Cost-effective Measures Research Articles

Public health and economic impact of COVID-19 vaccination with the Pfizer-BioNTech COVID-19 Vaccine, KP.2, among adults in 2024/2025 in the United States

ABSTRACT Objectives To assess the public health and economic impact of vaccination with the Pfizer-BioNTech COVID-19 vaccine, KP.2, in 2024/2025 in the United States. Methods A combined cohort Markov-decision tree model was used to estimate the cost-effectiveness and budget impact of vaccination versus no vaccination in adults aged ≥18 years. The adult population was further stratified into 18-64 years and ≥65 years age groups. Public health surveillance data informed the annual proportion of individuals infected with and vaccinated against SARS-CoV-2 and the proportion of those infected who were hospitalized, stratified by age. Other age-stratified clinical, cost, and vaccine effectiveness parameters were informed by literature. The budget impact analysis was based on a hypothetical 1-million-member plan and used a payer perspective. Parameter uncertainty was tested in sensitivity analyses. Results Without vaccination, the model projected 21.4 million new symptomatic cases, 15,793 deaths, 629,098 hospitalizations, $115.5 billion in total costs, and 1 million QALYs lost among adults aged ≥18 years, with the greatest health burden observed among older adults aged ≥65 years (72% of hospitalizations and 86% of deaths) and the greatest economic burden in adults aged 18 to 64 years (62% of total costs). Vaccination was projected to prevent 915,501 cases, 1,057 deaths, and 37,489 hospitalizations, resulting in cost savings of $513 million, 9,173 LYs gained, 56,482 QALYs gained, and a dominant ICER. In the budget impact analysis, vaccination was estimated to result in total incremental cost savings for the population aged ≥ 65 years and a modest budget increase for the population aged 18 to 64 years. Conclusions Vaccination with the Pfizer BioNTech COVID-19 vaccine, KP.2, is a cost-effective measure from the societal perspective at a willingness-to-pay threshold of $50,000 that could reduce the health and economic burden of COVID-19.

Integrating material flow analysis into hydrological model for water environment management of large-scale urban-rural mixed catchment

Simultaneous simulation of urban and rural hydrological processes is important for water environment management of mixed land-uses catchments. However, the discharge paths of pollution in the urban drainage system are not described in traditional catchment hydrological models. In this study, an urban-rural water environment (URWE) model is developed through incorporating the material flow analysis (MFA) and the soil and water assessment tool (SWAT) into a general framework. The URWE model is an advancement with respect to traditional hydrological models in terms of simultaneously simulating the urban organized and rural decentralized discharges of pollution. Due to the low data requirement and high computational efficiency of MFA, URWE model is applicable to large-scale catchment with wide urban area. The URWE model is applied to a typical urban-rural mixed catchment, the Dianchi Catchment (China), where the pollution characteristics are analyzed and the pollution control measures are investigated. Results indicate that the URWE model outperforms the conventional SWAT model for both water quantity and quality simulations, with an 8.5 % improvement in average coefficient of determination (R2) and a 67.4 % improvement in average Nash coefficient (NSE). Rural best management practice, rainwater-sewage separation, and storage capacity expansion are identified as the most cost-effective measures for COD, TN, and TP reduction, respectively. Contributions of this study are to improve the accuracy of water environment simulation in urban-rural mixed catchment, as well as to help decision-makers develop synergistic urban-rural water environment management measures.

Investigation of the risk influential factors of maritime accidents: A novel topology and robustness analytical framework

This study aims to develop a novel and fully data-driven approach to analyse the maritime accidents risk influential factors (RIFs) by integrating Association Rule Mining (ARM) and Complex Network (CN) modelling. Firstly, a comprehensive dataset comprising 21,206 maritime accident records from Marine Accident Investigation Branch and Transportation Safety Board is collected and processed to serve as the foundational data source supporting the development of the new approach. Secondly, a novel Combined Association Rule Mining method is proposed to extract the interconnections among RIFs, with the mined results mapped into a CN framework. Finally, two importance ranking algorithms, namely the PageRank-Information-Entropy algorithm and edge betweenness centrality, are applied to identify the key RIFs and their information transmission paths. By simulating deliberate and random attacks within this network, a robustness analysis is conducted to further explore the evolution of RIFs. The findings reveal that ship-related factors demonstrate greater centrality and connectivity, exerting a more substantial influence on information propagation within the network structure. The robustness analysis illustrates that strategic node and edge removals are effective in preventing risk propagation. It therefore makes contributions to the development of a theoretical basis for stakeholders to develop cost-effective preventive measures against specific RIFs, ultimately enhancing maritime safety.

Characterization of the Power Distribution Network for Commercialized STM32s Using a Resonance Frequency Measurement Method

Power integrity is a critical aspect of microcontroller (MCU) system design. The present tendency of increasing current density and operating frequency, along with decreasing operating voltage, significantly diminishes voltage margins. Given the cost efficiency required for MCU systems, this context places important constraints on the design of the power distribution network (PDN), which directly impacts power supply noise. Therefore, characterizing the PDN is necessary. This paper introduces a cost-effective measurement and modeling method to estimate the die-package resonance frequency of the PDN, a major threat to power integrity. The method, applied to two 32-bit MCUs from STMicroelectronics with varying PDN configurations, enables the identification of the die-package resonance frequency. The results lead to the refinement of the die capacitance model for both cases, with a maximum relative error of less than 7%. The final objective is to implement the measurement system in the die in order to adjust the PDN if necessary.

Characteristics of adolescents with acute alcohol intoxication in Belgium

Abstract Background Binge drinking and acute alcohol intoxication (AAI) are common in Belgian adolescents, posing a risk of serious health consequences. To develop cost-effective preventive measures for problematic alcohol use in adolescents in Belgium, more insight into the background of this group is necessary. Methods To gain more insight into the prevalence, medical characteristics and context of AAI, a retrospective multicentre hospital chart study was performed on adolescents aged 10 to 18 years with AAI in Antwerp, Belgium from 2015-2021. Furthermore, a prospective intervention study for adolescents with AAI in Antwerp was set up in 2023, of which the first results were not yet known at the time of submission. However, these results will be presented at the conference, if available. Results Over the study period, a total of 1032 admissions related to alcohol intoxication occurred in 1016 patients, with a median age of 16.6 years old and a median blood alcohol intoxication (BAC) of 1.95 g/L. There was combined drug use in 10% of the cases. Only 17% of the patients received additional care after admission. These findings did not significantly change over the study period. Multiple linear regression analyses indicated that after correcting for covariates, higher age, no combined drug use and decreased consciousness at admission were associated with more severe AAI cases (higher BAC). Conclusions AAI is prevalent among Belgian adolescents. Therefore, better-targeted preventive measures and policies are needed. Our findings could be taken into account when developing preventive measures. However, data addressing the demographics and context of AAI were mostly missing. Therefore, a prospective follow-up study was set up in Antwerp, which started in 2023 and is still ongoing. Furthermore, this study will investigate the feasibility and effectiveness of a follow-up intervention for this group of patients.

A higher adherence to perindopril-based anti-hypertensive therapy is associated with a reduced risk of cardiovascular outcomes and all-cause mortality in real clinical practice in Italy

Abstract Background Therapeutic management of hypertension is a landmark of cardiovascular (CV) risk prevention. Combined therapies with at least 2 anti-hypertensive agents are required in many patients in whom monotherapy and lifestyle interventions failed in blood pressure control. It is well-known that poor medication adherence remains a major barrier to achieving the therapeutic targets for all CV drugs, including anti-hypertensives. Purpose We evaluated the relationship between adherence to perindopril (PER)-based therapeutic regimen prescribed as single-pill combination (SPC) or free-pill and CV outcomes and all-cause mortality in a large Italian population. Methods A retrospective analysis was performed using administrative databases corresponding to around 6.7 million health-assisted residents. Hypertensive adults were first identified through hospitalization discharge diagnosis or exemption codes for hypertension between 2010 and 2021. Patients prescribed PER-based therapies were screened for all combinations of PER with amlodipine (AML) and/or indapamide (IND) (all formulations, single-pill or free-pill). Time of the first prescription of a PER-based regimen during the inclusion period was considered the index-date. The analysis included all hypertensive subjects prescribed a PER-based therapy, having available data at least 12 months before and 24 months after the index-date, respectively. Since the analysis was focused on the possible associations between adherence level and CV outcomes and all-cause mortality, adherence was assessed during the first year of follow-up on alive patients and outcomes were assessed during the second year. Adherence was assessed using the proportion of days covered (PDC) approach on 1-year follow-up, and considering a PDC<80% as poor-to-moderate adherence, and PDC ≥80% as good adherence. The Cox’s proportional hazard model was applied to estimate Hazard Ratio (HR) adjusting for baseline covariates, including comorbidity profile and pill burden. Results The included cohort (N=24,476) was divided into sub-groups according to adherence in poor-to-moderate (N=6,781) and good adherent patients (N=17,695) with a mean age of 64.8±13.3 and 64.6±11.9 years old, respectively. The Cox’s proportional hazard model showed that good adherence was associated with a relative risk reduction of 23% in all-cause mortality (Table 1A), 21% in all CV events (Table 1B), 17% in ischemic heart disease (Table 1C), 33% in cerebrovascular events (Table 1E), and 22% in the composite outcome of CV events/all-cause mortality (Table 1G). Conclusions The present analysis provided evidence from the Italian real clinical practice that good adherence to PER-based anti-hypertensive therapy results in significantly lower cardiovascular risk and all-cause mortality. These data further emphasize the importance of promoting cost-effective measures to increase medication adherence in patients on anti-hypertensive treatment.

The nexus between maternal antenatal care attendance, newborn postnatal care and neonatal mortality in India: a matched case-control study

IntroductionOur study examines the relationship between newborn postnatal care and neonatal mortality stratified by maternal antenatal care attendance under a matched case-control framework.MethodsData from the fifth round of the National Family Health Survey was used. A total of 172,079 recent births to eligible women (15–49 years) in five years preceding the survey were included in the study. We used the conditional logistic regression model, a commonly used regression model to fit matched case-control data to examine the effects of newborn postnatal care on neonatal mortality. The mother’s age at birth of the newborn, previous birth intervals, birth order of the newborn, and birthsize of the newborn were included as the matching variables.ResultsNewborns receiving postnatal care within two days or more than two days of birth are less likely to die during the neonatal period. Preferences for newborn postnatal care were also observed to increase with more maternal antenatal care visits. Our study also found a lower risk of neonatal mortality among those newborns whose umbilical cord was examined within two days of birth, regardless of the number of maternal antenatal care visits. Similarly, the risk of newborn deaths was lower among babies whose body temperature was measured within two days of birth. The tendency to breastfeed their newborns within an hour after delivery was considerably higher among those births that occurred to mothers who had a higher number of maternal antenatal care visits. The risk of newborn deaths was also observed to be lower among those born in public or private healthcare facilities.ConclusionConsidering the cohesive nature of the relationship between neonatal mortality and maternal and child healthcare utilisation, strategic planning and management of the existing policies and programmes related to accessibility, availability, and affordability of maternal and child healthcare services is needed to achieve goal 3.2 of the Sustainable Development Goals. Promoting cost-effective measures such as continuous monitoring of the baby’s body temperature and umbilical cord care could also effectively help reduce neonatal mortality.

Optimization of struvite from sewage sludge ash as phosphorus source.

Phosphorus is an essential macronutrient for crop production. Struvite precipitation and reuse from phosphorus-rich sewage sludge are cost-effective measures to improve phosphorus utilization efficiency and decrease its negative environmental impact. In this study, the objectives were to optimize the phosphorus extraction (using sulfuric acid) and recovery (as struvite) processes and determine the most appropriate process conditions using RSM. This was done by evaluating the effect of different parameters such as acid concentration (mol/l) (0.02 to 0.8), H2SO4/ISSA ratio (liquid/solid) (20 to 150ml/g), and time (0.5 to 4h) for leaching tests and N: P ratio (1 to 2), Mg: P ratio (1 to 2), and pH (8 to 11) for struvite precipitation. The optimization of the factors affecting PO43--P extraction from SSA by acidic leaching showed that applying 0.5mol/l H2SO4 and 57ml/g L/S ratio at 2h achieved the highest PO43--P extraction (99.8%). The extraction of phosphorus also leached heavy metals; however, using a cation exchange resin, it was possible to effectively remove heavy metals from P-rich solutions. The optimal phosphorus recovery as struvite (98.5%) was achieved at the lowest pH and N/P ratio, while an increase in Mg/P ratio from 1 to 2 positively affected phosphorus recovery. The obtained struvite had a high content 94.6%, and the heavy metal content in struvite was lower than the value of standard, so that the obtained struvite sample can be used as fertilizer.

Development, characterization and evaluation of in vitro safety and in vivo efficacy of repellent gel formulations

Contagious diseases caused by mosquito bites are responsible for epidemic outbreaks around the world. Applying mosquito repellents is the main and most cost-effective prophylactic measure to reduce the transmission risk of arboviruses. In this study, two topical gel Formulations were developed as mosquito repellents which use two different systems to release 20 % Icaridin. The first, Formulation 1b uses Pluronic F127®, and the second, Formulation 2b uses a biopolymer produced by bacteria from the Rhizobium tropici species. The repellent Formulations developed showed non-Newtonian behavior. For Formulation 1b the viscosity increased after adding Icaridin. However, for Formulation 2b, there was no increase in viscosity after adding the active substance. The thixotropy analysis showed that the Formulations have good recovery of their structure and adhesion. Adding of Icaridin led to an increase in gel strength in Formulation 1b and did not change the gel strength for Formulation 2b. The Formulations presented very similar occlusion capacities which were all higher than free Icaridin. The Formulations were not cytotoxic in the concentration range between 0.04 % and 0.3 %. In addition, at the 0.62 % concentration, they showed a slight reduction in cell viability, although the LD50 value was not reached. The mean protection time was longer for Formulation 2b compared to Formulation 1b. Both Formulations had a longer mean protection time than free Icaridin against Aedes aegypti. The combination of Icaridin with Pluronic F127® and the biopolymer is an innovation in the pharmaceutical area.

Correlation between the accuracy of the emergency response centre’s urgency assessment and emergency medical services non-conveyance: a retrospective register-based study in Finland

BackgroundIn modern emergency medical services (EMS), ambulances increasingly focus on examining and treating the patient at the scene. This has led to increased levels of non-conveyance. In Finland, for instance, approximately 40% of EMS dispatches end up in non-conveyance. As EMS systems evolve, the proportion of non-conveyance could serve as a cost-effective measure to assess the quality of the dispatch criteria, if a link to the performance of urgency assessment would be established. The purpose of this study was to investigate whether the proportion of non-conveyance is associated with the test performance levels of the urgency assessment. This investigation was done separately within each dispatch category.MethodsA retrospective evaluation of the data was conducted on all EMS dispatches in the Pirkanmaa Hospital District from 1 August 2021 through 31 August 2021. There were a total of 7,245 EMS dispatches during the study period of which 829 were excluded. This study was conducted by comparing the existing test performance levels (sensitivity, specificity and under- or overestimation) of the emergency response centre’s urgency assessment with the non-conveyance rate (%) of each dispatch category. The relationships between the variables were measured using Spearman’s rank correlation coefficient.ResultsThe proportion of over-triage was the only urgency assessment’s test performance variable that had a statistically significant correlation with the proportion of non-conveyance (r = 0.568; p = 0.003). Other test performance variables of the urgency assessment had no or little correlation to the proportion of non-conveyance. Of the 6,416 EMS dispatches in the study period, 42% (2,672) resulted in non-conveyance of the patient. In nine dispatch categories, at least half (51–69%) of the dispatches ended in non-conveyance.ConclusionsBased on this study, it seems that the percentage of non-conveyance in the dispatch category could be used, with certain limitations, to assess the proportion of over-triage in the dispatch category. The method is particularly applicable in scenarios where the dispatch criteria have undergone modifications and there is a need to monitor the effect of the changes on the level of over-triage.

Evaluation of balloon sinuplasty for the treatment of pediatric chronic rhinosinusitis.

This year marks 10 years from the publication of the clinical consensus statement on pediatric chronic rhinosinusitis (CRS). Balloon sinuplasty did not meet criteria for consensus at that time because there was insufficient evidence on its efficacy and safety. The purpose of this review is to summarize the current evidence on balloon sinuplasty treatment for pediatric CRS. Balloon sinuplasty is not a cost-effective measure compared to adenoidectomy and endoscopic sinus surgery (ESS). In the pediatric population, benefits include short operative time, reduced tissue manipulation, and potential for decreased antibiotic courses. Alternatively, balloon dilation has increased equipment costs and there is a lack of robust prospective data that fully elucidates balloon sinuplasty's role in the management of pediatric CRS. Pediatric otolaryngologists should continue to perform first-line adenoidectomy and consider ESS based on imaging and other validated clinical scoring systems. Balloon sinuplasty has not yet been proven as an effective treatment for pediatric CRS and further large-scale investigations are required to overcome its lack of cost-effectiveness.

A novel measurement for evaluating the capture efficiency of local ventilation system using background oriented schlieren

In-situ measurement of the capture efficiency of local ventilation systems (CELV) is a challenge in field of indoor air quality control. This study introduced a novel method for assessing the capture efficiency using background oriented schlieren (BOS). A 1:4 model experimental platform was constructed to investigate the feasibility. The CELV was compared using both the BOS and the tracer gas method, and the optimization of BOS device parameters for better CELV results was investigated. The results showed that the CCD camera-BOS could detect thermal airflows with a temperature difference over 40 K. The best post-processing algorithm for CELV by BOS, which was combined density gradient variation-rate and gray-scale method (CE-DGR&GS), was closely matched the results of the tracer gas method (CE-SF6), with a correlation of 0.97. When the capture efficiency exceeded 90%, the deviation between the two methods was less than 10%. However, when the ventilation system captured poorly, the CELV by CE-DGR&GS was over-estimated. Higher NR of BOS image causes large deviation of the calculated capture efficiency, and CELV by BOS under the same flow can differ by as much as 40 % by various cameras. A high-pixel CCD camera with a long focal length lens (f ≥ 35 mm, ISO≤100, f# = 16) was recommended. The interrogation window size for cross-correlation algorithms could be 33%–66% of the collected image pixel resolution. To achieve sufficient optical sensitivity, the distance ratio Zd/Zb was suggested to be 1:2. This study provides a cost-effective and entrie flow-field measurement for assessing local ventilation capture efficiency.

Pre-Operative Management of the Penicillin Allergic Patient: A Narrative Review

Penicillin is a frequently reported medication allergy. The beta-lactam ring shared between cephalosporins and penicillin often leads to the use of alternative antibiotics for surgical prophylaxis due to concern for cross-reactivity, despite a true IgE-mediated hypersensitivity being very rare. This misconception leads to the use of less effective second line antibiotics, such as clindamycin or vancomycin, for penicillin-allergic patients which has been shown to increase odds of postoperative infection in elective knee arthroplasty, shoulder arthroplasty and spine surgery. Preoperative penicillin allergy testing has been demonstrated to be a cost-effective measure in the prevention of prosthetic joint infection and is suggested for all penicillin-allergic patients in the peri-operative setting. This review highlights and summaries the outcomes of orthopaedic procedures in patients with reported penicillin allergies and discusses potential solutions to the perioperative challenges of patients with reported penicillin allergies.

Expert consensus on the construction and improvement of adult vaccination service system at medical institutions

The "Healthy China 2030" plan outlines the goal of providing equitable, accessible, and continuous health services to achieve overall health for the population. However, with the increasing aging population in China, the burden of chronic non-communicable diseases and infectious diseases negatively impacts public health. The elderly population has high hospitalization rates due to infections from influenza virus, respiratory syncytial virus, and Streptococcus pneumoniae, which can even lead to death, posing a heavy economic burden on the healthcare system. Meanwhile, the prevalence of chronic diseases and multimobidity among adults are continuously rising, and infections could attack the high-risk groups which cause comlicaitons and severe outcomes. Vaccination is considered as most cost-effective measure for preventing infectious diseases, significantly reducing the disease burden on individuals while effectively controlling the spread of epidemics within the community. Currently, the adult vaccination service system in China is significantly lagging, making it difficult to fully utilize the health protection benefits of vaccines throughout the entire lifecycle. Therefore, to improve adult vaccination services and increase the vaccination rate among high-risk populations for severe diseases, this expert consensus analyzes the current status and challenges of adult vaccination services based on literature reviews and expert discussions. To provide suggestions for the establishment and improvement of adult vaccination service system, and reference health authorities and disease control and prevention departments to formulate relevant policies.

Noise sensors - Part 1: Usage for the redesign of neighbourhoods

An interdisciplinary research project at the Stuttgart University of Applied Sciences with participation of the departments of urban planning, surveying and geoinformatics, business psychology and acoustics, present alternative urban scenarios. Different aspects for the redesign of the district, especially measures to reduce the individual motorised transport, were investigated. Virtual reality and augmented reality experiments are used in public spaces, to show redesign possibilities. Surveys of people, who had the experience of the future scenarios via the AR application and VR application, were carried out. Additionally, acoustical surveys and measurements in this research project were performed using so called noise sensors. These sensors based on MEMS microphones were developed for a simple and cost-effective measurement of external noise in a citizen sciences project. The measurement results of the noise sensors are saved online and can be accessed on the homepage "Sensor.Community". One of the noise sensors was used in the project area over a longer period. Measurement values were generated in third octave bands at intervals of 5 s and are available for further evaluations, e.g. for the calculation of indoor noise levels. The paper presents the research project and reports about the application of the noise sensor.

Advancements in railway noise simulation: assessment of tools for virtual validation

In pursuit of more efficient and cost-effective measurement campaigns, the railway industry is embracing the prospect of virtual validation based on simulations. The primary obstacle lies in the need for noise simulation tools capable of accurately replicating complex sources, installation effects, noise propagation, ground reflection and, for some cases, the diffraction in the different train surfaces. This paper presents insights derived from European project Shift2Rail S2R-CFM-CCA-01-2019 Energy and Noise & Vibration WP6, concentrating on the validation and enhancement of two exterior noise simulation tools, tailored for railway applications. The paper covers four reference cases, simulating exterior noise at standstill with diverse noise sources and varying source locations and noise emission (i.e. electrical noise, cooling, etc.). A correlation with previously conducted measurements at typical receiver locations (7.5 meters from the track centerline) is carried out. The measurements were conducted in a "controlled" configuration, isolating as much as possible the analyzed noise source and gathering all the needed information about the ground and train geometry. The evaluation between measurements and simulations is done against a global and a 1/3rd octave band criteria with successful results. Finally, key features essential for achieving more accurate simulations are listed.

Assessing the reliability of a ship energy performance simulation tool through on-board data

To mitigate the environmental impact of shipping on climate change, it is nowadays urgent to explore energy efficiency and cost-effective measures by means of reliable digital tools. These are becoming essential for assisting the design of new ships and the refurbishment of the existing ones, as well as for assessing and optimizing the energy performance of a ship during its entire life-cycle. This paper focuses on the verification of the reliability of a novel ship energy dynamic simulation tool, developed for the calculation of the energy, economic, and environmental performance of large ships, the design and optimization of energy system layouts and operational logics, as well as the definition of design and management guidelines for ships. The reliability of the developed model was verified through the use of data measured onboard an existing sample cruise ship. The verification procedure is conducted for assessing the reliability and for exploiting the potentiality of dynamic analysis for a more precise evaluation of ships energy loads, temperature levels, and necessary sizes of possible saving technologies. The validated tool will enable reaching two different goals: i) to evaluate different energy system layouts and to define the optimal one for achieving the present imposed targets and constraints, ii) to obtain a large amount of data for allowing the implementation of the digital twin approach in the maritime sector. The model validation was successfully achieved and very low or negligible deviations, lower than 4%, of numerical data vs. measurements were observed. Through the validated simulation tool approximately 23.4 GWh of primary energy from polluting fuels over two weeks is computed. In addition, the model provided insights into the flow rate, temperature levels, and energy flows of the ship energy system, necessary for identifying the amount of thermal energy to be recovered as well as potential solutions to enhance the energy efficiency of the entire system.

Technology And Innovation In HR

In India, the high cost of medical education, particularly for an MBBS degree, poses significant challenges for new doctors, who often find that their qualifications do not justify the Expenses incurred. This financial strain is exacerbated when these highly trained professionals are employed for routine tasks such as insurance treatment and billing verification, roles that are not commercially viable given their level of education and potential. As a cost-effective measure, many insurance companies and third-party administrators (TPAs) opt to employ doctors with BHMS or BMS degrees for these tasks. However, these professionals are often underqualified for the complexities of medical verification, leading to inefficiencies and errors in treatment validation and anomaly detection. The situation also adversely affects programs like the Ex-Servicemen Contributory Health Scheme (ECHS), where the need for accurate and efficient cashless medical services is critical. Delays and inaccuracies in medical verification can complicate the provision of timely healthcare to veterans and their families, underscoring the need for improvement in these processes. This paper proposes the implementation of an Artificial Intelligence (AI) ecosystem designed to function as highly qualified medical agents. This AI system will be capable of independently verifying diagnoses, treatment plans, and medical reports for accuracy while also identifying procedural anomalies. The primary objective is to augment the capabilities of the current workforce, enhancing overall efficiency and effectiveness in medical management. By deploying AI medical agents, the project aims to not only address the gap in qualification and task complexity but also improve the accuracy and reliability of medical administrative processes. This initiative promises to revolutionize the way medical verifications are handled, providing a sustainable, scalable solution to a pressing healthcare management issue in India.

Estimating sediment delivery ratio using the RUSLE-IC-SDR approach at a complex landscape: A case study at the Lower Snowy River area, Australia

Understanding the dynamics of sediment transport and deposition in natural landscapes is critical to developing cost-effective mitigation measures to control soil erosion and protect ecosystems. However, none of a single existing model can quantify sediment delivery ratio (SDR) and the impact factors such as vegetation and geomorphology, especially in a complex landscape. In this case study, we applied an integrated approach including the revised universal soil loss equation (RUSLE) and the index of connectivity (IC) to assess hillslope erosion and SDR, namely RUSLE-IC-SDR, across a complex landscape in the Lower Snowy River area, Australia. The RUSLE factors were derived from a high-resolution (2 m) digital elevation model (DEM), digital soil maps, high-resolution rainfall data and remotely sensed fractional vegetation cover. A seven-class landform classification was delineated from the high-resolution DEM using a fuzzy logic landform model (FLAG). We further examined the impacts of rainfall, vegetation cover and geomorphology on sediment dynamics and distribution across the study area. Field and laboratory data from 10 plot sites across the study area were collected and used for model validation. This case study showed that the RUSLE-IC-SDR approach can assess the overall sediment budget and the impacts of rainfall, vegetation cover and geomorphology across a complex landscape. Findings from this study can identify and track the areas likely to generate high sediment yield for developing ecological restoration, feral animal management and other catchment management measures.

A framework for cost-effectiveness analysis of greenhouse gas mitigation measures in dairy industry with an application to dairy farms in China

The dairy industry is a significant contributor to global greenhouse gas emissions (GHG). Although much effort has been directed to explore the cost-effective measures for many sectors such as electricity, building infrastructure, transportation, research on mitigation measures within dairy industry remains limited. A notable obstacle is the absence of a cost-effectiveness analysis (CEA) framework to guide decision-makers and practitioners in this sector. In response, we propose a comprehensive CEA framework tailored to mitigate GHG emissions in the dairy industry. Our conceptual framework consists of six steps: defining the system boundary to determine the activities generating GHG emissions; identifying GHG emission sources within the system boundary; identifying potential mitigation measures; determining methods to quantify GHG emissions; collecting data to estimate both GHG emissions and mitigation costs; and applying general econometric methodologies to analyze the cost-effectiveness of mitigation measures. We further conducted a case study focusing on dairy farms in China, analyzing three categories of mitigation measures: feed, energy, and manure management. The results indicate that implementing effective feed and energy measures is a cost-saving strategy, reducing the cost per unit of milk production. Conversely, adopting effective manure management measures may lead to increased costs for dairy farms. The findings offer strategic recommendations for reducing GHG emissions from dairy production in China and provide analytical insights and strategic references applicable to other developing countries.