Total Excess Research Articles

Ultraviolet photochemistry of the 2-buten-2-yl radical.

The ultraviolet (UV) photodissociation dynamics of the 2-buten-2-yl (C4H7) radical were studied using the high-n Rydberg atom time-of-flight (HRTOF) technique in the photolysis region of 226-246 nm. 2-Buten-2-yl radicals were generated by 193 nm photodissociation of the precursor 2-chloro-2-butene. The H-atom photofragment yield (PFY) spectrum of 2-buten-2-yl is broad, peaking at 234 nm. Quantum chemistry calculations show that the UV absorption is due to the 3py and 3px Rydberg states (parallel to the plane of CC double bond). The translational energy distributions of the H-atom loss product channel, P(ET)'s, of 2-buten-2-yl show a bimodal distribution indicating two dissociation pathways. The major pathway peaks at ET ∼ 7 kcal mol-1 with a nearly constant fraction of average ET in the total excess energy, 〈fT〉, at ∼0.11-0.12. This main pathway has an isotropic product angular distribution with β ∼ 0, consistent with the unimolecular dissociation of a hot 2-buten-2-yl radical following internal conversion from the electronically excited state, resulting in the formation of 2-butyne + H (∼84%) and 1,2-butadiene + H (∼16%). Additionally, there is a minor non-statistical pathway with an isotropic angular distribution. The minor pathway peaks at ET ∼ 35 kcal mol-1 in the P(ET) distributions and exhibits a large 〈fT〉 of ∼0.40-0.46. This fast pathway suggests a direct dissociation of the methyl H-atom on a repulsive excited state surface or on the repulsive part of the ground state surface, forming 1,2-butadiene + H. The fast/slow pathway branching ratio is in the range of 0.03-0.08.

The Diwali festival: short-term high effect of fireworks emissions on particulates and their associated empirically calculated health risk assessment at Bhubaneswar city.

This article elucidates the role of the short-term combustion of firecrackers and sparklers as a significant source of atmospheric pollutants that deteriorate ambient air quality and increase health risks during the popular Diwali festival. The study was conducted at Bhubaneswar during the festive celebration in early November 2021 (4th Nov) and late October 2022 (24th Oct) to assess the level of particulates (PM2.5 and PM10 mass concentration) and the relative health risks associated with them. PM2.5 (113.83µg/m3) and PM10 (204.32µg/m3) showed significant rises on D-day at all seven different sites that exceeded the NAAQS in 2021. From 2021 to 2022, an overall decrease in PM2.5 (41%) and PM10 (36%) was observed. On D-day, the total concentration of quantified metals in PM2.5 and PM10 were found to be 4.83µg/m3 5.97µg/m3 (2021) and 5.08µg/m3 5.18µg/m3 (2022) respectively. The AQI during both years (2021-2022) was found to be high for PM2.5 (unhealthy) and PM10 (moderate), but it was markedly goodfor all other pollutants on the scale. The overall population in the study area were under a significant health risk was observed in the overall population as PM surpassed the threshold concentration amid the festivities for consecutive years, with PM2.5 being more potent than PM10. The total excess health risk in 2022 was found to be decreased lower by ~ 88% from 2021 on D-day. But, metal exposure (through inhalation) in children were more compared to the adults for both the years. However, the exposure risk of both children and adults were high in the year 2022 with inhalation of metals like K, Al, Ba, Fe and Ca found in higher concentration and directly emitted from the firecrackers.

Estimation of the Added Cancer Risk Derived From EVAR and CTA Follow-Up.

The aim of this study was to assess the risk of radiation-induced cancer development in patients that have undergone an infrarenal EVAR, stratifying the relative contributions of the procedure and the preoperative and postoperative CTAs. The organ-specific absorbed radiation doses from CTA and the EVAR procedure were estimated from the radiation exposures of 95 and 45 male patients, respectively. Lifetime attributable risk (LAR) cancer predictions were calculated for 14 different organs. Life expectancy was assumed from a previous cohort of patients undergoing infra-renal EVAR. The calculated total excess cancer risk was 0.0046, ie, 1 out of 220 patients will develop a neoplasm after being exposed to the ionizing radiation from the preoperative CTA, the EVAR and annual CTA examinations for 15 years. The procedure and the preoperative CTA contributed with 38% of the total excess risk, while the rest was derived from the follow-up. If the entire CTA based follow-up would have been eliminated, an excess risk of 0.0018 (1/560) would remain. 1 out of 219 patients who have undergone EVAR of an infra-renal AAA have a lifetime risk of developing cancer secondary to the radiation exposures related to the procedure and the CTAs used preoperatively and during follow-up. This risk derives mostly from the yearly postoperative CTAs, underlining the potential benefits of reducing or replacing their use. A simulation-based estimation reinforced the potential deleterious effects of the radiation exposure for patients undergoing Endovascular Aneurysm Repair (EVAR) of Abdominal Aortic Aneurysms (AAA) and subsequently followed by yearly Computer Tomography Angiographies (CTAs). The risk could be as high as 1 out 219 patients developing a neoplasm after 15 years. The largest exposure derives from the follow-up CTAs and efforts to minimize their use as well as the intraoperative radiation are greatly needed. The simulation-based estimations done in this study reinforce potential deleterious effects of the radiation exposure for patients undergoing EVAR of AAA. Efforts should be done to minimize the intraoperative radiation and the number of CTAs used during follow-up.

Assessment of mortality risks due to a strong cold spell in 2022 in China.

With the intensification of global climate warming, extreme low temperature events such as cold spells have become an increasingly significant threat to public health. Few studies have examined the relationship between cold spells and mortality in multiple Chinese provinces. We employed health impact functions for temperature and mortality to quantify the health risks of the first winter cold spell in China on November 26th, 2022, and analyzed the reasons for the stronger development of the cold spell in terms of the circulation field. This cold spell was a result of the continuous reinforcement of the blocking high-pressure system in the Ural Mountains, leading to the deepening of the cold vortex in front of it. Temperature changes associated with the movement of cold fronts produced additional mortality risks and mortality burdens. In general, the average excess risk (ER) of death during the cold spell in China was 2.75%, with a total cumulative excess of 369,056 deaths. The health risks associated with temperatures were unevenly distributed spatially in China, with the ER values ranging from a minimum of 0.14% to a maximum of 5.72%, and temperature drops disproportionately affect southern regions of China more than northern regions. The cumulative excess deaths exibited the highest in eastern and central China, with 87,655 and 80,230 respectively, and the lowest in northwest China with 27,474 deaths. Among the provinces, excess deaths pronounced the highest in Shandong with 29,492 and the lowest in Tibet with only 196. The study can provide some insight into the mortality burden of cold spells in China, while emphasising the importance of understanding the complex relationship between extreme low temperature events and human health. The outcomes could provide valuable revelations for informing pertinent public health policies.

Excess Bed Days and Hospitalization Costs Associated With 30-Day Complications Following Catheter Ablation of Atrial Fibrillation.

The incidence and type of complications following catheter ablation of atrial fibrillation have been extensively examined, but the impact associated with these complications on the length of stay and hospitalization costs is unknown. This cohort study included 20 117 adult patients (mean age 62.6±11.4 years, 30.3% women, median length of stay 1 day [interquartile range 1-2 days]) undergoing atrial fibrillation ablation in financial years 2011 to 2017 in Australia with available cost data from the National Hospital Cost Data Collection, which determines government reimbursement of health services provided. The primary outcome was the costs associated with complications occurring up to 30 days postdischarge adjusted for inflation to 2021 Australian dollars. We used generalized linear models to estimate the increase in length of stay and cost associated with complications, adjusting for patient characteristics. Within 30 days of hospital discharge, 1151 (5.72%) patients experienced a complication with bleeding (3.35%) and pericardial effusion (0.75%) being the most common. On average, the occurrence of a complication was associated with an adjusted 3.3 (95% CI, 3.1-3.6) excess bed days of hospital care (totaling 3851 days), and a $7812 (95% CI, $6754-$8870) increase in hospitalization cost (totaling $9.0 million). Most of the total excess cost was attributable to bleeding ($3.8 million, 41.9% of total excess cost) and pericardial effusion ($1.6 million, 18.2%). Complications following atrial fibrillation ablation were associated with significant increase in length of stay and hospitalization costs, most of which were attributable to bleeding and pericardial effusion. Strategies to improve procedural safety and reduce health care costs should focus on these complications.

Spatiotemporal characteristics of air pollutants and their associated health risks in '2+26' cities in China during 2016-2020 heating seasons.

To understand characteristics of air pollutants and their associated health risks in recent heating seasons in China, ambient monitoring data of six air pollutants in '2 + 26' cities in Beijing-Tianjin-Hebei and its surrounding areas (known as the BTH2+26 cities) during 2016-2020 heating seasons was analyzed. Results show that daily average concentrations of PM2.5, PM10, SO2, NO2, and CO dropped significantly in BTH2+26 cities from the 2016-2017 heating season to 2019-2020 heating season, while 8h O3 increased markedly. During 2016-2020 heating seasons, annual average values of total excess risks (ERtotal) were 2.3% mainly contributed by PM2.5 (54.4%) and PM10 (36.1%). With PM2.5 pollution worsening, PM10 and NO2 were the important contribution factors of the enhanced ERtotal. Higher health-risk based air quality index (HAQI) values were mainly concentrated in the western Hebei and northern Henan. HAQI showed spatial agglomeration effect in four heating seasons. Impact factors of HAQI varied in different heating seasons. These findings can provide useful insights for China to further propose effective control strategies to alleviate air pollution in the future.

Hypertension and Stroke as Mediators of Air Pollution Exposure and Incident Dementia

Fine particulate matter air pollution (PM2.5) has been consistently associated with cardiovascular disease, which, in turn, is associated with an increased risk of dementia. As such, vascular dysfunction might be a mechanism by which PM2.5 mediates dementia risk, yet few prior epidemiological studies have examined this potential mechanism. To investigate whether hypertension and stroke serve as mediators and modifiers of the association of PM2.5 with incident dementia. As part of the Environmental Predictors of Cognitive Health and Aging (EPOCH) Project, this cohort study used biennial survey data collected between 1998 and 2016 from respondents of the Health and Retirement Study (HRS), a nationally representative, population-based, cohort in the US. Eligible participants were those over 50 years of age who were free of dementia at baseline and had complete exposure, mediator, outcome, and demographic data from the HRS. Data analysis was conducted from August to November 2022. Exposure to PM2.5, calculated for the 10 years preceding each person's baseline examination according to residential histories and spatiotemporal models. Incident dementia was identified using a validated algorithm based on cognitive testing and informant reports. The 4-way decomposition causal mediation analysis method was used to quantify the degree to which hypertension and stroke mediated or modified the association of PM2.5 with incident dementia after adjustment for individual-level and area-level covariates. Among 27 857 participants (mean [SD] age at baseline, 61 [10] years; 15 747 female participants [56.5%]; 19 249 non-Hispanic White participants [69.1%]), 4105 (14.7%) developed dementia during the follow-up period (mean [SD], 10.2 [5.6] years). Among participants with dementia, 2204 (53.7%) had a history of hypertension at baseline and 386 (9.4%) received a diagnosis of hypertension during the follow up. A total of 378 participants (9.2%) had a history of stroke at baseline and 673 (16.4%) developed stroke over the follow-up period. The IQR of baseline PM2.5 concentrations was 10.9 to 14.9 μg/m3. In fully adjusted models, higher levels of PM2.5 (per IQR) were not associated with increased risk of incident dementia (HR, 1.04; 95% CI, 0.98 to 1.11). Although there were positive associations of prevalent stroke (HR, 1.67; 95% CI, 1.48 to 1.88) and hypertension (HR, 1.15; 95% CI, 1.08 to 1.23) with incident dementia compared with those free of stroke and hypertension during follow-up, there was no statistically significant association of PM2.5 with stroke (odds ratio per IQR increment in PM2.5, 1.08; 95%CI, 0.91 to 1.29) and no evidence of an association of PM2.5 with hypertension (odds ratio per IQR increment in PM2.5, 0.99; 95%CI, 0.92 to 1.07). Concordantly, there was no evidence that hypertension or stroke acted as mediators or modifiers of the association of PM2.5 with incident dementia. Although the nonmediated interaction between PM2.5 and hypertension accounted for 39.2% of the total excess association (95% CI, -138.5% to 216.9%), the findings were not statistically significant. These findings suggest that although hypertension may enhance the susceptibility of individuals to air pollution, hypertension and stroke do not significantly mediate or modify the association of PM2.5 with dementia, indicating the need to investigate other pathways and potential mediators of risk.

Frequency-Dependent Dewetting of Thin Liquid Films Using External ac Electric Field.

The stability of thin liquid films on a surface can be controlled by using external stimuli, such as an electric field, temperature, or light, by manipulating the total excess free energy of the system. It has been previously shown that thin lubricating films on slippery surfaces can be destabilized via the spinodal mechanism using an external electric field, which returns to the original stable configuration upon the electric field. However, the role of the frequency of the applied ac electric field is not clear, which is the main topic of study in this report. When an ac electric field of fixed voltage and varying frequency is applied across thin lubricating films of slippery surfaces, a different dewetting behavior is observed. Characteristic length and time scales of dewetting depend strongly on the frequency of the applied voltage, which is primarily due to the change in the dielectric behavior of the lubricating fluid. In addition, the interplay of various time scales involved in the dewetting process also depends on the frequency.

Short-term excess mortality following tropical cyclones in the United States.

Knowledge of excess deaths after tropical cyclones is critical to understanding their impacts, directly relevant to policies on preparedness and mitigation. We applied an ensemble of 16 Bayesian models to 40.7 million U.S. deaths and a comprehensive record of 179 tropical cyclones over 32 years (1988-2019) to estimate short-term all-cause excess deaths. The deadliest tropical cyclone was Hurricane Katrina in 2005, with 1491 [95% credible interval (CrI): 563, 3206] excess deaths (>99% posterior probability of excess deaths), including 719 [95% CrI: 685, 752] in Orleans Parish, LA (>99% probability). Where posterior probabilities of excess deaths were >95%, there were 3112 [95% CrI: 2451, 3699] total post-hurricane force excess deaths and 15,590 [95% CrI: 12,084, 18,835] post-gale to violent storm force deaths; 83.1% of post-hurricane force and 70.0% of post-gale to violent storm force excess deaths occurred more recently (2004-2019); and 6.2% were in least socially vulnerable counties.

The impact of fireworks burning on air quality and their health effects in China during Spring Festivals of 2015–2022

Ambient monitoring online data of six criteria air pollutants (PM2.5, PM10, SO2, NO2, O3 and CO) in 31 provincial capital cities in China during Spring Festivals from 2015 to 2022 were analyzed to estimate contributions of fireworks burning to PM2.5 and their health effects. It shows that daily average concentrations of PM2.5, PM10, SO2, NO2, and CO during Spring Festivals of 2015-2022 dropped remarkably by 36.5%, 48.9%, 70.6%, 29.7%, and 36.8%, respectively, while 8h O3 concentrations increased significantly by 21.6%. Average contributions of fireworks burning to PM2.5 during intensive fireworks burning periods from 2015 to 2022 were 44.8 ± 14.7 %, 56.2 ± 16.9 %, 50.1 ± 16.2 %, 46.0 ± 16.8 %, 44.3 ± 14.9 %, 33.2 ± 20.7 %, 44.5 ± 15.5 % and 35.2 ± 23.3 %, respectively. The total excess health risk (ERtotal) based on Chinese Ambient Air Quality Standards (CAAQS) and World Health Organization (WHO) air quality guidelines, and health-risk based air quality index values (HAQI) were estimated. Annual average values of ERtotal based on the WHO standard were 1.5–4.7 times as many as those estimated by CAAQS standards and annual average values of HAQI based on CAAQS Grade Ⅰ standard were higher than those based on CAAQS Grade Ⅱ standard. Main health risk factors were different under different air quality standards. It is necessary to further improve air quality to protect human health during Spring Festivals in China in the future.

Venous Blood Gas and Acid-base Values in Captive Asian Elephants (Elephas maximus)

Background: Blood gas and acid base values are very much essential for health assessment and disease diagnosis of captive elephants especially when clinical signs were nonspecific and other diagnostic techniques may not be available for immediate applications. Region specific normal healthy animal profile is valuable in health care planning for captive elephants. The aim of this study was to assess and evolve the baseline reference values for Blood gas and acid base parameters in captive Asian elephants raised in the Tamil Nadu State of India. Methods: A total of 46 venous blood samples were analyzed for blood gas and acid base values such as partial pressure of oxygen (PvCO2), partial pressure of carbon-dioxide (PvO2), oxygen saturation (SvO2), total carbon dioxide content (TvCO2), Bicarbonate and Base excess (BEecf), bicarbonate (HCO3-) and pH by using i-STAT®1 hand held analyzer. Results: The mean±SE, lower and upper value, 95% and 99% of confidence interval of the pH, PvCo2, PvO2, TvCo2, BEecf, HCO3- , SvO2, Lactate were assessed. As the elephants in this study were apparently healthy, these range of values could well serve as a reference range for captive Asian elephants.

Validation and Neutronic Analysis of the CENM TRIGA MARK II SCALE Research Reactor Model: Computations Versus Experiment

This research analysis is mainly devoted to enhancing the safe and optimum use of the Center des Etudes Nucléaires de la Maâmora (CENM) TRIGA MARK II research reactor. To serve this purpose, various integral neutronic responses, such as the effective multiplication factor keff, the effective delayed neutron fraction βeff, the neutron flux distributions at the beam port entrances and the pneumatic transfer system bottom, the pin power peaking factors, the total excess reactivity, the control rod worth, the shutdown margin, and the worth of 11 fuel elements taken from different TRIGA core positions are calculated in order to evaluate the accuracy and the reliability of the developed TRIGA SCALE reactor model. The aim has been fulfilled by comparing the TRIGA SCALE results with those obtained by the MCNP TRIGA model, as well as with some recent experimental measurements from 2021. In general, all the obtained results reveal a good consistency between the SCALE and MCNP TRIGA models studied in this paper. The results analysis indicates also that the B-2 fuel element (Ring B) is the hottest rod among the 101 fuel rods existing in the TRIGA reactor core, which releases a maximum power of 31.67 kW. Furthermore, the total control rod worth, the total core excess reactivity, and the shutdown margin results are also closer to the experimental measurements.

An analytical solution for nonlinear consolidation of composite foundations improved by stone columns and vertical drains

The nonlinear compressibility and permeability of soft soils is a key factor in the consolidation of both composite and natural foundations. However, there are few corresponding consolidation theories for vertical drain-stone column composite foundations in which the nonlinear consolidation characteristics of soils can be taken into account. In this study, a nonlinear consolidation model is established to describe the seepage relations between soft soils, vertical drains and stone columns. Then, a consolidation governing equation is derived, where the total excess pore water pressure (EPWP), u¯, is a variable, and the average consolidation degree defined by strain and stress of the composite foundation is obtained, respectively. Numerous calculations are performed to analyze the consolidation behaviors of such composite foundations. The results show that the installation of vertical drains can enhance the consolidation rate effectively; the external load and the initial modulus ratio of column to soil have an influence on the stress concentration effect of stone columns. Finally, the proposed analytical solution is applied to the settlement calculation for an actual project, and the calculated results are in good agreement with the measured data in the early and late stages of consolidation.

Projections of excess deaths related to cold spells under climate and population change scenarios: A nationwide time series modeling study

BackgroundFuture climate change is likely to alter cold spell-related disease burden. Few projection studies have considered the potential impact of the aging population with changing population size on cold spell-related disease burdens. MethodsWe derived the association between cold spells and daily mortality for 272 main cities in mainland China. We combined these associations with modeled daily temperatures from three different climate models under two climate change scenarios and three population scenarios to project excess deaths related to cold spells. Furthermore, we used the factor separation method to calculate the independent contribution of future population size, age structure, and climate change on projected deaths attributable to cold spells. FindingsCompared to the baseline period, future excess deaths related to cold spells are expected to increase over most of the decades under RCP 2.6 (81.5% in 2050 s and 37% in 2090 s) and RCP 4.5 (55.5% in 2050 s and −19% in 2090 s). The factor analysis indicated that the rise of the aged population (≥65) substantially would amplify the excess deaths related to cold spells (increase by 101.1% in the 2050 s and 146.2% in the 2090 s). For the near future (2021–2040), population aging could fully offset the influence of decreased cold-spell days. In the middle of this century (2051–2070), the total excess deaths will exhibit significant variation across three scenarios. By the end of 21 century (2081–2100), the population shrinking would reduce the total excess deaths. InterpretationExcess deaths related to cold spells may still increase in a warming climate and future demographic shifts would produce considerable influences in this increase for different periods.

Evaluation of the Global Health Security Index as a predictor of COVID-19 excess mortality standardised for under-reporting and age structure

BackgroundPrevious studies have observed that countries with the strongest levels of pandemic preparedness capacities experience the greatest levels of COVID-19 burden. However, these analyses have been limited by cross-country differentials...

Efficacy and underlying mechanisms of acupuncture therapy for PTSD: evidence from animal and clinical studies.

As a major public health problem, posttraumatic stress disorder (PTSD) has a substantial impact on individuals and society. The total excess economic burden of PTSD in the US is estimated to be more than $232.2 billion a year. Acupuncture is widely used in patients with PTSD, and an increasing number of studies have been undertaken to assess the efficacy and underlying mechanisms of acupuncture for the treatment of individuals with PTSD. However, there has not yet been a review that simultaneously elucidates the therapeutic efficacy and biological mechanisms of acupuncture. We wished to examine the efficacy and underlying mechanisms of acupuncture for the treatment of individuals with PTSD. We conducted this review in three sections as follows: a meta-analysis, an acupoint analysis, and mechanism research. PubMed, Web of Science, Embase, Cochrane Library, China National Knowledge Infrastructure Database (CNKI), WanFang Database, China Biology Medicine Database (CBM), Chinese Science and Technology Journals Database (VIP), and other databases were searched from 1 January 2012 to 27 November 2022. Based on the included studies, we first determined whether acupuncture is more effective than psychological treatment or pharmacological treatment for treating and improving the quality of life of individuals with PTSD by meta-analysis. Second, the most commonly used acupoints and parameters of acupuncture were summarized based on animal and clinical studies. Third, we attempt to summarize the current mechanisms of acupuncture in the treatment of PTSD. Finally, 56 acupoint analyses, eight meta-analyses, and 33 mechanistic studies were included. Acupuncture outperformed pharmacotherapy treatment in improving symptom scores by CAPS, HAMA, HAMD, PCL-C, and SCL-90 somatization for PTSD and outperformed psychotherapy treatment in improving symptom scores by CAPS PCL-C and HAMD, according to the meta-analysis. GV20 was the most frequently used acupuncture point in clinical studies and animal studies, with a 78.6% application rate. Acupuncture may be effective in treating PTSD by regulating the structure and components of several brain areas, regulating the neuroendocrine system, and involving signaling pathways. In conclusion, this finding indicates that acupuncture has promising potential for treating PTSD.

Extended Hard X-Ray Emission in Highly Obscured AGNs

Kiloparsec-scale hard (>3 keV) X-ray continuum and fluorescent Fe Kα line emission has been recently discovered in nearby Compton-thick (CT) active galactic nuclei (AGNs), which opens new opportunities to improve AGN torus modeling and investigate how the central supermassive black hole interacts with and impacts the host galaxy. Following a pilot Chandra survey of nearby CT AGNs, we present in this paper the results of Chandra spatial analysis of five uniformly selected non-CT but still heavily obscured AGNs to investigate the extended hard X-ray emission by measuring the excess emission counts, excess fractions, and physical scales. Three of these AGNs show extended emission in the 3.0–7.0 keV band detected at >3σ above the Chandra point-spread function with total excess fractions ranging from ∼8% to 20%. The extent of the hard emission ranges from at least ∼250 pc to 1.1 kpc in radius. We compare these new sources with CT AGNs and find that CT AGNs appear to be more extended in the hard band than the non-CT AGNs. Similar to CT AGNs, the amounts of extended hard X-ray emission relative to the total emission of these obscured AGNs are not negligible. Together with other AGNs detected with extended hard X-ray emission in the literature, we further explore potential correlations between the extended hard X-ray component and AGN parameters. We also discuss the implications for torus modeling and AGN feedback. Considering potential contributions from X-ray binaries (XRBs) to the extended emission, we do not see strong XRB contamination in the overall sample.

The Electric Dial-a-Ride Problem on a Fixed Circuit

Shared mobility services involving electric autonomous shuttles have increasingly been implemented in recent years. Because of various restrictions, these services are currently offered on fixed circuits and operated with fixed schedules. This study introduces a service variant with flexible stopping patterns and schedules. Specifically, in the electric dial-a-ride problem on a fixed circuit (eDARP-FC), a fleet of capacitated electric shuttles operates on a given circuit consisting of a recharging depot and a sequence of stations where passengers can be picked up and dropped off. The shuttles may perform multiple laps, between which they may need to recharge. The goal of the problem is to determine the vehicles’ stopping sequences and schedules, including recharging plans, so as to minimize a weighted sum of the total passenger excess time and the total number of laps. The eDARP-FC is formulated as a nonstandard lap-based mixed integer linear programming and is shown to be NP-Hard. Efficient polynomial time algorithms are devised for two special scheduling subproblems. These algorithms and several heuristics are then applied as subroutines within a large neighborhood search metaheuristic. Experiments on instances derived from a real-life system demonstrate that the flexible service results in a 32%–75% decrease in the excess time at the same operational costs. Funding: This work was supported by the Fonds Wetenschappelijk Onderzoek [Project Data-Driven Logistics: Grant S007318N; Project Optimizing the Design of a Hybrid Urban Mobility System: Grant G020222N; and Grant OR4Logistics]. Y. Molenbruch is partially funded by the Fonds Wetenschappelijk Onderzoek [Grant 1202719N]. The computational resources and services used in this work were provided by the Flemish Supercomputer Center funded by the Fonds Wetenschappelijk Onderzoek and the Flemish Government. Supplemental Material: The electronic companion is available at https://doi.org/10.1287/trsc.2023.1208 .

The Healthcare Cost Burden of Asthma in Children: A Longitudinal Population-Based Study

ObjectivesThis study aimed to investigate the extent of healthcare cost increase at population level due to childhood asthma. We aimed to investigate the cross-sectional relationship between asthma and healthcare costs among children aged 2 to 18 years and, in longitudinal analyses, whether costs increase with an increase in the duration of asthma prevalence. MethodsStudy participants are 4175 and 4482 children of birth and kindergarten cohorts from the nationally representative Longitudinal Study of Australian Children for whom the linked Medicare cost data are available. The children were followed in all waves from the year 2004 to 2018. Generalized linear models were used to estimate the excess healthcare costs associated with asthma. The sum of Medicare Benefits Schedule and Pharmaceutical Benefits Scheme costs constitutes the total healthcare costs. ResultsTotal excess healthcare costs associated with asthma among the 2- to 18-year-old children were A$4316 per child. At the population level, the estimated total excess Medicare costs associated with current asthma treatment among 2- to 18-year-old children were, on average, A$190.6 million per year (2018 population and price). Compared with the non-asthmatic children, peers with persistent asthma morbidity and treatment requirements had excess costs up to A$20 727 for the B cohort children until 14 years of age, whereas excess costs for the K cohort children were A$19 571 until 18 years of age. ConclusionsAsthma in children imposes a significant financial burden on the public health system. Higher excess healthcare costs of all asthmatic children than the costs of nonasthmatic children provide further economic justification for promoting preventive efforts at early ages.

Assessment Of COVID-19 Pandemic-Related Detrimental Impact On The Population Of Nuclear City: Two-Year Results

Background — Since the announcement of the global coronavirus infection disease (COVID-19) pandemic, the attempts to assess the pandemic-related detrimental impact are of particular interest. The methodology of assessing the overall mortality attributed to COVID-19 pandemic, unlike the use of specific indicators that are sensitive to different methods of accounting the number of infected and deaths, provides more clear understanding of the pandemic-related impact. Objective — Quantitative assessment of the pandemic-related detrimental impact caused by the novel coronavirus infection in a small nuclear city, which is relevant for evaluating the effectiveness of anti-epidemic measures. Methods and Results — The population changes in a small urban district located in the South Ural Region of the Russian Federation were retrospectively analyzed for the decade, based on the open-source demographic data. The pandemic-related detrimental impact was calculated as overall excess mortality rate, compared with the previous non-pandemic years by using the additive model of excess absolute risk. The number of absolute excess deaths, adjusted for gender, age, population size, and number of diseased, was modeled using multivariate linear regression. The pandemic-related detriment was calculated based on the number of predicted excess deaths attributed to COVID-19. The relationship between the total number of deaths and the number of COVID-19 cases was analyzed. The total predicted two-year excess of pandemic-related deaths was 557.9. The pandemic-related total excess mortality per 1,000 patients infected with SARS-Cov-2 was 50.2 (95% CI 38.4; 62.0). Conclusion — The analyses revealed significant impact of the COVID-19 pandemic on the overall excess mortality in the nuclear city population in 2020 and 2021 implemented in both direct and indirect way. The population size was a major significant risk factor confounding the overall mortality. In order to develop an effective strategy to control and prevent the consequences of a pandemic, further monitoring of the epidemic situation in a nuclear city is required.