Search Results (2,199)

Introduction and Objectives: Risk-sharing agreements (RSAs) have emerged as a key strategy for financing high-cost medical technologies while ensuring financial sustainability. These payment mechanisms mitigate clinical and financial uncertainties, optimizing pricing and reimbursement decisions. Despite their widespread adoption globally, Latin America has reported limited implementation, particularly for high-cost medical devices. This study aims to share insights from designing RSAs in the form of Outcome Protection Programs (OPPs) for medical devices in Latin America from the perspective of a medical devices company. Methods: The report follows a structured approach, defining key OPP dimensions: payment base, access criteria, pricing schemes, risk assessment, and performance incentives. Risks were categorized as financial, clinical, and operational. The framework applied principles from prior models, emphasizing negotiation, program design, implementation, and evaluation. A multidisciplinary task force analyzed patient needs, provider motivations, and payer constraints to ensure alignment with health system priorities. Results: Over two semesters, a panel of seven experts from the manufacturer designed n = 105 innovative payment programs implemented in Argentina (n = 7), Brazil (n = 7), Colombia (n = 75), Mexico (n = 9), Panama (n = 4), and Puerto Rico (n = 3). The programs targeted eight high-burden conditions, including Coronary Artery Disease, atrial fibrillation, Heart Failure, and post-implantation arrhythmias, among others. Private providers accounted for 80% of experiences. Challenges include clinical inertia and operational complexities, necessitating structured training and monitoring mechanisms. Conclusions: Outcome Protection Programs offer a viable and practical risk-sharing approach to financing high-cost medical devices in Latin America. Their implementation requires careful stakeholder alignment, clear eligibility criteria and endpoints, and robust monitoring frameworks. These findings contribute to the ongoing dialogue on sustainable healthcare financing, emphasizing the need for tailored approaches in resource-constrained settings. Full article

Although technological innovations are often intended to improve quality and efficiency, they can exacerbate systemic challenges when not aligned with the principles of value-based care. As a result, healthcare systems in many countries face persistent inefficiencies stemming from the overuse, underuse, misuse, and waste associated with the adoption of health technology. This narrative review examines the dual impact of healthcare technology and evaluates how contract mechanisms can serve as strategic tools for promoting cost-effective, outcome-oriented integration. Drawing from healthcare management, and supply chain literature, this paper analyzes various payment and contract models, including performance-based, bundled, cost-sharing, and revenue-sharing agreements, through the lens of stakeholder alignment. It explores how these mechanisms influence provider behavior, patient access, and system sustainability. The study contends that well-designed contract mechanisms can align stakeholder incentives, reduce inefficiencies, and support the delivery of high-value care across diverse healthcare settings. We provide concrete examples to illustrate how various contract mechanisms impact the integration of health technologies in practice. Full article

This paper develops a unified framework for mathematical finance under general semimartingale models that allow for dividend payments, negative asset prices, and unbounded jumps. We present a rigorous approach to the mathematical modeling of financial markets with dividend-paying assets by defining appropriate concepts of numéraires, discounted processes, and self-financing trading strategies. While most of the mathematical results are not new, this unified framework has been missing in the literature. We carefully examine the transition between nominal and discounted price processes and define appropriate notions of admissible strategies that work naturally in both settings. By establishing the equivalence between these models and providing clear conditions for their applicability, we create a mathematical foundation that encompasses a wide range of realistic market scenarios and can serve as a basis for future work on mathematical finance and derivative pricing. We demonstrate the practical relevance of our framework through a comprehensive application to dividend-paying equity markets where the framework naturally handles discrete dividend payments. This application shows that our theoretical framework is not merely abstract but provides the rigorous foundation for pricing derivatives in real-world markets where classical assumptions need extension. Full article

While IPV is often studied as a predictor of housing insecurity, few U.S. studies explore how different forms of housing instability may contribute to intimate partner violence (IPV) risk. Using a mixed-methods approach and a cross-sectional design, this study examined the association between four housing instability domains and IPV among a sample of tenants that had either experienced eviction or were at high risk for eviction. Tenants in Harris and Travis counties (Texas, USA) completed an online survey (n = 1085; March–July 2024). Housing instability was assessed across four domains: homelessness, lease violations, utility hardship, and poor housing quality. IPV was measured using the Hurt, Insult, Threaten, Scream Screener. Covariate-adjusted logistic regression models suggest indicators within the four housing instability domains were associated with IPV risk. Within the homelessness domain, experiences with lifetime homelessness (AOR = 1.92, 95%CI 1.61–2.28), in the past 12 months living in unconventional spaces (AOR = 2.10, 95%CI 1.92–2.29), and moving in with others (AOR = 1.20, 95%CI 1.06–1.36) were associated with IPV. Within the lease violations domain, missed rent payments (AOR = 1.69, 95%CI 1.68–1.71) and non-payment lease violations (AOR = 2.50, 95%CI 2.29–2.73) in the past 12 months were associated with IPV. Utility shutoffs (AOR = 1.62, 95%CI 1.37–1.91) and unsafe housing (AOR = 1.65, 95%CI 1.31–2.09) in the past 12 months were associated with IPV. Homelessness, housing-related economic hardships and substandard living conditions predict an elevated risk of IPV. Full article

This study aims to map the scientific knowledge of bank profitability and its determinants. It identifies trends and gaps in existing research through a bibliometric analysis. To this end, 634 documents published in the Web of Science database over the last 54 years were analyzed using the bibliometric package. The results indicate an increase in the volume of publications following the 2008 financial crisis, focusing on analyzing the factors influencing bank profitability and economic growth. The Journal of Banking and Finance is the preeminent publication in this field. The literature reviewed shows that bank profitability depends on internal factors (size, credit risk, liquidity, efficiency, and management) and external factors (such as GDP, inflation, interest rates, and unemployment). In addition to the traditional determinants, the recent literature highlights the importance of innovation and technological factors such as digitalization, mobile banking, and electronic payments as relevant to bank profitability. ESG (environmental, social, and governance) and governance indicators, which are still emerging but have been extensively researched in companies, indicate a need for evidence in this area. This paper also provides relevant insights for the formulation of monetary policy and the strategic formulation of banks, helping managers and owners to improve bank performance. It also provides directions for future empirical studies and research collaborations in this field. Full article

Large-scale events, such as festivals and public gatherings, pose serious problems in terms of traffic congestion, slow transaction processing, and security risks to transportation planning. This study proposes a blockchain-based solution for enhancing the efficiency and security of intelligent transport systems (ITS) by utilizing state channels and rollups. Throughput is optimized, enabling transaction speeds of 800 to 3500 transactions per second (TPS) and delays of 5 to 1.5 s. Prevent data tampering, strengthen security, and enhance data integrity from 89% to 99.999%, as well as encryption efficacy from 90% to 98%. Furthermore, our system reduces congestion, optimizes vehicle movement, and shares real-time, secure data with stakeholders. Practical applications include fast and safe road toll payments, faster public transit ticketing, improved emergency response coordination, and enhanced urban mobility. The decentralized blockchain helps maintain trust among users, transportation authorities, and event organizers. Our approach extends beyond large-scale events and proposes a path toward ubiquitous, Artificial Intelligence (AI)-driven decision-making in a broader urban transit network, informing future operations in dynamic traffic optimization. This study demonstrates the potential of blockchain to create more intelligent, more secure, and scalable transportation systems, which will help reduce urban mobility inefficiencies and contribute to the development of resilient smart cities. Full article

The value realization of ecological products is an important part of rural and agricultural development. As a significant force for protecting traditional agricultural systems and promoting rural revitalization, agricultural heritage systems (AHSs) have formed diverse value realization paths of ecological products in the process of dynamic protection and adaptive management. Through theoretical research, this article analyzed the characteristics of ecological products in AHS sites (EPAHSSs) and summarized the framework of value realization paths of EPAHSSs. Then, the Wannian Rice Culture System in China was selected as a case for conducting empirical research. The results showed that EPAHSSs exhibit obvious uniqueness in terms of climate environment, germplasm resources, farming and breeding models, and cultural heritage. The value realization paths of EPAHSSs mainly include industrial development support, such as the extension of agricultural industrial chains and the development of tourism, as well as fiscal transfer payments. The case analysis results indicated that Wannian County contains a rich variety of ecological products and developed a value realization pathway mainly based on the integration of industries and supplemented by fiscal transfer payments during the process of protection and development. However, further optimization is needed to promote the development of tourism and other paths. This study not only contributes to the sustainable development of the Wannian Rice Culture System, but the proposed framework is also applicable to other heritage systems and similar regions. Full article

Drylands cover approximately 41% of Earth’s land surface, supporting about 500 million people and 45% of global agriculture. Groundwater is essential in drylands and is crucial for maintaining ecosystem services and offering numerous benefits. This article, for the first time, analyses and valuates the hydrological ecosystem services (HESs) provided by groundwater in a region of the Colorado River Delta in Mexico, an area with uncertain economic impact due to water scarcity. The main water sources are the Colorado River and groundwater from the Mexicali and San Luis Rio Colorado valley aquifers, both of which are overexploited. Valuation techniques include surrogate and simulated market methods for agricultural, industrial, urban, and domestic uses, the shadow project approach for water conservation and purification cost avoidance, and the contingent valuation method for recreation. Data from 2013 to 2015 and 2020 were used as they are the most reliable sources available. The annual value of HESs provided by groundwater was USD 883,520 million, with water conservation being a key factor. The analyzed groundwater uses reflect differences in efficiency and economic value, providing key information for decisions on governance, allocation, conservation, and revaluation of water resources. These results suggest reorienting crops, establishing differentiated rates, and promoting payment for environmental services programs. Full article

The continued migration of physicians from independent practice to affiliation with larger entities has garnered significant scrutiny. These affiliation models include hospitals and health systems, payers and corporate entities, and management services organizations, which may or may not be private equity (PE)-backed. Data on the impact of different physician affiliation models on cost of care is limited. We examined the relationship between provider affiliation model, site of care (SOC), and cost of care for certain high-volume procedures in procedure-intensive specialties for both Medicare and commercial insurance. We found that hospital-affiliated physicians are least likely—and PE-affiliated physicians are most likely—to provide care in lower-cost settings. For both Medicare and commercial insurance, SOC contributes meaningfully to procedure unit price, which is consistently greater in hospital-based settings. These findings suggest that the physician affiliation model and associated SOC cost differentials contribute materially to healthcare expenditures. As the Medicare cost differentials are set by statute and regulations, strategies such as site-neutral payments are needed to mitigate the monetary impact of historical and future physician practice migration. Full article

The Gahai wetland in Gansu, China, is a key wetland for nationally and globally threatened bird species. This research aims to quantify the economic value of wetland birds by the method of contingent valuation questionnaire, thereby providing a foundation for conservation of avian species. The result indicated that residents were willing to pay between 208 and 230 CNY (29–32 USD $) annually for bird protection, a total annual value of wetland birds in Luqu County ranging from 7.9 M to 8.8 M CNY (1.1–1.3 M USD $). Men, locals, and older individuals were more inclined to contribute and offered higher payments, albeit non-significant correlation between education level and annual income with the willingness to pay. While the depth of understanding of wetland pressures did not significantly influence the willingness to pay, it did show a positive correlation; those with more profound understanding tended to be more generous in their payments. Tibetan male residents were more likely to prioritize ecological and environmental protection due to their religious beliefs and cultural customs, which emphasize the reverence for and compassion towards birds. This research not only complemented and validated the applicability of the contingent valuation method in China but also underscores the considerations that should be taken into account when employing this method. Full article

Data over sound (DoS) is an established technique that has experienced a resurgence in recent years, finding applications in areas such as contactless payments, device pairing, authentication, presence detection, toys, and offline data transfer. This study introduces CardiaWhisper, a system that extends the DoS concept to the medical domain by using a medical data-over-sound (MDoS) framework. CardiaWhisper integrates wearable biomedical sensors with home care systems, edge or IoT gateways, and telemedical networks or cloud platforms. Using a transmitter device, vital signs such as ECG (electrocardiogram) signals, PPG (photoplethysmogram) signals, RR (respiratory rate), and ACC (acceleration/movement) are sensed, conditioned, encoded, and acoustically transmitted to a nearby receiver—typically a smartphone, tablet, or other gadget—and can be further relayed to edge and cloud infrastructures. As a case study, this paper presents the real-time transmission and processing of ECG signals. The transmitter integrates an ECG sensing module, an encoder (either a PLL-based FM modulator chip or a microcontroller), and a sound emitter in the form of a standard piezoelectric speaker. The receiver, in the form of a mobile phone, tablet, or desktop computer, captures the acoustic signal via its built-in microphone and executes software routines to decode the data. It then enables a range of control and visualization functions for both local and remote users. Emphasis is placed on describing the system architecture and its key components, as well as the software methodologies used for signal decoding on the receiver side, where several algorithms are implemented using open-source, platform-independent technologies, such as JavaScript, HTML, and CSS. While the main focus is on the transmission of analog data, digital data transmission is also illustrated. The CardiaWhisper system is evaluated across several performance parameters, including functionality, complexity, speed, noise immunity, power consumption, range, and cost-efficiency. Quantitative measurements of the signal-to-noise ratio (SNR) were performed in various realistic indoor scenarios, including different distances, obstacles, and noise environments. Preliminary results are presented, along with a discussion of design challenges, limitations, and feasible applications. Our experience demonstrates that CardiaWhisper provides a low-power, eco-friendly alternative to traditional RF or Bluetooth-based medical wearables in various applications. Full article

Research on ecosystem carbon sequestration services and ecological compensation is crucial for advancing carbon neutrality. As a public good, ecosystem carbon sequestration services inherently lead to externalities. Therefore, it is essential to consider externalities in the flow of sequestration services. However, few studies have examined intra- and inter-regional ecosystem carbon sequestration flows, making regional ecosystem carbon sequestration flows less comprehensive. Against this background, the research objectives of this paper are as follows. The flow of carbon sequestration services between Henan Province and out-of-province regions is studied. In addition, this study clarifies the beneficiary and supply areas of carbon sink services in Henan Province and the neighboring regions at the prefecture-level city scale to obtain a more systematic, comprehensive, and actual flow of carbon sequestration services for scientific and effective eco-compensation and to promote regional synergistic emission reductions. The research methodologies used in this paper are as follows. First, this study adopts a meta-coupling framework, designating Henan Province as the focal system, the Central Urban Agglomeration as the adjacent system, and eight surrounding provinces as remote systems. Regional carbon sequestration was assessed using net primary productivity (NEP), while carbon emissions were evaluated based on per capita carbon emissions and population density. A carbon balance analysis integrated carbon sequestration and emissions. Hotspot analysis identified areas of carbon sequestration service supply and associated benefits. Ecological radiation force formulas were used to quantify service flows, and compensation values were estimated considering the government’s payment capacity and willingness. A three-dimensional evaluation system—incorporating technology, talent, and fiscal capacity—was developed to propose a diversified ecological compensation scheme by comparing supply and beneficiary areas. By modeling the ecosystem carbon sequestration service flow, the main results of this paper are as follows: (1) Within Henan Province, Luoyang and Nanyang provided 521,300 tons and 515,600 tons of carbon sinks to eight cities (e.g., Jiaozuo, Zhengzhou, and Kaifeng), warranting an ecological compensation of CNY 262.817 million and CNY 263.259 million, respectively. (2) Henan exported 3.0739 million tons of carbon sinks to external provinces, corresponding to a compensation value of CNY 1756.079 million. Conversely, regions such as Changzhi, Xiangyang, and Jinzhong contributed 657,200 tons of carbon sinks to Henan, requiring a compensation of CNY 189.921 million. (3) Henan thus achieved a net ecological compensation of CNY 1566.158 million through carbon sink flows. (4) In addition to monetary compensation, beneficiary areas may also contribute through technology transfer, financial investment, and talent support. The findings support the following conclusions: (1) it is necessary to consider the externalities of ecosystem services, and (2) the meta-coupling framework enables a comprehensive assessment of carbon sequestration service flows, providing actionable insights for improving ecosystem governance in Henan Province and comparable regions. Full article

During the last decade, the blockchain landscape has rapidly evolved, fostering the development of decentralized applications (DApps) that utilize cross-chain interactions. Although existing technologies have enhanced transaction processing and introduced interoperability solutions, scalability challenges persist, undermining their effectiveness. In particular, traditional cross-chain DApp interaction protocols experience performance bottlenecks due to their dependence on on-chain validation mechanisms, resulting in increased latency and computational costs. To address these issues, this paper presents the ScaL2Chain protocol, which is designed to facilitate efficient and secure cross-chain transactions for DApps. ScaL2Chain leverages off-chain technologies, such as payment channels, to enable participants to conduct transactions with a minimal on-chain footprint. By implementing an innovative state verification mechanism, ScaL2Chain guarantees high performance, confidentiality, and transaction integrity. Our empirical evaluations indicate that ScaL2Chain significantly outperforms existing solutions in terms of transaction throughput. Specifically, compared to baseline systems, ScaL2Chain achieves a 7.9-times to 8.4-times improvement in permissionless environments and a 1.9-times to 35.8-times improvement in permissioned environments under workloads with 4-64 DApps and varying cross-chain transaction ratios (0–100%). Full article

Off-chain payments in the Internet of Things (IoT) enhance the efficiency and scalability of blockchain transactions. However, existing privacy mechanisms face challenges, such as the disclosure of payment channels and transaction traceability. Additionally, the rise of quantum computing threatens traditional public key cryptography, making the development of post-quantum secure methods for privacy protection essential. This paper proposes a post-quantum ring signature scheme based on hash functions that can be applied to off-chain payments, enhancing both anonymity and linkability. The scheme is designed to resist quantum attacks through the use of hash-based signatures and to prevent double spending via its linkable properties. Furthermore, the paper introduces an improved Hash Time-Locked Contract (HTLC) that incorporates a Signature of Knowledge (SOK) to conceal the payment path and strengthen privacy protection. Security analysis and experimental evaluations demonstrate that the system strikes a favorable balance between privacy, computational efficiency, and security. Notably, the efficiency benefits of basic signature verification are particularly evident, offering new insights into privacy protection for post-quantum secure blockchain. Full article

Supplier selection is one of the critical processes that entail multiple complex deliberations. The selection of an appropriate alternative supplier is a highly intricate process, primarily due to there being multiple criteria which are exceptionally subjective. This paper aims to develop a practical framework for choosing a suitable precast supplier by integrating the Value Engineering (VE) concept, Stepwise Weight Assessment Ratio Analysis (SWARA), and the Weighted Aggregated Sum Product Assessment (WASPAS) technique. This paper introduces a novel method to estimate the quality weights of alternative suppliers’ criteria (CQW) by linking factory capacity with the coefficients of the nine significant criteria, computed using principal component analysis (PCA). None of the formal studies make this link directly. The framework’s findings were validated by comparing its results with an expert assessment of five Saudi supplier alternatives. The results revealed that the framework’s results agree with the expert’s judgment. The method of payment criterion received the highest weight, indicating that it was considered the most important of the nine criteria identified. Combining PCA and VE with the WASPAS technique resulted in an unprecedentedly effective selection tool for precast suppliers. Full article