General Utility Research Articles

The M-POHL Health Literacy Population Survey 2024-2026 (HLS24)

Abstract Background Inspired by the first European Health Literacy Survey (HLS-EU) and its policy impact, the WHO Action Network on Measuring Population and Organizational Health Literacy (M-POHL) was established in 2018 under the auspices of WHO Europe to monitor and strengthen health literacy (HL) in Europe. The Health Literacy Survey 2019-2021 (HLS19) was the first project of M-POHL, focusing on both general and specific aspects of HL. The follow-up survey (HLS24) builds on this work and will provide even more comprehensive data on HL by including more countries and new aspects of HL. By also focusing on NCDs and prevention, HLS24 is a key partner in the European Joint Action PreventNCD. Methods The HLS24 is a cross-sectional study based on nationally representative samples of the adult population (18+) in more than 20 participating countries. The HLS24 core questionnaire includes items on general HL, sociodemographics, health behavior, health status, and health care utilization. Some countries also include questions on prevention and early detection of chronic diseases and health problems. Five optional packages (OPs) enable countries to focus on specific aspects of HL, namely digital, communicative, navigational, vaccination and mental HL. Results HLS24 uses a harmonized set of HL instruments that provide a solid database for health policy decisions to strengthen HL and health equity in Europe. In addition to the three OPs on digital, communicative and navigational HL discussed in the following presentations, an 11-item set on vaccination literacy and a 21-item set on mental HL are provided. Conclusions Covering NCDs, prevention, digital health, immunization, and mental health, the HLS24 provides important data on current health challenges and highlights the needs of the European population regarding health information and services upon which policy and action interventions can be based.

Validation of diagnostic wearable ECG data from high-risk patients and integration into the atrial fibrillation catheter ablation pathway

Abstract Background Wearables like the Apple Watch (AW) offer non-invasive, long-term monitoring and patient-led, single-lead ECG recordings. Although validated for Atrial Fibrillation (AF) detection in the general population, the accuracy and clinical utility of the single-lead ECG recording feature for the diagnosis of AF has not been evaluated in patients at high risk of atrial arrhythmias.(1) An evaluation of the accuracy of the Wearable-derived labels is important to determine the feasibility of integrating AW-based remote monitoring into clinical pathways. Objective To evaluate the accuracy and data burden from AW-based, patient-led ECG monitoring in patients undergoing AF catheter ablation. Methods Patients referred for first-time AF catheter ablation to the Study Institution between January 2022 and March 2023 were invited to enrol in the AF Follow-up with Apple Watch (AFFU-AW) Trial. Patients randomised to the active arm of the study received 12 months of post-ablation follow-up using a loaned Apple Watch. Participants underwent an education session and were asked to perform daily ECGs; sending through any labelled as AF, inconclusive, or in the context of symptoms. The accuracy of the automated ECG labelling was determined against blinded, independent labelling by two experienced Electrophysiologists. Results 1093 remote transmissions were emailed in for evaluation from 52 patients to the Study team. This was a median of 6 [2, 17] per patient and a receiver burden of 2 [1, 4] ECGs per day. 475 were categorised by the AW as AF with a sensitivity of 0.71 and specificity of 0.96 compared to expert labelling. 342 (31%) were not categorised by the wearable, with an ‘inconclusive’ interpretation (161 [47%]) or ‘high heart rate’ (108 [32%]) as the most cited reasons. 178 (55%) of the uncategorised ECGs were subsequently overread as AF. Accompanying symptoms were reported with 324 (30%) ECGs, most commonly palpitations. Conclusion This is the first reported evaluation of the AF diagnostic feature based on AW ECG recordings as part of a remote patient rhythm surveillance pathway after catheter ablation. The high positive predictive value of ‘Sinus Rhythm’ and ‘AF’ labels and the high specificity of the ‘AF’ label are comparable to diagnostic algorithms in implantable loop recorders.(2) The source code to automate data curation and structured databasing of wearable ECGs has been made available for care providers to integrate the service into device monitoring workflows.(3)

Exploring the impact of multiple stressors on cultural and ecological values: A case study from Te Rerenga Parāoa (Whangārei Harbour), Aotearoa New Zealand

Estuarine systems often have degraded ecology and functioning due to the multiple interacting stressors that they face. While conventional management might address such a situation with narrow focus, ecosystem based management provides a more holistic and adaptive option allowing for multiple objectives and values. Such an approach has some commonality with that of the Indigenous Māori of New Zealand, who have holistic, interconnected and intergenerational aspirations. In this study we utilised Te-Rerenga-Parāoa, Whangārei Harbour, Aotearoa New Zealand as a case study to explore how ecological and Māori knowledge systems and approaches may align to address complex multi-stressor and multi-value scenarios common to estuarine systems. To achieve this we co-developed a Bayesian network heuristic modelling tool which provided a probabilistic framework to consider the relationship between stressors and the outcome states for ecological function and cultural values. The process of model development itself was a rewarding exercise of joint learning. For example, this process illustrated that while western ecological values can focus on endpoints such as abundance, cultural values were more diverse, experiential in nature, with value often centred on a cultural practise being enabled, not just the ecological component the value was connected to. Once the model was developed we considered three specific scenarios relating to harbour dredging, environmental degradation from land use changes, and fishery extraction. Model predictions for these scenarios generally matched expectations, but were generic in nature and could therefore benefit from more specificity relating to aspects such as spatial scale and context around cultural interpretation. Overall, the model demonstrated generic utility as an interactive educational tool for resource managers considering the broader impacts (on ecology and cultural values) of major societal challenges.

Neighborhood disadvantage and general anesthesia utilization in cesarean delivery: a retrospective analysis

BackgroundNeighborhood disadvantage, a social driver of health (SDOH), has been associated with adverse perinatal outcomes; yet little is known about its association with anesthetic choice. ObjectiveThe purpose of this study is to assess the association of neighborhood disadvantage and anesthetic choice for cesarean deliveries. We hypothesize that people from the most disadvantaged neighborhoods are more likely to receive general anesthesia for cesarean deliveries compared to those from the most advantaged neighborhoods. Study designThis single-center retrospective cohort study identified index cesarean deliveries performed between 2008 and 2017. People were categorized into no, low, moderate, and high disadvantage neighborhood using the area deprivation index. The odds of receiving general anesthesia versus neuraxial anesthesia (epidural, spinal, or combined spinal-epidural) were compared using logistic regression models. ResultsOf the 16,351 people with cesarean deliveries, 96.0% received neuraxial versus 4.0% general anesthesia. The rates of general anesthesia were 6.3%, 4.2%, 3.1%, and 2.4% for the high, moderate, low, and no disadvantage groups (P<.001), respectively. Indications for general anesthesia by obstetric indication were different by neighborhood disadvantage (P<.001), but no differences were observed by contraindications of neuraxial anesthesia (P=.091). Compared to the no disadvantage group, the high disadvantage group had higher odds of general anesthesia (aOR 2.0, 95% CI (1.5 to 2.7), P<.001). Results were unchanged after evaluating people in labor only. ConclusionsPeople from disadvantaged neighborhoods are more likely to receive general anesthesia for cesarean deliveries, even after considering clinical features. The general anesthesia rate is a meaningful benchmark in obstetric anesthesia that may contribute to disparities.

Age-induced changes in affective prosody comprehension and its relationship with general cognitive ability and social support utilization among older adults

ABSTRACT Aging can impact emotional recognition, affecting older adults’ mental health and social function. This study examined how aging affects affective prosody comprehension (APC: understanding emotions through speech) across seven emotions (happiness, surprise, sadness, anger, fear, disgust, and neutrality) and its relationship with cognitive function (via the Montreal Cognitive Assessment) and social support (via the Social Support Rating Scale) in 199 cognitively normal older adults. We found that older adults had lower APC accuracy and more errors, often mistaking negative emotions for neutral or positive ones. APC accuracy was significantly associated with social support, and a partial least squares (PLS) cognitive component fully mediated the relationship between the APC component and social support utilization, explaining 61.7% of the total effect. These results suggest that declines in APC during aging are linked to social support utilization through cognitive function, offering insights for interventions to improve social and cognitive health in older adults.

Mugen-UMAP: UMAP visualization and clustering of mutated genes in single-cell DNA sequencing data

BackgroundThe application of Uniform Manifold Approximation and Projection (UMAP) for dimensionality reduction and visualization has revolutionized the analysis of single-cell RNA expression and population genetics. However, its potential in single-cell DNA sequencing data analysis, particularly for visualizing gene mutation information, has not been fully explored.ResultsWe introduce Mugen-UMAP, a novel Python-based program that extends UMAP’s utility to single-cell DNA sequencing data. This innovative tool provides a comprehensive pipeline for processing gene annotation files of single-cell somatic single-nucleotide variants and metadata to the visualization of UMAP projections for identifying clusters, along with various statistical analyses. Employing Mugen-UMAP, we analyzed whole-exome sequencing data from 365 single-cell samples across 12 non-small cell lung cancer (NSCLC) patients, revealing distinct clusters associated with histological subtypes of NSCLC. Moreover, to demonstrate the general utility of Mugen-UMAP, we applied the program to 9 additional single-cell WES datasets from various cancer types, uncovering interesting patterns of cell clusters that warrant further investigation. In summary, Mugen-UMAP provides a quick and effective visualization method to uncover cell cluster patterns based on the gene mutation information from single-cell DNA sequencing data.ConclusionsThe application of Mugen-UMAP demonstrates its capacity to provide valuable insights into the visualization and interpretation of single-cell DNA sequencing data. Mugen-UMAP can be found at https://github.com/tengchn/Mugen-UMAP

Diagnostic performance of simultaneous PET-magnetic resonance versus PET-computed tomography in oncology with an overview on clinical utility and referral pattern of PET-magnetic resonance: a single institutional study.

PET-magnetic resonance (PETMR) imaging is an upcoming investigative modality with a few installations in Asia and only three in India. PET-Computed tomography (PETCT) is an established diagnostic cornerstone for oncological indications but with limited resolution for small lesions due to low soft-tissue contrast and additional radiation exposure. Our primary objective was to evaluate the diagnostic performance of simultaneous PETMR and PETCT in lesion detection in oncological practice. Secondly to assess the referral pattern and study the clinical utility of PETMR in a university hospital practice. A total of 100 consecutive biopsy-proven cancer patients (breast or lung malignancy with suspected metastases) underwent 18F fluorodeoxyglucose (FDG) PETMR and PETCT for staging as a single injection, double examination protocol. Morphological lesion detection on correlative imaging/histopathology was used as the gold standard. Analysing the referral pattern, a total of 9366 patients underwent simultaneous PETMR imaging for indications in the past 5 years since installation. 18F FDG PETMR detected 100% of primary tumours in breast/lung carcinoma (Ca) patients while PETCT was positive in 96%. Overall accuracy of nodal metastases detection for PETMR and PETCT was 96 and 88%, while for distant metastases the accuracy was 100 and 93%, respectively. FDG PETMR proved more sensitive and specific than PETCT for regional nodal (P = 0.011 and P < 0.001) and distant metastases detection (P = 0.017 and P < 0.001, respectively). Analysing the general referral pattern for PETMR, the majority were oncology referrals (66.5, 33.5%) when compared to nononcological indications. About 66.24% were FDG based, followed by Ga prostate-specific membrane antigen and dodecane tetraacetic acid. The general utility of PETMR was found incremental in better delineation of small lesions especially in head, neck, liver, brain and gynaecological malignancies. In our past 5 years of PETMR practice, we found that simultaneous PETMR is a highly recommended ideal imaging technique for oncological and nononcological indications. It has excellent diagnostic performance with high sensitivity, specificity and accuracy when compared to PETCT in tumour, nodal metastases staging in specific subgroup of breast and lung malignancy patients.

Evaluating the Environmental Impact of Reusing Baghouse Dust in Asphalt Concrete: A Sustainable Approach

The purpose of this study is to assess the environmental impact of reusing baghouse dust in asphalt concrete production. Baghouse dust, a byproduct of asphalt creation, presents natural removal challenges; nonetheless, its true capacity reuse in asphalt concrete could give an economical solution. This study aims to survey and align the environmental and ecological implications of utilizing varying extents of baghouse dust in asphalt mix combinations. This research review starts by describing the physical and chemical properties of baghouse dust. In this way, substantial samples were ready and prepared with various percentage rates of baghouse residue to examine the effect on the mechanical properties of the mix. The discoveries demonstrate that consolidating baghouse dust into asphalt cement mostly decreases peak stress and strength qualities characteristics. As far as the environmental and ecological effect, the investigation analysis shows that utilizing baghouse residue can decrease in general energy utilization and discharge emissions. The energy utilization rate diminished from 500 MJ/ton for ordinary conventional asphalt to 400 MJ/ton for asphalt with 20% baghouse residue, and CO2 emanations decreased from 120 kg/ton to 80 kg/ton for a similar correlation. Also, the squander and waste decrease was huge, with 200 tons/year saved at 10% baghouse dust and 400 tons/year at 20%. Asset resources proficiency likewise improved, with raw unrefined material savings investment funds of 150 tons/year at 10% baghouse dust and 300 tons/year at 20%. Notwithstanding this decrease, the mechanical properties stay within ranges for specific applications, proposing that baghouse dust residue can be effectively and successfully utilized in non-basic underlying structural layers of asphalts.

Making target sites in large structured RNAs accessible to RNA-cleaving DNAzymes through hybridization with synthetic DNA oligonucleotides.

The 10-23 DNAzyme is one of the most active DNA-based enzymes, and in theory, can be designed to target any purine-pyrimidine junction within an RNA sequence for cleavage. However, purine-pyrimidine junctions within a large, structured RNA (lsRNA) molecule of biological origin are not always accessible to 10-23, negating its general utility as an RNA-cutting molecular scissor. Herein, we report a generalizable strategy that allows 10-23 to access any purine-pyrimidine junction within an lsRNA. Using three large SARS-CoV-2 mRNA sequences of 566, 584 and 831 nucleotides in length as model systems, we show that the use of antisense DNA oligonucleotides (ASOs) that target the upstream and downstream regions flanking the cleavage site can restore the activity (kobs) of previously poorly active 10-23 DNAzyme systems by up to 2000-fold. We corroborated these findings mechanistically using in-line probing to demonstrate that ASOs reduced 10-23 DNAzyme target site structure within the lsRNA substrates. This approach represents a simple, efficient, cost-effective, and generalizable way to improve the accessibility of 10-23 to a chosen target site within an lsRNA molecule, especially where direct access to the genomic RNA target is necessary.

Photobleaching analysis of fluorescent proteins in two-photon microscopy at high repetition rates

Severe photobleaching in two-photon excitation fluorescence microscopy (TPM) has limited its potential for long-term and quantitative imaging of live cells and tissues. One solution is to excite fluorophores with a high-repetition rate which reduces the peak intensity of irradiance. However, there is a lack of knowledge about the general utility of this strategy for fluorescent proteins. Here, using simple photobleaching assay, we studied the photobleaching of EGFP and tdTomato at 80 MHz and 640 MHz repetition rates. Our analysis shows that the impact of high repetition rate excitation on reducing photobleaching in TPM is highly dependent on the excitation wavelength and fluorophores. Our results are useful for selecting optimal parameters to minimize photobleaching and photodamage in TPM.

Classification of select functional dietary fiber ingredients based on quantitative properties and latent qualitative criteria.

Functional dietary fiber ingredient (FDFI) functionality can depend on the fibers' chemistry, composition, size, botanical origin, and microstructure. However, such claims have never been generalized for a broad range of fibers in one study before. To support these claims, 23 FDFIwere characterized based on 11 physicochemical, physical, and compositional property measurements: Water- and oil-holding capacity (WHC and OHC), water absorption and solubility indices (WAI and WSI), flour-swelling potential (FSP), particle size distribution (D10, D50, and D90 values), and soluble, insoluble, and total dietary fiber content. Multivariate statistical techniques were employed to partition fiber ingredients into functional categories based on these quantitative data, and scanning electron microscopy was used to examine the microstructure of the FDFI. Strong correlations (p<0.05) were found among many of the physicochemical properties measured, and five categories based on quantitative physicochemical functionality, size, and fiber composition were ultimately found. Distinct patterns emerged between these quantitative partitions and the latent microstructure features and botanical origins of the FDFI. These results can be combined into one intuitive summary of FDFI functionality based on the described quantitative and qualitative observations. Such summaries are useful for ingredient suppliers or product developers with limited resources to infer the general functionality, structure, and food applications utility of their materials based on a subset of the information provided here. PRACTICAL APPLICATION: The quantitative and qualitative relationships among a range of commercially available functional dietary fiber ingredients are documented. Industry may utilize this information to predict the general functionality of their ingredients based on a subset of the information provided here by assuming that the same relative relationships will exist. This cansave time during the ingredient screening process, either for product developers looking to optimize a formulation or for ingredient suppliers doing new ingredient applications testing.

Clickable Probes for Pathogen Proteasomes: Synthesis and Applications.

The 20S proteasome is a multimeric protease complex that is essential for proteostasis in the cell. Small molecule proteasome inhibitors are approved drugs for various cancers and are advancing clinically as antiparasitics. Although tools and technologies to study the 20S proteasome have advanced, only one probe is commercially available to image proteasome activity. This probe consists of a fluorescently labeled, peptidyl vinyl sulfone that binds to one or more of the catalytic proteasome subunits. Here, we synthesized two, active site-directed epoxyketone probes, LJL-1 and LJL-2, that were based on the peptidyl backbones of the anticancer drugs, carfilzomib and bortezomib, respectively. Each probe was conjugated, via click chemistry, to a bifunctional group comprising 5-carboxytetramethylrhodamine (TAMRA) and biotin to, respectively, visualize and enrich the 20S proteasome from protein extracts of two eukaryotic pathogens, Leishmania donovani and Trichomonas vaginalis. Depending on species, each probe generated a different subunit-binding profile by sodium dodecyl sulphate-polyacrylamide gel electrophoresis (SDS-PAGE), and the biotin tag enabled the enrichment of the bound subunits which were then formally identified by proteomics. Species differences in the order of electrophoretic migration by the β subunits were also noted. Finally, both probes reacted specifically with the 20S subunits in contrast to the commercial vinyl sulfone probe that cross reacted with cysteine proteases. LJL-1 and LJL-2 should find general utility in the identification and characterization of pathogen proteasomes, and serve as reagents to evaluate the specificity and mechanism of binding of new antiparasitic proteasome inhibitors.

Parsimonious streamflow forecasting system based on a dynamical systems approach

Operational hydrologic forecasting often relies on the use of physically-based computer models at the catchment scale. However, our understanding of streamflow generation is still evolving and incomplete, and oftentimes linearization assumptions must be made to make physically-based hydrologic and hydraulic models tractable. In addition to uncertainty in the physical runoff-generation mechanisms, many physically-based approaches do not formally assimilate observed streamflow data. Streamflow is their output, deterministically simulated from observed inputs (such as precipitation, temperature, etc.). Divergences between observed and simulated streamflow may be due to input uncertainty, calibration issues, or problems with the inherent physical process representation. Thus, data-driven approaches that are responsive to observed streamflow by including assimilation as an essential feature are promising in operational hydrology. In this study, we use a novel forcings-weighted k-Nearest Neighbor (kNN) nonlinear timeseries forecasting method developed in the context of the modeling of nonlinear dynamical systems. The rainfall-runoff transform is assumed to be a low-dimensional system of (unknown) nonlinear differential equations; the deterministic state space is reconstructed based on the streamflow timeseries; and a forecast is generated based on how “similar” the current hydrograph is to historical events encoded within the reconstructed state space, weighted by the similarity of forcings. We tested the model in a long-term test period with no real data assimilation, and in forecast mode with daily data assimilation. When used for forecasting, we also illustrate two different uncertainty quantification approaches: forecast postprocessing and internal-to-the-model ensemble generation. The method is conceptually and computationally simple, but offers promising results. We tested the model in three different scenarios. First, investigating a long-term test period with no real data assimilation in a rainfall-dominated research catchment at the Coweeta Hydrologic Lab in North Carolina, USA. The simulation exhibited an NSE of 0.73. Next, we included a conceptual snowmelt model to drive the long term simulation and studied boreal-temperate transition zone catchments in northern Minnesota, USA. The study area included a small (<0.1 mi2) reference research catchment at the Marcell Experimental Forest, and a large river basin (>19 k mi2) with incomplete forcings information. The kNN method yielded NSEs from 0.28 to 0.50. And finally, we conducted a pseudo-operational forecasting test for a large river basin in northern Minnesota, USA with a focus on performance forecasting a flood-of-record on the Rainy River. The test involved reforecasting, data assimilation, and implementation of ensemble and postprocessing bias correction uncertainty-quantification schemes. The technique demonstrated good performance capturing a flood-of-record on a large catchment (−5.7 to −3.3 % crest error with 1-day of lead time). For the entire test period in forecast mode, the 1-day lead time NSE was 0.99, going down to 0.79 for the 7-day lead time, showing its general utility as an operational forecasting tool.

EQ-5D Based Utility Values for Adults with Chronic Obstructive Pulmonary Disease: A Systematic Review, Meta-Analysis, and Meta-Regression

Chronic obstructive pulmonary disease (COPD) is a common lung disease that negatively affects health-related quality of life (QoL). Utility values, which measure QoL by weighting health states with societal preferences, are required for the cost-utility models that drive economic evaluations and policy decisions. Moayeri et al. published a systematic review and meta-analysis of utilities (EQ-5D) in COPD in June 2016. The current study investigated changes in mean utilities in more recent studies thereafter, exploring heterogeneity in utilities across diverse clinical and study characteristics. Systematic searches of databases, such as MEDLINE and Embase were undertaken from 1 July 2015 until 20 May 2024. A random-effects meta-analysis of utilities (EQ-5D) was performed which addressed inter-study heterogeneity and subgroup analyses. The pooled general mean (95% CI) utility value was 0.761 (0.726–0.795) from 43 studies, whereas Moayeri et al. reported 0.673 (0.653–0.693) from 32 studies. This improvement in mean utilities could be due to increased awareness, early detection, and better medical interventions over the past decade, but demonstrates that a general utility value should be approached with caution given significant heterogeneity. Four meta-regressions were performed on each subgroup: region, method of elicitation, reported comorbidities, and disease stage; of which, method of elicitation, disease stage, and region were found to be significant moderators of utilities. It is, therefore, important to use meta-analysed utilities for cost-utility analyses that reflect the context and patient population of the model. Moreover, these results provide additional evidence for the precision and sensitivity of EQ-5D-5L over EQ-5D-3L.

Fluoro-Crown Ether Phosphate as Efficient Cell-Permeable Drug Carrier by Disrupting Hydration Layer.

Fast and direct permeation of drug molecules is crucial for effective biotherapeutics. Inspired by a recent finding that fluorous compounds disrupt the hydrogen-bonded network of water, we developed fluoro-crown ether phosphate CyclicFP-X. This compound acts as a fast cell-permeating agent, enabling direct delivery of various bioactive cargos (X) into cancer cells without endocytic entrapment. In contrast, its nonfluorinated cyclic analog (CyclicP-X) failed to achieve cellular internalization. Although the acyclic fluorous analog AcyclicFP-X was internalized, this process occurred slowly owing to the involvement of an endocytic trapping pathway. Designed with a high fluorine density, CyclicFP-X exhibits compactness, polarity, and high-water solubility, facilitating lipid vesicle fusion by disrupting their hydration layers. Raman spectroscopy confirmed the generation of dangling -OH bonds upon addition of CyclicFP-OH to water. Furthermore, conjugating CyclicFP-X with fluorouracil (FU, an anticancer drug) via a reductively cleavable disulfide linker (CyclicFP-SS-FU) demonstrated the general utility of fluoro-crown ether phosphate as a potent carrier for biotherapeutics.

Dynamic equilibrium with insider information and general uninformed agent utility

Dynamic equilibrium with insider information and general uninformed agent utility

Handheld Ultrasound Bladder Volume Assessment Compared to Standard Technique.

Urinary retention is a common complaint encountered in the emergency department (ED).Current tools for the assessment of urinary retention are either bladder volume estimation with a bladder scanner performed by nursing staff or direct visualization and measurement via bedside ultrasound performed by an emergency physician. Newer handheld ultrasound devices such as the Butterfly iQ have been brought to the market to bring ultrasound more conveniently to the bedside.A recently released handheld auto-calculation tool produces a 3D image of the bladder and instant bladder volume measurement in milliliters. However, there is a paucity of data assessing the validity of the new Butterfly iQ at the bedside. This study sought to compare the diagnostic accuracy and rated user convenience of the nursing bladder scanner, the cart-based ultrasound machine, and the Butterfly iQ auto-bladder volume tool. ED patients were prospectively enrolled and underwent bladder measurements in a randomized, pre-determined order with each modality. Measurements were subsequently compared to the gold standard of catheterization. Cart-based ultrasound had the highest agreement to catheterization when compared to the RN scanner and the Butterfly iQ.However, the Butterfly iQ and RN scanner were both considered more convenient measurement modalities than the cart-based ultrasound. The Butterfly iQ serves as a cost-effective alternative to cart-based ultrasound while providing greater general utility compared to bladder scanners.

THE FINANCIAL IMPACT OF CARBON EMISSIONS ON POWER UTILITIES UNDER CLIMATE SCENARIOS

Power utilities, especially those that generate electricity by burning fossil fuels, produce significant amounts of carbon emissions. Mitigation of [Formula: see text]-equivalent ([Formula: see text]) emissions can be achieved by replacing power plants with renewable power installations and by adopting carbon-sequestration technologies. Physical upgrades are expensive, but carbon taxes, or the purchase of certificates and allowances on a voluntary carbon market, can be costly, too. Carbon costs may increasingly become a threatening liability for power utilities, eating into profits and undermining the financial viability of emission-intensive electricity generation. Thus, we consider an asset-and-liability, structural firm model to investigate the creditworthiness of a generic power utility. The utility’s assets dynamics are driven by the financial returns generated from the sold electricity for a set tariff which is modeled by a simple stochastic process. The liabilities not only depend on fuel, running, and depreciation costs, but also on the costs of [Formula: see text] emissions. As a case study, we consider Eskom, the South African power utility. We show the evolution of Eskom’s default probability under various fuel mix plans and technologies (as per SA’s Integrated Resources Plan (IRP) 2019), and under the Network for Greening the Financial System (NGFS) carbon price scenarios. The obtained results and insights present a trying path ahead, especially for carbon-intensive power utilities.

Rotten Apples and Sterling Examples: Norm-Based Moral Reasoning and Peer Influences on Honesty

ABSTRACT We develop a general norm-dependent utility function with disutility for actions that are inferior or superior to a norm. We test its validity by assessing the moderating role of norm sensitivity in explaining responses to peer influences in a budget reporting experiment. Managers become less honest after seeing a less honest peer (the rotten apple effect) and more honest after seeing a more honest peer (the sterling example effect). We measure the sensitivity to social norms by the Maintaining Norms Schema score generated from the responses to the Defining Issue Test-2 moral reasoning questionnaire. We find that (1) the sterling example effect is significantly increased in an individual’s sensitivity to social norms and (2) the rotten apple effect does not vary significantly with an individual’s sensitivity to social norms. Our evidence supports inclusion of a disutility component for actions that are inferior to the norm in representations of personal preferences. JEL Classifications: C72, D03; J44; M41; M55.

Evaluation of the Viral Hemorrhagic Fever Surveillance System in the Assaba region, Mauritania (2020-2022)

Several arboviral diseases have been known to be endemic (e.g., Crimean-Congo hemorrhagic fever, Rift Valley fever) or are emerging (dengue fever, chikungunya, O'nyong-nyong) in human populations in Mauritania, while others have become rare in recent years (e.g. yellow fever). Moreover, domestic animals, especially cattle, camels, goats, and sheep, are also known to be infected with some of these arboviruses (e.g. Crimean-Congo hemorrhagic fever, Rift Valley fever). For these reasons, viral hemorrhagic fever surveillance in Mauritania is part of the Integrated Disease Surveillance and Response (IDSR). However, limited information is available on the efficacy of the viral hemorrhagic fever surveillance system in the Assaba region of Mauritania. The aim of the present study was to assess the performance of the surveillance system, in particular its general utility, simplicity, flexibility, acceptability, and reactivity. A descriptive cross-sectional study was conducted from July to August 2022 in the Assaba region with the objective of evaluating the characteristics of the system by interviewing key actors involved in the surveillance of viral hemorrhagic fevers, with a focus on Rift Valley fever and Crimean-Congo hemorrhagic fever, using questionnaires developed following the guidelines of the Centers for Disease Control and Prevention (Atlanta, Georgia, USA). Data from 2020-2022 on viral hemorrhagic fevers from the National Institute of Public Health laboratory were analyzed. Medians, interquartile ranges, and proportions were calculated using Epi Info® 7.2.5.0 and Excel® 2021. The questionnaire was answered by all twenty-six persons involved in the viral hemorrhagic fever surveillance system in Assaba region. The majority of survey respondents found the system to be useful (51%), simple (63%), acceptable (46%), responsive (64%), and flexible (46%). An analysis of the data revealed a positive predictive value of 28% for Rift Valley Fever. The weekly distribution of cases within the wilaya indicates that the moughataa of Kiffa recorded the highest number of cases in September, with a notable weekly peak during that month in 2020. According to the analysis of the National Institute of Public Health database, cases of viral hemorrhagic fevers were promptly handled. Survey responses and database analysis revealed issues related to data quality and data management mechanisms. These limitations in the surveillance system are likely to be due to insufficient resources and training of the personnel, in particular with regards to data collection and management, which in turn led to incomplete or missing data and invalid data entry. These weak points can be ascribed, at least in part, to financial constraints and inadequate attribution of priority to arboviral diseases. Despite these limitations, disease data generated by the surveillance system were generally reliable. The viral hemorrhagic fever surveillance system in the Assaba region adheres to the organization and functioning of the national viral hemorrhagic fever surveillance system, which is part of the IDSR. The characteristics of utility, simplicity, responsiveness, and flexibility of the viral hemorrhagic fever surveillance system are good, but acceptability and flexibility need further improvement. The earlier the first arboviral human or animal cases are detected, the more likely an active intervention can be organized in response to the emerging epidemic or epizootic and prevent the spread of the disease. An efficient viral surveillance system is the key to reducing the negative impact of arboviral diseases in Assaba region.