Search Results (310)

At present, most plateau-constrained cities worldwide—plateau cities whose spatial form is strictly constrained by topography—have entered the late stage of urbanization. The relationship between urban form and the surrounding geographic spatial pattern has consequently exhibited distinctive new characteristics. However, planning and policy often continue to adopt green-space allocation schemes developed in the mid-stage of urbanization and based on the experience of plain cities, resulting in difficulties in plan implementation, intensified human–land conflicts, and imbalances in both the supply–demand relationship and equity of green public services with severe challenges to urban sustainable development, calling for urgent correction and reconstruction. Through a literature review and comparative case analysis, this study clarifies global trends in the paradigm shift in plateau-city planning and develops an evaluation system comprising “adaptability analysis of originally planned spaces within the built-up area + assessment of the potential for converting ecological value in green spaces outside the built-up area + integrated spatial optimization.” Building on Analytic Hierarchy Process (AHP) weighting and spatial analysis, the study establishes a comprehensive assessment framework and applies it empirically to Kunming as a typical case, with the aim of proposing a correction-and-reconstruction paradigm for green-space allocation tailored to plateau-constrained cities to achieve sustainable development goals. The results indicate a widespread paradigm shift in many cities from “pattern optimization during incremental expansion” and “passive adaptation to ecological patterns” toward “enhancing governance effectiveness during stock-based renewal” and “proactive innovation in governance instruments.” The Kunming case shows that, during the mid-stage of urbanization, numerous parks and green spaces were planned within the built-up area (flat land), yet many of these proposals proved infeasible due to excessive costs and trade-offs. Meanwhile, the adjacent mountainous ecological spaces with substantial scenic and recreational potential were long excluded from the urban public service system. In response, this study proposes a three-dimensional allocation model that combines “optimized adaptation” within the built-up area and “potential conversion” in adjacent peri-urban areas together with differentiated policy instruments and an implementation/transfer assurance mechanism. This approach not only offers practical planning guidance for Kunming but also provides a broadly applicable set of theoretical and practical tools for improving land-use efficiency and promoting green equity in similar cities worldwide. Full article

The upscaling of turbines in the offshore wind industry has been unprecedented, as compared to 5–6 MW rated turbines 10 years ago. A typical 20–26 MW rated turbine in modern commercial applications (MingYang MySE 18.X-20 MW installed in 2025 and 26 MW prototype by Dongfang Electric tested in 2025) has been demonstrated. This scaling has been made possible by increasing rotor diameters (>250 m) and hub heights (>150–180 m) to achieve capacity factors of up to 55–65%, annual energy generation of more than 80 GWh/turbine, and significant decreases in levelised cost of energy (LCOE) to current values of up to 63–65 USD 2023/MWh globally averaged in 2023 (with minor variability in 2024 due to market changes and new regional areas). The paper analyses turbine upscaling over three levels of hierarchy, including turbine scale—rated capacity and physical aspect, project scale—multi-gigawatts of farms, and market scale—the global pipeline > 1500 GW level, and combines techno-economic evaluation, structural evaluation of loads, and infrastructure needs assessment. The upscaling has the advantage of reducing the number of turbines dramatically (e.g., 500 to 67 turbines in a 1 GW farm, as turbine size is increased to 15 MW) and balancing-of-plant (BoP) CAPEX (turbine-to-turbine foundations and cables) by some 20 to 30 percent per unit of capacity, and serial production learning rates of between 15 and 18% per doubling of capacity. But the problems that come with the increase in ultra-large designs are nonlinear increments in mass and load (i.e., blade-root and tower-bending moments), logistical constraints (blades > 120 m, nacelle up to 800–1000 tonnes demanding special vessels and ports), supply-chain issues (rare-earth materials, vessel shortages increase day rates by 30–50%), and technology limitations (aeroelastic compounded by numerical differences between reference 5 MW, 10 MW, and 15 MW models), it becomes evident that there is a significant increase in deflections of the tower and blades and platform surge/pitch responses with continued increases in power levels, but without a correspondingly mature infrastructure. The regional differences (mature ports of Europe vs. U.S. Jones Act restrictions vs. scale-up of vessels/manufacturing in China) lead to the necessity of optimisation depending on the context. The analysis concludes that, to the extent of mature markets with adapted logistics, continuous upscaling is an effective business strategy and can result in 5 to 12 percent further reductions in LCOE, but beyond that point, gains become marginal or even negative, as risks and costs increase. The competitiveness of the future depends on multi-scale/multi-market-based approaches—modular-based families of turbines, programmatic standardisation, vibration control innovations, and industry coordination towards supply-chain alignment and standards. Its major strength is that it transcends mere size–cost relationships and shows how nonlinear structural processes, aero-hydro-servo-elastic interactions, and bottlenecks in logistical systems are becoming more determinant of the efficiency of ultra-large turbines. The study demonstrates that upscaling turbines has LCOE benefits through the support of associated improvements in installation facility, supply-chain preparedness, and structural vibration control potential, based on the comparisons of quantitative loads, techno-economic scaling trends, and regional market differentiation. Full article

Background: This study aimed to evaluate the prognostic performance of four albumin-anchored ratios—blood urea nitrogen/albumin ratio (BAR), C-reactive protein/albumin ratio (CAR), lactate/albumin ratio (LAR), and albumin/creatinine ratio (ACR)—in predicting short-term mortality among intensive care unit (ICU) patients with pre-existing chronic comorbidities. Additionally, we assessed their incremental prognostic value beyond established severity scores such as APACHE II and SOFA. Materials and Methods: This retrospective cohort study included 520 chronically ill adult ICU patients admitted between July 2022 and July 2025. Patients with missing laboratory data, ICU stay <24 h, or postoperative monitoring only were excluded. BAR, CAR, LAR, and ACR were calculated from admission laboratory values. The primary outcome was 28-day mortality. Receiver operating characteristic (ROC) analyses, multivariate logistic regression, and model improvement metrics (C-statistics, NRI, IDI) were used to assess predictive performance. Results: Non-survivors had significantly higher BAR (15.0 vs. 8.2), CAR (39.2 vs. 19.1), and LAR (0.86 vs. 0.44) values and lower ACR (2.0 vs. 3.4) (all p < 0.001). In multivariate analysis, all four ratios independently predicted 28-day mortality (p < 0.001 for each). CAR showed the highest AUC (0.80), followed by LAR (0.79), BAR (0.78), and ACR (0.76). Incorporating all four ratios improved model discrimination (C-statistic 0.872 vs. 0.823; Δ = +0.049, p < 0.001) and reclassification (NRI = 0.162; IDI = 0.052). Conclusions: BAR, CAR, LAR, and ACR are independent and complementary predictors of short-term mortality in ICU patients with chronic comorbidities. Among them, CAR exhibited the best discriminative power. The combined use of these ratios enhanced risk prediction beyond traditional severity scores, suggesting their utility as simple, cost-effective markers for early mortality assessment. Because these indices are calculated from routinely measured laboratory parameters, they may represent practical and widely accessible tools for mortality risk stratification in routine ICU practice. Full article

Machine Learning (ML) models trained on large-scale datasets learn useful predictive patterns, but they may also memorize undesired information, leading to risks such as information leakage, bias, copyright violations, and privacy attacks. As these models are increasingly deployed in real-world and regulated settings, the consequences of such memorization become practical and high-stakes, reinforced by data-protection frameworks that grant individuals a Right to be Forgotten (e.g., the GDPR). Simply removing a record from the training dataset does not guarantee the elimination of its influence from the model, while retrain-from-scratch procedures are often prohibitive for modern architectures, including Transformers and Large Language Models (LLMs). In this work, we provide a perspective on Machine Unlearning (MU) in supervised learning settings, with a particular focus on Natural Language Processing (NLP) scenarios, grounded in a PRISMA-driven systematic review. We propose a multi-level taxonomy that organizes MU techniques along practical and conceptual dimensions, including exactness (exact versus approximate), unlearning granularity, guarantees, and application constraints. To complement this perspective, we run an illustrative benchmark evaluation using a standardized unlearning protocol on DistilBERT trained on a public corpus of news headlines for topic classification, contrasting the retraining gold standard with representative design-for-unlearning and approximate post hoc techniques. For completeness, we also report two oracle-assisted upper-bound baselines (distillation and scrubbing) that rely on a clean retrained reference model, and we account for their incremental cost separately. Our analysis jointly considers model utility, probabilistic quality, forgetting and privacy indicators, as well as computational efficiency. The results highlight systematic trade-offs between accuracy, computational cost, and removal effectiveness, providing practical guidance for selecting machine unlearning techniques in realistic deployment scenarios. Full article

Background: While surgery and radiotherapy are the standard of care for patients with cervical cancer (CC), debate persists regarding the choice of whether treatment should consist of surgery followed by radiotherapy or initial direct radical radiotherapy. The present study was therefore devised to compare real-world clinical outcomes and economic assessments associated with these different treatment approaches. Methods: Six tertiary medical centers retrospectively identified patients with International Federation of Gynecology and Obstetrics (FIGO) 2018 stage I-IVA CC who underwent surgery followed by radiotherapy (surgery–radiotherapy group) or radical radiotherapy (radiotherapy group) between 2015 and 2023 in China. The progression-free and overall survival (PFS and OS) of these patients were compared using Kaplan–Meier and propensity-score-weighted proportional risk models. Economic analyses were also conducted based on patient follow-up for up to 8 years from the start of treatment. Results: A total of 980 patients receiving surgery–radiotherapy and radiotherapy were identified for matching. Propensity score weighting revealed no significant statistical differences in PFS (hazard ratio [HR], 0.75; 95% confidence interval [CI], 0.44–1.28; p = 0.29) and OS (HR, 0.49; 95% CI, 0.20–1.21; p = 0.12) when comparing these groups. Subgroup analysis found differences in PFS (HR, 0.17; 95% CI, 0.04–0.77; p = 0.02) among adenocarcinoma. Economic analyses revealed that the incremental cost-effectiveness ratio of the surgery–radiotherapy group versus the radiotherapy group was $40,831/quality-adjusted life-year (QALY), which is higher than the Chinese willingness-to-pay threshold of $35,841/QALY. Conclusions: Survival outcomes were similar for patients with CC who underwent surgery–radiotherapy and radiotherapy. Further, radical radiotherapy may be cost-effective for such patients considering economic factors in China. Full article

Background: The PROSPET-BX trial compared [⁶⁸Ga]PSMA-11 PET/CT (PSMA-PET) with multiparametric MRI (mpMRI) in parallel in men with suspicion of prostate cancer (PCa) after at least one previously negative biopsy (ClinicalTrials.gov: NCT05297162; GR-2018-12366240). In this study, we performed the cost analysis of the two imaging modalities with respect to the detection of clinically significant PCa (csPCa). Methods: We analyzed the data from patients enrolled in the trial who met the inclusion criteria. For the cost analysis, we identified six competing triage strategies, each defined as a binary decision rule for referral to prostate biopsy: (1) biopsy-all; (2) elevated PSA-density (PSAD; biopsy if PSAD > 0.15 ng/mL/cc; (3) mpMRI positive (PIRADS 3–5); (4) PSMA-PET positive (PRIMARY 3–5); (5) mpMRI or PSMA-PET positive; (6) PSAD and mpMRI. For each strategy, we yielded sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy for csPCa. Direct hospital costs were modeled from a provider perspective, incorporating testing and procedural costs. Unit costs (in EUR) were sourced from our institutional accounting records. Pairwise cost-effectiveness comparisons were performed using incremental cost-effectiveness ratio (ICER) and incremental net benefit (INB). Results: Among the six triage strategies evaluated, the “biopsy-all” approach achieved perfect sensitivity, whereas the PSAD + mpMRI pathway was the most parsimonious strategy but missed 14 csPCa cases (53.8%). The combined “mpMRI or PSMA-PET” strategy maximized detection (22 cPCa, missing only 4) at an intermediate cost (EUR 81.991 total; EUR 3.727 per csPCa). The pairwise comparison of each strategy with mpMRI alone showed for the mpMRI or PSMA-PET pathway a low ICER (~EUR 2.900/extra csPCa), with consistently positive and increasing INB across higher WTP (willingness-to-pay). Therefore, this combination provided the most favorable cost-effectiveness profile, balancing detection, efficiency, and cost. Conclusions: To the best of our knowledge, this is the first cost analysis study to compare different strategies incorporating PSMA-PET in the re-biopsy setting, demonstrating that the combined “mpMRI or PSMA-PET” pathway is the most cost-effective diagnostic pathway for csPCa detection. Full article

Background: Influenza imposes a substantial burden on Argentina, particularly among adults aged 50–64 with comorbidities and those aged ≥65. The adjuvanted trivalent influenza vaccine (aTIV) has shown superior effectiveness compared with non-adjuvanted vaccines; however, its cost-effectiveness and budget impact in the 50–64 high-risk population have not been assessed nationally. This study evaluates the cost-effectiveness and budget impact of introducing aTIV for high-risk adults aged 50–64, alongside its use in adults aged ≥65, compared with standard-dose trivalent influenza vaccine (SD-TIV) from the Argentine health care system perspective. Methods: A decision-analytic static model was used to compare aTIV with SD-TIV over a single influenza season. In addition, a 5-year budget impact analysis (BIA) was conducted under scenarios of progressive uptake. Model inputs were derived from international literature, local data, and expert opinion. Deterministic and probabilistic sensitivity analyses were performed. Results: Compared with SD-TIV, aTIV yielded a lifetime gain of 1489 quality-adjusted life-years (QALYs) at an incremental cost of USD 8.34 million, resulting in an incremental cost-effectiveness ratio (ICER) of USD 5599 per QALY gained—well below Argentina’s cost-effectiveness threshold (USD 11,059/QALY). Higher vaccine acquisition costs were largely offset by reductions in outpatient visits and hospitalizations. The BIA showed a modest average annual per-member-per-month increase of USD 0.0025, remaining below the estimated budget impact threshold (USD 0.0065). Conclusions: Implementing aTIV in adults aged ≥50 with risk factors would be cost-effective and affordable in Argentina. These findings support the consolidation and potential expansion of current vaccination strategies to reduce influenza burden. Full article

Background/Objectives: To compare diagnostic performance and cost-effectiveness of [¹⁸F]FDG PET/CT versus MRI for cervical lymph node assessment in nasopharyngeal carcinoma (NPC) and to evaluate their impact on N-staging and upper-neck-only irradiation planning. Materials and Methods: We retrospectively identified treatment-naïve NPC patients who underwent both MRI and FDG PET/CT within 14 days prior to ultrasound-guided biopsy of specific cervical lymph nodes with rigorous one-to-one multimodal matching. Using histopathology as the reference standard (Cohort A, node level), sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the curve (AUC) were compared between PET/CT and MRI. In a staging cohort (Cohort B, patient level), we compared imaging-based N-staging accuracy and the pathology-concordant classification of treatment recommendations assuming upper-neck-only irradiation for N0 to N1 disease. In discordant cases (Cohort C), three experienced radiation oncologists designed dose prescriptions and neck irradiation volumes, first using MRI alone and then after reviewing PET/CT to quantify decision impact. A decision tree/Markov model (10-year horizon) evaluated cost-effectiveness of MRI- versus PET/CT-initiated strategies. Results: In total, 694 biopsy-verified lymph nodes from 649 patients were analyzed. PET/CT demonstrated higher sensitivity (96.0% vs. 92.6%, p = 0.001) and NPV (80.2% vs. 66.7%, p < 0.001) than MRI, with comparable specificity (64.0% vs. 59.0%, p = 0.317) and PPV (91.4% vs. 90.0%, p = 0.203); AUCs were 0.864 and 0.841, respectively (p = 0.298). In Cohort B (N = 503), PET/CT provided accurate N-staging for a significantly higher proportion of patients compared to MRI (8.0% vs. 4.2%, p = 0.021) and yielded more accurate recommendations for upper-neck-only irradiation when restricted to N0 to N1 disease (93.8% vs. 88.9%, p = 0.003). In discordant cases (Cohort C, N = 62), PET/CT substantially improved accuracy compared with MRI and prompted clinically meaningful plan adjustments, including dose escalation for metastatic nodes (up to 16.7%) and expansion from upper-neck-only to whole-neck irradiation with rates of 6.4%, 8.0%, and 11.3% for the three radiation oncologists, respectively. In the base case economic analysis, PET/CT achieved higher effectiveness (5.329 vs. 5.305 quality-adjusted life years [QALYs]) at higher cost (US$27,228 vs. US$25,596), with an incremental cost–effectiveness ratio (ICER) of approximately US$68,000 per QALY, remaining below a willingness-to-pay threshold of US$100,000 per QALY; probabilistic sensitivity analysis favored PET/CT in 79.6% of iterations. Conclusions: FDG PET/CT provided superior sensitivity and negative predictive value versus MRI for detecting nodal metastases in NPC, improving pathology-adjudicated N-staging and the accuracy of upper-neck-only irradiation recommendations. PET/CT was cost-effective in the modeled setting, although treatment de-escalation for benign nodes remained conservative in clinical decision-making. Full article

Effective scheduling and charging management of electric buses is essential for minimizing investment and operational costs while improving transit efficiency. The paper presents an optimization framework which provides a 3D Pareto frontier of fleet size, deadhead distance, and charging cost, while accounting for heterogeneous battery energy, charger power, charging spot capacities, integrated daily and night charging, and a charge sustaining condition. Two optimization approaches are developed: Mixed-Integer Linear Programming (MILP), which finds globally optimal solutions, and an Insertion Heuristic (IH), which generates feasible schedules in a computationally efficient way. The framework operates iteratively, starting with MILP to determine the minimum number of buses for feasible operation. Then, additional buses are incrementally incorporated, and for each fixed fleet size, a multi-objective optimization of scheduling and charging management is applied to minimize deadhead distance and charging costs using both approaches. A case study on a synthetic transport network demonstrates that the proposed IH algorithm achieves nearly optimal performance at a fraction of the computational time and memory requirements of the MILP approach. A Pareto analysis shows that increasing fleet size reduces deadhead distance and charging costs up to a saturation point, beyond which further additions yield minimal benefits. Full article

Background/Objectives: Iron-deficiency anemia (IDA) is a common extraintestinal complication of inflammatory bowel disease (IBD). Among high-dose intravenous (IV) iron options, ferric carboxymaltose (FCM) carries a higher risk of treatment-emergent hypophosphatemia than ferric derisomaltose (FDI), with potential clinical consequences. Slovenia’s healthcare setting, characterized by very low IV iron infusion tariffs and recent pricing in which FCM is substantially less expensive than FDI, warrants a setting-specific cost effectiveness evaluation. Methods: We integrated two methodological components: (i) a payer-perspective cost-effectiveness analysis using a patient-level microsimulation model with (ii) an umbrella review of systematic reviews and a targeted search of expert consensus statements on IV-iron-associated hypophosphatemia. Results: In the base case, FDI required fewer infusions than FCM (11.1 vs. 14.2 over 10 years) but generated only €95 in IV iron administration savings due to low tariffs, while drug procurement was €1166 higher with FDI than FCM. When incorporating the clinical impact of hypophosphatemia, incremental quality-adjusted life years (QALYs) were 0.136, yielding an incremental cost-effectiveness ratio (ICER) of €6590/QALY. The umbrella review consistently showed higher hypophosphatemia incidence with FCM (up to 92%) compared with other IV iron formulations (<10%), with recent recommendations emphasizing phosphate monitoring and risk mitigation through alternative formulations. Conclusions: Despite Slovenia’s low IV iron infusion tariffs and lower FCM price, FDI remained cost-effective in this model, largely due to its more favorable hypophosphatemia profile within the model. These findings suggest that hypophosphatemia risk should be considered when selecting IV iron therapy in routine IBD care. Full article

Introduction: Women with breast cancer experience psychological distress, and resilience-strengthening psychosocial support may improve their quality of life (QoL). Identifying those at risk of low QoL is challenging. This study evaluated the cost-effectiveness of a machine learning-based QoL predictor to support clinical decision-making regarding psychosocial support (sample size: 660). Methods: A decision tree cost–utility model was developed to compare four decision-making strategies in offering psychosocial support: the clinician alone, the QoL predictor alone, the clinician supported by the predictor, and no prediction with no psychosocial support. QoL after one year was used as a proxy for resilience. Costs, health outcomes, and net monetary benefits (NMBs) were estimated using a one-year time horizon. Incremental cost-effectiveness ratios (ICERs) were calculated and dominance assessed. A societal scenario analysis incorporated productivity losses. A probabilistic sensitivity analysis generated cost-effectiveness acceptability curves. Results: Clinicians supported by the QoL predictor produced the highest NMB (EUR 16,349) and the greatest quality-adjusted life year (QALY) gain (0.759), with an ICER of EUR 22,892 compared with the next least costly strategy. Clinician-only prediction and predictor-only approaches were dominated or extendedly dominated. Under the societal perspective, all strategies produced negative NMB values due to productivity losses, but the overall ranking remained unchanged. The probabilistic sensitivity analysis showed that the combined clinician and predictor strategy had a 69% probability of being cost-effective at a willingness to pay threshold of EUR 30,000. Conclusions: Combining clinician judgement with the machine learning-based QoL predictor improved the targeting of psychosocial support and was the most cost-effective strategy. Further prospective and comparative studies are needed to confirm its long-term effectiveness and cost-effectiveness in clinical practice. Full article

Background: Hand, foot, and mouth disease (HFMD) remains a major public-health concern in China. While the monovalent EV-A71 vaccine has effectively reduced EV-A71–associated cases, it offers no protection against CV-A16. The introduction of a bivalent EV-A71/CV-A16 vaccine may offer broader protection, but its economic viability under different immunization strategies remains uncertain. Methods: We developed a dynamic transmission model integrated with cost-effectiveness analysis to assess the epidemiological and economic impact of a hypothetical bivalent EV-A71/CV-A16 vaccine in China. Based on the immunization program policy, seven vaccination strategies, vaccine effectiveness (VE) levels ranging from 50–95% against EV-A71/CV-A16, and coverage levels from 0–95% were evaluated. The threshold vaccine price (TVP) was derived based on incremental cost-effectiveness ratio (ICER) calculations. Cost-effectiveness was assessed using willingness-to-pay (WTP) thresholds defined as 1–3 times the gross domestic product (GDP) per capita. Results: The mean cost of two doses of the monovalent EV-A71 vaccine was USD133.0 (95% CI: 126.9–139.1). Strategy 2, which targeted individuals unvaccinated with the monovalent EV-A71 vaccine, demonstrated the most favorable cost-effectiveness. At 45% coverage and 85% vaccine effectiveness, the estimated threshold price per dose was USD 107.7 (95% CI: 103.4–112.0), with threshold vaccine prices increasing as coverage declined. When vaccination coverage exceeded 80%, the threshold vaccine price decreased substantially, falling below USD 45.9 (95% CI: 43.5–48.3) per dose. Conclusions: Large-scale inclusion in the national immunization program may not be economically justified at current cost levels. Targeted voluntary vaccination of unvaccinated, susceptible populations represents a more cost-effective and practical strategy during the early stage of vaccine introduction. Full article

Background/Objectives: Hypertensive disorders of pregnancy (HDP) remain a significant cause of maternal and perinatal morbidity worldwide. In some healthcare settings, access to angiogenic testing is limited, underscoring the need for affordable biomarkers to guide risk assessment. NT-proBNP, a marker of myocardial wall stress and cardio-renal dysfunction, may offer complementary prognostic value to the angiogenic sFlt-1/PlGF ratio. Methods: In this prospective multicenter observational study, we enrolled 180 pregnant women and categorized them into preeclampsia (PE, n = 95), non-PE HDP (gestational or chronic hypertension, n = 25), and healthy controls (n = 60). NT-proBNP and sFlt-1/PlGF levels were measured at enrollment, after 20 weeks of gestation, predominantly during the second and third trimesters. Associations with proteinuria, uric acid, creatinine, and maternal–fetal complications were examined using multivariable logistic regression adjusted for maternal age, BMI, and gestational age. Discrimination was assessed using receiver operating characteristic (ROC) curve analysis, and the incremental value of NT-proBNP beyond the sFlt-1/PlGF ratio was evaluated using ΔAUC and net reclassification improvement (NRI). Results: Median NT-proBNP levels were significantly higher in PE compared with non-PE HDP and controls (p < 0.01). NT-proBNP ≥200 pg/mL independently predicted maternal–fetal complications (adjusted OR 3.12, 95% CI 1.41–6.90, p = 0.005) and correlated with proteinuria (r = 0.47), creatinine (r = 0.43), and uric acid (r = 0.40) (all p < 0.001). sFlt-1/PlGF alone yielded an AUC of 0.84 (95% CI 0.77–0.89), while NT-proBNP alone demonstrated an AUC of 0.78 (0.71–0.84). Combining both biomarkers improved discrimination (AUC 0.88, 95% CI 0.82–0.92), with a ΔAUC of 0.04 (p = 0.02) and a continuous NRI of 0.21 (p = 0.03). The 200 pg/mL threshold for NT-proBNP achieved 80% sensitivity and 71% specificity (p < 0.001). Conclusions: NT-proBNP provides independent and complementary prognostic value to the sFlt-1/PlGF ratio in predicting maternal–fetal complications in HDP. A practical threshold of 200 pg/mL aids risk assessment, and integrating NT-proBNP into angiogenic models improves prediction. Further multicenter studies are needed to validate multimarker strategies and their cost-effectiveness. Full article

Windows contribute 40–50% of envelope heat loss despite occupying only 1/8–1/6 of the surface area. Conventional frame retrofits rely on geometry optimization or cavity insulation yet remain limited by cost and invasiveness. This study introduces electrochemical polishing to reduce cavity surface emissivity of multi-cavity broken-bridge aluminum window frames to suppress radiative heat transfer, offering a non-invasive, low-cost retrofit strategy for existing building windows. Using a typical 75-series casement window, finite element analysis (MQMC) reveals that reducing cavity surface emissivity from 0.9 to 0.05 lowers frame U-values by 12.39–30.38% and whole-window U-values by 2.72–9.69%, with full-cavity treatment outperforming insulating-cavity-only by an average of 0.29 W/(m²·K). EnergyPlus simulations across multiple climate zones show 0.74–2.26% annual heating and cooling energy savings (with max reduction of 8.99 MJ/m²·yr) in severe cold and cold regions (e.g., Harbin, Beijing), but 1.25–3.04% penalties in mild and hot-summer zones due to impeded nighttime heat rejection. At an incremental cost of 62.5 CNY/window (6.6–7.4% increase), the static payback period is 4.1 years in Harbin. The approach mitigates thermal bridging more effectively than foam-filled frames in whole-window performance. This scalable, minimal-intervention technology aligns with low-carbon retrofit imperatives for existing aging windows, particularly in heating-dominated climates. Full article

Background/Objectives: Venous thromboembolism (VTE) is an important global health concern associated with considerable morbidity and mortality. Despite established guidelines for VTE treatment, there is a gap between clinical recommendations and their implementation in practice because of limited accessibility, particularly in low- and middle-income countries and among patients with cancer. This study aimed to assess the cost-effectiveness of direct oral anticoagulants (DOACs) on VTE in patients with cancer at a Thai university-affiliated hospital. Methods: A cost–utility analysis using a Markov model was developed to estimate costs and quality-adjusted life-years (QALYs) of DOACs and low-molecular weight heparin (LWMH) in Thai patients with cancer aged over 60 years. The model with eight health states, including CAT on treatment, pulmonary embolism (PE), deep vein thrombosis (DVT), clinically relevant nonmajor bleeding (CRNMB), non-intracranial hemorrhage major bleeding (non-ICH MB), intracranial hemorrhage (ICH), off treatment, and any death, was developed with a one-month cycle length and used to estimate costs and health outcomes from a societal perspective with a lifetime horizon. The efficacy and safety of DOACs compared to LMWH were obtained from a network meta-analysis, while the costs were based on a Thai university hospital database. All costs and outcomes were discounted at 3%, and the Thai societal willingness-to-pay (WTP) threshold (THB 160,000 per QALY gained) was applied. The incremental cost-effectiveness ratio (ICER) was calculated to compare costs and QALYs of the interventions. Results: The total lifetime cost of LMWH was THB 70,928 (USD 2,163), while for apixaban, dabigatran, edoxaban, and rivaroxaban, the costs were THB 26,323 (USD 803), THB 33,667 (USD 1,027), THB 29,570 (USD 902), and THB 22,310 (USD 680), respectively. The QALYs for LMWH, apixaban, dabigatran, edoxaban, and rivaroxaban were 0.771, 0.775, 0.746, 0.759, and 0.770 QALYs, respectively. Compared to LMWH, apixaban provided 0.004 additional QALYs, with a decreased cost of THB 44,605 (USD 1,360), resulting in reduced expenses. On the other hand, dabigatran, edoxaban, and rivaroxaban were also associated with lower lifetime costs but reduced life-years and QALYs when compared with LMWH. Conclusions: This study revealed that apixaban is likely to be the preferred option for treating patients with CAT. However, policy decision-making process should take into account the uncertainties related to the implementation of this practice. Full article