable to the central government sector. The key stakeholders identified several economic and financial reporting needs that exceed what formal Consolidated Financial Statement (CFS) can offer. Consolidation is needed but not according to the extensive full control approach, but rather following the budgetary approach consolidating units of the legal person of the government, and further using the partial control approach for consolidating by discretion essential special purpose SOEs.Research limitations/implicationsRespondents and interviewees represented governmental internal organisations, free experts, auditors and financial managers from the group entities. Politicians and citizens were not directly represented.Practical implicationsResearch gives applicable insights into central governments planning and developing group reporting for information needs in a favourable cost-benefit ratio. Findings benefit the development of EU's EPSAS (European Public Sector Accounting Standards) project which is still incomplete.Social implicationsResearch recommends governments to make a thorough analysis before deciding on a new financial reporting system. A critical analysis prevents governments to waste money and resources on a reporting system not fulfilling the real needs of information users.Originality/valueThe value of this research is that the private sector approach in consolidation was not taken as granted. This study investigated critically and empirically the real need for consolidated information serving steering and overseeing purposes of the government's group entities.

Biorational Based IPM Module for the Management of Shoot and Fruit Borer, Leucinodes Orbonalis in Brinjal

The present investigation was undertaken to evaluate the integrated pest management module against L.orbonalis in brinjal under field conditions. The brinjal fruit obtained Salem district is being sell to other states. Due to this massive requirement, farmers have a tendency to spray a higher number of pesticidal sprays to thwart slight damage or bore hole due to L.orbonalis. Crop damage produced by brinjal shoot and fruit borer was evaluated on the basis of damaged shoot and fruits separately. In order to assess the per cent shoot damage, the damaged shoots on five randomly selected tagged plants were counted as against total available shoots on the observed plants. In present study, Kharif and Rabi season recorded highest fruit yield of 288.71 and 307.50 quintals/ha and favorable cost benefit ratio of 1:2.07 and 1: 2.03 was recorded in IPM module plot respectively.

Economic analysis of financial incentives for smoking cessation during pregnancy and postpartum

Higgins and colleagues' recently-completed randomized controlled trial and pooled data with 4 related trials of smoking cessation in pregnant women in Vermont (USA) showed that abstinence-contingent financial incentives (FI) increased abstinence over control conditions from early pregnancy through 24-weeks postpartum. Control conditions were best practices (BP) alone in the recent trial and payments provided independent of smoking status (noncontingently) in the others. This paper reports economic analyses of abstinence-contingent FI. Merging trial results with maternal and infant healthcare costs from all Vermont Medicaid deliveries in 2019, we computed incremental cost-effectiveness ratios (ICERs) for quality-adjusted life years (QALYs) and compared them to established thresholds. The healthcare sector cost (±standard error) of adding FI to BP averaged $634.76 ± $531.61 per participant. Based on this trial, the increased probability per BP + FI participant of smoking abstinence at 24-weeks postpartum was 3.17%, the cost per additional abstinent woman was $20,043, the incremental health gain was 0.0270 ± 0.0412 QALYs, the ICER was $23,511/QALY gained, and the probabilities that BP + FI was very cost-effective (ICER≤$65,910) and cost-effective (ICER≤$100,000) were 67.9% and 71.0%, respectively. Based on the pooled trials, the corresponding values were even more favorable–8.89%, $7138, 0.0758 ± 0.0178 QALYs, $8371/QALY, 98.6% and 99.3%, respectively. Each dollar invested in abstinence-contingent FI over control smoking-cessation programs yielded $4.20 in economic benefits in the recent trial and $11.90 in the pooled trials (very favorable benefit-cost ratios). Medicaid and commercial insurers may wish to consider covering financial incentives for smoking abstinence as a cost-effective service for pregnant beneficiaries who smoke.Trial Registration: ClinicalTrials.gov identifier: NCT02210832.

Narrowing crop yield gaps in Ethiopia under current and future climate: A model-based exploration of intensification options and their trade-offs with the water balance

In the Central Rift Valley of Ethiopia (CRV), actual productivity of most cereals is less than 3 t ha −1 associated with low input use and poor crop management. After calibrating and validating the Agricultural Production System Simulator (APSIM) using experimental data, we explored and prioritized promising intensification options for rainfed maize and wheat that enable to narrow prevailing yield gaps in the CRV, and quantified trade-offs with the water balance and gross margins. We set up a factorial simulation experiment combining Genetic x Environment x Management factors that influence crop yield and water use at field scale to simulate yield and water balance components under current and future climate scenarios (pessimistic scenario for mid-century). Varietal selection and nitrogen (N) fertilization were the most important factors contributing to yield gap closure. Although yields were maximized with N application rates up to 250 kg −1 in most soils and varieties, maximum gross margin and maximum water use efficiency (WUE) were attained at lower N rates, associated with a small yield reduction compared to the maximum. There was a trade-off between intensification and increased absolute water use through transpiration, while the water use per kg product was decreased. However, location-specific N application rates that allow producing at least 80% of the water-limited potential yield (Yw) of maize and wheat resulted in high water use efficiencies as well as favorable cost-benefit ratios. Climate change was projected to lower yield as it advanced maturity, and to result in decreased drainage and increased soil evaporation across all variety, location and management combinations for both crops. Climate change reduced crop yield by 15–25% for wheat and 2–30% for maize. We conclude that the locally-calibrated APSIM model could be used to derive key lessons from the genetic, environment and management interactions, and generate information on sustainable intensification pathways that combine narrowing yield gaps with maximizing WUE and gross margins. • Variety selection and N fertilization contribute most to closing yield gaps (Yg) • Yg can be narrowed at N rates that maximize water use efficiency and gross margin • The potential for yield gap closure is crop, variety, soil and climate specific • Crop intensification increases total water use but decreases water per kg product • Climate change reduces land productivity by 15–25% for wheat and 2–30% for maize

Cost-Benefit Analysis of the Implementation of an Integrated Production Software in the Raw Materials Sector of A Pharmaceutical Industry

The pharmaceutical industry currently has computer systems that seek to optimize processes and allow the maximum performance of its resources through the use of computer tools. The objective of the work was to determine the costs and benefits of two different software in management of raw materials for the pharmaceutical industry. Methods: observational, descriptive, cross-sectional, study that compared ONDANET and SAP software in positive and negative costs inferred in the implementation of the tools and the benefits in terms of the profitability of the management of raw materials for the elaboration of pharmaceutical products. Results: it has been observed by using direct costs and benefits that the benefit-cost ratio of the SAP software implementation yielded a result of 15.37, whereas the ONDANET software presented a cost-benefit ratio of 0.05, which could have been demonstrated Conclusion: A widely favorable cost-benefit ratio was found for SAP Software compared to the previously used ONDANET Software, indicating that the new software used is profitable. It is desirable to periodically carry out this type of analysis to guarantee not only that the Pharmaceutical Industry has a greater profitability, without also being able to provide its products with continuity and at affordable prices for the population.