Search Results (1,334)

In the United States, access to healthcare is shaped not only by patient need but also by payer policies that determine which providers are reimbursable, how care is sequenced, and what constitutes a legitimate entry point into the system. These gatekeeping functions, while valuable for supporting clinical prioritization, risk stratification, and continuity of care, can also unintentionally reinforce structural inequities and credential hierarchies that delay or limit timely and equitable care, particularly for historically marginalized populations. While reform efforts often focus on expanding benefits or provider networks, fewer address the underlying design of access itself or the rules that govern how patients enter care. It is argued in this paper that a more equitable and efficient healthcare system requires multi-entry care models, in which nurses, behavioral health clinicians, pharmacists, and community health workers may serve as condition-appropriate, reimbursable first points of contact within coordinated care teams. Drawing on evidence from Medicare, Medicaid, the Veterans Health Administration, and commercial payers, these models may support cost containment, improve care coordination, facilitate appropriate utilization, and promote earlier patient engagement. While findings from these models are not uniform across all settings, evidence suggests that outcomes are highly dependent on implementation context, system design, and supporting infrastructure. When implemented with appropriate safeguards (such as interoperable health records, team-based care requirements, and coordinated referral tracking), multi-entry systems can preserve continuity while expanding access. Payers are uniquely positioned to lead this transformation by aligning reimbursement policy with patient needs, supporting team-based care infrastructure, and embedding accountability into access pathways, thereby creating a system that can be more responsive, inclusive, and sustainable. Full article

Since tumor spread through air spaces (STAS) was first described over a decade ago, numerous studies have demonstrated that it is a high-risk prognostic feature in non-small cell lung cancer (NSCLC). However, due to preoperative and intraoperative limitations in pathologic diagnosis, STAS is generally diagnosed following curative intent resection. While STAS should influence NSCLC treatment strategy—particularly upfront surgical decision-making—postoperative diagnosis of STAS has heretofore limited this possibility. While limited to retrospective studies, the current evidence suggests that patients with tumor STAS should undergo a more extensive anatomical resection—preferably a lobectomy, if they are candidates. These results are particularly important in the setting of the results of the JCOG0802 and CALGB 140503 randomized controlled trials which have begun a paradigm-shift toward sublobar resections for early-stage NSCLC, which may not hold similar benefit for early-stage STAS+ disease. The aims of this review are to: (1) detail the current evidence concerning choice of resection extent for STAS+ disease, (2) summarize the current evidence about optimum surgical margins for STAS+ disease, (3) detail the potential role for adjuvant chemotherapy in early-stage STAS+ disease, (4) assess the current limitations in preoperative STAS risk prediction and intraoperative STAS detection, and (5) highlight promising AI-based advancements which will allow surgeons to risk-stratify STAS probability or confirm STAS status intraoperatively. The main limitation of this review is the reliance on retrospective studies as there is a current lack of prospective or randomized data within STAS+ NSCLC, particularly regarding optimal resection strategy for STAS+ disease. Full article

Urban pluvial flooding is becoming more severe in rapidly urbanizing cities under increasingly frequent extreme rainfall. Although Low Impact Development (LID) is widely used to improve infiltration and on-site stormwater retention, its hydrological performance may differ greatly across urban functional zones with distinct land-cover patterns, development intensity, and retrofit constraints. To address the lack of comparative evidence under consistent conditions, this study mapped land cover in five representative functional zones in Nanjing—old residential, new residential, commercial, industrial, and cultural/educational areas—and applied a unified CITYgreen (SCS-CN) framework under a 72 mm, 24 h, two-year design storm to simulate four standalone LID measures: ground-level greening, permeable pavement, green roofs, and grassed swales. Results showed big zone-dependent differences in hydrological benefits. Runoff reduction was greatest in highly impervious industrial and commercial areas, whereas the new residential zone showed only a marginal improvement due to its relatively favorable baseline retention conditions. Across all zones, measures that enhanced infiltration and near-surface storage performed best, with ground-level greening and permeable pavement achieving the highest retention efficiency. These findings highlight the importance of zoning-based, context-sensitive LID prioritization for urban renewal, sponge-city retrofitting, and stormwater planning in rapidly urbanizing cities. Full article

Decarbonizing air travel poses a major technological challenge, driven by the substantial power requirements of the drivetrain and the demanding weight and volume constraints of airborne systems. One promising avenue involves leveraging the high specific energy of hydrogen by designing compact, high-power fuel cell stacks to supply power for electric drivetrains. However, a key drawback of such propulsion architectures is the substantial heat generated within the fuel cells, which necessitates bulky and heavy thermal management systems to ensure safe and continuous operation. This study investigates a proposed air-based thermal management system, which operates by introducing pulsating heat pipes into the bipolar plates of a High-Temperature Polymer Electrolyte Membrane Fuel Cell (HT-PEM FC) stack. If proven to be feasible, heat pipe assisted air cooling may provide the benefit of reducing overall system complexity by decreasing the number of components in the thermal management system. To evaluate the thermal performance of the proposed system, a one-dimensional thermal model was initially developed in a previous study to describe the temperature distribution along the length of a heat pipe. Building upon this foundation, the present work extends the model by incorporating a two-dimensional Computational Fluid Dynamic (CFD) analysis to account for geometry-specific effects within the hexagonal design. Results indicate that the heat transfer from the hexagonal heat pipe geometry to the coolant air flow was marginally overestimated in previous analytical calculations. Revised heat transfer rates led to a shift in the predicted temperature distributions, resulting in the need for either increased external airflow, extended condenser sections, or reduced inlet temperatures to maintain target operating conditions. Although these adjustments may result in a slight increase in system mass and parasitic power consumption, the overall impact is limited, and the heat pipe-assisted air cooling approach remains theoretically feasible. Based on the results, design modifications are proposed and their impact on thermal performance is evaluated to address the challenges of heat rejection and temperature uniformity. A modification based on variation and optimization of PHP meander lengths was evaluated using the updated model and it significantly improved temperature homogeneity across the evaporator. Full article

The implementation of the national emergency industry demonstration bases’ policies is a new way to achieve safety production governance and a key factor in improving the effectiveness of national safety production governance. This study regards China’s national emergency industry demonstration bases’ policies as a quasi-natural experiment. Based on panel data from 31 provinces in China from 2010 to 2022, a multi-period difference in differences (DID) model is conducted to systematically evaluate the impact and mechanism of this policy on China’s safety production governance. The results show that this policy significantly reduced the death rate of safety production accidents with a GDP of 100 million yuan and has a significant governance improvement effect. Further analysis of the mediating effect shows that policies mainly exert governance effects by increasing public safety financial investment and promoting innovation output. The heterogeneity analysis results indicate that policy effects are more significant in regions with weaker energy-resource industrial bases and lower levels of digital development, suggesting that the marginal governance benefits of policies are mainly concentrated in areas with relatively weak supporting conditions for safety governance. This study makes three primary contributions to the literature. Theoretically, it expands the safety governance paradigm by shifting the focus from traditional administrative “command and control” regulations to market-driven industrial agglomeration. Methodologically, by utilizing a multi-period DID model, it overcomes endogeneity issues prevalent in prior correlation-based studies to rigorously identify causal effects. Empirically, it opens the “black box” of policy transmission by validating dual pathways—fiscal resource allocation and technological innovation—while highlighting a critical “filling the gap” marginal utility effect in resource-constrained regions. This study empirically reveals the mechanism and context-dependent characteristics of industrial policies in safety governance, providing empirical evidence for understanding the inherent logic between industrial policies, public safety governance, and regional sustainable development. It offers practical insights for optimizing the precise implementation and resource allocation of emergency industrial policies to foster socially sustainable and resilient industrial growth. Full article

This study presents a pilot cost–benefit analysis of a nature-based therapy (NBT) for Chronic Obstructive Pulmonary Disease (COPD) in Austria. Within the framework of a randomised controlled trial, we identify cost categories, quantify the costs and benefits, and synthesise findings through a partial economic evaluation. Costs were estimated for two scenarios: the trial setting and a hypothetical roll out. Benefits were valued using contingent valuation to estimate willingness to pay (WTP). The trial scenario costs were €326.27 per patient per day, while the roll out scenario estimated was €171.84 per patient per day. Cost component analysis revealed accommodation and staff as the highest contributors in both scenarios. Marginal WTP was estimated at between €25–€35 per day, indicating patients’ perceived added value of NBT over standard clinic-based rehabilitation. These exploratory findings suggest NBT could be financially viable if marginal costs are lower than the estimated WTP. This study provides important preliminary evidence on the economic aspects of NBT, highlighting its potential as a sustainable alternative to standard COPD therapy. We recommend that future research expand upon our initial findings and incorporate economic assessments from the early trial design stage to enable more comprehensive cost–benefit analyses, thus facilitating informed decision-making on the implementation of such programmes. Full article

This study presents a systematic bibliometric analysis and critical review of assessment indicators and multi-criteria decision-making methods for rural energy systems from 2010 to 2025. It examines the evolving definitions and regional variations in these indicators and methods. The research hotspots of rural energy systems have shifted from basic rural electrification to multi-dimensional assessment indicators and hybrid multi-criteria decision-making methods. The assessment indicators for rural energy systems demonstrate a marked imbalance, dominated by economic and technical dimensions. Specifically, economic evaluations for rural energy systems frequently utilize net present cost and levelized energy cost, shifting from static capital comparisons to comprehensive lifecycle assessments. Meanwhile, loss of power supply probability is identified as the primary inherent constraint among technical assessment indicators for rural energy systems. Geographically, assessment indicators for rural energy systems priorities exhibit significant divergence. Developing regions prioritize basic power supply and affordability, whereas developed regions focus on grid stability and market risk resilience. In addition, environmental evaluations for rural energy systems remain fixated on carbon emissions. Developed nations emphasize global climate benefits, while developing nations focus on localized dividends like indoor air quality improvement. Critically, despite an increasing focus on rural livelihoods, social indicators remain systematically marginalized in rural energy systems, leading to the neglect of local requirements and increasing technical risks. The field of rural energy system assessment is advancing toward multi-criteria decision-making indicators. Future methodologies must integrate robust, dynamic adaptive mechanisms that respond to evolving developmental priorities in order to effectively address inherent data scarcity and complex socio-economic uncertainties of rural energy systems. Full article

Amid rapid digital transformation in emerging economies, firms face increasing pressure to modernize accounting information systems (AIS) to enhance transparency and decision usefulness. Limited evidence exists on when IT investment yields differential returns across firm life-cycle stages, particularly in transition economies. Vietnam, as a transition economy with a state-led digital transformation agenda, provides a relevant context to examine whether firm age moderates the relationship between information technology (IT) investment and AIS quality. AIS quality is conceptualized through two dimensions: system quality and information quality. Using survey data from 649 Vietnamese enterprises, the study employs SPSS and the PROCESS macro (version 4.2) to test moderation effects. The results show that IT investment positively affects both system quality and information quality, while firm age also has a positive direct effect on AIS quality. However, the interaction between IT investment and firm age is negative, indicating that the marginal benefits of IT investment are weaker in mature firms than in younger firms, as structural rigidity and legacy system constraints limit the effective leverage of additional IT investment despite higher baseline AIS quality. The study contributes by linking the IS Success Model with an Organizational information processing theory-based contingency perspective, identifying firm age as a structural boundary condition that explains heterogeneous IT returns within an institutional digital governance context. The findings suggest that managers and policymakers should align digital investment and regulatory strategies with organizational maturity to support sustainable digital business ecosystems. Full article

Spectral remote sensing enables efficient acquisition of large-scale land surface information and is a key approach for monitoring soil salinity content (SSC). However, surface mulching significantly alters the spectral reflectance responses of croplands, increasing the uncertainty of SSC retrieval using remote sensing. This study aimed to systematically identify SSC-sensitive spectral features under different mulching conditions and to evaluate the effects of spatial resolution on SSC–spectral relationships. Multi-resolution datasets were constructed based on plastic mulch geometric parameters, and SSC–spectral relationships were analyzed using correlation methods and recursive feature elimination (RFE). Results indicate that under near-ground ultra-high-resolution conditions, the correlation between inter-mulch bare soil spectral features and SSC was weakly influenced by mulch type, and distinguishing mulch types provides limited improvement in inter-variable relationships. Pearson’s r exceeded 0.40 for both white- and black-mulched samples, and distinguishing mulch types provided only marginal gains in model accuracy (RFR–RFE R² = 0.9524 for white-mulched and 0.9252 without distinguishing; R² = 0.9387 for black-mulched). In contrast, under multi-resolution settings at the field scale, separating black-mulched, white-mulched, and non-mulched fields significantly enhanced the correlation between spectral indices (SIs) and SSC, with the coefficient of determination (R²) based on the recursive feature elimination (RFE) algorithm increasing by up to 0.28. The highly sensitive SIs of non-mulched farmland are generally consistent with those of white-mulched farmland but differ markedly from those of black-mulched farmland. Scale optimization analysis further indicated that the optimal spatial resolution was 1.35 m for white-mulched and non-mulched farmland. Black-mulched farmland performed best at 5.4 m, likely because stronger spectral masking by black mulch increases mixed-pixel dominance and benefits from spatial aggregation. These findings provide methodological guidance and practical approaches to accurately retrieve SSC in plastic-mulched croplands and to determine the optimal image spatial resolution. Full article

South Africa’s food system reflects a growing imbalance between nutritionally rich indigenous foods and the increasing dominance of commercially processed alternatives. Despite well documented health, cultural, and environmental benefits, indigenous leafy vegetables and edible insects remain marginal within formal markets and everyday diets. This systematic review synthesised 141 empirical and theoretical studies to examine how household attitudes, consumption behaviours, and market structures interact to shape the role of indigenous foods in South Africa. The review identifies a consistent pattern in which positive perceptions of indigenous foods do not translate into regular consumption. Rural households continue to utilise these foods as part of seasonal and livelihood strategies, while uptake in urban areas remains uneven and context specific. Emerging interest among certain consumer segments highlights potential for product diversification and market development, particularly where indigenous foods are adapted to align with modern preferences. However, this potential is constrained by weak value chain integration, limited standardisation, and the absence of reliable consumption data. These structural limitations restrict both market participation and consumer access, reinforcing the peripheral position of indigenous foods within the broader food system. The findings suggest improving availability, strengthening markets, and enhancing positioning critical for inclusion of indigenous foods in diets. Full article

The rapid integration of renewable energy is increasing the need for fast and sustained load-side frequency regulation, and public electric vehicle (EV) charging networks are promising providers. Their participation, however, is constrained by the volatile charging demand and strict service requirements, which make it difficult to balance regulation revenue with charging quality. This paper proposes a three-layer coordinated framework for multi-site charging networks participating in secondary frequency regulation, comprising market bidding, rolling planning, and fast-response tracking. At the market layer, baseline charging schedules are co-optimized with symmetric regulation capacity bids. At the planning layer, completion margin and progress protection constraints are introduced as tractable service safeguards that preserve charging continuity and deadline compliance. At the execution layer, coordinator-assisted distributed station-level tracking and charger-level urgency-aware allocation track automatic generation control (AGC) commands while correcting the charging progress in real time. The station-level problem is decomposed into local box-constrained subproblems coordinated by a scalar dual signal, enabling real-time AGC tracking with limited inter-station information exchange. Case studies on a reproducible simulated network with 20 stations and 600 chargers show that the proposed method improves ancillary service benefits while maintaining strong tracking performance and markedly improving the charging continuity, deadline compliance, and spatial load balance. Full article

Colorectal cancer (CRC) is the second most common cancer in Europe. There is a need to explore and validate new blood-based tumor markers to improve the selection of patients who are likely to benefit from an early, non-invasive diagnosis of CRC. The purpose of this report is to present the test protocol and its verification. The study is planned in four phases. The first trial phase involves collecting material, consisting of healthy tissue, diseased tissue, and plasma, from 120 CRC patients over 50 years old during surgery. This phase also involves identifying microRNAs (miRNAs) and comparing their expressed levels in colorectal cancer cells with those in healthy tissue taken from a standard resection margin. We detected measurable levels of miRNAs in tissue samples taken from patients, confirming that the material was correctly removed for testing. Statistically significant differences were obtained between healthy and cancerous tissue for selected miRNAs. Some of the selected miRNAs have higher expression levels in CRC tissue and could be potential candidate biomarkers for laboratory-based colorectal cancer diagnosis. Full article

During the critical period of agricultural green transformation, clarifying the evolutionary logic of farmers’ green production behavior under a multi-stakeholder framework provides significant insights for implementing “Dual Carbon” goals, establishing long-term mechanisms for high-quality agricultural development, and resolving deep-seated contradictions in agricultural non-point source pollution. Based on the social co-governance and public participation framework, this paper constructs a tripartite evolutionary game model involving government departments, farmer groups, and the general public, grounded in cost–benefit analysis, social governance friction, and evolutionary game theory. Through simulation, the study explores the equilibrium states and the specific impacts of varying parameter values on stable points. The findings reveal that: (1) The “interest price scissors” (benefit disparity) between green and conventional production is the key determinant of farmers’ strategic equilibrium. Once this structural contradiction is resolved, green production becomes the optimal strategy. (2) Farmers are highly sensitive to marginal cost–benefit fluctuations, leading to a sequential behavioral cascade: farmers retreat first, followed by the government, and finally the public. (3) Public participation cost is the pivotal variable for activating the co-governance mechanism, and the application of digital governance tools determines the time required to reach equilibrium. (4) A “Success Paradox” exists in government regulation; incentive mechanisms must be adjusted promptly after initial success. (5) Integrated policy combinations outperform single instruments; breaking the “locked-in” state requires a policy shock of sufficient intensity. This research offers a theoretical basis and policy enlightenment for optimizing the social co-governance landscape and promoting sustainable agricultural modernization. Full article

AI data-center (DC) growth is increasingly constrained by limited deliverable electricity, interconnection capacity, and cooling demand. This study develops a boundary-consistent screening framework for waste-to-energy (WtE)-coupled AI DC cooling, treating cooling as an energy service that can be supplied through grade matching rather than solely through electricity-driven mechanical chilling. The framework translates plant-side exportable heat into corridor-level planning objects by explicitly accounting for thermal attenuation, absorption-based conversion, and parasitic electricity associated with delivery and auxiliaries. Three results structure the analysis. First, a reference-case energy-service ledger shows how a representative regulated WtE plant with municipal solid-waste throughput of 1500 t/day and lower heating value of 10 MJ/kg yields ~78.1 MWth of exportable driving heat and, at a 20 km corridor, ~53.0 MWcool of delivered cooling and ~8.0 MWe of net avoided cooling electricity after parasitic debiting. Second, the coupled system is governed by operating regimes, not a single efficiency score. Under the baseline package, full thermal coverage is maintained up to ~20.9 km, the stricter quality-adjusted criterion remains positive to ~22.9 km, and the electricity–relief criterion remains positive to ~44.7 km. Third, deployment-scale translation for a 1 GW IT campus (u = 0.70, L = 5 km) implies a net grid relief of ~116.9–264.4 MW across scenario packages, while the required WtE footprint ranges from roughly three to 148 equivalent representative plants, or about 0.6–40 full-load-equivalent plants at a 25% displacement target. The contribution is a siting-ready planning framework that identifies when WtE-coupled cooling remains corridor-feasible, when it becomes hybrid and marginal, and when infrastructure scale rather than thermodynamic benefit becomes the binding constraint. It is intended as a screening tool for planning and comparison, not as a project-specific hydraulic or plant-cycle design. Full article

Liver transplantation is the definitive therapy for end-stage liver disease, yet persistent organ shortages result in approximately 10% of recovered livers being discarded, with markedly higher discard rates among marginal grafts from elderly donors, donation after circulatory death (DCD), and those with macrovesicular steatosis. Machine perfusion (MP) has emerged as a paradigm-shifting preservation strategy with the potential to safely expand the usable donor pool. This narrative review examines the current evidence for three MP modalities—hypothermic machine perfusion (HMP), normothermic machine perfusion (NMP), and normothermic regional perfusion (NRP)—across various marginal donor populations, including elderly donors, steatotic grafts, donors with infectious diseases, and split liver transplantation. Current evidence demonstrates that MP significantly increases utilization of steatotic grafts with up to an eightfold rise in usage of severely steatotic organs. HMP consistently reduces non-anastomotic biliary strictures and early allograft dysfunction across donor types, while NMP enables real-time viability assessment and reduces post-reperfusion syndrome in steatotic grafts. NRP shows particular benefit in DCD organs, reducing biliary complications and improving one-year survival. Additionally, MP extends preservation times enabling next-day split liver transplantation and shows promise as a platform for ex situ antiviral therapy. Despite compelling evidence supporting MP in marginal grafts, widespread adoption remains constrained by high costs, logistical complexity, and the absence of standardized protocols. Future progress will require multicenter studies evaluating long-term outcomes alongside consensus-driven implementation frameworks. Full article