Use Of Resources Research Articles

Cost-Utility Analysis of LifeVest® in Post-Myocardial Infarction Patients at Risk of Sudden Cardiac Death in England.

Patients with a left ventricular ejection fraction ≤ 35% are at increased risk of sudden cardiac death (SCD) within the first months after a myocardial infarction (MI). The wearable cardioverter defibrillator (WCD) is an established, safe and effective solution which can protect patients from SCD during the first months after an MI, when the risk of SCD is at its peak. This study aimed to evaluate the cost-effectiveness of WCD combined with guideline-directed medical therapy (GDMT) compared to GDMT alone, after MI in the English National Health Service (NHS). A multi-state Markov model, with a hypothetical cohort of 1000 patients, was developed to evaluate WCD + GDMT compared with GDMT alone, over a lifetime time horizon. Model input parameters were obtained from the pivotal randomised controlled trial and literature. The outcomes were costs and quality-adjusted life-years (QALYs), discounted at 3.5% annually, with overall results presented as an incremental cost-effectiveness ratio (ICER). The cost-effectiveness analysis demonstrated that WCD + GDMT is potentially a cost-effective option with an ICER of £23,024 per QALY gained, which is in the acceptable willingness to pay threshold (WTP) range of £20,000-£30,000 set by the National Institute for Health and Care Excellence (NICE) in England. Results of probabilistic sensitivity analysis (PSA) indicated that WCD + GDMT has 89.3% and 23% probability of being cost-effective at WTP thresholds of £30,000 and £20,000, respectively. Implementation of WCD in patients post-MI is potentially a cost-effective use of resources for the NHS and improves clinical outcomes amongst adherent patients and in circumstances where implantable cardioverter defibrillators are not indicated by the guidelines.

Equitable marine carbon dioxide removal: the legal basis for interstate benefit-sharing

ABSTRACT Marine carbon dioxide removal (mCDR) deployment strategies appear likely to involve the use of common ocean resources to generate financial benefit for mCDR developers. An important consideration for the future design of an equitable mCDR governance regime is the distribution of those benefits between states, particular between developed and developing states. This paper addresses the legal basis for inter-state benefit-sharing arrangements arising from mCDR activities through an analysis of existing inter-state benefit-sharing arrangements in international resource regimes. The paper identifies a set of key conditions that are present and justify the imposition of benefit-sharing between states. Specifically, claims for inter-state benefit-sharing are legally justified where the resources exploited are located in areas beyond national jurisdiction; the resource opportunities are finite; and the ability to access the resource opportunities are constrained by technological and financial capacity. These conditions will most likely be present for many deployment scenarios for key mCDR technologies. In presenting an argument in favour of inter-state benefit-sharing, this paper seeks to provide a more complete understanding of the equitable and legal dimensions of distributing the economic and non-economic benefits from mCDR activities.

The Use of Stone Resources in the Roman Architecture of Oderzo (Treviso, Italy)

The Use of Stone Resources in the Roman Architecture of Oderzo (Treviso, Italy)

Patient-Reported Outcome Measures: A key to patient-tailored and outcome-driven care in Pulmonary Embolism survivors.

Almost half of the acute pulmonary embolism (PE) survivors suffer from long-term sequelae that limit quality of life and their reintegration in society. The post-PE syndrome involves a spectrum of complications ranging from life-threatening pulmonary hypertension to deconditioning and psychosocial issues. The follow-up of acute PE has been demonstrated to be rife with challenges including long diagnostic delays, inefficient use of healthcare resources and the ignorance of psychosocial complications such as depression and anxiety. The best way to monitor recovery of PE comprehensively and reproducibly is the application of patient-reported outcome measures (PROMs), including quality of life assessment. PROMs help to identify and guide diagnostic tests and therapeutic interventions as well as to monitor the impact of the latter. In our view, therefore, PROMs should be integrated as a fundamental part of routine PE follow-up.

Controls on the industrial mineral potential of ore-proximal carbonate rocks, Garpenberg Zn-Pb-Ag-(Cu-Au) deposit, Bergslagen Sweden

ABSTRACT The c. 1.89 Ga Garpenberg Zn-Pb-Ag-(Cu-Au) deposit is hosted by dolomite marble, skarn and felsic metavolcanic rocks. Extensive marble units host part of the mine infrastructure, including sections of bright-colored, chemically pure marble. Assessing the potential of carbonates as by-products to base metal mining is of interest for a sustainable and efficient use of resources and for securing a domestic supply of carbonates. This study characterizes marble units proximal to the Dammsjön and Lappberget ore bodies at Garpenberg based on their optical, chemical, mineralogical, and textural properties to delineate controls on their brightness, color, and purity. Methods employed include drill core logging, whole-rock lithogeochemistry, petrography, SEM-EDS, μXRF, spectrophotometric brightness measurements, and tests of AIR and magnetic separation. The marble units are divided into bright calcite marble (white, gray, and green varieties), dark calcite marble (salmon pink, spotted, brecciated, and ophicalcite varieties) and dolomite marble. Brightness and purity of the marbles are highly correlated, with Fe having a particularly detrimental effect on brightness, both via substitution in the dolomite and calcite lattices, but also via presence of accessory minerals that grind to dark powders. Ore-proximal dolomite marble shows a hydrothermal signature, with elevated base metals, Fe, S and Mn content, whereas impurities in calcite marble seem to mainly be of detrital origin, reflecting co-settled volcaniclastic and siliciclastic material in the limestone precursors. Mainly the bright calcite marble varieties are of potential industrial quality and are present in Garpenberg in significant volumes, but the technoeconomic feasibility of by-product valorization requires further analysis.

A health economic evaluation of the multinational, randomized controlled CONVINCE trial - cost-utility of high-dose online hemodiafiltration compared to high-flux hemodialysis.

High-flux hemodialysis (HD) and high-dose hemodiafiltration (HDF) are established treatments for patients with kidney failure. Since HDF has been associated with improved survival rates compared to HD, we evaluated the cost-effectiveness of HDF compared to HD. Cost-utility analyses were performed from a societal perspective alongside the multinational randomized controlled CONVINCE trial. A Markov cohort model was used to extrapolate results to a lifetime time horizon. Costs of dialysis sessions were based on published data, with two scenarios reflecting different estimates for costs of dialysis staff. Other healthcare resource use, productivity losses and quality of life were collected in the electronic case report form or by country-adapted, self-reported questionnaires. Scenario and probabilistic sensitivity analyses were performed. In the two-year trial-based analysis, HDF was associated with higher quality-adjusted life years (QALYs) and higher costs, with incremental costs per QALY (ICER) of €31,898 and €37,344, depending on dialysis staff costs. The lifetime Markov cohort model resulted in ICERs of €27,068 and €36,751. Compared to HD, HDF resulted in an additional year in perfect health at increased costs. Sensitivity analyses of the lifetime analyses showed the probability of cost-effectiveness was more than 90% at willingness-to-pay threshold of €50,000/QALY. The ICER was €13,231 when excluding all costs in additional life years. The probability of cost-effectiveness was mainly driven by costs due to additional dialysis sessions in life years gained, and not due to additional costs per dialysis session. As costs may differ between countries and centers, we recommend translating our results to local settings.

Assessment of walnut (Juglans regia L.) cultivation land suitability using a multiple-criteria decision-making method in Southeastern Turkey

Site selection for agricultural products is critical for agricultural planning, productivity, and farmers. Site selection is also critical for agricultural sustainability, as it helps ensure the efficient use of natural resources and avoids environmental degradation. This research proposes an evaluation model for walnut cultivation in the Savur (Mardin, Turkey) district in the Southeastern Anatolia region. Based on literature data, expert opinion, and local walnut producers’ perspectives, a spatial decision support system was developed using Geographic Information System (GIS)-based Multi-Criteria Decision Analysis (MCDA). This model provides farmers and stakeholders with a comprehensive evaluation of the different walnut-producing sites in the Savur district. It allows them to make informed decisions about the most suitable areas for walnut production. The land suitability assessment for walnut orchards included four primary evaluation aspects, ten main criteria, and forty-seven sub-criteria. Evaluation criteria were weighted using the Analytic Hierarchy Process (AHP). A land suitability map was created using the weighted overlay method in overlap with the evaluation criteria. The results showed 442.56 ha of very highly suitable land, 9789.43 ha of highly suitable land, and 1140.76 ha of moderately suitable land in the Savur district. In order to determine the accuracy of the study model, ROC (Receiver Operating Characteristic) analysis was conducted. As a result of the validation analysis, the constructed model had an Area Under the Curve (AUC) of 0.911, which indicates an excellent fit between the model and reality; therefore, the model is acceptable. This study demonstrates that integrating AHP and GIS can aid agricultural land use planning and decision-making.

The impact of palliative care contact on the use of hospital resources at the end of life for brain tumor patients; a nationwide register-based cohort study.

The aim of this nationwide retrospective cohort study was to evaluate the timing of the first specialist palliative care (SPC) contact and its impact on the use of hospital resources at the end of life in patients with brain tumors. The analysis comprised 373 brain tumor patients who died during 2019 in Finland. Patients were divided into two groups according to the time of first SPC contact: early, i.e. first SPC contact more than 30 days before death, and late, i.e. no SPC contact or 30 days or less before death. 216 (58%) were male, with a mean age of 67 years (range 18-94). SPC contact was established for 102 (27%) patients and the median time of first SPC contact before death was 76 days. Patients with an early SPC contact had fewer outpatient clinic contacts (28% vs. 53%; p-value < 0.001) and fewer hospitalization (10% vs. 37%; p-value < 0.001) in secondary care compared with patients with late SPC contact. Early SPC contact had no impact on emergency department contacts. Patients with early SPC contact were more likely to die at long term care facility or in SPC wards instead of hospital (p-value < 0.001) compared to patients with late SPC contact (hospital deaths 51% vs. 80%, respectively). Early SPC contact reduced the burden on secondary care for brain tumor patients in the last months of life. Palliative care contact should be offered early to all brain tumor patients.

Exploitation of the Nutraceutical Potential of the Infesting Seaweed Chaetomorpha linum as a Yellow Mealworms' Feed: Focus on Nutrients and Antioxidant Activity.

According to the Sustainable Blue Economy Communication, the Farm to Fork Strategy, and the European Green Deal, novel business models supporting the use of resources from oceans and seas are of primary importance. Interestingly, several infesting seaweeds are consumed as foods in Asia and are fundamental ingredients in several traditional dishes. Herein, according to the circular economy approach, we investigate the use of Chaetomorpha linum (CL) as a Tenebrio molitor larvae feed in different percentages: 20%, 50%, and 100%, respectively. We analyzed the effects of CL on the survival and biometric parameters of larvae. The survival rate remained comparable to the control, while the mean weight was inversely proportional to the CL%. The nutrient composition was substantially different from the control, showing increased protein and reduced fat content. Analysis of the secondary metabolites revealed a better fatty acid composition, rich in PUFA, with lipid nutritional indexes comparable to seaweeds and crabs. The simulated gastrointestinal digestion highlights the increased content of essential amino acids, and a two times higher antioxidant activity with respect to the control. Taken together, our results confirm that CL can be used as a TML supplement, with beneficial effects in protein content and fat quality.

Composition and antioxidant activity of flavonoids from two different species of Amomi Fructus extracted using natural deep eutectic solvents.

Amomi Fructus, a mature fruit from a ginger family plant, has various species, resulting in inconsistent sourcing and quality. Most studies distinguish species by volatile compounds, yet research shows it also contains flavonoids with notable pharmacological effects. Solely focusing on volatile compounds could lead to considerable resource waste. This study aims to establish flavonoid markers in Amomi Fructus to distinguish its species, assess quality, and promote efficient resource use. Utilizing natural deep eutectic solvents (NADES) and response surface methodology (RSM), an optimal extraction system (choline chloride-ethylene glycol) yielded 41.38mg RE/g total flavonoids. LC-MS analysis of 18 Amomi Fructus batches identified 26 flavonoids, quantified 19, and highlighted three key markers-epicatechin, procyanidin B2, and procyanidin B4-that effectively differentiate Amomum villosum Lour. (AMV) from Amomum villosum Lour. var. xanthioides T.L. Wu et Senjen (AMVX). Finally, flow cytometry confirmed these markers' antioxidant activity, effectively reducing H₂O₂-induced oxidative damage in GES-1 cells.

A Dynamic Evaluation of the Use of Natural Resources in Crop Rotation in Family Farming Production Units

A Dynamic Evaluation of the Use of Natural Resources in Crop Rotation in Family Farming Production Units

Optimal use of limited proton resources for liver cancer patients in combined proton–photon treatments

Objective. Liver cancer patients may benefit from proton therapy through increase of the tumor control probability (TCP). However, proton therapy is a limited resource and may not be available for all patients. We consider combined proton-photon liver SBRT treatments (CPPT) where only some fractions are delivered with protons. It is investigated how limited proton fractions can be used best for individual patients and optimally allocated within a patient group.Approach. Photon and proton treatment plans were created for five liver cancer patients. In CPPT, limited proton fractions may be optimally exploited by increasing the fraction dose compared to the photon fraction dose. To determine a patient's optimal proton and photon fraction doses, we maximize the target biologically effective dose (BED) while constraining the mean normal liver BED, which leads to an up- or downscaling of the proton and photon plan, respectively. The resulting CPPT balances the benefits of fractionation in the normal liver versus exploiting the superior proton dose distributions. After converting the target BED to TCP, the optimal number of proton fractions per patient is determined by maximizing the overall TCP of the patient group.Main results. For the individual patient, a CPPT treatment that delivers a higher fraction dose with protons than photons allows for dose escalation in the target compared to delivering the same proton and photon fraction dose. On the level of a patient group, CPPT may allow to distribute limited proton slots over several patients. Through an optimal use and allocation of proton fractions, CPPT may increase the average patient group TCP compared to a proton patient selection strategy where patients receive single-modality proton or photon treatments.Significance. Limited proton resources can be optimally exploited via CPPT by increasing the target dose in proton fractions and allocating available proton slots to patients with the highest TCP increase.

Digital happiness in tourism: towards a conceptual framework

ABSTRACT This research note scrutinises the ambivalent dimensions of digital technology within the realm of tourism, highlighting its complex interaction with physical engagement. By exploring existing literature on the evolving landscape of tourism experiences through an interdisciplinary approach, this paper recognises that the current analysis of digital technology use in tourism often remains biased and narrow. Furthermore, despite ongoing debates surrounding digital well-being, discussions have been largely restricted to the utility, emotional use, and moderation of digital resources. Drawing on philosophical insights from the Chinese classic I-Ching, which offers a holistic understanding of happiness in the contemporary digital era and the tourism domain, this research provides a comprehensive theoretical blueprint for digital happiness in tourism. This robust framework aims to elucidate the harmonious integration of digital elements into the tourism landscape.

Review of sustainable temporary housing and reuse strategy for post-disaster architectures: current trends and strategic gaps

Sustainable temporary architecture after a disaster includes temporary buildings designed to meet the emergency housing needs of disaster victims. This approach minimizes the use of waste and natural resources, reduces the environmental impact, and assumes an important responsibility to maintain the long-term ecological balance. Within the scope of this research, comprehensive and systematic results are presented by analyzing disaster issues with the “reuse” strategy, which has started to be frequently encountered in the current literature. The studies were scanned in the Web of Science and Scopus databases under the heading “Title//Keywords,” and the data were analyzed in detail. The findings indicate research trends in the literature and gaps for future research. The results highlight the innovative approach for sustainable post-disaster temporary architecture in the context of reuse strategies and present the field’s challenges, limitations, and opportunities. This study is expected to help researchers, practitioners, experts, and politicians understand the evolutionary implications of disaster reuse strategies and develop other theoretical and practical initiatives that can be applied in this field.

Microcontaminants and microplastics in water from the textile sector: a review and a database of physicochemical properties, use in the textile process, and ecotoxicity data for detected chemicals.

Microcontaminants (MCs) and microplastics (MPs) originating from the textile sector are today receiving a great deal of attention due to potential environmental concerns. Environmental pressures and impacts related to the textile system include not only the use of resources (e.g., water) but also the release of a wide variety of pollutants. This review's main objective is to highlight the presence of textile MCs and MPs in water, in their full path from textile factories (from raw materials to the final product) to wastewater treatment plants (WWTPs), and finally to the receiving surface waters. Their environmental fate and ecotoxicity were also addressed. Overall, more than 500 compounds were found, many of which are so called "contaminants of environmental concern" such as per- and polyfluoroalkyl substances (PFAS) and alkylphenol compounds. A database of physicochemical properties, ecotoxicity, and place of detection (specific textile process, WWTP, surface water or sediment) (classification by several international agencies) was compiled for the chemical detected. Preliminary risk assessment was conducted for those MCs for which the reported environmental concentrations exceeded the Predicted No Effect Concentration (PNEC). These chemicals were some nonylphenols, nonylphenol ethoxylates and organophosphate esters. Among MPs, polyester and nylon fibres were the most abundant. The highest concentration of MPs was reported in sludge (about 1.4 × 106 MPs per kg) compared to wastewater and surface water which showed MP concentrations at least two orders of magnitude lower. The role of transboundary contamination due to the release of chemicals from imported textile products was also assessed.

Real-world ePRO use and clinical outcomes using electronic patient-reported symptom monitoring for patients with advanced non-small-cell lung cancer receiving first-line pembrolizumab.

Aim: This ambispective observational study assessed the impact of Noona, an electronic patient-reported outcomes (ePRO) platform, for patients with non-small cell lung cancer (NSCLC) treated in a community oncology setting. Methods: Adults with advanced NSCLC, ECOG performance status of 0-2, who received first-line (1L) pembrolizumab (monotherapy or with chemotherapy) were eligible. Those initiating pembrolizumab from 1 July 2017 to 30 June 2019, identified retrospectively (historical cohort), were compared with those initiating pembrolizumab from 1 October 2019 to 30 September 2021 who were prospectively offered Noona (standard of care [SoC] cohort). The Kaplan-Meier method and Cox proportional hazards models were used to compare pembrolizumab real-world time on treatment (rwToT; primary outcome measure) and rw time to next treatment or death (rwTTNTD) between historical and SoC cohorts. Healthcare resource use (HCRU) was compared using generalized linear models with Poisson distribution. Analyses were repeated to compare outcomes in the SoC cohort between Noona users (created a profile and used any function ≥one-time during 1L therapy) and nonusers with >42days on 1L pembrolizumab. Data cutoff was 30 June 2020 and 30 September 2022 for historical and SoC cohorts, respectively. Results: Median pembrolizumab rwToT was 4.4months (95% CI: 3.9-5.1) in the historical cohort (n=448) versus 4.1months (95% CI: 3.3-4.8) in the SoC cohort (n=462; adjusted hazard ratio [aHR], 0.9; 95% CI: 0.8-1.0; p=0.14 vs historical cohort). In the SoC cohort, 147 of 341 eligible patients (43%) established a Noona profile; 122/341 (36%) were Noona users. Median rwToT was 6.4months (95% CI: 5.1-7.4) and 6.9months (95% CI: 5.6-7.6) among Noona users and Noona nonusers (n=219), respectively (aHR, 1.1; 95% CI: 0.8-1.4; p=0.95 vs Noona users). The rwTTNTD and HCRU were comparable in historical versus SoC cohorts and for Noona users versus nonusers. During the first year after establishing a Noona profile, 92 of 147 patients (63%) used the platform; monthly use was 32-42%, and checking laboratory results was the most used function overall (by 52% of the 147). Conclusion: Notwithstanding the null findings of this study, positive results of ePRO use in clinical trials and observational studies support the treatment-related symptom monitoring and survival benefits of ePRO utilization.

Optimizing Early Growth of Laminaria hyperborea in Controlled Settings: A Pathway to Improved Restoration Efforts

Laminaria hyperborea, a key species in marine forest ecosystems, is experiencing pressure at its southern distribution limit in northern Portugal due to climate change and human-induced stressors. The ongoing degradation of marine forests highlights the need for effective restoration strategies to protect biodiversity and maintain the essential services provided by these habitats. Cultivation of juvenile kelps in laboratory settings is a common approach shared across multiple strategies aimed at supporting reforestation efforts; however, the specific cultivation process for L. hyperborea remains largely underexplored. In this study, we tested two seeding densities to optimize the production of L. hyperborea recruits for reforestation initiatives. We assessed the effects of seeding density on juvenile development by measuring both area coverage and length. Our findings revealed that higher seeding density initially promoted greater area coverage (e.g., 8.69 ± 0.38 cm2 vs. 3.35 ± 0.27 cm2) but reduced the length of individual recruits over time (e.g., 0.26 ± 0.0026 cm vs. 0.39 ± 0.003 cm at T3). This suggests that increased competition for resources at high densities limits individual growth. In contrast, lower densities produced larger, more robust individuals (e.g., 0.50 ± 0.004 cm vs. 0.262 ± 0.003 cm at T4), which may enhance post-transplantation survival in challenging environmental conditions. This suggests that utilizing lower seeding densities may improve individual growth while decreasing overall resource use and maintenance needs, promoting a more sustainable cultivation process and minimizing impacts on donor populations. However, further research is essential to refine the cultivation protocols and fully understand the variables influencing juvenile kelp development. Improving all phases of the restoration process, from laboratory cultivation to field deployment, will be critical for reducing costs, streamlining logistics, and ensuring the scalability of future kelp restoration efforts.

Resources Use Efficiency and Resources Utilization Efficiency of Major Crops in North Gujarat, India

Resources Use Efficiency and Resources Utilization Efficiency of Major Crops in North Gujarat, India

Effectiveness of a co-management program with internal medicine on hip fracture patients at a regional hospital in northwest Spain. Co-inter-Monf study.

Hip fractures represent a serious public health problem with a high burden of mortality, morbidity, and resource use. Co-management has proven to enhance the clinical outcomes of hip fracture patients hospitalized in various settings. This study aims to evaluate whether the previously observed benefits of co-management can be achieved when such a program is implemented in a rural-based district hospital. A prospective, single-center observational study was conducted on hip fracture patients hospitalized for hip fracture. Patients were either co-managed by an internal medicine specialist with part-time dedication or not co-managed. The study was conducted in a rural hospital located in Galicia, Northwestern Spain, which serves a population of 45,000. A total of 207 patients were included in the study, of whom 97 received co-management. The majority of the patients who were co-managed were female (69.1%) and had a median age of 88years (interquartile range 83-92). The study showed a high burden of comorbidity with a median Charlson index of 6 points, along with high prevalence rates of dementia (46%), functional disability (50%), and chronic anticoagulant therapy (25%). Despite no differences in age, sex, or preadmission cognitive or functional status, the study found lower 30-day postdischarge mortality in co-managed patients (9.3%) compared with the 110 controls (20.0%, p = 0.049). The prevalence of osteoporosis treatment, both calcium/vitamin D (87.8% vs. 60.7%, p < 0.001) and bisphosphonates/denosumab/teriparatide (42.4% vs. 15.7%, p < 0.001), was higher in the co-managed patients at 30days after discharge. No differences were observed between the two groups in terms of in-hospital mortality and length of stay. The implementation of internal medicine co-management for hip fracture patients resulted in enhanced outcomes, particularly in the reduction of mortality within 30days of discharge as well as in the prevalence of osteoporosis treatment.

EP72 Assessing the Utility of Abdominal X-Rays in Emergency Settings: Are They Adding Value?

Abstract Background The clinical value of abdominal X-rays (AXRs) in emergency departments (EDs) is debated, particularly with the availability of advanced imaging modalities like ultrasound (US) and computed tomography (CT). Despite the 2016 Royal College of Radiologists (RCR) guidelines limiting AXR use to specific indications, concerns about their overuse persist. Methods A retrospective observational study was conducted from January 1st to March 31st, 2023, in a London district general hospital. We evaluated 473 patients who underwent AXRs, examining compliance with RCR guidelines, clinical indications, AXR findings, follow-up imaging, and referrals to General Surgery. Pearson’s chi-squared test was used for statistical analysis, with significance set at p &amp;lt; 0.05. Results 81.6% of AXRs met RCR guidelines, primarily for suspected bowel obstruction; however, only 11.4% of patients had all three key symptoms (abdominal pain, vomiting, failure to open bowels). Follow-up imaging was performed in 37.6% of cases, mainly CT scans. Abnormal findings were noted in 15% of AXRs, but 63.4% of these required additional imaging. Significant associations were found between abnormal AXRs and General Surgery referrals, as well as between referrals and subsequent CT scans. Conclusions AXRs are frequently overused in the ED, with limited diagnostic value. Even when AXRs identify abnormalities, CT follow-up is often required, suggesting AXRs may not significantly alter management. Reconsidering the role of AXRs in ED practice and promoting advanced imaging modalities could enhance diagnostic efficiency and reduce unnecessary resource use.