Search Results (1,087)

Background/Objectives: To analyze the financial impact of the ERAS program in two major surgical procedures (colon resection for cancer and hip replacement) in two second-level healthcare centers. Methods: A cost–benefit analysis was carried out on four hypothetical scenarios, based on the rate of compliance with the ERAS program, focusing on the additional costs and the additional benefits deriving from the decrease in hospital stay caused by the application of the ERAS protocol, with particular regard to the interventions envisaged by the National Waiting List Management Plan (PNGLA). Results: In the most optimistic scenario, with a coefficient of application of ERAS of 100% and a number of 800 days of hospitalization gained per year, the revenue–cost ratio was equal to 2.92. In the least favorable scenario, with a coefficient of application of ERAS of 50% and a number of 400 days of hospitalization gained per year, the revenue–cost ratio was equal to 1.11. Conclusions: In all the scenarios, the revenue–cost ratio was higher than 1. Implementation of the ERAS program is feasible also in second-level centers with the costs for additional healthcare professionals. Application of the ERAS program leads to a more sustainable health policy with an improvement in the number of treated patients per year and an advantage in the waiting list. Full article

Establishing a mechanism for ecological product value realizing (EPVR) is a critical component of China’s ecological civilization strategy, aimed at translating the concept that “lucid waters and lush mountains are invaluable assets” into actionable economic policies. Although central government investments in the form of project for EPVR have increased significantly, surpassing CNY 700 billion by 2024, studies rarely focus on these projects and how to evaluate them. Evaluating the performance of EPVR projects is essential for optimizing resource allocation, enhancing project accountability, and ensuring the sustainable realization of ecological, economic, and social values. This study innovatively defines the conceptual connotation of EPVR projects and constructs a comprehensive performance evaluation system based on a “benefit-cost” analysis, comprising a multi-dimensional indicator system, quantifiable calculation methods, and explicit evaluation criteria. As water source protection projects are typical EPVR projects, the comprehensive water environment management project of Hongfeng Lake is selected for an in-depth empirical study. The results reveal that (1) the total annual benefits amount to CNY 923.66 million, dominated by ecological benefits (84.04%); (2) with an investment of CNY 1194.66 million, the project yields a net loss and a moderate performance index (PCPI = 0.77); (3) the project performance is primarily affected by weak economic value conversion stemming from restrictive zoning policies and underdeveloped market mechanisms for ecological services; and (4) integrated development pathways—such as ecotourism, eco-aquaculture, and ecological branding—are proposed to enhance the long-term sustainability of the project. The Hongfeng Lake case establishes a replicable framework for global assessment of analogous projects and delivers actionable insights for enhancing benefit–cost ratios in public ecological initiatives, with costs confined to data collection, modeling, and validation. Therefore, this study contributes a quantifiable and reproducible tool for the full lifecycle management of EPVR projects, thereby facilitating more informed government decision-making. Key findings reveal the following: (1) A comprehensive “Benefit-Cost” performance evaluation framework, pioneered in this study and tailored specifically for individual EPVR projects, surpasses regional-scale accounting methodologies like Gross Ecosystem Product (GEP). (2) A novel consolidated metric (PCPI) is introduced to integrate ecological, economic, and social dimensions with cost input, thus enabling direct cross-project comparison and classification. (3) The framework operationalizes evaluation by providing a detailed, adaptable indicator system with explicit monetization methods for 26 distinct benefits, thereby bridging the gap between theoretical value accounting and practical project assessment. (4) The empirical application to a drinking water source protection project addresses a critical yet understudied category of EPVR projects, offering insights into “protection-oriented” models. Full article

Due to the development of the Internet of Things (IoT) and maritime wireless networks, the wireless networking of vessels will be the future trend. Furthermore, long-range (LoRa) technology is widely used in the marine field with the benefits of long range, lower power consumption, security, scalability, and robustness. In this study, LoRa is used as the solution for internal wireless networks of vessels as well as considering external and internal wireless communication, aiming to reduce construction and maintenance costs. The received signal strength (RSS) and signal to interference plus noise ratio (SINR) were measured and analyzed. The findings demonstrated that the mean value of the RSS and the SINR in the cockpit are above −81.70 dBm and 4.45 dB respectively, which indicates that there is a good communication link between the deck and the cockpit. Furthermore, the RSS value acquired by the nodes located on the same side of the gateway is stronger than that of the other nodes. Additionally, the RSS value acquired by the nodes close to the windows is found to be as high as 6–9 dB over that of the node located in the middle of the cockpit. Full article

Landslides rank among the most frequent and devastating natural hazards globally, causing significant loss of life and property. As a result, landslide susceptibility assessment has become a central focus in geohazard research, which is devoted to preventing and alleviating the frequent occurrence of landslides. Numerous analytical models have been applied to evaluate landslide susceptibility, including Frequency Ratio (FR), Logistic Regression (LR), Support Vector Machine (SVM), Random Forest (RF), and various hybrid and neural network-based approaches. This review synthesizes current progress in integrating Nature-based Solutions (NBS) with modeling and policy frameworks, highlighting their potential to provide cost-effective, sustainable, and adaptive alternatives to conventional landslide mitigation strategies. Based on a systematic review of 127 peer-reviewed publications published between 2023 and 2025, selected from Web of Science, ScienceDirect, MDPI, Springer, and Google Scholar using predefined keywords and screening criteria, this study reveals that the most frequently used conditioning factors in landslide susceptibility modeling are slope (96 times), aspect (77 times), elevation (77 times), and lithology (77 times). Among modeling approaches, Random Forest (RF), Support Vector Machine (SVM), hybrid models, and neural network models consistently demonstrate high predictive performance. Despite the expanding body of literature on NBS, only 2.3% of all NBS-related studies specifically address landslide mitigation. The existing literature primarily concentrates on assessing the biophysical effectiveness of interventions such as vegetation cover, root reinforcement, and forest-based stabilization using a range of predictive modeling techniques. However, significant gaps remain in the integration of economic valuation frameworks, particularly cost–benefit analysis (CBA), to quantify the monetary value of NBS interventions in landslide risk reduction. This highlights a critical area for future research to support evidence-based decision-making and sustainable risk governance. Full article

Background: In the era of rapid digital transformation, efficient food logistics (FL) is critical for sustainability and competitiveness. Maintaining food quality, minimizing waste, and optimizing costs are complex challenges that advanced digital technologies aim to address, particularly amid growing e-commerce and last-mile delivery demands. This underscores the need for a structured, quantitative evaluation of technological solutions to ensure operational reliability, efficiency, and sustainability. Methods: This study employs a Multi-Criteria Decision Making (MCDM) model combining Criterion Impact LOSs (CILOS) and Multi-Objective Optimization on the basis of Simple Ratio Analysis (MOOSRA) to evaluate key FL technologies: IoT, blockchain, Big Data analytics, automation and robotics, and cloud/edge computing. Nine evaluation criteria relevant to logistics providers were used, covering operational efficiency, flexibility, sustainability, food safety, data reliability, KPI support, scalability, costs, and implementation speed. CILOS determined criteria weights by considering interdependencies, and MOOSRA ranked technologies by benefits-to-costs ratios. Sensitivity analysis validated result robustness. Results: Automation and robotics ranked highest for enhancing efficiency, reducing errors, and improving handling and safety. Blockchain was second, supporting traceability and data security. Big Data analytics was third, enabling demand prediction and inventory optimization. IoT ranked fourth, providing real-time monitoring, while cloud/edge computing ranked fifth due to indirect operational impact. Conclusions: The CILOS–MOOSRA model enables transparent, structured evaluation, integrating quantitative metrics with logistics providers’ priorities. Results highlight technologies that enhance efficiency, reliability, and sustainability while revealing integration challenges, providing a strategic foundation for digital transformation in FL. Full article

Background/Objectives: The Zika virus (ZIKV) represents an ongoing threat to public health due to its neurological and congenital complications. Even after 10 years since the first major outbreak, correlated with an increase in congenital ZIKV syndrome, there is still no vaccine or treatment for this infection. Among the various existing platforms, DNA vaccines combined with the use of immunoinformatics tools allow for the efficient selection of immunogenic epitopes and immunostimulatory molecules with greater flexibility, in addition to being simple to manufacture and having a higher cost–benefit ratio in production. Methods: In this work, we conducted an integrated approach, combining in silico analyses and in vivo experimental validations, for the development of multi-epitope DNA vaccines against ZIKV. The computational analyses confirmed structural stability, adequate solubility, absence of toxicity, and immune induction potential for constructs based on epitopes from the Envelope (E) and NS1 proteins. Therefore, we evaluated DNA constructs containing the ENV + NS1 epitopes, both with and without fusion to the ssPGIP signal peptide, in BALB/c mice. Results: Both vaccines increased the population of CD4⁺ and CD8⁺ T lymphocytes, in addition to the production of IgG antibodies associated with the Th1 profile. The fusion with ssPGIP broadened the response, stimulating the release of Th1, Th2, and Th17 cytokines, as well as enhancing antibody formation. In contrast, its absence was associated with a slight increase in CD4⁺ and CD8⁺ T cells, accompanied by restricted cytokine production. Conclusions: These results indicate that epitope-targeted techniques offer a viable and safe method for inducing robust immune responses, demonstrating that combining immunoinformatics methods with early preclinical testing is an effective strategy for ZIKV vaccine development. Furthermore, although the present study focused on initial immunogenic characterization, future studies involving viral challenge in a suitable animal model will be essential to conclusively determine the protective efficacy of these vaccine candidates. Full article

With global climate changing, numerous cities have a rise in the frequency of heavy rainfall events. Concurrently, the rapid urbanization is increasing the impermeable surfaces, heightening the vulnerability to cope with flooding of urban stormwater drainage systems. This work compared the different retention strategies to mitigate flooding risks by simulating various scenarios using StormDesk 2.0. Additionally, it conducts multi-objective optimization of retention volume reduction, overflow volume reduction, and cost constraints through NSGA-II to obtain adaptation schemes across diverse scenarios. The findings demonstrate that, compared with the maximum area and overflow reduction ratio schemes, the drainage capacity can increase 15% under the adaptation scheme. Furthermore, the investment of the adaptation scheme is the most economical, at 10.59% of the maximum area scheme, and the overflow reduction surpasses that of the maximum area scheme by 45.8%. The most economical unit control cost in the adaptation scheme was USD 64.2/m³, while the full cost reached USD 277,337.9, highlighting its superior cost-benefit. The above results can provide a paradigmatic reference for enhancing stormwater drainage capacity in urban built-up areas. Full article

Background/Objectives: Adherence to the Mediterranean Diet (MD) is shaped by its multidimensional nature, encompassing nutritional, cultural, and environmental dimensions. However, systematic reviews indicate a notable decline in MD adherence across Mediterranean countries over the past decade. This study aimed to objectively assess the affordability of the MD under Turkish conditions using nationally representative data for a typical four-person household. Methods: A Turkish Mediterranean Diet Food Basket (MDFB) was developed for a reference household and its affordability evaluated through a four-step analytical framework: (i) construction of the MD food basket, (ii) collection of price data and estimation of average monthly cost, (iii) verification of nutritional adequacy, and (iv) assessment of affordability by comparing the basket cost with household income indicators Results: Based on the regional equivalised median income in the TR62 region (21,331 TRY/month), the monthly cost of the MDFB (TRY 20,930) represented 98% of household income. Using the national median income for couples with children (27,918 TRY/month), this share decreased to 75%. Both estimates substantially exceed the national average share of food expenditure (18.1%). Among the lowest-income households, the MDFB cost corresponded to 214% of income, indicating economic inaccessibility. For middle- and high-income groups, the ratios were 91.9% and 37.3%, respectively. Conclusions: Despite its recognized health benefits, the MD remains economically unattainable for most households in Türkiye, underscoring persistent socioeconomic disparities in diet quality and accessibility. Full article

This study introduces the Product Variety Costing Method (PVCM), a data-driven framework that addresses the limitations of existing costing approaches, which fail to accurately present the cost of product and part variety, thereby constraining cost-informed decision-making in modular product development. Traditional cost allocation methods often lack one or more of the following: a full life-cycle perspective, a lower level of granularity according to the product structure, or a combined integration of qualitative and quantitative data. The PVCM bridges these gaps by combining Time-Driven Activity-Based Costing (TDABC) with hierarchical product structures and empirical enterprise data, enabling the quantification of variety-induced resource consumption across components, subsystems, and complete products. An industrial application demonstrates that the PVCM enhances cost accuracy and transparency by linking resource use directly to specific product abstraction levels, thereby highlighting the true cost impact of product variety. In this case, results revealed deviations of up to 60% in the adjusted contribution margin ratio relative to traditional overhead-based methods, clearly indicating the influence of product variety on cost assessments. The method supports design and managerial decision-making by allowing evaluation of modularization based on detailed cost insights. While the study’s scope is limited to selected life-cycle phases and a single company case, the findings highlight the method’s future potential as a generalizable tool for evaluating economic benefits of modularization. Ultimately, the PVCM contributes to a more transparent and analytically grounded understanding of the cost of variety in complex product portfolios. Full article

Background: Digital technologies can contribute to healthcare democratization in an ethical, safe, and sustainable context. The remote monitoring of implantable cardiac devices enables the follow-up of patients from a distance. Patients with anti-bradycardia pacemakers represent the largest group and have the least access to this technology due to the controversial cost–benefit ratio and barriers to its widespread implementation, such as equipment costs and organizational challenges. In contrast, reimbursed transportation in Portugal reached approximately 82 million euros in 2024. Objectives: The aim of the present study was to assess the financial viability of remote pacemaker follow-up in a Portuguese district hospital, comparing the non-urgent transportation costs and the investment in remote monitoring equipment while measuring user acceptance and satisfaction. Methods: A total of 41 surveys were conducted with patients who received a pacemaker and used publicly reimbursed transportation. The projected costs were calculated for two simulated protocols: the first involved in-person visits every six months, while the second involved in-person visits every two years with remote consultations every six months, over the expected lifespan of the devices. EZR, version 1.61, was used. Results: Our data showed a 74% overall reduction in face-to-face visits. The implementation of remote follow-up would result in a cost saving of EUR 373/patient (21.2%), with total reimbursement (p = 0.01151). The savings increased to 33.3%, reaching EUR 764/patient (p = 0.0002742) for distances greater than 60 km (round trip) for ambulance users with total reimbursement. Acceptance and satisfaction achieved 88%. Conclusions: Remote monitoring of pacemakers can be a financially viable alternative with high acceptance and satisfaction. Full article

The railway industry is increasingly pressured to adopt sustainable practices, seeking alternatives to virgin natural aggregates that reduce environmental impact and lifecycle costs. The extraction of slate for ornamental purposes generates significant waste, approximately 30% by mass, which is typically disposed of in landfills, causing environmental and economic concerns. This study comprehensively investigates the potential of slate waste as a primary component in sub-ballast layers for railways. Laboratory tests were conducted on mixtures of slate waste and a clayey soil, with granular contents ranging from 60% to 90%. The key geotechnical parameters evaluated included the California Bearing Ratio (CBR), Resilient Modulus (RM), compaction characteristics, granulometry and Atterberg limits. In addition, the DNIT ISF-212 standard was used to verify compliance with the Brazilian requirements for the use of materials in sub-ballast layers. The results indicate that mixtures with slate waste (SLT) exhibit performance comparable to conventional gneiss aggregate mixtures (REF); however, verification against the DNIT ISF-212 standard showed that only the SLT 80/20 and SLT 90/10 mixtures fully meet the requirements for use as railway sub-ballast. The RM and CBR values for the SLT mixtures increased by 48.5% and 38.4%, respectively, when the slate waste content was raised from 60% to 90%. A non-linear relationship was found between RM and CBR for both material types. Furthermore, the study integrates findings from related research on recycled ballast and tropical soils, highlighting the synergistic benefits of using industrial by-products. It concludes that slate waste presents a viable, high-performance, and sustainable solution for railway sub-ballast, contributing to circular economy principles in railway infrastructure. Full article

Thirty-six Dorper × Katahdin intact male lambs [44.0 ± 0.27 kg initial body weight (BW)] were used in a randomized complete block design to evaluate the effects of supplementing different organic chromium (OrCr) sources on growth performance, dietary energetics, carcass traits, meat quality, and economic return. Treatments (n = 9 lambs/treatment) were (1) Control (no Cr), (2) chromium-enriched yeast (Cr-Yeast), (3) chromium–methionine (Cr-Met), and (4) chromium–propionate (Cr-Pr). All Cr sources were provided at 1.2 mg elemental Cr/lamb/d for 45 d. Lambs received a high-energy finishing diet (78:22 concentrate/forage; steam-rolled corn-based). Dry matter intake was not affected (p = 0.583; 1.27 ± 0.034 kg/d). Compared with Control, Cr-Pr increased final BW (+5%; p = 0.025) and average daily gain (+66%; p = 0.034), and improved feed efficiency (+59%; p = 0.045) and observed-to-expected net energy ratio (+22%; p = 0.042); Cr-Met and Cr-Yeast showed intermediate responses. No differences were observed (p > 0.05) in longissimus lumborum muscle area, cold carcass weight, dressing percentage, cooling loss, or zoometric traits. Rib and rump fat thickness decreased with Cr-Met (−15 and −12%; p = 0.024 and p = 0.048) and with Cr-Pr (−19 and −13%; p = 0.024 and p = 0.048), and all OrCr sources reduced omental (−6 to −25%; p = 0.034), mesenteric (≈−7%; p = 0.042), visceral (−12 to −16%; p = 0.034), and perirenal fat (−25 to −39%; p = 0.028). Empty body weight and hot carcass weight increased with Cr-Pr (p = 0.029 and p = 0.031, respectively). Cr-Yeast and Cr-Pr increased muscle proportion (+5 to +7%; p = 0.003) and reduced carcass fat (−20 to −27%; p = 0.018), improving the muscle/fat ratio (+42 to +50%; p = 0.045). Cr-Pr improved water-holding capacity (+27%; p = 0.014) without affecting pH_24h, purge loss, cooking loss, or Warner–Bratzler shear force (p > 0.05). Cr-Pr reduced cost per kg of gain (−31%; p < 0.001) and increased income (+188% live; +105% carcass; p < 0.001), whereas Cr-Met and Cr-Yeast provided moderate benefits. In conclusion, OrCr supplementation improved dietary energy utilization, growth, carcass traits, and meat quality, enhancing profitability in lambs finished at heavier weights, with Cr-Pr producing the greatest responses. Full article

To address the challenges of difficult recovery, significant environmental hazards associated with homogeneous catalysts, and insufficient catalytic activity of heterogeneous supports in the catalytic dehydration of fructose to produce 5-hydroxymethylfurfural (5-HMF), this study employs a straightforward nitric acid modification method to prepare an acid-activated silica gel catalyst for application in this reaction system. Through systematic investigation of the influence of modification conditions on catalyst performance and economic benefits, optimal reaction conditions were determined: DMSO as the solvent, nitric acid-modified silica gel as the catalyst, a reaction temperature of 120 °C, a solid–liquid ratio of 1:30 (g∙mL⁻¹), and a fructose-to-catalyst mass ratio of 1:1. Under these conditions, the maximum 5-HMF yield reached 91.6%. Characterization via specific surface area, pore size analysis, and acid/base site characterization (NH₃-TPD) revealed that nitric acid modification preserved the silica gel’s pore structure. Through oxidative cleaning, etching to expose silanol groups, and inducing surface defects, this process significantly increased the number of acid sites on the silica gel surface, thereby enhancing catalytic activity. This study presents a low-cost, easily recoverable, and environmentally friendly heterogeneous catalytic strategy for the efficient conversion of fructose into 5-HMF. It also provides experimental guidance for the targeted functionalization of silica-based catalytic materials, holding significant implications for advancing the high-value utilization of biomass resources. Full article

Many electricity providers are offering their customers an array of tariff options intended to discourage electricity consumption at specific times of the day. The problem facing a customer is whether to switch from their existing tariff to a new tariff. The aim of this paper is twofold: first, to develop two analytical methods that help residential customers evaluate when switching from a flat-rate tariff to time-varying pricing options, specifically the Time-of-Use (TOU) tariff and an event-based tariff, becomes economically beneficial, and second, to review customers’ experiences with the tariffs. The methods identify the specific consumption distributions at which the TOU or event-based tariffs are in energy- and cost-equilibrium with the domestic service tariff for residential customers. For the TOU structure, the analysis shows that customers must maintain a non-winter-to-winter-peak consumption ratio exceeding 3.0756 for cost neutrality, a condition rarely met by households with winter-dominant loads. In contrast, event-based structures require only minimal behavioral adjustments to achieve savings, with as little as 1.75% of annual consumption needing to be avoided during event periods to match domestic-service costs. Additional savings are observed with partial or full load shifting away from peak events. The findings highlight that while TOU may benefit households with high summer usage, event-based tariffs present a more practical and economically favorable option for residential customers living in the Canadian province of Nova Scotia. The paper concludes with implications for tariff selection and consumer behavior. This research will be of value to anyone considering designing a time-varying rate or having to choose between an existing flat-rate tariff and a time-varying tariff. Full article

Aim: Preoperative planning and in-office patient education are essential elements of clinical management in patients afflicted with hand injuries. Three-dimensional (3D) printing aims to tackle these challenges by converting feedstock material into solid replicas. The purpose of this study was to review the clinical uses for 3D printing in hand surgery to identify approaches for delivering more personalized treatment strategies. Method: A systematic review was completed following PRISMA guidelines using Medline, Embase, and CINAHL databases, identifying studies published between 2013 and January 2025. A two-stage screening process, involving title, abstract, and full text reviews, was performed independently by two reviewers. Eligible studies included those involving patients with hand or wrist injuries (up to the distal radius) where 3D printing was utilized for diagnosis, surgical intervention, or rehabilitation. Results: The review included 751 patients (mean age: 38 years, range: 5–81 years) across 58 studies. The distal radius was the most commonly studied anatomical region (47%, N = 27), followed by the scaphoid (19%, N = 11). Key applications of 3D printing included preoperative planning (19%, N = 11), patient education (5%, N = 3), medical training (7%, N = 4), intra-operative assistance (38%, N = 22), splinting and casting (19%, N = 11), and prothesis and functional reconstruction (12%, N = 7). Conclusions: Despite its early stage of adoption in hand surgery, 3D printing has shown advantages, especially in enabling more personalized treatment strategies by improving intra-operative assistance, preoperative planning, and patient education. Further research is required to determine whether it positively affects postoperative outcomes, to calculate the cost–benefit ratio, and to compare its usage against standards of care. Full article