Search Results (247)

Purpose: To effectively reduce cancer burden, genetic testing programs should identify high-risk individuals prior to cancer development, when risk-reduction strategies can be implemented. We evaluated trends in BRCA1/BRCA2 testing use after implementation of a publicly funded testing program. Methods: We conducted a retrospective, near population-based study of women who underwent BRCA1/BRCA2 testing in Ontario, Canada, (2007–2016) (n = 15,986). Temporal trends were evaluated using linear and Poisson regression. Results: Although annual utilization of testing increased over time (p < 0.001), mean age at testing increased from 49.9 years (SD 13.8) in 2007 to 53.8 years (SD 13.7) in 2016 (p < 0.001). The proportion of women with a cancer history at testing also increased from 53.5% in 2007 to 66.3% in 2015 (p < 0.001); the proportion of women free from breast cancer did not change significantly (49.2% in 2007 versus 45.1% in 2015, p = 0.90). As a proportion of all tested, those with breast cancer tested within 3 months of diagnosis increased over time (0.39% of tests in 2007 versus 13.6% of tests in 2015; p < 0.001). Conclusions: While the institution of a publicly funded genetic testing program was associated with rising utilization, increasing age at testing and decreasing testing of unaffected women suggest limitations in identifying high-risk individuals eligible for risk-reduction. Full article

This paper explores the effectiveness of an innovative FinTech risk-scoring model to predict the risk-appropriate return for short-term credit sales. The risk score serves to mitigate the information asymmetry between the seller of receivables (“Seller”) and the purchaser (“Funder”), at the same time providing an opportunity for the Funder to earn returns as well as to diversify its portfolio on a risk-appropriate basis. Selling receivables/credit to potential Funders at a risk-appropriate discount also helps Sellers to maintain their short-term financial liquidity and provide the necessary cash flow for operations and other immediate financial needs. We use 18,304 short-term credit-sale transactions between 23 April 2020 and 30 September 2022 from the private FinTech startup Crowdz and its Sustainability, Underwriting, Risk & Financial (SURF) risk-scoring system to analyze the risk/return relationship. The data includes risk scores for both Sellers of receivables (e.g., invoices) along with the Obligors (firms purchasing goods and services from the Seller) on those receivables and provides, as outputs, the mutual gains by the Sellers and the financial institutions or other investors funding the receivables (i.e., the Funders). Our analysis shows that the SURF Score is instrumental in mitigating the information asymmetry between the Sellers and the Funders and provides risk-appropriate periodic returns to the Funders across industries. A comparative analysis shows that the use of SURF technology generates higher risk-appropriate annualized internal rates of return (IRR) as compared to nonuse of the SURF Score risk-scoring system in these transactions. While Sellers and Funders enter into a win-win relationship (in the absence of a default), Sellers of credit instruments are not often scored based on the potential diversification by industry classification. Crowdz’s SURF technology does so and provides Funders with diversification opportunities through numerous invoices of differing amounts and SURF Scores in a wide range of industries. The analysis also shows that Sellers generally have lower financing stability as compared to the Obligors (payers on receivables), a fact captured in the SURF Scores. Full article

In November 2024, the fourth annual Symposium focusing on early-age onset cancer (EAOC) was hosted by the Colorectal Cancer Resource & Action Network (CCRAN), assembling clinicians, researchers, and patients virtually to discuss challenges in early detection and diagnosis of individuals afflicted with EAOC across tumour types. The meeting addressed the rising rates of EAOC and identified strategies to overcome barriers to timely detection and diagnosis by closing gaps in public and healthcare provider knowledge on symptoms of cancer in younger adults and reducing inequities in standard screening for younger age groups. Discussions also encompassed the various factors that serve as impediments to accessing diagnostic testing and obtaining results, as well as the critical need for access to diagnostics such as comprehensive genomic profiling (CGP), the results of which could be imperative in helping to guide clinical decisions regarding effective and well-tolerated targeted therapies. The Symposium generated key calls to action regarding increasing EAOC education and awareness among primary care providers and the public, re-evaluation of cancer screening programs’ eligibility criteria to include younger populations, and mechanisms to reduce waiting times for diagnostic testing by addressing technologist shortages and improving access to CGP through national collaborative strategies and increased funding. Full article

Objectives: This study evaluates the economic impact of digital health interventions (DHIs) developed under the HosmartAI EU-funded program, focusing on obstetrics, cardiology, and gastroenterology. Methods: A Cost Consequence Analysis (CCA) was chosen in order to be able to examine the costs and consequences of AI technologies in early diagnosis of preterm births, echocardiography, coronary computed tomography angiography (CCTA), and capsule endoscopy (CE). Results: The results show that in obstetrics and CCTA, the AI technologies are cost-saving, with the AI-based preterm birth detection leading to savings of 99,840 EUR due to reduced severity of prematurity. In the echocardiography scenario, the new AI technology slightly increased costs (9409 vs. 2116 EUR), but offered benefits in diagnostic accuracy and shorter interpretation duration, particularly for less experienced physicians. Similarly, the capsule endoscopy AI technology raised annual costs by 6626 EUR but improved productivity, accuracy, and user satisfaction. Conclusions: The findings emphasize the need for standardized frameworks to guide economic evaluations of DHIs, ensuring informed healthcare investment and reimbursement decisions in the future. Full article

Non-point source (NPS) pollution continues to pose threats to ecosystems and NPS pollution control represents a significant global challenge. This study presents a bibliometric analysis of 1328 studies on the assessment of NPS pollution control, collected from the Web of Science (WOS) Core Collection database for the period between January 1993 and April 2025. The analysis encompassed multiple dimensions, including annual publication volume, most prolific authors and journals, top funding organizations, and keyword co-occurrence. Results reveal a consistently accelerating publication trend, with China and the United States emerging as the most prominent contributors. The findings highlight a distinct evolution in research focus—from early efforts centered on pollutant source tracing and model-based simulations of best management practices (BMPs), such as SWAT and AnnAGNPS, to more holistic, multidimensional assessments that integrate economic, environmental, ecological, and social dimensions to support multi-objective optimization. Future directions are expected to emphasize non-structural measures and promote the development of globally standardized evaluation frameworks for NPS control strategies, thereby enhancing cross-regional comparability and aligning with the United Nations Sustainable Development Goals (UNSDGs). Full article

Tropical peatlands store approximately 105 gigatons of carbon (GtC), serving as vital long-term carbon sinks, yet remain critically underrepresented in climate policy. Indonesia peatlands contain 57GtC—the largest tropical peatland carbon stock in the Asia–Pacific. However, decades of drainage, fires, and lax enforcement practices have degraded vast peatland areas, turning them from carbon sinks into emission sources—as evidenced by the 1997 and 2015 peatland fires which emitted 2.57 Gt CO₂eq and 1.75 Gt CO₂eq, respectively. Using system theory validated against historical data (1997–2023), we develop a causal loop model revealing three interconnected feedback loops driving irreversible collapse: (1) drainage–desiccation–oxidation, where water table below −40 cm triggers peat oxidation (2–5 cm subsistence) and fires; (2) fire–climate–permafrost, wherein emissions intensify radiative forcing, destabilizing monsoons and accelerating Arctic permafrost thaw (+15% since 2000); and (2) economy–governance failure, perpetuated by palm oil’s economic dominance and slack regulatory oversight. To break these vicious cycles, we propose a precautionary framework featuring IoT-enforced water table (≤40 cm), reducing emissions by 34%, legally protected “Global Climate Stabilization Zones” for peat domes (>3 m depth), safeguarding 57 GtC, and ASEAN transboundary enforcement funded by a 1–3% palm oil levy. Without intervention, annual emissions may reach 2.869 GtCO₂e by 2030 (Nationally Determined Contribution’s business-as-usual scenario). Conversely, rewetting 590 km²/year aligns with Indonesia’s FOLU Net Sink 2030 target (−140 Mt CO₂e) and mitigates 1.4–1.6 MtCO₂ annually. We conclude that integrating peatlands as irreplaceable climate infrastructure into global policy is essential for achieving Paris Agreement goals and SDGs 13–15. Full article

This study examines the feasibility of implementing circles of support for persons with disabilities within social service centers in Poland as a systemic solution promoting community-based support. The research follows the action research approach, combining theory and practice through participant involvement, reflection, cooperation, and change-oriented actions to address analyzed problems. The authors developed and tested the model in two diverse municipalities, analyzing legal, financial, and organizational dimensions. Results demonstrate that circles of support are legally feasible and financially sustainable, with approximate annual costs per participant comparable across different organizational models. Main challenges include limited funding and staff, especially in rural areas. Despite this, the model supports deinstitutionalization and can improve social inclusion, independence, and quality of life for people with disabilities. The study highlights the need for stable funding, thorough staff training, and coordination of formal and informal support, offering practical recommendations for scaling up such services in Poland. Full article

Capital investment in longevity science—research targeting the biological processes of aging through interventions like cellular reprogramming, AI-driven drug discovery, and biological age monitoring—may create significant divergence between traditional actuarial projections and emerging mortality improvements. This paper examines how accelerating investment in life extension technologies affects mortality improvement trajectories beyond conventional actuarial assumptions, building on the comprehensive investment landscape analysis documented in “Investors in Longevity” supported by venture capital databases, industry reports, and regulatory filings. We introduce an Investment-Adjusted Mortality Model (IAMM) that incorporates capital allocation trends as leading indicators of mortality improvement acceleration. Under high-investment scenarios (annual funding of USD 15+ billion in longevity technologies), current insurance products may significantly underestimate longevity risk, creating potential solvency challenges. Our statistical analysis demonstrates that investment-driven mortality improvements—actual reductions in death rates resulting from new anti-aging interventions—could exceed traditional projections by 18–31% by 2040. We validate our model by backtesting historical data, showing improved predictive performance (35% reduction in MAPE) compared to traditional Lee–Carter approaches during periods of significant medical technology advancement. Based on these findings, we propose modified insurance structures, including dynamic mortality-linked products and biological age underwriting, quantifying their effectiveness in reducing longevity risk exposure by 42–67%. These results suggest the need for actuarial science to incorporate investment dynamics in response to the changing longevity investment environment detailed in “Investors in Longevity”. The framework presented provides both theoretically grounded and empirically tested tools for incorporating investment dynamics into mortality projections and insurance product design, addressing gaps in current risk management approaches for long-term mortality exposure. Full article

The Greek islands have been blessed with excellent wind potential, with hundreds of sites featuring annual average wind velocity higher than 8–10 m/s. Due to specific regulations in the legal framework, some GWs of wind parks have been submitted since the late 2000s by a small number of large investors in the Greek islands, favoring the creation of energy monopolies and imposing serious impacts on natural ecosystems and existing human activities. These projects have caused serious public reactions against renewables, considerably decelerating the energy transition. This article aims to summarize the legal points in the Greek framework that caused this distorted approach and present the imposed potential social and environmental impacts. Energy monopolies distort the electricity wholesale market and lead to energy poverty and a low standard of living by imposing higher electricity procurement prices on the final users. The occupation of entire insular geographical territories by large wind park projects causes important deterioration of the natural environment, which, in turn, leads to loss of local occupations, urbanization, and migration by affecting negatively the countryside life. Serious concerns from the local population are clearly revealed through an accomplished statistical survey as well as a clear intention to be engaged in future wind park projects initiated by local stakeholders. The article is integrated with specific proposed measures and actions toward the rational development of renewable energy projects. These refer mainly on the formulation of a truly supportive and just legal framework aiming at remedying the currently formulated situation and the strengthening of the energy communities’ role, such as through licensing priorities, funding mechanisms, and tools, as well as additional initiatives such as capacity-building activities, pilot projects, and extensive activation of local citizens. Energy communities and local stakeholders should be involved in the overall process, from the planning to the construction and operation phase. Full article

Tropical pasture degradation represents a major challenge for global food security and environmental conservation, particularly in Brazil, where up to 60% of pastures are degraded. This study evaluates the economic viability of recovery of degraded pastures using an integrated crop–livestock–forest (ICLF) system. A representative 2-hectare system in the Brazilian Cerrado was analyzed, featuring native Dipteryx alata trees interplanted with pasture for cattle grazing. A deterministic financial model was developed to simulate annual cash flows over a 20-year period under various financing scenarios, including self-financing and multiple subsidized rural credit lines (e.g., Pronaf and Pronamp programs, and ABC Ambiental). The analysis shows that subsidized credit lines with low interest rates and extended grace periods significantly improve project profitability, yielding positive NPVs and robust internal rates of return, while self-financing and high-cost credit options (such as Pronaf Mulher) result in negative NPVs. The dual cash flow strategy—where borrowed funds are immediately invested in secure fixed-income instruments—further enhances economic performance. The findings demonstrate that ICLF-based pasture recovery is economically viable when supported by appropriate financing, offering a scalable model for sustainable agriculture that delivers both economic and environmental benefits. Full article

Addressing the urgent need for sustainable energy transitions in rural development while achieving the dual carbon goals, this study focuses on resolving critical challenges in agricultural photovoltaic (PV) applications, including land-use conflicts, compound energy demands (electricity, heating, cooling), and financial constraints among farmers. To tackle these issues, a dual-mode cost–benefit analysis framework was developed, integrating two distinct investment models: self-invested construction (SIC), where farmers independently finance and manage the system, and energy performance contracting (EPC), where third-party investors fund infrastructure through shared energy-saving or revenue agreements. Then, an integrated photovoltaic-storage agricultural greenhouse (PSAG) microgrid optimization model is established, synergizing renewable energy generation, battery storage, and demand-side management while incorporating operational mode selection. The proposed model is validated through a real-world case study of a village agricultural greenhouse in Gannan, China, characterized by typical rural energy profiles and climatic conditions. Simulation results demonstrate that the optimal system configuration requires 27.91 kWh energy storage capacity and 18.67 kW peak output, with annualized post-depreciation costs of 81,083.69 yuan (SIC) and 74,216.22 yuan (EPC). The key findings reveal that energy storage integration reduces operational costs by 8.5% compared to non-storage scenarios, with the EPC model achieving 9.3% greater cost-effectiveness than SIC through shared-investment mechanisms. The findings suggest that incorporating an energy storage system reduces costs for farmers, with the EPC model offering greater cost savings. Full article

The intelligent connected vehicle (ICV) industry encounters substantial challenges related to technology, policies, and funding. Its development relies not only on the close collaboration and technological innovation between carmakers and technology companies but also on the support of government’s incentive policies. Therefore, this paper establishes a tripartite evolutionary game model that involves governments, carmakers, and technology companies to investigate the stability equilibrium strategy of multi-party participation in promoting the development of the ICV industry. In addition, by analyzing relevant regulations and company annual reports, this paper conducts a simulation analysis to examine how government incentive policies and benefit distribution mechanisms impact the evolutionary trajectory. Several insightful and practical conclusions are drawn. First, in the early stages of industrial development, the government’s infrastructure investment could promote the cross-border innovation cooperation between carmakers and technology companies, thereby accelerating the advancement of ICVs; however, the long-term impact of the sustained investment remains limited. Second, the incremental government subsidies for carmakers and technology companies within limits could increase the probability of them choosing to cooperate and innovate with each other. Still, the excessive subsidies could result in unstable industry growth. Finally, the increase in the benefit distribution ratio for carmakers with professional technology in automotive technology and vehicle design has a positive effect on the development of the ICV industry. This paper expands the research scope of ICVs and provides theoretical insights for promoting the sustainable development of the ICV industry from policy and market viewpoints. Full article

Human papillomavirus (HPV) infection remains a critical public health challenge in China, particularly in Guangdong Province, where HPV-52, 16, and 58 genotypes predominate, and male infection rates exceed 40%. Despite the successful implementation of a government-funded school-based program that has achieved 88% HPV vaccine coverage among adolescent girls, several persistent barriers, including genotype mismatch (the free HPV vaccine covers < 50% of high-risk local strains), regional disparities (80% vs. 60% for first-dose coverage), and exclusion of males, thwart progress toward herd immunity. Financial sustainability risks pose an even more significant threat to the expansion of HPV vaccination programs, especially in Guangdong province where annual expenditures exceed CNY 200 million. This review delves into Guangdong’s pioneering efforts and proposes practical solutions: accelerating domestic multivalent HPV vaccine development, adopting gender-neutral vaccination policies, and leveraging mobile clinics for remote populations. These strategies not only provide a roadmap for China but also serve as valuable insight for other LMICs striving to overcome HPV-related inequalities. Full article

This article presents the first discussion of a musicologist’s work as a member of the commission appointed by the Serbian Ministry of Culture to select cultural projects in the field of contemporary music creation and performance for annual funding. The analysis draws from the disciplines of applied musicology and autoethnography. My appointment at the Serbian Ministry of Culture lasted five years, from 2018 to 2022, during which I observed first-hand the inner workings of the Serbian cultural scene and associated policies; more importantly, I utilized my musicological expertise to influence the very same cultural scene. The article also presents the legislative and practical challenges of working in a country that allocates less than 1% of its annual budget for culture. Full article

Background: Globally, pneumonia claims the lives of about 700,000 children under the age of 5 every year. Pneumococcal conjugate vaccine (PCV) was introduced in India phase-wise, beginning in high-burden states, and the rollout was completed nationwide by 2021—representing a major initiative by the Ministry of Health and Family Welfare (MoHFW). Despite the challenges posed by the COVID-19 pandemic, the campaign succeeded in maintaining progress and achieving nationwide coverage. This narrative review highlights the significant decisions, processes, and coordinated efforts of the various stakeholders involved that led to this successful PCV rollout. Methodology: A comprehensive desk review of both published and unpublished literature relevant to pneumonia burden and the efficacy and effectiveness of PCVs, along with documentation of PCV introduction and the scale-up was carried out. Results: The documentation of the PCV journey has been broken down into four sections: pre-introduction, PCV Phase-I introduction, pan-India rapid expansion, and the period post-introduction. Since the nationwide rollout in 2021, PCV coverage in India has steadily increased, reflecting successful immunization efforts. WUENIC, which is an annual WHO, and UNICEF estimates of national immunization coverage also show a positive trend in vaccination coverage (PCV booster coverage = 25% (2021), rising to 83% (2023), aligning with the goals of the WHO and UNICEF’s Global Action Plan for the Prevention and Control of Pneumonia and Diarrhoea (GAPPD). Conclusions: The phased rollout was an ambitious effort by the MoHFW, which was particularly challenging given the overlap with the COVID-19 pandemic. Despite these hurdles, the MoHFW, along with strong collaboration from development partners and stakeholders, successfully navigated the complex rollout. Future studies on the role of PCVs in reducing antibiotic resistance and the economic benefits of PCV introduction could help policymakers sustain funding and prioritize vaccine procurement decisions. Full article