Keep it local vs. financial benefits: Compensation payments through cost savings in renewable energy provision for green hydrogen production in Germany

Long-term health care in Greece is covered by a variety of health structures. In contrast to other northern European countries, it is incomplete and fragmented or even absent. The demand for long-term care has been addressed through informal caregiving, provided by family members supporting voluntarily or caregivers getting informal compensation. In recent years, efforts have been made to restructure long-term health care and to introduce services and structures that are conducive to this purpose. In our country there is no corresponding planning or any support for informal care. The provision of informal care has multiple benefits, mainly financial and organizational, for patients, health systems and the state. Compared to Greece, other European countries support informal care through various financial, insurance and social benefits for its providers, thus favoring and facilitating their work. Given that the need for long-term health care and, by extension, the need for informal care will increase continuously and exponentially over time, it is important to recognize and meet the needs of informal caregivers and to formalize this form of care provision. The development of a policy of formal recognition of informal care and the establishment of supportive measures, such as financial assistance, insurance, and education will ensure the sustainability of long-term health care and the health system in general.

Alternative community participation models for a just energy transition in Ireland: A comparative analysis of community benefit funds and share schemes under ORESS1

ABSTRACT Australian tropical rainforests are increasingly recognised as cultural landscapes. Aboriginal peoples maintain strong and complex connections with rainforest. Stories told by migrant and settler-colonial writers often misrepresent or omit Indigenous perspectives and thus facilitate exploitation of traditional knowledge for commercial gain. This has ongoing consequences for Aboriginal peoples due to loss of intellectual property rights and financial benefits. Despite Indigenous writers increasingly producing self-authored literature and criticism, the voices of some identity groups remain under-represented. This article argues for employing conversation as a tool to accelerate the reach of Indigenous voices into Australian literary studies. Through a conversation about Welsh migrant writing in John Naish’s The Cruel Field, Mbabaram ethnobotanist Gerry Turpin and literary scholar Elizabeth Smyth reposition Naish’s representation of rainforest relative to Aboriginal biocultural knowledge. This cross-disciplinary approach demonstrates how oral communication can fruitfully advance literary research when essential comparative stories are held in minds and memories.

This paper addresses the critical challenge of accelerating the adoption of sustainable innovations by examining the interdependence between managerial credibility and consumer pragmatism. The aim of the study was to investigate how perceived trust in management influences purchase intention, specifically analysing both the mediating role of financial perceptions and the moderating effect of digital literacy. The study had a quantitative approach, with data being collected from 408 Romanian respondents. The statistical analysis was performed using JASP software (version 0.96.0.0), applying both multiple and simple linear regression as well as a mediation analysis (SEM). The results indicate that both perceived trust in management and the perception of innovation as an investment directly stimulate purchase intention such that that credible management can convince consumers of the financial benefits. However, even though digital literacy plays a fundamental role in consumers’ lives, it does not affect the relationship between managers’ credibility and the willingness to buy sustainable products. The paper concludes that for sustainable innovations to be financially successful, organisations must move beyond the green labelling and focus on building genuine strategic credibility. Therefore, these findings offer valuable insights for both managers and policymakers in their efforts to support the transition to a more sustainable market.

Patient and provider cost analysis of integrating rheumatic heart disease care into the primary healthcare system in Northern Uganda.

Private equity acquisitions in aesthetic surgery have grown exponentially over the past 2 decades, transforming a profession built on surgical artisanship into an increasingly corporate enterprise. Although the financial and operational benefits of these partnerships are well documented, their implications for clinical autonomy, professional identity, and surgical training have received insufficient critical attention. This viewpoint examines the corporatization of aesthetic surgery from the perspective of a senior European surgeon with 25 years of clinical experience. Drawing on the legacy of Pitanguy's artisan training model and current data on private equity consolidation, the author identifies 3 domains at risk: the surgeon's freedom to make independent clinical decisions, the erosion of the artisan identity that has defined the specialty, and the threat to apprenticeship-based training. Concrete principles are proposed to preserve surgical values within evolving corporate structures.

To quantify the comprehensive financial impact from implementing a deep learning algorithm for assistive patient triage within a high-volume Head and Neck Surgical Oncology center operating under a fee-for-service framework. A prospective cost-benefit analysis compared a deep learning algorithm to standard manual triage on all incoming new patient referrals (n = 214) in one fiscal quarter (FY24 Q3). Financial impact was calculated using a model aggregating two economic components: (1) annualized labor displacement savings, and (2) revenue impact of reallocating verified non-indicated clinic slots to appropriate surgical candidates. Automated head and neck referral triage demonstrated a net annual operating gain of $535,989, yielding a 14.9× return on investment. Directly measured labor savings ($236,788.80; 5.6× ROI) represent the conservative estimate; capacity value is modeled, contingent on slot reallocation. The AI-assisted workflow displaces 1951.20 h of manual work (0.94 FTEs) annually per 6-provider division processing 30 referrals/week, and up to 351,936 h (169.20 FTEs) per hospital system. Furthermore, the algorithm's superior accuracy identified 80 verified recoverable clinic slots per year for the division; reallocating these to appropriate candidates generated an additional $6.2 million in downstream revenue. The integration of a deep learning algorithm for Head and Neck Surgical Oncology referral triage delivers substantial financial benefits through the dual mechanisms of direct reduction of administrative labor and the strategic optimization of clinical capacity. By identifying non-indicated referrals, the system allows for the reallocation of limited resources to patients requiring high-acuity surgical oncological care, offering a scalable model for financial sustainability. NA.

BackgroundMalaria remains the leading cause of morbidity and mortality in Ghana, particularly in rural high-burden communities. Mass drug administration (MDA) has re-emerged as a complementary strategy to reduce transmission, yet community acceptability and implementation challenges remain underexplored.MethodsWe conducted a cross-sectional study in the Pokrom subdistrict following pilot mass drug administration (MDA) interventions. Data were collected through eleven focus group discussions (FGDs), nine with community members and two with healthcare providers, comprising 97 participants, as well as eight in-depth interviews (IDIs) with assemblymen, healthcare providers and personnel of malaria elimination programme. Thes were complemented by field notes. Participants were purposively selected from individuals who had participated in the MDA interventions and provided informed consent. This study explored community perceptions of malaria burden, perceived MDA effectiveness, reported adverse events, health-seeking behaviour, financial implications and acceptability. Transcripts were analysed thematically using a hybrid inductive–deductive approach informed by reflexive thematic analysis.ResultsMalaria was widely identified as the most pressing health concern in the subdistrict prior to the MDA intervention, with frequent hospitalisation and substantial household expenditure on treatment reported. Following the MDA interventions, notable reductions in malaria episodes were described, with some households transitioning from frequent infections to rare or no illness. These perceived improvements were accompanied by decreased healthcare-related costs, indicating important financial and economic benefits. Though adverse events, including dizziness, abdominal pain, and weakness, were reported, they were generally perceived as mild and transient. Initial challenges included inadequate community sensitization and negative messaging from some health workers, which temporarily affected uptake. Despite these concerns, willingness to participate in future MDA rounds remained high among community members, with recommendations emphasizing continued sensitization, strengthened drug delivery systems, and enhanced monitoring of side effects.ConclusionsThe MDA interventions were widely perceived as beneficial in reducing malaria burden and associated household healthcare costs in rural Ghana. Consistent with the Theoretical Framework of Acceptability, perceived effectiveness and economic benefits outweighed the burden of transient adverse events, contributing to perceived high community acceptability. Strengthening communication, pharmacovigilance, and community engagement could be critical for sustaining uptake and supporting the potential scale-up of MDA in high-burden malaria settings.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12936-026-05979-w.

The integration of renewable energy sources (RESs) into energy systems poses considerable operational challenges, due to their intermittent and stochastic nature. Grid-connected energy storage systems (ESSs) present a compelling alternative for reliably accommodating various RESs. This paper presents an optimal scheduling for allocating wind-storage system capacity in high mountain regions with abundant wind resources and irrigation pumping demand. To capture uncertainty in wind and solar generation, a scenario-free stochastic formulation is adopted, enabling tractable and scalable uncertainty modelling. To reduce the overall lifecycle comprehensive cost (COC), a synergistic optimization model is developed by integrating features of wind energy, pumping unit parameters, and storage configurations. The model considers startup/shutdown losses, optimal flow distribution, and operating expenses of the pumping station while optimizing energy storage capacity. A single-battery system is compared with a hybrid battery-hydrogen storage strategy. Results show the hybrid solution reduces COC by 5.4%, alleviates battery operational stress, and maintains pumping station efficiency. The framework incorporates a reliability model for wind power generation, ensuring robust lifecycle cost optimization. This approach demonstrates the financial and technological benefits of hybrid storage in renewable energy-driven irrigation systems. Simulations in the case study validate the flexibility and effectiveness of the proposed approach across various practical settings.

Enhanced Recovery After Surgery (ERAS) pathways safely reduce length of stay (LOS) and resource use in many surgical fields, but their economic impact in thyroidectomy within the Italian National Health Service (SSN) is unclear, particularly under Diagnosis-Related Group (DRG) rules that penalize early discharge. A decision-analytic model compared an ERAS-inspired thyroidectomy pathway-same-day discharge after hemithyroidectomy and 24-hour discharge after total thyroidectomy-with a conventional DRG-driven pathway based on ≥2 postoperative inpatient days. The analysis adopted a hospital/provider perspective over 30 days, using data from a high-volume endocrine surgery unit and contemporary ERAS literature. Outcomes included LOS, postoperative complications, 30-day readmissions, direct hospital costs, and contribution margin under current SSN tariffs (including early-discharge penalties) and under a neutral reimbursement scenario. In hemithyroidectomy (400 cases/year), ERAS reduced mean LOS from 2.6 to 0.33 days (-2.27 days; p<0.001), freeing 908 bed-days annually and lowering variable costs by €1,332 per patient, without increasing complications or readmissions. Despite a 30% DRG penalty for LOS <2 days, the contribution margin increased by €147 per case. In total thyroidectomy (600 cases/year), ERAS reduced LOS from 3.1 to 1.16 days (-1.94 days; p<0.001) and variable costs by €1,079 per patient, again without compromising safety. However, DRG penalties reduced the margin by €481 per case, resulting in an annual loss of approximately €289,000 despite substantial real-resource savings. Overall, ERAS reduced mean LOS by 2.1 days and variable costs by €1,190 per patient across 1,000 procedures. ERAS thyroidectomy is clinically safe and markedly reduces LOS and hospital costs, but current SSN DRG rules penalizing early discharge blunt or reverse its financial benefits for public hospitals, particularly for total thyroidectomy. These findings highlight a structural mismatch between surgical efficiency and reimbursement incentives and support revising thyroidectomy tariffs to reward evidence-based early discharge. Because this is a model-based economic evaluation, these results should be interpreted as scenario-based evidence rather than as definitive real-world cost-accounting estimates.

Moral distress among nurse managers contributes to burnout, disengagement, and turnover, with significant organizational and financial consequences. Despite growing recognition of this issue, few evidence-based interventions specifically address moral distress in this leadership population. This evidence-based practice initiative evaluated the impact of facilitated ethical discussions on moral distress and intent to leave among nurse managers at a community hospital. A pretest-posttest design was used with a convenience sample of 10 nurse managers at a Magnet®-recognized, 180-bed community hospital. Participants attended four monthly facilitated ethical discussions grounded in the Unit-Based Ethics Conversations model. Moral distress was measured before and after the intervention using the Moral Distress-Appraisal Scale. Intent to leave was assessed using a single-item Likert-scale measure. Mean moral distress scores decreased from 16.8 to 14 following the intervention, representing a medium effect size (0.64). Although intent to leave didn't change, all nurse managers remained in their roles postimplementation. Most participants indicated that they would recommend facilitated ethical discussions to peers. Facilitated ethical discussions may reduce moral distress and support nurse manager retention. This low-cost intervention demonstrates potential clinical and financial benefits and warrants continued use and broader implementation among nursing leadership.

ABSTRACT In recent decades, the management of economic affairs has largely transitioned to digital platforms. Electronic identification and online money management have not only simplified individuals’ daily lives but have also introduced new methods for financially harming one’s partner or ex-partner. This study explores the various types of digitally facilitated economic abuse (DFEA) reported by clinical professionals who work with victim-survivors of violence. The data consist of 102 open-ended survey responses and four focus group interviews conducted with 15 participants. The findings suggest that DFEA can be categorized into two main types: digitally facilitated economic exploitation and digitally facilitated economic control. Digitally facilitated economic exploitation encompasses three distinct forms: The perpetrator (1) steals the victim’s money, (2) uses the victim’s identity to obtain financial benefits or (3) threatens to inflict financial harm. By contrast, digitally facilitated economic control involves 1) dominating victims of violence by taking control of their finances or 2) surveilling them through digital platforms, such as their online banking or loyalty card accounts. The motivation behind these actions differs from that of economic exploitation; it is not primarily for financial gain but rather a desire for control. Based on the findings of this study, there is a pressing need to critically examine digital practices and platforms to mitigate the potential for abuse. Preventing DFEA requires collaboration among a range of societal actors, including social and healthcare service providers, policymakers, law enforcement, prosecutors and financial and technology institutions.

Organizations increasingly seek sustainable competitive advantage through effective utilization of internal capabilities and customer-oriented strategies. The present study examines the relationships among organizational culture, consumer behavior, and financial performance through an integrated conceptual framework grounded in Resource-Based View and Stakeholder Theory. The study investigates how organizational culture influences financial outcomes directly and indirectly through consumer behavior. A quantitative research design was employed using a structured questionnaire adapted from previously validated measurement scales. Data were analyzed using Partial Least Squares Structural Equation Modeling (PLS-SEM) through ADANCO software. Reliability and validity assessments confirmed satisfactory psychometric properties of the measurement model. The findings revealed that organizational culture significantly and positively influences consumer behavior, while consumer behavior demonstrates a significant positive effect on financial performance. The mediation analysis further indicated that consumer behavior fully mediates the relationship between organizational culture and financial performance. The results suggest that organizational culture alone may not directly generate financial benefits but contributes to organizational success through its impact on customer-related behavioral outcomes. The study contributes to existing literature by integrating organizational and consumer perspectives within a single framework and provides practical insights for managers seeking to enhance organizational performance through customer-centered cultural strategies and long-term relationship development.

This article presents a technology for the physical recycling of printed circuit boards (PCBs) that is consistent with the principles of circular economy and sustainable production. A life cycle assessment (LCA) was performed for PCB recycling using shredding, grinding, and physical and physicochemical processes such as electrostatic separation, gravity separation, and flotation for the separation of metals and plastics. Based on this assessment and the selectivity criterion, electrostatic separation was found to be the best separation method, followed by shredding and cryogenic grinding. For this option, the yield of metals and plastics was 25.1% and 72.5% of feed, respectively, while the yield of the middling’s product (mixture of metals and plastics) was only 2.4%. Furthermore, the financial benefits of recycling, including economics of the business case and the environmental benefits are presented. The possibility of using non-metallic fraction (plastic) generated during recycling as an additive in the production of composite materials was also assessed. The results suggest that low filler contents (2.5–5%) provide a compromise between maintaining mechanical performance and improving hardness and tribological properties. Physical recycling technology is a pretreatment method for WPCB, complementing conventional chemical recycling methods. The global warming potential for the entire physical and chemical process is then lowered by about 70%, due to the smaller mass of input material going to the downstream metallurgical processes.

The US's imposition of tariffs on Canada has lent urgency to diversification of Canada's exports, including oil and gas. While investors have yet to propose another oil pipeline, they have initiated multiple liquified natural gas (LNG) projects. I employ four criteria – export diversification, climate change mitigation, Indigenous reconciliation, and value for public money – to compare two policy packages, the status quo (LNG expansion) and various restrictions on LNG development. While LNG expansion promises export diversification in the near term, that comes at a cost of undermining both Canada's ability to meet its Paris Agreement targets and global climate action and risks to public investments over the longer term. LNG development promises greater financial benefits to some Nations, but by sacrificing other Nations’ right to free, prior, and informed consent. I conclude that an economic future predicated on fossil fuel exports is risky, both for Canada's prosperity and humankind.

This study evaluated the impact of a fully subsidized behavioral weight management program (WW; formerly WeightWatchers®) among adults with type 2 diabetes or prediabetes enrolled in the 1199SEIU Benefit Funds, a self-administered labor-management fund providing health coverage to over 360,000 union members, retirees, and their families. Using a quasi-experimental mixed-methods design, we analyzed clinical claims data and focus group transcripts. Quantitative outcomes included HbA1c, body mass index (BMI), and program engagement. A one-to-one propensity score-matched control group was constructed to compare pre-post changes over a minimum six-month exposure period. Qualitative analysis explored barriers and facilitators to program participation. Among participants living with type 2 diabetes, those enrolled in WW experienced significant reductions in BMI and significant improvements in HbA1c control, while those with pre-diabetes demonstrated BMI reductions and no significant change in HbA1c levels. Higher engagement with WW, particularly through food tracking, activity tracking, and workshop participation, was associated with greater BMI reductions. GLP-1 medication use in the study sample was independently associated with reductions in HbA1c, and the combined effect of WW participation and GLP-1 use on BMI warrants further study given that interaction effects were non-significant in adjusted models. Qualitative findings highlighted key barriers and facilitators to engagement, including time constraints, family dietary preferences, and program accessibility. These findings provide real-world evidence supporting employer- or payer-sponsored behavioral weight management programs as a strategy to improve diabetes-related outcomes. Integration with pharmacotherapy warrants further investigation.

There are environmental and financial benefits to reducing iodinated contrast media (ICM) waste. While Imaging Bulk Package (IBP) bottles have been demonstrated to reduce contrast waste in adult hospitals, lower computed tomography (CT) volumes and smaller contrast doses pose challenges for utilizing IBP in children's hospitals. Primary outcome: quantification of CT contrast waste during a 6-month period at a single children's hospital. quantification of single-use product waste and greenhouse gas emissions, identification of the 12-h periods of highest contrast use, and estimation of reductions in contrast waste, single-use product use, costs, and greenhouse gas emissions by using IBP ICM during peak hours. All contrast-enhanced CT performed from January through June 2025 were reviewed. Volume of contrast wasted was calculated. The 12-h time period with the highest contrast-enhanced CT volume was determined. Reductions in contrast waste, single-use products, cost, and greenhouse gas emissions by using IBP ICM during these peak hours were estimated. Approximately 291 contrast-enhanced CT exams were performed per month. Mean contrast waste was 37mL per study, totaling 66 L of wasted contrast over 6months. Peak hours were 9 AM to 9 PM on weekdays. The mean ICM waste per exam was 37mL using single-dose bottles versus 17mL using IBP bottles during peak hours (P<0.001). Using IBP ICM during peak hours and single-use ICM at other times could reduce contrast waste by 56%, glass bottle waste by 33%, and save $40,740 per year. Using IBP during peak hours with a syringeless contrast injector would decrease greenhouse gas emissions by 72% due to added benefits of decreased waste of single-use plastics. Implementing IBP ICM during peak hours would substantially reduce contrast waste, single-use product waste, and costs at our hospital. Other children's hospitals may evaluate their contrast utilization practices, including quantification of contrast waste and single-use products, to identify opportunities to reduce waste through use of IBP and syringeless contrast injectors.

ABSTRACTLatine couples often face high levels of financial stress, which can significantly strain romantic relationships. Yet few programs are designed to address both financial and relational distress for this population. Juntos en Pareja (JEP) is a socio‐culturally responsive program designed to address these challenges by providing relationship and financial education to Spanish‐speaking Latine couples. JEP is a cultural and linguistic adaptation of the evidence‐based program TOGETHER. This study evaluates JEP's effectiveness by comparing pre‐ and post‐workshop outcomes among Latine couples in JEP with a comparison group of non‐Latine couples in the TOGETHER program. We examined three domains: psychological well‐being, relationship quality, and financial stability. The analytic sample included 284 couples (568 individuals) in JEP and 266 couples (532 individuals) in TOGETHER, all residing in the United States. Using linear mixed models, we assessed changes from pre‐ to post‐test across key indicators. Similar to TOGETHER, JEP participants showed significant declines in psychological distress, negative conflict management, and psychological aggression toward the partner and by the partner, and significant increases in time spent with the partner. Additionally, JEP couples also reported reduced difficulty in paying bills. These results provide support for JEP as a beneficial program for Spanish‐speaking Latine couples, but they should be considered with caution as they represent the experience of program completers with high attendance and immediately upon program completion. Further studies should assess the sustainability of changes over time. Nonetheless, these initial findings underscore the need for accessible, socio‐culturally attuned interventions to promote resilience and stability in underserved immigrant communities.

Universal Credit (UC) is a major UK welfare reform that consolidates six means-tested benefits into a single monthly payment, aiming to simplify benefits delivery and incentivize labor market participation. However, concerns have emerged regarding its potential adverse consequences on recipients' mental and physical well-being. Existing evidence is limited by methodological weaknesses, short follow-up time, and a narrow focus on psychological distress. Applying the heterogeneous difference-in-differences approach developed by Callaway and Sant'Anna, we used waves 6-14 of the UK Household Longitudinal Survey (UKHLS), focusing on working-age individuals receiving social benefits to evaluate the short- and long-term effects of that welfare reform on psychological distress (GHQ-12), mental functioning (SF-12 MCS), physical functioning (SF-12 PCS), but also employment, perceived financial outlook, benefits income, and total income. Transitioning to UC significantly increased GHQ-12 scores by 1.20 points (95% CI: 0.33 to 2.07) and decreased SF-12 MCS scores by 2.19 points (95% CI: - 3.79 to - 0.59), indicating deteriorating mental health. No significant effect was observed for SF-12 PCS. UC was also associated with a £93.05 reduction in monthly benefit income, a £222 decrease in total income, and an 8%-point decrease in perceived financial optimism. No significant effect on employment status was detected. Our findings suggest that the transition to UC adversely affected mental health and financial well-being, while yielding limited employment benefits. These adverse impacts reflect both implementation challenges, such as payment delays and benefit deductions, and structural design flaws, including rigid conditionality and reduced income security for vulnerable groups. The results underscore the need for welfare reforms that integrate health considerations and provide more flexible, targeted support to mitigate unintended harms.