In 2007, the Office of the Assistant Secretary of Defense issued guidance to routinely monitor post concussive symptoms following mild traumatic brain injury (mTBI). Subsequent clinical practice guidelines published as early as 2009 further underscored the importance of routine symptom monitoring following mTBI using standardized assessments such as the Neurobehavioral Symptom Inventory (NSI), though the NSI was not specifically recommended until 2015. The study objective was to describe the frequency of NSI administration, as documented in the Military Health System (MHS) electronic medical record (EMR), within one year after mTBI diagnosis among post-9/11 Active-Duty Service Members. Data for this effort were extracted from the Military Health System (MHS) Data Repository and used to identify Service Members whose first mTBI (i.e., index) was documented between Fiscal Years 2002 and 2021 (index TBI; n = 150,976). Members were excluded from the cohort for a history of a more severe TBI (n = 128,253) and/or a catastrophic injury (e.g., spinal cord injury; n = 3,805). Members were matched with data from completion of the NSI that was contained within the DoD TBI portal. The cohort was further evaluated to determine the frequency of documented NSI administration within one year of the index mTBI date. Among those with an index mTBI meeting inclusion criteria, 3,351 (2.2%) Service Members had an NSI documented within the EMR. When filtered to NSI surveys completed within 1 year of the index mTBI date, 1,182 (0.78%) NSIs were recorded. The prevalence of a matched NSI increased as time went on, with the highest number administered in 2019. Findings suggest relatively infrequent administration and documentation of the NSI following mTBI. System- and individual-level barriers may have played a role in this. Increased understanding regarding barriers and facilitators to administering and documenting the NSI within the EMR are needed to inform future implementation efforts to further measurement-based care among Service Members.

Shelter-in-place (SIP) is positioned alongside evacuation as a primary protective action during nuclear emergencies in Japan. However, despite the progressive development of institutional systems and guidelines, limited attention has been paid to the practical implementation of SIP in medical institutions. In particular, hospitals that must continue to provide care for the elderly, critically ill, and other non-evacuable inpatients lack integrated operational models that address business continuity planning (BCP), radiation protection, staff mobilisation, zoning, and the real-world operation of positive-pressure systems. Against this background, since the fiscal year 2024, a working group on nuclear disaster preparedness has been established at Japanese Red Cross Matsue Hospital, a designated disaster base hospital located within the urgent protective action planning zone (UPZ) of the Shimane Nuclear Power Plant. This working group brings together multidisciplinary hospital departments and external stakeholders, including local governments, relevant service providers, and academic institutions, and operates under a permanent, multilayered governance structure. Through staged preparatory reviews within each department and integrated discussions at plenary meetings, operational challenges related to SIP were systematically identified and incorporated into hospitallevel BCP. This initiative represents Japan's first implementation-oriented effort to examine SIP not only as a conceptual or administrative measure but also as an operational strategy grounded in realworld hospital practice. By enhancing the feasibility of nuclear emergency preparedness in medical institutions located within UPZs, this study provides practical insights that may inform future policy development and be applicable to other regions.

In 2020, ready-to-use nasal glucagon was introduced in Japan, enabling more rapid caregiver response during episodes of severe hypoglycemia. However, nationwide prescribing patterns and changes in drug expenditures for glucagon products remain unclear. Additionally, updated information on insulin formulations, which are major contributors to hypoglycemia, is lacking. Understanding the recent trends in these medications is, therefore, necessary. We analyzed publicly available aggregated prescription data from the National Database Open Data Japan. Annual outpatient prescription counts for nasal glucagon, injectable glucagon, and insulin formulations were extracted for fiscal years 2014-2023, and their annual trends were then described. The nasal glucagon prescription increased markedly in fiscal year 2020, the year of market introduction, and remained stable from 2021 to 2023. Contrarily, injectable glucagon prescriptions declined after 2020. Total glucagon-related expenditures, calculated based on the annual drug prices, increased approximately 28-fold between fiscal years 2019 and 2023. Insulin prescriptions increased steadily throughout the study. By age group, long-acting insulin showed increasing use among older patients, whereas rapid- and ultra-rapid-acting insulin showed increasing use among older and younger patients. Nasal glucagon demonstrated a rapid initial uptake but remained at a stable prescription level thereafter, while substantially increasing the overall glucagon expenditures. Although the drug cost is high, its potential to enable rapid rescue by caregivers is critical. Identifying the appropriate target populations by balancing high drug costs against reduced emergency medical costs to ensure cost-effectiveness will be critical for the effective management of severe hypoglycemia. The online version contains supplementary material available at 10.1007/s13340-026-00880-y.

Special health examinations in Japan lack standardized judgment guidelines, potentially leading to wide variation in outcomes. This study quantified inter-institutional differences in abnormal-finding rates for examinations targeting specified chemical substances and organic solvents, and examined whether institutional judgment criteria are associated with these rates. We conducted a cross-sectional questionnaire survey of 115 facilities affiliated with the National Federation of Industrial Health Organizations (Zen-Eiren). Facilities reported abnormal-finding rates for fiscal years 2022-2024. Physicians' judgment criteria were assessed using case vignettes addressing the use of exposure information and biological monitoring. Associations between rates and judgment criteria were evaluated using non-parametric tests (Spearman's rank correlation; Wilcoxon rank-sum). Valid responses were obtained from 45 facilities (39.1%). Abnormal-finding rates for specified chemical substances and organic solvent examinations were strongly correlated within facilities. For organic solvent examinations, facilities that did not emphasize the exposure-finding association reported higher abnormal-finding rates than those that did. A similar, but non-significant trend was observed for specified chemical substance examinations (P = 0.066). Abnormal finding Rates tended to rise when biological monitoring alone triggered abnormalities and non-occupational factors were not excluded in both examinations. Major special health examinations in Japan show substantial inter-institutional variation in abnormal-finding rates, partly explained by differences in judgment criteria-particularly the weight placed on linking clinical findings to workplace exposure. Establishing standardized national guidelines is essential to improve consistency, reliability, and system effectiveness.

Budget absorption remains a critical issue in public sector financial management, particularly within regional government agencies in Indonesia. One persistent challenge is the uneven pattern of budget realization, which tends to be low at the beginning of the fiscal year and accumulates toward the end, potentially disrupting public service delivery and program effectiveness. This research examines the influence of budget planning, human resource competency, and budget implementation processes on the optimization of budget absorption. The study was conducted at the Social Service Office of Central Java Province. The research objects included the planning, finance, and technical implementation departments. The sampling method used was purposive sampling, with the research period set for 2025. The relationships and influences among variables were analyzed using multiple regression analysis. The results showed that budget implementation had a significant and positive effect on budget absorption, while budget planning and human resource competency did not show a significant effect. The study concludes that strengthening the budget execution stage—including accelerating administrative processes and enhancing coordination among work units—is essential to improve budget absorption performance. These findings provide valuable insights for regional governments in designing more effective budget management strategies to support public service delivery and community welfare.

This research seeks to provide empirical evidence regarding the influence of local own-source revenue and capital expenditure on the financial performance of local governments, as well as to analyze the moderating role of community participation in these relationships. The study population comprises all regency and municipal governments in Indonesia for the fiscal years 2022–2023. A census (total sampling) approach was employed by utilizing all available observations, yielding 1,016 data points from regency and city governments over the two-year period. The data were sourced from Budget Realization Reports and Operational Reports as presented in the Local Government Financial Statements. The empirical results indicate that local own-source revenue exerts a positive and statistically significant effect on local government financial performance. Likewise, capital expenditure is found to have a positive and significant impact on financial performance. Community participation is shown to significantly weaken the relationship between local own-source revenue and financial performance. Conversely, community participation strengthens the effect of capital expenditure on financial performance; however, this moderating effect is not statistically significant.

As telehealth (ie, telephone and video) becomes a larger component of primary care, understanding its impact on care quality is critical. To evaluate whether the proportion of primary care received via telehealth is associated with differences in quality-of-care outcomes among veterans who frequently use primary care. This is a retrospective cohort study of veterans empaneled to Veterans Health Administration (VHA) primary care in fiscal years 2022 and 2023 (October 1, 2021, to September 30, 2023) with 3 or more primary care visits. Telehealth proportion categories were none (0.0% primary care visits telehealth), low (>0.0% to <28.6%), intermediate (28.6% to <50.0%), or high (≥50.0%). Proportion of primary care delivered via telehealth. The primary outcomes were influenza vaccination, hypertension control, statin therapy and adherence, and screenings and/or counseling for depression, tobacco, and alcohol use. Multivariable logistic regression was used to estimate adjusted average marginal effects (AMEs), controlling for sociodemographic, geographic, and clinical characteristics. This study included 744 599 veterans (mean [SD] age, 65 [15] years; 638 289 male [86%]). Compared with veterans receiving in-person care only, those who received a low proportion of care via telehealth had similar quality of outcomes for all cardiovascular and behavioral health measures. Influenza vaccination rates were modestly lower in the low-telehealth group vs the in-person only group (age ≥66 years, AME, -1.93% [95% CI, -2.58% to -1.29%]; age 19-65 years, AME, -1.57% [95% CI, -2.28% to -0.86%]). High telehealth users (≥50% telehealth) had the lowest adjusted likelihoods for most quality outcomes, including influenza vaccination (age ≥66 years, AME, -8.96% [95% CI, -9.84% to -8.07%]; age 19-65 years, AME, -9.72% [95% CI, -10.84% to -8.60%]) statin adherence (AME, -2.03% [95% CI -2.93% to -1.14%]) and depression screening (AME, -2.14% [95% CI, -3.20% to -1.08%]). In this cohort study of veterans with 3 or more primary care visits, primary care quality was similar for individuals who received all in-person care and those receiving low or intermediate proportions of telehealth. However, high telehealth use was associated with lower quality for several services, especially those requiring in-person interaction. Findings demonstrate the viability of hybrid telehealth and in-person models. Additional resources might be needed to ensure high-quality primary care for high proportion telehealth users.

Social and Clinical Variables Associated with Outpatient Mental Health Care Utilization following Positive Suicide Risk Screening.

Pharmacogenomic testing (PGx) is often completed after an adverse drug event (ADE) has occurred, but moving toward a preemptive rather than reactive testing approach could potentially decrease preventable drug-related hospitalizations and positively impact combat readiness. Although prior research has suggested that PGx testing may aid in individual patient medical management, there is limited research assessing the potential impact of preemptive PGx testing in the Military Health System (MHS). In this study, we utilized MHS prescription data along with available genotypic and phenotypic population frequency data to estimate the potential impact of PGx testing in the diverse MHS patient population. A retrospective cross-sectional study was conducted using fiscal year 2021 (FY21) prescription data from the Defense Health Agency (DHA) Pharmacy Operations Division. Medications that had Clinical Pharmacogenetics Implementation Consortium (CPIC) level A, A/B, and B designations prescribed to Active Duty, Reserve, Retired, and Dependent MHS beneficiaries ages 18 and up were included in the analyses. We evaluated the prescription count along with the age, biological sex, and MHS beneficiary status for medications prescribed within the MHS. We then estimated the number of MHS beneficiaries predicted to have non-normal metabolism of a given PGx-related medication. This data was presented as a range based on the CPIC allele and metabolizer frequency data which varies across PharmGKB-defined biogeographical groups. This study was approved and was determined exempt by the Uniformed Services University of Health Sciences (USUHS) and the Augustana University institutional review boards. There were over 8 million unique prescriptions for 83 PGx-related medications with CPIC level A, A/B, or B designation in FY21. Of these, over 1.2 million prescriptions (15%) were for Active Duty and Reserve members, with the top 5 prescribed PGx-related medications for Active Duty members being ibuprofen, ondansetron, hydrocodone, omeprazole, and meloxicam. This study further analyzed 64 medications with known metabolism frequency data. In FY21, there were up to 632,974 MHS beneficiaries taking omeprazole who were predicted to have non-normal CYP2C19 metabolism, which represents the medication with the highest number of prescriptions among individuals with estimated non-normal metabolism. Among medications with a risk for severe ADE, allopurinol was at the top with up to 301 prescriptions provided to Active Duty members estimated to have the *58:01 variant, which is associated with increased risk for toxic epidermal necrolysis. Currently, PGx testing is an underutilized resource in the MHS system, despite the many PGx-related medications that are widely prescribed among all MHS beneficiaries who have actionable CPIC guidelines. Based on published allele and metabolizer frequencies in the general population, a significant number of MHS beneficiaries taking these medications may be predicted to have non-normal metabolism and be at increased risk for adverse drug events and/or therapeutic failure. Given high prescription counts across all MHS beneficiaries, including Active Duty members, this data should be used to inform a preemptive PGx testing implementation approach in the MHS with the goal to reduce ADEs and therapeutic failure, while improving readiness among service members.

Breast cancer is one of the deadliest diseases in the world. It accounts for 22.2% of all cancers and is the most common site of cancer in women in Japan. Although hormone therapy with aromatase inhibitors or tamoxifen has been widely used, it is unclear which agent is more cost-effective. This study examined the cost-effectiveness of anastrozole as an aromatase inhibitor from a healthcare payer's perspective compared to tamoxifen in Japan. A Markov model, for comparing anastrozole with tamoxifen as a reference agent, was developed using data from a randomized clinical trial conducted in Japan. The costs were derived from the Japanese health care fee index for 2022. Based on the results of a questionnaire on the general health-related quality of life associated with cancer (FACT-G), utilities were converted to EuroQol-5 Dimension-5 Level. The time horizon was set to 10 years. In addition, deterministic and probabilistic sensitivity analyses were conducted. Anastrozole was dominated by tamoxifen. Deterministic one-way sensitivty analysis showed the expected value (EV) of incremental net monetary benefit for anastrozole was the highest sensitive to the pharmaceutical "drug price of anastrozole in fiscal year (FY) 2022," where the generic drug price was applied. The EV remained negative across the other parameters. Probabilistic sensitivity analysis revealed that anastrozole dominance over tamoxifen was 47.2%. Anastrozole was less cost-effective than tamoxifen in Japan. Our findings support clinical practice and suggest that payers and policymakers should promote cost-effective therapies.

This study aimed to clarify trends in the incidence of secondary hip fractures and pharmacotherapy after primary fractures over time in Japan. Using Japan's National Database of Health Insurance Claims and Specific Health Checkups, we examined the number of hip fracture patients and their osteoporosis medication status from fiscal year (FY) 2012 to FY2023. A total of 1,289,333 females and 312,968 males had primary fractures. Among them, 42,835 females and 8,249 males had a secondary fracture within 1year following the primary fracture. The incidence rates averaged 3.44% annually, ranging from 3.26 to 3.57% by fiscal year. These rates showed an increasing trend from FY2012 to FY2018, followed by a decreasing trend until FY2020, but increased again in FY2021. The medication administration rate within the first year following the primary fracture progressively increased over time, from 39.1% in FY2012 to 49.6% in FY2021, followed by a notable increase to 65.5% in FY2022. Bisphosphonates were the most frequently administered medications, and the number of patients receiving bisphosphonates, eldecalcitol, denosumab, and romosozumab increased over time. The medication administration rate has consistently increased. The incidence of secondary fractures decreased from FY2019 but then increased in FY2021 due to the impact of the coronavirus disease 2019 (COVID-19) pandemic. However, in FY2022, this increase was mitigated by the introduction of management fees. It is anticipated that the incidence of secondary fractures will decline again due to a further increase in medication rates following the COVID-19 pandemic.

Cost–benefit analysis (CBA), particularly the economic internal rate of return (EIRR), continues to play an important role in infrastructure project appraisal. Using EIRR data from 387 infrastructure projects financed under Japan’s ODA loans (Japanese fiscal years 2001–2020), this study identifies clear sectoral trends: economic infrastructure and brownfield projects generally exhibit higher EIRRs, while no significant differences are observed between tied projects (i.e., projects whose contracts are primarily tied to Japanese firms) and untied projects. A comparison of ex ante and ex post EIRRs for 84 projects shows that estimates may vary due to factors such as changes in demand, project costs, and implementation periods, indicating the practical challenges involved in estimating EIRRs. Qualitative analysis further suggests that non-economic considerations—such as humanitarian needs, national development priorities, and diplomatic interests—may also influence financing decisions. Overall, while CBA remains a valuable and widely used tool, the findings highlight the importance of complementing it with broader sustainability-oriented appraisal approaches that capture the multidimensional value of infrastructure projects.

Holistic Health and Fitness (H2F) is the United States Army's largest force modernization initiative aimed at preserving combat power by optimizing soldier readiness across five domains: physical, mental, nutritional, sleep, and spiritual. At the core of this effort are H2F Performance Teams (HPTs): embedded, interdisciplinary subject matter experts, composed of strength and conditioning coaches, athletic trainers, physicalandoccupational therapists, registered dietitians, and mental readiness professionals. These teams operate within brigades to deliver proactive, preventive, and performance-enhancing interventions that reduce injury risk, accelerate rehabilitation, improve fitness and cognitive performance, and sustain deployability. This evaluation quantified the return on investment (ROI) of embedded HPTs across 56 matched active-duty brigades (28 HPT-resourced, 28 controls), encompassing over 1,000,000 soldiers from fiscal year (FY) 2019 through FY2023. A quasi-experimental, presence-based difference-in-differences framework estimated multiyear treatment effects for musculoskeletal injury (MSKI) referrals and profiles, behavioral health (BH) and substance abuse (SA) profiles, Army Combat Fitness Test (ACFT) pass/failure rates, Army Body Composition Program (BCP) noncompliance, and Rifle Marksmanship Qualification (RMQ). Outcome deltas were monetized using validated cost-per-case benchmarks from military/government reports and peer-reviewed studies. A 10,000-draw Monte Carlo simulation, incorporating triangular distributions and a ρ = 0.15 Gaussian copula, modeled fiscal uncertainty, interdomain dependency, and force-wide extrapolation. Despite significantly worse baseline odds pre-resourcing, HPT brigades reversed all major readiness disadvantages by FY2023. MSKI referral odds declined 61% (odds ratio [OR] 1.16 → 0.45), SA profile odds dropped 79% (OR 1.92 → 0.41), and BH > 90-day profile odds fell 44% (OR 1.51 → 0.84). ACFT failure odds decreased 22% (OR 1.05 → 0.82), RMQ expert qualification odds increased 33% (OR 1.21 → 1.60), BCP failure odds decreased 12%, and RMQ failure odds declined 28%. Annually, per brigade, these effects translated to 1363 adverse events avoided and 37,484 duty days restored. Using domain-specific cost estimates, a 10,000-draw Monte Carlo simulation estimated mean annual cost avoidance of $14.06M per brigade (95% CI $12.25-16.19 million), with 99.05% of draws exceeding a 4:1 ROI. Duty day restoration and expert RMQ gains added $10.38 million (95% CI $8.15-13.00 million) in readiness value. Combined, annual total economic value reached $24.44 million per brigade (ROI = 8.15:1; 95% CI 7.17-9.27), with force-wide extrapolation yielding $5.28 billion in annual total Army returns. Every $1 invested in HPTsreturns $8.15 in value($4.69 in costavoidances and $3.46 in readiness improvements). Embedded HPTs produce robust, statistically significant, multidomain improvements in readiness, performance, and cost efficiency. These estimates exclude long-horizon returns such as retention, disability deferral, or downstream system savings-suggesting total ROI is significantly underestimated. This study indicates HPTs are core readiness infrastructure. Their full-scale implementation is a strategic imperative for modernizing force sustainment and preserving the Army's most critical asset: the soldier.

Artificial intelligence (AI) scribes are being rapidly adopted in oncology, yet their real-world impact on physician productivity, workflow, and workplace satisfaction is understudied. We evaluated the quantitative and qualitative effects of an AI scribe with electronic medical record (EMR) integration in a multisite community oncology practice. This single-center, multisite study enrolled 22 medical oncologists and three primary care physicians randomly assigned to receiving training and exposure to the Knowtex AI scribe in an initial phase or control phase. Physician billing data were collected for 6 months before the onboarding of intervention arm physicians and for 16 weeks afterward-within the 2024 fiscal year. Surveys administered at baseline and week 8 postexposure assessed documentation burden, quality, EMR experience, and overall documentation satisfaction. All enrolled providers adopted the Knowtex AI scribe during their respective study phase. Intervention arm physicians exhibited an increase in mean visits (β = 3.35, SE = 1.08, P = .010) and mean total billing per working day (β = $433.61 in US dollars, SE = $134.82, P = .007). There was no change in the number of diagnostic codes per visit. Physicians' perceptions of EMR challenges markedly decreased after implementing the AI scribe (P < .001) with no significant change in the quality of documentation. Physicians reported higher satisfaction with documentation workflow, reduced in-clinic documentation hours, and increased time with patients. Adoption of an AI scribe with EMR integration in oncology clinics may enhance certain billing metrics and positively shift physician perceptions of documentation processes and EMR challenges. These findings highlight potential benefits and limitations of AI scribes in improving physician productivity and satisfaction.

Although the incidence rate of exertional heat stroke (EHS) in the U.S. military decreased from 2018 to 2022, a resurgence in 2024 highlights the importance of continued refinement of effective preventive measures. This study aimed to describe the burden of exertional heat illness (EHI) in the U.S. Air Force Special Warfare Training Wing (SWTW) from FY19 to FY24 and assess changes in annual external heat exhaustion (EHE) and EHS risk following implementation of mitigation strategies in 2019. This descriptive epidemiology study analyzed 195 EHI cases among SWTW trainees from FY19 to FY24. Data on EHE and EHS were extracted from Military Health System records. Cumulative incidence (proportion of affected trainees per year) was calculated using the annual trainee population as the denominator. Mitigation strategies implemented in 2019 were assessed. Chi-square testing indicated that the distribution of EHS and EHE differed by fiscal year (χ2 = 12.92, P = .0241), reflecting year-to-year variation in case proportions. Historical weather data were reviewed to descriptively contextualize seasonal environmental conditions during periods of elevated EHI proportions. During FY19 to FY24, there were 195 reported cases of EHI: 135 EHE and 60 EHS. EHE exceeded EHS annually from FY19 to FY23, with EHI peaking in FY22 (n = 45), declining in FY23 (n = 19), and resurging in FY24 (n = 36), driven by increased EHS (n = 19). EHE cumulative incidence (0.91%-1.90%) outpaced EHS (0.28%-0.79%) until FY24, when EHS rose to 1.80%, surpassing EHE (1.61%). A significant association was identified between EHI type and fiscal year (χ2 = 12.92, P = .0241) with an increased EHS rate in FY24 versus FY20 (P = .012) and FY23 (P = .045); FY22 versus FY20 (P = .039). No significant year-over-year variation in EHE was observed. The SWTW implemented various measures to mitigate heat injury. Despite interventions at the SWTW, EHI remained prevalent to include an EHS proportion surge (1.80%) in FY24, indicating potential limitations and need for improved training adaptations, early detection, and risk management in high-intensity environments. Achieving zero EHI may not be feasible, thus, leadership must make decisions that acknowledge risk and apply evidence-based strategies to meet mission objectives. Seasonal patterns suggest tailored interventions may be necessary. Future studies should assess morbidity metrics, trainee fitness, and acclimatization to further evaluate and refine prevention strategies.

This research analyzed the factors influencing financial statement integrity among companies listed on the Indonesia Stock Exchange during the 2022 fiscal year. The study examined the roles of the audit committee, company size, and leverage as primary determinants of reporting honesty. It integrated the alignment between financial data and non-financial disclosures in sustainability reports to identify potential greenwashing practices that could mislead stakeholders. A quantitative approach was employed, utilizing multiple linear regression analysis to evaluate the relationships between the variables. The researcher selected the sample through purposive sampling, focusing on issuers that provided complete annual and sustainability reports. The results indicated that the audit committee and company size exerted a positive and significant influence on financial statement integrity. These findings suggested that independent oversight and reputational risks associated with large organizations effectively reduced information asymmetry. Conversely, leverage demonstrated a negative and significant impact, which implied that high debt burdens encouraged opportunistic managerial behavior through earnings management. This study offered practical contributions for regulators and investors in evaluating corporate information credibility during an era of increasing environmental, social, and governance transparency and digital reporting integration.

This study introduces the Korean Tax Avoidance Panel (KoTaP), a long-term panel dataset of non-financial firms listed on KOSPI and KOSDAQ between 2011 and 2024. After excluding financial firms, firms with non-December fiscal year ends, capital impairment, and negative pre-tax income, the final dataset consists of 12,653 firm-year observations from 1,754 firms. KoTaP is designed to treat corporate tax avoidance as a predictor variable and link it to multiple domains, profitability, stability, growth, and governance. Tax avoidance itself is measured using complementary indicators-cash effective tax rate, GAAP effective tax rate, and book-tax difference measures-with adjustments to ensure interpretability. A key strength of KoTaP is its standardized firm-year panel structure with standardized variables and its consistency with international literature on the distribution and correlation of core indicators. At the same time, it reflects distinctive institutional features of Korean firms, such as concentrated ownership, high foreign shareholding, and elevated liquidity ratios, providing both international comparability and contextual uniqueness. KoTaP enables applications in econometric and machine-learning applications, including explainable methods.

BackgroundEnvironmental issues related to air pollution in Southeast Asia have persisted for more than a decade, especially in Thailand. This study aims to estimate the treatment costs of respiratory diseases caused by exposure to ambient PM₂.₅ and to identify the factors that influence these costs.MethodsThis retrospective study analyzed secondary data on OPD and IPD respiratory disease treatment costs from government hospitals, along with ambient PM₂.₅ data from low-cost monitoring stations, to estimate the cost of illness across 25 districts in Chiang Mai during Thailand’s fiscal year 2023. Economic cost was estimated using the Cost-of-Illness method formula: Economic Cost Loss = Health Impact × Treatment Cost. K-means cluster analysis was used to classify estimated costs into minimum, medium, and maximum cost scenarios. Multiple linear regression was applied to identify significantly associated factors with treatment cost.ResultsUnder the maximum cost scenario identified through K-means cluster analysis stratification, the total treatment cost associated with an average PM₂.₅ concentration of 42.59 µg/m³ was 460,122.58 USD, averaging 41.62 USD per case. Each 1 µg/m³ increase in PM2.5 was associated with a cost rise ranging from 403.84 to 13,159.87 USD. Non-infectious respiratory diseases incurred costs approximately two times higher than infectious ones. The estimate of maximum treatment burden for respiratory disease cases was highest in urban areas, totaling 102,878.88 USD. The urban area showed a significantly higher cost of treatment both in OPD and IPD cases (p < 0.001). Moreover, higher healthcare levels and older age were associated with higher costs in OPD cases. In IPD cases, length of hospital stay was a significant predictor.ConclusionsAmbient PM₂.₅ exposure contributes significantly to the economic burden of respiratory diseases in polluted areas. These highlight the importance of pollution control policies and healthcare resource planning in high-risk areas.Trial registrationnot applicable.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12889-026-26478-2.

This study aims to analyze the quality of the Bali Provincial Government Financial Report (LKPD) through the application of accrual-based Government Accounting Standards (SAP). This study uses a qualitative descriptive approach with a case study method on the Bali Provincial Government Financial Report for the 2022–2024 fiscal years. The research data consists of secondary data obtained from LKPD that has been audited by the Supreme Audit Agency (BPK), Audit Reports (LHP), as well as laws and regulations and official documents related to the implementation of SAP. Data collection techniques were carried out through documentation and literature study. The results of the study indicate that the implementation of accrual-based SAP has improved the quality of regional financial reporting, as reflected in the completeness of financial reports and the achievement of an Unqualified Opinion (WTP). However, there are still weaknesses in regional asset management, consistency of disclosure, and human resource readiness, so that continuous strengthening of regional financial management is needed.

Performance assessment is a crucial component of an organization's evaluation process for assessing the performance of its personnel. Appraisal is an ongoing procedure that occurs once a year as a formal evaluation before the end of the fiscal year. The purpose of performance appraisal is to enhance the employee's motivation inside the organization, hence facilitating the attainment of organizational objectives. People are the primary assets of an organization. Without people, it is challenging to sustain the firm in the market for an extended duration. The research examines the performance appraisal method at IT companies in the tricity, focusing on how management fosters employee motivation and understanding of the working environment. The study aims to meet the partial requirement and gain insight into the satisfaction level of employees as it is connected directly with the sustainable development.