Priority Allocation Research Articles

Household Budgets Among Different Income Groups in Klang Valley

Budgeting is a common approach financial advisors introduce to teach individuals how to manage their expenses. Without budgeting, however, family living expenses may exceed the available income and jeopardise the family's overall financial goals. Financial issues are one of the significant causes of instability among families, especially lowincome earners who live below the usual standard and have an income that can only go for food and housing, making it impossible to satisfy their family's needs and attain goals. This scenario puts low-income families in a problematic state or condition that can be resolved through adequate financial support. This study examines the dynamics of household budgeting practices across various income groups within the Klang Valley region. The study also aims to identify the importance of budget allocation and expenditure priorities among low-income, middle-income, and high-income households. It underscores the crucial role of financial literacy and planning factors in budgeting practices, empowering individuals with the knowledge to manage their finances effectively. Data were collected from 65 tourism industry workers with multiple backgrounds by distributing questionnaires using a convenient sampling approach. The data collected were analysed using the Statistical Package for Social Science (SPSS) software. The findings contribute to a better understanding of how income disparities shape household finances and inform policy interventions to enhance financial resilience and equity within the Klang Valley community.

Cardiopulmonary exercise testing predicts risk of progressive heart failure and long term mortality in ambulatory patients awaiting isolated heart transplant

Abstract Introduction Cardiopulmonary exercise testing (CPET) parameters such as peak VO2 ≤ 14ml/kg/min, percentage predicted peak VO2 (ppVO2) ≤ 50% and ventilation equivalent of carbon dioxide (Ve/VCO2) >35 l/min/l/min are recommended thresholds to list for isolated heart transplant. There is minimal data on clinical events after listing to guide clinical management or priority in organ allocation. Purpose To assess the effect of peak VO2, ppVO2, Ve/VCO2 on clinical events after listing for isolated heart transplant. Methods In a single centre retrospective study, we identified patients who were status 6 or status 2 prior to 2018 at time of listing for isolated heart transplant between 2007 and 2021. Clinical data were collected by chart review. Primary outcome of progressive heart failure was defined as death or upgrade in transplant priority status (new inotropes or mechanical circulatory support). Comparison was made between peak VO2 strata (> 14 vs ≤ 14 ml/kg/min), ppVO2 strata (> 50% vs 40-50% vs <40%) and Ve/VCO2 strata (<35 vs >35 l/min/l/min). Secondary outcome was time dependent survival after listing for heart transplant. Results We identified 141 patients of which 133 underwent CPET and follow up was available for 130 who were included in the analysis. Median age was 53 years (interquartile range 41-59 years), 29.1% of patients were female. Median peak VO2 was 14.0 ml/kg/min (11.2-15.7), ppVO2 was 44% (36-52), Ve/VCO2 slope was 34.0 (31.0-37.0) and RER was 1.1 (1.1-1.2). 87 patients had progressive heart failure consisting of 34 deaths and 83 patients having upgrade in priority status. There was a significant difference in risk of progressive heart failure comparing peak VO2 strata (Figure 1) (freedom from event at one year 71.4% with peak VO2 > 14 vs 46.5% with peak VO2 ≤ 14, p=0.00061) and ppVO2 strata (Figure 2) (freedom from event at one year 75.0% with ppVO2 >50% vs 61.2% with ppVO2 40-50% vs 42.6% with ppVO2 <40%, p=0.0015). There was no significant difference with Ve/VCO2 strata (freedom from event at one year 59.8% with Ve/VCO2 <34 vs 54.9% with Ve/VCO2 >34, p=0.52). There were 34 deaths before transplant and 23 deaths after transplant. 87 patients underwent transplant. In a time dependent survival analysis, age, gender and ppVO2<50% (HR 1.65 (0.87-3.12)) were not significant predictors of mortality. Both early transplant (defined as < 1 year after listing, HR 0.14 (0.06-0.34) and late transplant (defined as > 1 year after listing, HR 0.16 (0.08-0.32)) were significant predictors of lower mortality whilst Ve/VCO2>35 (HR 2.09 (1.19-3.68)) was a significant predictor of higher mortality. Conclusions Peak VO2 and ppVO2 stratify risk of progressive heart failure in ambulatory patients awaiting isolated heart transplant. However, Ve/VCO2 is a predictor of significantly higher mortality. These findings should affect clinical management and transplant priority status; and influence revision of future guidelines.Freedom from event by peak VO2 strataFreedom from event by ppVO2 strata

Heterogeneous multi-task allocation algorithm based on multi-round distributed auction

Aiming at the distributed decision-making needs of different combat tasks such as multi-machine collaborative detection, attack, and evaluation, a multi-round distributed auction algorithm for heterogeneous tasks with time constraints is established. The algorithm flexibly solves the distributed collaborative task allocation problem with complex constraints between drones with different capabilities. In the distributed task allocation framework, each drone can realize distributed asynchronous computing and asynchronous communication, and can ensure good solution efficiency and accuracy. The task allocation principle is mainly based on the nearest allocation, while taking into account the target value and time constraints, realizing the priority allocation of important targets under limited resources and making the total journey as short as possible. Simulation results show that: given any number of drones and targets and the configuration of drone combat capabilities, the heterogeneous multi-round distributed auction algorithm can obtain good allocation results.

ANALYSIS OF ECOTOURISM AND DISASTER MITIGATION DATA AT THE KUALA LANGSA MANGROVE FOREST BY USING THE ANALYTIC HIERARCHY PROCESS

The problem in the management of a public area is to determine aspects that contribute most as its best practices. This paper explores the contributions of the Kuala Langsa Mangrove Forest located in Langsa City, Aceh Province, for ecotourism and disaster mitigation. This research was intended to analyze the aspects of forest management that has successfully reformed dry coast into an ecotourism site. The Analytic Hierarchy Process (AHP) as a multicriteria decision making method was used to analyze the best indicators data. This method was selected as the suitable method since it utilizes the objectivity of mathematics in comparing some subjective criteria to obtain the best indicators. The implementation of the AHP method consists of three stages: the development of the criteria’s hierarchy table; the development of pairwise matrix related to the intention of giving weights for the criterion’s elements; the logical concistency verification of the matrix. Indicators were written on a five point scale related to a value judgement. The results of the research show that as an ecotourism site, the activities of the mangrove forest are motivated and based on the existing rules which attract people to become interested. The role of the local government has resulted: developed the programs according to the existing mangrove management law that reached 67% among other law related indicators; budget allocation priority by self-generating which get priority of 59% among budget indicators; oriented on the increasing of fishermen, obtained 49% of economical function elements; encouraged the involvement and partnership of the local resources around the mangrove forest which reached 31% among other programs offered and sustainability approach by considering ecological functions aspect. For physical contribution for disaster mitigation, the largest dissipation is given by Rhizophora mucronata due to its height compared to the other types.

Motion priority optimization framework towards automated and teleoperated robot cooperation in industrial recovery scenarios

In this study, we introduce an optimization framework to enhance the efficiency of motion priority design in scenarios involving automated and teleoperated robots within an industrial recovery context. The increasing utilization of industrial robots at manufacturing sites has been instrumental in reducing human workload. Nevertheless, achieving effective human–robot collaboration/cooperation (HRC) remains a challenge, especially when human workers and robots share a workspace for collaborative tasks. For instance, when an industrial robot encounters a failure, such as dropping an assembling part, it triggers the suspension of the corresponding factory cell for safe recovery. Given the limited capacity of pre-programmed robots to rectify such failures, human intervention becomes imperative, requiring entry into the robot workspace to address the dropped object while the robot system is halted. This discontinuous manufacturing process results in productivity loss. Robotic teleoperation has emerged as a promising technology enabling human workers to undertake high-risk tasks remotely and safely. Our study advocates for the incorporation of robotic teleoperation in the recovery process during manufacturing failure scenarios, which is referred to as “Cooperative Tele-Recovery”. Our proposed approach involves formulating priority rules designed to facilitate collision avoidance between manufacturing and recovery robots. This, in turn, ensures a continuous manufacturing process with minimal production loss within a configurable risk limitation. We present a comprehensive motion priority optimization framework composed of an HRC simulator and a cooperative multi-robot controller to identify optimal parameters for the priority function. The framework dynamically adjusts the allocation of motion priorities for manufacturing and recovery robots while adhering to predefined risk limitations. Through quantitative and qualitative assessments, we validate the novelty of our concept and demonstrate its feasibility.

Liver transplantation plus chemotherapy versus chemotherapy alone in patients with permanently unresectable colorectal liver metastases (TransMet): results from a multicentre, open-label, prospective, randomised controlled trial

Despite the increasing efficacy of chemotherapy, permanently unresectable colorectal liver metastases are associated with poor long-term survival. We aimed to assess whether liver transplantation plus chemotherapy could improve overall survival. TransMet was a multicentre, open-label, prospective, randomised controlled trial done in 20 tertiary centres in Europe. Patients aged 18-65 years, with Eastern Cooperative Oncology Group performance score 0-1, permanently unresectable colorectal liver metastases from resected BRAF-non-mutated colorectal cancer responsive to systemic chemotherapy (≥3 months, ≤3 lines), and no extrahepatic disease, were eligible for enrolment. Patients were randomised (1:1) to liver transplantation plus chemotherapy or chemotherapy alone, using block randomisation. The liver transplantation plus chemotherapy group underwent liver transplantation for 2 months or less after the last chemotherapy cycle. At randomisation, the liver transplantation plus chemotherapy group received a median of 21·0 chemotherapy cycles (IQR 18·0-29·0) versus 17·0 cycles (12·0-24·0) in the chemotherapy alone group, in up to three lines of chemotherapy. During first-line chemotherapy, 64 (68%) of 94 patients had received doublet chemotherapy and 30 (32%) of 94 patients had received triplet regimens; 76 (80%) of 94 patients had targeted therapy. Transplanted patients received tailored immunosuppression (methylprednisolone 10 mg/kg intravenously on day 0; tacrolimus 0·1 mg/kg via gastric tube on day 0, 6-10 ng/mL days 1-14; mycophenolate mofetil 10 mg/kg intravenously day 0 to <2 months and switch to everolimus 5-8 ng/mL), and postoperative chemotherapy, and the chemotherapy group had continued chemotherapy. The primary endpoint was 5-year overall survival analysed in the intention to treat and per-protocol population. Safety events were assessed in the as-treated population. The study is registered with ClinicalTrials.gov (NCT02597348), and accrual is complete. Between Feb 18, 2016, and July 5, 2021, 94 patients were randomly assigned and included in the intention-to-treat population, with 47 in the liver transplantation plus chemotherapy group and 47 in the chemotherapy alone group. 11 patients in the liver transplantation plus chemotherapy group and nine patients in the chemotherapy alone group did not receive the assigned treatment; 36 patients and 38 patients in each group, respectively, were included in the per-protocol analysis. Patients had a median age of 54·0 years (IQR 47·0-59·0), and 55 (59%) of 94 patients were male and 39 (41%) were female. Median follow-up was 59·3 months (IQR 42·4-60·2). In the intention-to-treat population, 5-year overall survival was 56·6% (95% CI 43·2-74·1) for liver transplantation plus chemotherapy and 12·6% (5·2-30·1) for chemotherapy alone (HR 0·37 [95% CI 0·21-0·65]; p=0·0003) and 73·3% (95% CI 59·6-90·0) and 9·3% (3·2-26·8), respectively, for the per-protocol population. Serious adverse events occurred in 32 (80%) of 40 patients who underwent liver transplantation (from either group), and 69 serious adverse events were observed in 45 (83%) of 54 patients treated with chemotherapy alone. Three patients in the liver transplantation plus chemotherapy group were retransplanted, one of whom died postoperatively of multi-organ failure. In selected patients with permanently unresectable colorectal liver metastases, liver transplantation plus chemotherapy with organ allocation priority significantly improved survival versus chemotherapy alone. These results support the validation of liver transplantation as a new standard option for patients with permanently unresectable liver-only metastases. French National Cancer Institute and Assistance Publique-Hôpitaux de Paris.

The Use of Smartphone-Based Highly Realistic MCI Training as an Adjunct to Traditional Training Methods.

Training for mass casualty incident (MCI) response is critical to ensure that resource allocation and treatment priorities limit preventable mortality. Previous research has investigated the use of immersive virtual environments as an alternative to high fidelity MCI training, which is expensive and logistically challenging to implement. While these have demonstrated positive early results, they still require complex technology deployment, dedicated training facilities, and significant time from instructors and facilitators. This study explores the feasibility of a smartphone-based application for trauma care training and MCI triage to fill the gap between classroom learning and high-fidelity simulation. The goals of this investigation were to evaluate clinician perceptions of a virtual MCI training simulator's usability, acceptability, fidelity, functionality, and pacing. This study used a smartphone-based training simulation called Extensible Field and Evacuation Care Training in a Virtual Environment (EFECTIVE), which presents virtual patient scenarios in a gamified, but visually high-fidelity environment. A total of 21 participants were recruited as a convenience sample of medical students, paramedics, nurses, and emergency medicine resident and attending physicians at University of Massachusetts Memorial Medical Center, an urban tertiary care medical center. Participants completed a brief tutorial and then performed a series of virtual patient scenarios and 1 MCI scenario on the simulator, each of which was 5 minutes in duration. Then, each participant completed a survey assessing the perceived usability, acceptability, fidelity, functionality, and pacing of the virtual training simulator. The research protocol was approved by the University of Massachusetts Chan Medical School Institutional Review Board. 48% of participants disagreed that a virtual simulator could completely replace live MCI training, though 71% agreed that app-based simulations could effectively supplement live MCI training and 67% felt that they could be used to learn how to order medical interventions in care under fire scenarios. 80% of participants agreed that the simulation could be used to practice MCI triage and to gain experience with coordinating movement of casualties to casualty collection points. 67% of participants believed that use of virtual simulators would increase their MCI preparedness. 76% agreed that the clinical cases depicted were medically realistic and that the clinical cases presented accurately represented the scenarios described. In addition, despite being presented on a smartphone as opposed to virtual reality, 62% of participants rated the experience immersive. This study provides encouraging evidence that easy to deploy smartphone-based simulations may be an effective way to supplement MCI and care under fire training. Although the study is limited by a small sample size, there was strong agreement among participants from a wide variety of emergency medicine roles that such a simulation could train core topics associated with MCI triage. Because app-based simulations are easily deployable and can be executed quickly and frequently, they could be used as a more flexible training model compared to large scale live or virtual reality-based simulations. The results of this investigation also indicate that a sufficient level of medical realism can be achieved without live simulation.

From tree to plot: investigating stem CO2 efflux and its drivers along a logging gradient in Sabah, Malaysian Borneo.

Stem respiration constitutes a substantial proportion of autotrophic respiration in forested ecosystems, but its drivers across different spatial scales and land-use gradients remain poorly understood. This study quantifies and examines the impact of logging disturbance on stem CO2 efflux (EA) in Malaysian Borneo. EA was quantified at tree- and stand-level in nine 1-ha plots over a logging gradient from heavily logged to old-growth using the static chamber method. Tree-level results showed higher EA per unit stem area in logged vs old-growth plots (37.0 ± 1.1 vs 26.92 ± 1.14 g C m-2 month-1). However, at stand-level, there was no difference in EA between logged and old-growth plots (6.7 ± 1.1 vs 6.0 ± 0.7 Mg C ha-1 yr-1) due to greater stem surface area in old-growth plots. Allocation to growth respiration and carbon use efficiency was significantly higher in logged plots. Variation in EA at both tree- and stand-level was driven by tree size, growth and differences in investment strategies between the forest types. These results reflect different resource allocation strategies and priorities, with a priority for growth in response to increased light availability in logged plots, while old-growth plots prioritise maintenance and cell structure.

Health impact evaluation of Aspirational Districts Program in India: Evidence from National Family Health Survey

The Aspirational District Program (ADP) is a unique initiative of Government of India launched in 2018 that aims to reduce inter-district multidimensional inequality. ADP aims to bring the least developed districts to catch up with the rest of the other districts in the country. The program is comprehensive in its scope as it targets improvement of several key development indicators spanning health and nutrition, education, agriculture and water resources, financial inclusion and skill development and basic infrastructure indicators. Aspirational districts (ADs) are eligible for enhanced funding and priority allocation of various initiatives undertaken by the central and the state governments. Our research estimates the causal impact of ADP on the targeted health and nutrition indicators using a combination of propensity score matching and difference-in-differences (PSM-DID). We use the fourth and fifth rounds of National Family Health Survey (NFHS) data collected in 2015–16 and 2019–21 respectively which serve as the pre and post-treatment data for our analysis. Moreover, we take advantage of the transparent mechanism outlined for the identification of ADs under ADP, which we use for propensity score matching for our PSM-DID. While we observe negative impact of ADP on early initiation of breastfeeding, we believe that the impact is confounded with the effects of Covid-19 since part of NFHS-5 data was collected during the pandemic. However, the negative impact of ADP on early initiation of breastfeeding disappears when we only use pre-covid data (i.e. data for districts from states surveyed before the pandemic). Additionally, using pre-covid data we find a reduction in the prevalence of underweight children younger than 5 years to an extent of 2 to 4 percentage points in ADs as an impact of ADP, which is robust across multiple specification. We do not find evidence of a positive or a negative impact of ADP on any other health and nutrition indicators. Future research efforts should be made towards impact evaluation of all the targeted indicators in order to get a comprehensive unbiased evaluation of ADP.

Measuring leaf and root functional traits uncovers multidimensionality of plant responses to arbuscular mycorrhizal fungi.

While many studies have measured the aboveground responses of plants to mycorrhizal fungi at a single time point, little is known about how plants respond belowground or across time to mycorrhizal symbiosis. By measuring belowground responses and growth over time in many plant species, we create a more complete picture of how mycorrhizal fungi benefit their hosts. We grew 26 prairie plant species with and without mycorrhizal fungi and measured 14 functional traits to assess above- and belowground tissue quality and quantity responses and changes in resource allocation. We used function-valued trait (FVT) modeling to characterize changes in species growth rate when colonized. While aboveground biomass responses were positive, the response of traits belowground were much more variable. Changes in aboveground biomass accounted for 60.8% of the variation in mycorrhizal responses, supporting the use of aboveground biomass response as the primary response trait. Responses belowground were not associated with aboveground responses and accounted for 18.3% of the variation. Growth responses over time were highly variable across species. Interestingly, none of the measured responses were phylogenetically conserved. Mycorrhizal fungi increase plant growth in most scenarios, but the effects of these fungi belowground and across time are more complicated. This study highlights how differences in plant allocation priorities might affect how they utilize the benefits from mycorrhizal fungi. Identifying and characterizing these differences is a key step to understanding the effects of mycorrhizal mutualisms on whole plant physiology.

Interdisciplinarity in Smart Systems Applied to Rural School Transport in Brazil

Interdisciplinarity applied to rural transport in Brazil through expert systems is the focus of this paper. Rural school transport is a challenge, considering the size of Brazil, the great diversity of biomes and insufficient infrastructure. Collaboration between areas by interdisciplinarity articulates individual knowledge through the object and by transdisciplinarity requires developing new knowledge, based on an individual area, going beyond and extrapolating with different criteria. The "Transcolar Rural" intelligent transport system has been developed at the UFMG School of Engineering to plan and manage rural school transport by optimizing routes and costs. The system is used in 13 states in Brazil, 500 municipalities and manages the daily transport of more than 400 thousand students in rural areas. Reducing transportation costs allows resources to be reallocated to other educational activities. The project highlights Brazil's limited resources, recognized by the government, to meet the population's health, education and transport priorities. Transparent information helps managers make decisions and supervise citizens, allowing both parties to determine priorities for resource allocation. The Project demonstrates how interdisciplinarity is effective for complex problems. The project comprehensively addresses the challenges of transporting children in Brazil by integrating technology, exact sciences and applied social sciences.

THE ROLE OF PUBLIC FINANCE IN ECONOMIC GROWTH: THE PLACE OF PUBLIC INVESTMENT

Ensuring economic growth is a necessary condition for the successful socio-economic development of the country as a whole. This requires the activation of the role of public finance and public investment for the development and activation of processes in local self-government bodies, the state and local business as a key factor that determines the dynamics of capital in the economy and has an impact on the pace and nature of economic growth. At the same time, public investment can be considered as a management tool for promoting sustainable development. In conditions of socioeconomic instability, public finances are an important component of the financial system, which cannot adapt to changes automatically. The inertia of public finances generates additional risks notonly for the resource provision of the state's functioning, but also leads to a number of negative phenomena of a macroeconomic and social nature. Under these conditions, the budget is not only an important instrument of the state, through which monitoring of the state of public production and provision of social guarantees to the population is ensured, but also stabilization of the financial system as a whole is carried out. The article proves that an important determinant of socio-economic development of regions is financial decentralization, which contributes, on the one hand, to reducing the role of the state in their financial support, and on the other hand, creates opportunities for strengthening the autonomy of local budgets. The article substantiates the main methods of attracting public investment in the region, namely: regulatory and legal support; allocation of priorities for the selection of investment projects; definition and use of mechanisms for supporting investment activity; development of an investment passport; creation of a separate investment promotion service. A comprehensive analysis of the current state of the public finance system makes it possible to derive some limitations and criteria for the organization of relations between the fiscal and monetary systems in the context of current tasks of socio-economic development

High-value breast cancer care within resource limitations.

Breast cancer care is a costly global health issue where effective management depends on early detection and treatment. A breast cancer diagnosis can result in financial catastrophe especially in low- and middle-income countries (LMIC). Large inequities in breast cancer care are observed and represent a global challenge to caregivers and patients. Strategies to improve early diagnosis include awareness and clinical breast examination in LMIC, and screening in high-income countries (HIC). The use of clinical guidelines for the management of breast cancer is needed. Adapted guidelines from HIC can address disparities in populations with limited resources. Locally developed strategies still provide effective guidance in improving survival. Integrated practice units (IPU) with timely multidisciplinary breast care conferences and patient navigators are required to achieve high-value, personalized breast cancer management in HIC as well as LMIC. Breast cancer patient care should include a quality of life evaluation using ideally patient-reported outcomes (PROM) and experience measurements (PREM). Evaluation of breast cancer outcomes must include the financial cost of delivered care. The resulting value perspective should guide resource allocation and program priorities. The value of care must be improved by translating the findings of social and economic research into practice and resolving systemic inequity in clinical breast cancer research. Cancer survivorship programs must be put in place everywhere. The treatment of patients with metastatic breast cancer must require more attention in the future, especially in LMIC.

Incentivizing Organ Donation Under Different Priority Rules: The Role of Information

This paper examines the incentive to register for deceased organ donation under alternative organ allocation priority rules, which may prioritize registered donors and/or patients with higher valuations for organ transplantation. Specifically, the donor priority rule grants higher priority on the organ waiting list to those who have previously registered as donors. The dual-incentive priority rules allocate organs based on donor status, followed by individual valuations within the same donor status, or vice versa. Both theoretical and experimental results suggest that the efficacy of the donor priority rule and the dual-incentive priority rules critically depends on the information environment. When organ transplantation valuations are unobservable prior to making donation decisions, the hybrid dual-incentive rules generate higher donation rates. In contrast, if valuations are observable, the dual-incentive priority rules create unbalanced incentives between high- and low-value agents, potentially undermining the efficacy of the hybrid dual-incentive rules in increasing overall donation rates. This paper was accepted by Marie Claire Villeval, behavioral economics and decision analysis. Funding: This research is supported by the National Natural Science Foundation of China [Grants 72173103, 72373127, and 71988101], the Singapore Ministry of Education (MOE) Academic Research Fund Tier 1 [RG57/20], and the Open Foundation of Key Laboratory of Interdisciplinary Research of Computation and Economics (Shanghai University of Finance and Economics), Ministry of Education of China. Supplemental Material: The online appendices and data files are available at https://doi.org/10.1287/mnsc.2022.01530 .

Multi-Objective Task-Aware Offloading and Scheduling Framework for Internet of Things Logistics.

IoT-based smart transportation monitors vehicles, cargo, and driver statuses for safe movement. Due to the limited computational capabilities of the sensors, the IoT devices require powerful remote servers to execute their tasks, and this phenomenon is called task offloading. Researchers have developed efficient task offloading and scheduling mechanisms for IoT devices to reduce energy consumption and response time. However, most research has not considered fault-tolerance-based job allocation for IoT logistics trucks, task and data-aware scheduling, priority-based task offloading, or multiple-parameter-based fog node selection. To overcome the limitations, we proposed a Multi-Objective Task-Aware Offloading and Scheduling Framework for IoT Logistics (MT-OSF). The proposed model prioritizes the tasks into delay-sensitive and computation-intensive tasks using a priority-based offloader and forwards the two lists to the Task-Aware Scheduler (TAS) for further processing on fog and cloud nodes. The Task-Aware Scheduler (TAS) uses a multi-criterion decision-making process, i.e., the analytical hierarchy process (AHP), to calculate the fog nodes' priority for task allocation and scheduling. The AHP decides the fog nodes' priority based on node energy, bandwidth, RAM, and MIPS power. Similarly, the TAS also calculates the shortest distance between the IoT-enabled vehicle and the fog node to which the IoT tasks are assigned for execution. A task-aware scheduler schedules delay-sensitive tasks on nearby fog nodes while allocating computation-intensive tasks to cloud data centers using the FCFS algorithm. Fault-tolerant manager is used to check task failure; if any task fails, the proposed system re-executes the tasks, and if any fog node fails, the proposed system allocates the tasks to another fog node to reduce the task failure ratio. The proposed model is simulated in iFogSim2 and demonstrates a 7% reduction in response time, 16% reduction in energy consumption, and 22% reduction in task failure ratio in comparison to Ant Colony Optimization and Round Robin.

IJCM_42A: Nutritional Assessment and Association of Malnutrition with Food Insecurity among Adolescent Females of Age 15-19 Years in an Urban Slum of Raipur City

Background: Adolescent girls constitute about one-tenth of our country’s population. They suffer the brunt of malnutrition due to increased nutritional needs; compounded by urbanization, peer and social pressure. They are food insecure either due to unavailability, lack of resources or lower priority in food allocation. The NFHS-5 revealed that in the age group of 15€“19 years, about 39.7% of girls were thin, while 5.4% were overweight or obese. Objective: To assess the nutritional status of adolescent females of age 15-19 years in the urban field practice area of the CFM department of AIIMS Raipur and to determine if malnutrition is associated with food insecurity. Methodology: A sample size of 401 was determined, using the prevalence of 46.1% malnourishment among girls aged 15-19 years from NFHS-4 data. A community-based cross-sectional study was conducted. Participants were selected using consecutive sampling method, and anthropometric measurements were taken. Food insecurity was measured using Food Insecurity Experiential Scale. Results: According to WHO BMI-for-age Z scores for adolescents, 2% had severe thinness (&lt;-3SD), 9.7% had thinness (-3 to &lt;-2SD), 5% were overweight (&gt;1 to 2SD) and 1.5% were obese (&gt;2SD). The odds of being thin (low BMI for age) were high among girls who faced moderate to severe food insecurity [OR 3.2, CI 1.5-6.8, P &lt;0.002]. Conclusion: The high prevalence of thinness and its significant association with food insecurity as revealed in our study, calls for immediate nutritional policy interventions to make this vulnerable group, food secure.

RISKS AND OPPORTUNITIES FOR THE IMPLEMENTATION OF KAZAKHSTAN'S DEMOGRAPHIC POLICY

The purpose of the study is to identify the risks and opportunities of implementing demographic policy in Kazakhstan and taking into account changes in economic, political, financial and other factors in modern conditions. The following methods were used to conduct the research: historical, monographic, abstract-logical method. Using historical methods, the goals and objectives of demographic policy, changing due to changing conditions and factors, were considered. The monographic method also allowed us to study the historical experience of implementing demographic policy abroad and applied in Kazakhstan. The abstract-logical method made it possible to identify the priorities of Kazakhstan's demographic policies at each stage of implementation. The use of research methods made it possible to identify modern directions for the implementation of demographic policy in Kazakhstan based on the analysis of state program documents and the allocation of priorities for each of them. During the implementation of the demographic policy, the main risks associated with formal and informal processes in the system were identified. In addition, the possibilities of implementing demographic policy related to completely new socio-economic and political conditions that require a revision of policies, concepts, programs, institutional forms and their legislative formalization are highlighted.

Waitlist Outcomes for Exception and Non-exception Liver Transplant Candidates in the United States Following Implementation of the Median MELD at Transplant (MMaT)/250-mile Policy.

Since February 2020, exception points have been allocated equivalent to the median model for end-stage liver disease at transplant within 250 nautical miles of the transplant center (MMaT/250). We compared transplant rate and waitlist mortality for hepatocellular carcinoma (HCC) exception, non-HCC exception, and non-exception candidates to determine whether MMaT/250 advantages (or disadvantages) exception candidates. Using Scientific Registry of Transplant Recipients data, we identified 23 686 adult, first-time, active, deceased donor liver transplant (DDLT) candidates between February 4, 2020, and February 3, 2022. We compared DDLT rates using Cox regression, and waitlist mortality/dropout using competing risks regression in non-exception versus HCC versus non-HCC candidates. Within 24 mo of study entry, 58.4% of non-exception candidates received DDLT, compared with 57.8% for HCC candidates and 70.5% for non-HCC candidates. After adjustment, HCC candidates had 27% lower DDLT rate (adjusted hazard ratio = 0.68 0.73 0.77 ) compared with non-exception candidates. However, waitlist mortality for HCC was comparable to non-exception candidates (adjusted subhazard ratio [asHR] = 0.93 1.03 1.15 ). Non-HCC candidates with pulmonary complications of cirrhosis or cholangiocarcinoma had substantially higher risk of waitlist mortality compared with non-exception candidates (asHR = 1.27 1.70 2.29 for pulmonary complications of cirrhosis, 1.35 2.04 3.07 for cholangiocarcinoma). The same was not true of non-HCC candidates with exceptions for other reasons (asHR = 0.54 0.88 1.44 ). Under MMaT/250, HCC, and non-exception candidates have comparable risks of dying before receiving liver transplant, despite lower transplant rates for HCC. However, non-HCC candidates with pulmonary complications of cirrhosis or cholangiocarcinoma have substantially higher risk of dying before receiving liver transplant; these candidates may merit increased allocation priority.

Effects of conservation versus elimination of growing points on yield, C: N: P stoichiometry, and root morphology of Leymus chinensis

AbstractThe conservation and elimination of the growing point of Leymus chinensis (Trin.) Tzvel. are two common contrasted scenarios during grazing. However, the biomass and nutrient allocation in L. chinensis, as well as their contribution to yield under these conditions are unclear. Therefore, a simulated grazing experiment was conducted using a factorial design that combined two defoliation heights (conservation versus elimination of growing points) and four plant heights (18, 24, 31, and 35 cm) during two growing seasons (2020 and 2021), resulting in eight treatments. Additionally, the experiment also included two identical control treatments with a single mowing in mid‐August. The results demonstrated that conservation treatments for the growing point increased the regeneration time of L. chinensis during the entire growing season in both years compared to elimination treatments for the growing point, due to the alteration in biomass allocation priority and C: N: P stoichiometric ratio between stems and leaves of L. chinensis, as well as root morphological traits. The growth strategy in the treatment with 17 cm defoliation height at 35 cm plant height demonstrated the optimal combination, resulting in stabling the accumulated DM yield of L. chinensis in both years. The findings emphasize the significance of comprehending the correlation between the growing point of L. chinensis and its yield, providing a pioneering approach to guide sustainable grazing practices for L. chinensis grassland.

Adapting the Client Priority Rating Scale to better fit the sexual health counselling setting: a quality improvement study.

When demand for counselling in community-based clinics exceeds capacity, waiting lists are typically formed. Determining allocation priority solely on wait time can overlook client risk factors that can elevate priority. We undertook to rigorously adapt the only existing validated counselling triage tool, to better fit the sexual health setting. Sexual health counsellors were surveyed about aspects of client presentations that flagged increased priority. The revised Client Priority Rating Scale (CPRS-R) was created through systematic analysis and decision making, informed by survey results and literature review. Four expert sexual health counsellors independently rated the priority of 14 hypothetical clinical vignettes using the CPRS and CPRS-R. Criterion (concurrent), content and face validity are evidenced in the revised scale. Average interrater agreement was higher on the CPRS-R (28%) than the CPRS (11%); however, this difference was marginal (P =0.06). According to Gwet's Agreement Coefficient (AC) and Krippendorff's Alpha, both the CPRS and the CPRS-R demonstrate comparable interrater reliability, substantial and moderate, respectively. Kendall's W indicates the CPRS yielded higher reliability. However, the difference is not substantial. The CPRS-R is a triage tool designed for the sexual health counselling setting. This tool has demonstrated criterion, content and face validity, as well as moderate to substantial inter-rater reliability. It can be used in sexual health settings to inform assessments about client priority, along with clinical judgement and peer consultation.