Long-term Costs Research Articles

Direct and indirect healthcare costs of ocular diseases in Italy: a literature review on glaucoma, diabetic retinopathy, and macular degeneration.

Glaucoma, diabetic retinopathy, and age-related macular degeneration impose substantial economic burdens on healthcare systems due to their high prevalence and chronic nature. Nevertheless, comprehensive Italian data is limited. This study aims to collect Italian evidence on the economic impact of these conditions to support more effective healthcare planning. Systematic review. A systematic literature search was conducted in accordance with PRISMA guidelines across PubMed, Scopus, Web of Science, and EMBASE databases. Studies reporting cost evaluations of managing glaucoma, diabetic retinopathy, and age-related macular degeneration in Italy were included. Direct, indirect and non-medical costs were considered. The review included 23 studies exhibiting considerable heterogeneity in timeframes, regions, and economic evaluation approaches. For glaucoma, annual direct costs ranged from €788.70 for early-stage cases to €8,368.51 for advanced cases requiring surgery. Annual costs associated with diabetic retinopathy ranged from €4,050 to €5,799 per patient, depending on disease severity and treatment approach. The financial burden of age-related macular degeneration varied considerably, with costs ranging from €1,399.20 for early-stage cases to €3,973.30 for advanced stages. Although non-medical and indirect costs, such as lost productivity and caregiving expenses were less frequently assessed, they represented a significant contributor to the overall financial burden. This study highlights the substantial economic burden ocular diseases place on the Italian healthcare system. Early intervention and preventive strategies could reduce the long-term costs of managing diabetic retinopathy and age-related macular degeneration. Further research into indirect costs and cost-effective interventions is necessary to support more efficient healthcare resource allocation.

Relationship between kidney function and healthy life expectancy: A historical cohort study

BackgroundThe impact of chronic kidney disease (CKD) on healthy life expectancy and healthcare costs requires research. This study examined associations between CKD and healthy life expectancy, and its economic burden.MethodsThis study of community-dwelling adults residing in Hakui City, Ishikawa Prefecture, Japan used data from the National Health Insurance database between 2012 and 2022. Participants were grouped by baseline estimated glomerular filtration rate (eGFR) (< 45, ≥ 45 to < 60, ≥60 to < 75, ≥75 to < 90, and ≥ 90 mL/min/1.73 m²). The primary endpoint was a composite of becoming a care level ≥ 2 or death. Multivariable Cox proportional hazards models were used to calculate the risk regarding time to the primary endpoint. Secondary endpoints were the annual medical and long-term care costs.ResultsThe 5,592 participants had a mean follow-up of 6.4 years. The hazard ratio was 1.86 (95% confidence interval [CI]: 1.35 to 2.55) for the eGFR < 45 group and 1.60 (95% CI: 1.13 to 2.25) for the eGFR ≥ 90 group, both compared with the eGFR ≥ 60 to < 75 group. Both annual costs were significantly higher in the lower eGFR groups than in the higher eGFR groups. For the eGFR < 45 group, the median medical care cost was 0.38 million yen/year in all participants and the median long-term care cost was 0.40 million yen/year in primary endpoint achievers. A lower eGFR was correlated with longer unhealthy years of life.ConclusionsHigher and lower eGFRs were associated with increased risks of reduced healthy life expectancy. A lower eGFR was associated with higher medical and long-term care costs.

Association Between Diagnostic Delay and Economic and Clinical Burden in Axial Spondyloarthritis: A Multicentre Retrospective Observational Study.

Axial spondyloarthritis (axSpA) is a chronic inflammatory condition associated with considerable pain and impaired health-related quality of life (HRQoL) for affected patients. Despite the documented increase in healthcare resource utilization (HRU) related to axSpA, few studies have explored the impact of diagnostic delays on these outcomes. This study sought to determine the association between diagnostic delay of axial spondyloarthritis (axSpA) and costs in the 3years after diagnosis. This is a retrospective, observational study based on routine follow-up data from adult patients with confirmed axSpA diagnosis in three tertiary Spanish hospitals. Sociodemographic and clinical variables were collected at diagnosis. Direct and indirect healthcare costs were estimated from healthcare resource use (HRU) and productivity losses. The correlation between diagnostic delay and total healthcare costs was analyzed. Eighty-two patients (62.2% men; mean age: 39.3 years at diagnosis) were included, mostly with radiographic axSpA (r-axSpA) (67.1%). The mean (standard deviation, SD) diagnostic delay was 10.1 (9.3) years, with a median (interquartile range, IQR) of 5.4 (2.3, 17.2) years. The mean total healthcare cost per patient accumulated over 3years was €25,812.6 (direct: €16,384.7; indirect: €9427.9). Patients with longer diagnostic delay (> 5.4years) had 57% higher total healthcare cost (€31,717.7 vs. €20,188.7, p = 0.029) and higher disease activity at diagnosis (BASDAI score 4.7 vs. 3.4, p = 0.007) and after 3years (3.9 vs. 2.9, p = 0.042) compared to those with shorter delay (≤ 5.4years). The diagnostic delay in axSpA remains high and is associated with an increase in healthcare costs post-diagnosis. Actions to reduce diagnostic delay should be prioritized by healthcare systems to potentially improve outcomes and reduce long-term costs.

Projected costs of long-term care for older people in England: The impacts of housing quality improvements.

Good quality housing is vitally important to public health. However, its economic consequences for the long-term care sector and implications for health policy have not been thoroughly examined. This study investigates the impacts of housing improvements on future costs of long-term care in England. Using data from two national surveys, the English Longitudinal Study of Ageing (ELSA) and the Health Survey for England (HSE), we combined a Markov model with a macrosimulation model to make projections of long-term care costs under a series of housing intervention scenarios. We project that, without housing interventions, formal care costs will increase from £22.4 billion to £40.8 billion and unpaid/informal care costs will increase from £55.2 billion to £90.8 billion between 2022 and 2042. In a scenario where all housing problems are remedied, formal and unpaid care costs in 2042 are projected to be £2.8 billion and £7.1 billion lower than the no intervention scenario, respectively. There are substantial synergies between health and housing policies. Well-designed housing improvement programmes delay the progression of long-term care needs, resulting in lower long-term care costs. The cumulative savings of long-term care costs over time can pay back the investment needed for housing improvements.

Longer-term survival, quality of life, and cost-effectiveness of conservative versus liberal oxygenation targets in critically ill children: a pre-specified analysis from Oxy-PICU, a multicentre, open, parallel-group, randomised controlled trial.

Peripheral oxygen saturation (SpO2) above 94% is typical in children in paediatric intensive critical care units (PICUs) who are receiving invasive ventilation and supplemental oxygen. In a previous report from the Oxy-PICU trial, we showed that lower (conservative) oxygenation targets (SpO2 88-92%) are beneficial, showing small but statistically significant differences in duration of organ support and large but non-significant cost reductions at 30 days. In this pre-specified analysis of the Oxy-PICU trial, we compare longer-term outcomes and cost-effectiveness of conservative versus liberal (SpO2 >94%) oxygenation targets in children with emergency PICU admission. Oxy-PICU was a pragmatic, multicentre, open-label, randomised controlled trial in England and Scotland. Eligible children were older than 38 weeks and younger than 16 years and had been admitted for emergency care in one of 15 participating PICUs, where they received invasive respiratory support for abnormal gas exchange. Participants were randomly assigned (1:1) to either a conservative oxygenation target (SpO2 88-92%) or liberal oxygenation target (SpO2 >94%). Survival status was assessed at 90 days and 1 year, and health-related quality of life (HRQoL), quality-adjusted life-years (QALYs), health-care costs, and incremental net monetary benefit were assessed at 1 year after the index hospital admission and randomisation. HRQoL was measured with age-appropriate Paediatric Quality of Life Generic Core Scales and mapped onto the Child Health Utility 9D index score. HRQoL and survival data were combined to construct QALYs. Costs at 1 year were derived from use of hospital, outpatient, and community health services. The trial was registered in the ISRCTN registry (ISRCTN92103439). 2040 children were enrolled between Sept 1, 2020 and May 15, 2022. 1868 (91·6%) children were included in the 90-day survival analysis; of these 930 (49·8%) had been assigned liberal oxygen and 938 (50·2%) conservative oxygen. 1867 (91·5%) children were included in the 1-year survival analysis; 930 (49·8%) had been assigned liberal oxygenation and 937 (50·2%) conservative oxygen. At 90 days, 35 (3·7%) patients in the conservative oxygenation group and 45 (4·8%) patients in the liberal oxygenation group had died (adjusted hazard ratio [aHR] 0·75 [95% CI 0·48 to 1·17]). By 1 year, 52 (5·5%) patients in the conservative oxygenation group and 66 (7·1%) patients in the liberal oxygenation group had died (aHR 0·77 [95%CI 0·53 to 1·10]). Overall, mean HRQoL, life-years, and QALYs at 1 year were similar in the two groups. The adjusted incremental effect on cost of conservative oxygenation versus liberal oxygenation was -£879 (95% CI -9036 to 7278), whereas the incremental difference in QALYs was estimated at 0·001 (-0·010 to 0·011), leading to an incremental net monetary benefit of £894 (-7290 to 9078) associated with conservative oxygenation relative to liberal oxygenation. These results did not vary by age (<12 months vs ≥12 months), comorbidity at baseline, age-adjusted heart rate, or haemoglobin level at admission and were robust to alternative assumptions. Compared with usual care (SpO2 >94%) for invasively ventilated children who are admitted as an emergency to a PICU, conservative oxygenation (SpO2 88-92%) was not associated with differences in longer-term survival, costs, or cost-effectiveness. Taken together with previous findings of Oxy-PICU that conservative oxygenation compared with liberal oxygenation leads to better patient-centred and parent-centred outcomes at 30 days, these findings support the use of conservative oxygenation targets for this population. UK National Institute for Health and Social Care Research Health Technology Assessment Programme.

Non-conjugated Polymer Regulated Photoelectrochemical Water Oxidation

Co-catalyst engineering has significantly bolstered the tunable photoinduced charge migration/separation in solar-driven photoelectrochemical (PEC) technology, but intricate synthesis procedures, unfavorable long-term stability, high cost, and difficult interface configuration modulation retard...

Real-time peer-to-peer energy trading for networked multi-energy systems with hybrid energy storage

Integrated use of electricity and heat is an effective way to improve energy efficiency, precipitating the advent of multi-energy systems. In a network of multi-energy systems connected via power electronics devices, the power flow through soft-open points can be directly controlled, which allows peer-to-peer (P2P) energy trading. This paper proposes an online distributed decision scheme for this scenario. We begin with the deterministic centralized model of P2P energy trading problem, aiming to minimize long-term energy cost. Then the problem is decomposed temporally and spatially. To handle uncertainty, Lyapunov optimization is employed to decompose inter-temporal constraints in storage operation model, thus the problem in each period can be solved independently, yielding an online prediction-free policy. It is proven that, by properly selecting parameters, online policy generates a strategy that satisfies inter-temporal constraints and enjoys guaranteed performance. To protect privacy, an alternating direction method of multipliers (ADMM) based algorithm is employed to decompose the one-time-slot problem spatially, so that the subproblem of each peer admits a solver-free solution. The P2P trading price is intrinsically generated during the consensus-reaching process. Case studies demonstrate the prediction-free, performance-competitive, solver-free advantages of the proposed method. Both total and individual energy costs are reduced, and close to offline optimum.

MAXIMIZING PROFIT POTENTIAL IN SUPPLY CHAIN FROM SUPPLIER-RETAILER INVENTORY REPLENISHMENT IN RURAL AREAS

Successful collaborative relationship enhances profitability in the delivery of products or services to customers in a supply. This study focuses on the impact of successful relationships in supply chain management on customer exploration and profitability. By implementing a strong strategy, more customers can be brought into the supply chain, leading to increased productivity and ultimately, higher profitability. The main objective is to determine the optimal quantity levels in supplier relationships that minimize long-term costs in the supply chain. A mathematical model incorporating shipment consolidation was utilized to derive the profit function. Numerical examples were then employed to illustrate the developed models. The results demonstrate variations in total quantity and relevant costs based on factors such as retailer input, supplier replenishment quantities, optimal order quantities, and total relevant costs within the supply chain, ultimately contributing to enhanced profitability. Our result shows that. there is an increase in the supply chain profitability when the retailer orders greater number of items from the supplier.

Assessing the financial and environmental impact of natural dyes and mordants: ROI and sustainability metrics in sonication-assisted dyeing

The growing environmental consciousness in the textile dyeing industry has led to an increased interest in natural dyes as sustainable alternatives to synthetic dyes, which are often toxic and harmful to the environment. However, the use of metallic mordants in natural dyeing processes raises concerns about their overall eco-friendliness. This study investigates the dyeing of cotton knit fabrics using dyes extracted from Marigold flowers, coupled with the use of lime juice as a natural mordant. Various techniques and equipment were employed to assess the dyeing outcomes, focusing on colorfastness, dye uptake, and overall fabric quality. While the natural mordant showed slight fading in wash fastness tests, the staining properties were notably strong, suggesting its potential for effective dye fixation. The results demonstrate that lime juice is a viable natural mordant for enhancing the dyeing properties of Marigold-based dyes, offering an eco-friendly alternative in textile dyeing practices. The study's ROI analysis demonstrates that the initial investment in sonication technology is offset by long-term cost savings, enhanced productivity, and the ability to market eco-friendly textiles at a premium.

Short- and long-term costs of sinus balloon sinuplasty and middle meatal antrostomy.

To evaluate and compare hospital related costs, postoperative costs, and the long-term costs of maxillary balloon sinuplasty (BSP) and middle meatal antrostomy (MMA) in patients with chronic rhinosinusitis. Data were collected from patient registers on 88 patients treated with BSP and 240 patients treated with MMA between 2011 and 2017. Information was also gathered on the related costs of surgery, material, postoperative ward care, and any extra patient visits that took place within one year following the operation. The costs of sick leave were estimated based on the number of sick leave days. The total costs of BSP (mean 3382 €, 95% CI 3157-3607) within one year after the operation were lower than those of MMA (mean 4546 €, 95% CI 4297-4796) (p < 0.001). However, the hospital related 24 h perioperative costs were higher in BSP (mean 1853 €, 95% CI 1781-1925) than in MMA (mean 1581 €, 95% CI 1515-1647) (p < 0.001). The number of sick leave days after BSP (mean 4 days) was half that of MMA (8 days) (p < 0.001), leading to an increase in sick leave costs after MMA. The duration of the BSP operation was significantly shorter than that of MMA. BSP of the maxillary sinus ostium appears to be less expensive than MMA when the total costs are calculated one year after the operation. This information should be considered in the preoperative visit.

Urban Resilience through Design: A Holistic Framework for Sustainable Redevelopment of Brownfield Sites

This study presents a holistic framework for sustainable urban design, using the proposed redevelopment design of Berlin's Tegel Airport as a case study. The research addresses the need for comprehensive, real-world applications of sustainable urban design principles in the context of climate change and urban challenges. The proposed framework integrates multiple sustainability elements, including adaptive reuse, innovative energy systems, and a 'resource community' concept. Key features include mixed-use development, a phased approach, and innovative mobility solutions. The study demonstrates the practical application of urban resilience theory, adaptive reuse concepts, circular economy principles, and compact city theory. Findings reveal the potential for significant environmental benefits, including reduced energy consumption and improved resource efficiency. The framework shows promise in fostering social cohesion through mixed-use spaces and community-centered design. Economic implications include creating local job opportunities and the potential for long-term cost savings through efficient resource management. However, challenges such as initial implementation costs and the need for stakeholder coordination are identified. The study contributes to sustainable urban planning by bridging the theoretical concepts and practical implementation gap. It offers a model for transforming urban brownfields into sustainable communities, providing valuable insights for urban planners, policymakers, and developers. Future research directions include longitudinal studies of implemented projects and comparative analyses across diverse urban contexts.

Cost-effectiveness of caplacizumab in immune thrombotic thrombocytopenic purpura in the United States.

Immune thrombotic thrombocytopenic purpura (iTTP) is a rare, life-threatening thrombotic microangiopathy. Caplacizumab is the only treatment approved by the European Medicines Agency and the US Food and Drug Administration for iTTP, to be given in combination with plasma exchange therapy (PEX) and immunosuppression (IS). The National Institute for Health and Care Excellence's independent appraisal committee assessed the cost-effectiveness of caplacizumab and concluded that the addition of caplacizumab to PEX+IS is cost-effective under a patient access scheme in the United Kingdom. To assess the cost-effectiveness of caplacizumab in iTTP from the US payer perspective. The National Institute for Health and Care Excellence's model was adapted to the US setting using US costs and discount rates. In contrast to previous cost-effectiveness analyses that accounted only for acute outcomes, our model consisted of a 3-month decision tree for an acute iTTP episode, followed by a Markov model to project long-term costs and outcomes (time horizon: up to 55 years; 3-monthly cycles). Patients taking caplacizumab with PEX+IS experienced an incremental gain of 2.96 life years (LYs) and 1.75 quality-adjusted LYs relative to PEX+IS alone, at an increased lifetime cost of $256,000. The incremental cost-effectiveness ratio was $86,400 per LY and $146,300 per quality-adjusted LY gained. Considering willingness-to-pay thresholds of $150,000 to $200,000, the addition of caplacizumab to PEX+IS may be cost-effective compared with PEX+IS alone for the treatment of iTTP in a US setting.

A mobile-based randomized controlled trial on the feasibility and effectiveness of screening for major depressive disorder: study protocol

BackgroundMobile-based screening interventions to detect and treat Major Depressive Disorder (MDD) at an early stage might be a promising approach for reducing its societal burden. In the present study, we will evaluate the feasibility and effectiveness of screening for MDD using a mobile-based screening protocol.MethodsThis study will be a three-arm, parallel randomized control trial (RCT) performed in a multi-ethnic population within the municipality of Rotterdam (the Netherlands). The trial includes two intervention groups that will be screened 4-weekly for MDD for 12 months using the Patient Health Questionnaire (PHQ-9) and a control group who does not receive mobile-based screening for MDD. Participants in the one-test intervention arm will be referred for further diagnosis and treatment, if necessary, after a single positive test score for moderate-severe major depression symptoms (PHQ-9 > 10). Participants in the multiple-test intervention arm will only be referred after three consecutive positive test scores. 1786 eligible participants will be included in the RCT, with 446 and 447 in the one-test and multiple-test referral arms, respectively, and 893 in the control arm. Primary outcome is participants’ QoL after 12 months (EQ-5D-5L). Secondary outcomes include participants’ QoL after 24 months (EQ-5D-5L), evaluating the occurrence and severity of MDD symptoms (PHQ-9), intervention engagement, and identifying public mental health differences based on sociodemographic characteristics, including age, gender, ethnicity, financial situation, educational background, and living area. Long-term results of the RCT will be incorporated into a microsimulation model to determine the long-term benefits, harms, and costs of MDD screening.DiscussionThe information gained from examining the feasibility and (cost-) effectiveness of mobile-based screening for MDD could be of guidance for mental health policy implementations and support the introduction of mobile-based screening for MDD in the Netherlands and/or other nations.Trial registrationClinicalTrials.gov: NL84280.078.23, NCT05989412, August 8, 2024.

The Use of Nanosecond Pulsed Fibre Laser Treatment to Improve the Corrosion Resistance of 316L SS Utilised as Surgical Devices.

The nanosecond pulsed fibre laser (NsPFL) treatment is extensively employed to distinguish hospital surgical instruments (micro-surgical forceps, surgical blades, orthopaedic drills, and high-precision laparoscopic tools), which are generally composed of stainless steel. Nevertheless, if the laser parameters are not properly optimised, this process may unintentionally provoke corrosion. Maintaining the structural integrity of these materials is essential for ensuring patient safety and minimising long-term costs. This work aims to optimise the laser scanning parameters for marking 316L stainless steel (316L SS), seeking to improve its corrosion resistance. The corrosion behaviour was assessed by using open circuit potential (OCP), potentiodynamic polarisation curves (PPc), and electrochemical impedance spectroscopy (EIS) techniques, conducted in 0.9% wt NaCl solution at a controlled temperature of 25 ± 1 °C. A comprehensive study employing optical profilometry has significantly enhanced our understanding of the corrosion micromechanisms of 316L SS, comparing specimens both with and without NsPFL treatment. Considering applications involving environments rich in chloride ions, the results indicated that the NsPFL-316L SS samples demonstrated markedly enhanced performance compared to the untreated base material after 48 h of immersion in 0.9% wt NaCl solution. This improvement is particularly noteworthy given the widespread utilisation of 316L SS in the manufacturing of surgical instruments, where corrosion resistance is of paramount importance.

Settlement and Acclimatization of Sika Deer in the Russian Federation

The article discusses the issues of conservation, distribution and acclimatization of sika deer on the territory of the Russian Federation, the Central Federal District and of the National Park “State Complex “Zavidovo”. A detailed analysis of the condition of the first range of sika deer in the Primorsky Krai, as well as the history of settlement and dynamics of its population in the Russian Federation. For the regions of the Central Federal District, the results of the cadastral assessment of sika deer resources were calculated, including the average long-term week, the average long-term illumination of the population (animals) per 1000 hectares of characteristic lands and the average long-term cost of resources (million rubles). As an effective model for the acclimatization of sika deer, an experience of its economic use was carried out in the National Park “State сomplex “Zavidovo” (Tver region).

CRISPR therapy: A revolutionary breakthrough in genetic medicine

Gene editing with CRISPR-Cas9 technology revolutionizes modern medicine by enabling precise DNA modifications. Initially discovered as a bacterial defense mechanism, the Cas9 enzyme, guided by RNA, can target and cut specific DNA sites, allowing for gene editing. Applications include genetic engineering, functional studies, and potential treatments for genetic diseases like cancer. Notably, in 2023, CRISPR-Cas9 was approved for treating sickle cell anaemia with significant results, despite challenges like long-term security and high costs. CRISPR-Cas9 technology allows for correcting genetic defects, treating diseases, and improving agricultural crops. It can regulate gene transcription through the CRISPRi system, using an inactive Cas9 to interfere with gene expression without permanently altering DNA. This gene-editing tool shows promise in gene therapy, potentially curing diseases like HIV-1, sickle cell disease, and haemophilia B. However, challenges include off-target mutations and efficient delivery of CRISPR/Cas9. Precise target site selection and dosage control are crucial, with tools like CasOT helping identify and prevent unwanted mutations. CRISPR-Cas9 requires a PAM sequence to function, narrowing its targets in the genome but increasing specificity. Production of gRNA faces challenges due to mRNA processing, with alternatives like the artificial gene RGR showing promise. Efficient delivery methods are still needed, with current techniques involving DNA and RNA injection. Future applications include treating genetic diseases and agricultural improvements, with ongoing research essential for overcoming challenges and ensuring safety and accuracy. Global collaboration is vital for the ethical use of this technology. Contribution to evidence-based healthcare: CRISPR therapy represents an exciting frontier in genetic medicine, allowing for precise gene editing and opening up new possibilities for treating incurable diseases.

ESG and the Demand for State Tax Incentives

This Article argues that a business which embeds environmental, social, and governance (ESG) considerations in its strategy should consider whether seeking or accepting targeted state and local economic development incentives (which we refer to as “state tax incentives”) is consistent with that strategy. The outcome of that consideration will vary by locality, incentive package, and strategy. But given the demonstrated negative impact of state tax incentives on government finances and the community, most ESG-minded companies should either forgo them or cooperate with the state in crafting incentives that benefit both the company and the community. A well-crafted ESG reporting standard on this topic can help guide companies towards such win-win incentives and help them credibly communicate their approach to investors and other stakeholders. This Article proposes that companies, investors and governments should lobby ESG standard setters to create an effective reporting standard, and we offer some recommendations for its characteristics. We believe this is the first article to examine state tax incentives in the context of ESG and the first to suggest that the demand for state tax incentives can be reduced as more companies (and their investors) realize that taking incentives is inconsistent with their ESG strategies. All prior attempts to curtail state tax incentives have targeted the supply of state tax incentives by seeking to encourage or force states to limit their use. These attempts are essential and must continue. But they have not achieved the hoped-for results, in part, because they relied on persuading political actors to stop taking actions that they believe are in their own self-interest. In contrast, a demand side, company-and investor-driven approach may be more successful because applying an ESG framework requires companies to act in their own interest, while better taking into account long-term costs and benefits. This Article explains the problems that have resulted from state and local tax incentives and the various efforts to curtail them; reviews the emerging concept of ESG; applies the literature on tax avoidance and corporate social responsibility to state tax incentives; provides a basic outline for a state tax incentive ESG reporting standard; highlights the strategic benefits that will accrue to a company that takes a more deliberateapproach to deciding whether to seek and accept state tax incentives; and identifies issues at the intersection of ESG and state tax incentives that are ripe for future research.

Strategic Pathways to Sustainable Development: A Comprehensive Review of the Benefits and Barriers of Green Buildings

As environmental concerns grow globally, green building practices have become essential in promoting sustainable development. This paper provides a comprehensive review aimed at evaluating the multifaceted benefits, barriers, and strategic pathways related to the implementation of green buildings. The study employs a systematic literature review, analysing 90 significant studies from databases such as Scopus, Google Scholar, and Web of Science, to assess the economic, environmental, and social impacts of green building practices. The results highlight that green buildings offer substantial benefits, including reduced energy consumption, improved indoor air quality, enhanced occupant health and productivity, and long-term cost savings. Despite these advantages, the widespread adoption of green building practices faces considerable challenges, notably high initial construction costs, regulatory obstacles, and limited awareness among stakeholders. Furthermore, the study identifies significant gaps in the existing literature concerning the regional and contextual variations in the effectiveness of green building strategies. The implications of this research are crucial for policymakers, developers, and industry professionals who are working towards sustainable urban development. The findings suggest that overcoming the identified barriers requires coordinated efforts, including the implementation of supportive policies, financial incentives, and extensive public education campaigns. By addressing these challenges, green buildings can play a pivotal role in achieving global sustainability goals and fostering resilient, eco-friendly urban environments.

Recurrent Neural Network for Quantitative Time Series Predictions of Bridge Condition Ratings

Traditional forecasting models for bridge conditions, such as ARIMA and Markov chains, often fail to adequately capture nonlinear and dynamic relationships among critical variables like age, traffic patterns, and environmental factors, leading to suboptimal maintenance decisions, increased long-term maintenance costs, and heightened safety risks. This study addresses these limitations by developing recurrent neural network (RNN) models utilizing Long Short-Term Memory (LSTM) and Gated Recurrent Unit (GRU) architectures with a TimeDistributed output layer. This novel approach enables accurate forecasting of the Bridge Health Index (BHI) and condition ratings for key components—deck, superstructure, and substructure—while effectively modeling temporal dependencies. Applied to bridge data from Georgia, USA, the regression models (BHI) achieved R2 values exceeding 0.84, while the classification models (components condition ratings) demonstrated accuracy between 84.78% and 87.54%. By modeling complex temporal trends in bridge deterioration, our method processes time-dependent data from multiple bridges simultaneously, revealing intricate relationships that influence bridge performance within a state’s inventory. These results provide actionable insights for maintenance planning, optimized resource allocation, and reduced risks of unexpected failures. This research establishes a robust framework for bridge performance prediction, ensuring improved infrastructure safety and resilience amid aging assets and constrained maintenance budgets.

Cost-effectiveness of human papillomavirus (HPV) vaccination in Tunisia: a modelling study

ObjectivesThe objective of this study is to assess the cost utility of the implementation of the human papillomavirus (HPV) vaccination programme in Tunisia in addition to the current cytology screening...