Objectives People with type 1 diabetes may be at increased risk of disordered eating, which may increase risk of elevated poor outcomes and high-risk complications. Type 1 diabetes disordered eating (T1DE) services were set-up to integrate diabetes and mental healthcare to better support people with T1DE and improve longer-term outcomes. A rapid evaluation was conducted to explore the implementation of T1DE services. Specifically, we aimed to: describe service delivery models; investigate staff experiences of impact and delivery of implementation; explore patient experiences of T1DE services; and to report health outcomes and associated costs.Design Rapid evaluation using mixed methods (service mapping, staff and patient interviews, staff survey, analysis of clinical and economic data). Health outcome data was reported at baseline and 6 months.Setting This study explored the implementation of five new T1DE services and three existing services.Participants Staff working within T1DE services and patients who received care from T1DE services.Results Assessment of our mixed methods study identified four key findings: (1) T1DE delivery models: The T1DE services displayed modest variation in models of delivery, but similarities were more evident, with a focus on direct delivery to patients involving joint meetings between diabetes and mental health staff. Nevertheless, some services also took on a ‘consultation’ role, providing advice and support to wider staff outside the service also managing these patients. Delayed implementation of the services slowed the formation of fully integrated teams and the ability of services to operate at scale. (2) Staff experience: Workforce issues were a crucial aspect of T1DE pilots. Managing this patient population is associated with high levels of anxiety for staff. Nevertheless, once formed, staff reported a very positive experience of working in integrated teams. (3) Patient experience: Although only a small sample of patients were interviewed, they reported a profoundly different experience to their previous care, which was now perceived as supportive and relationship focused. Although such improvements were aligned with the integrated care model underlying T1DE, it was less clear how such changes in patient experience would feature in decisions about commissioning. (4) Health outcomes and associated costs: There were 139 patients accepted onto the care pathway. Improvements were seen for all health outcomes. Compared with baseline measures, there was a mean 0.97% reduction in HbA1c (glycated haemoglobin) from 11.2% to 10.2% at 6 months. Improvements were also seen in other outcomes, including the diabetes eating problem scale and the diabetes distress scale. However, the number of patients on the care pathway with follow-up at 6 months was relatively small (n=29–47) and definitive statements about clinical or cost-effectiveness were not possible.Conclusions Overall, T1DE services were well received by both staff and patients. Due to a number of logistical challenges, the implementation of services was slower than anticipated, resulting in a limited number of patients on the care pathway. Securing local funding for existing services, once national pilot funding ended, was identified as a significant challenge. In order to ensure services are sustainable and commissioned at a local level, consideration may need to be given to alternative service delivery models.
Pradesh Jena, Francis Dutta, Bijoy Krishna Handique
et al.
Abstract Precision farming (PF) has emerged as a game-changer in agriculture, offering technological solutions to address the critical challenges of food security and climate change. However, the widespread adoption of PF faces hurdles due to the complexities of diverse cropping systems and the high costs associated with advanced ground-based instruments. To overcome this, an innovative approach was introduced in Bandia village of Assam, India by using UAV multispectral and Sentinel 2 data synergistically. The UAV imagery acquired on 17th March 2021, with ten multispectral bands (444–842 nm) was used for classifying different land use types using Object Based Image Analysis (OBIA) technique. The classification resulted into a moderately diverse cropping system with maize and rice cultivated as dominant crops occupying 45.56% and 40.87% of the total cultivated area. The diversity of the cropping pattern was further validated by ecological indices, with Shannon's Diversity Index (DI) at 1.09, Simpson's DI at 0.62, and Evenness Index at 0.78. Successively, crop above ground biomass, leaf area index and height were monitored based on the optimized Partial Least Square Regression (PLSR) model using vegetation indices from both the platforms. Cost analysis of this approach revealed a remarkable 99% cost reduction compared to traditional PF techniques. Our findings strongly suggest that the synergistic use of UAV and satellite data offers a more comprehensive view of agriculture lands, enabling high-precision monitoring of crop growth and development throughout the growth cycle and facilitating improved field level management.
Margarita Velandia, Carlos Trejo-Pech, David Butler
et al.
Alley cropping is an agroforestry practice that involves the planting of trees or shrubs alongside herbaceous crops within the same production system. Potential benefits of alley cropping include crop diversification, enhanced productivity of annual crops, reduced soil erosion, improved pollinators and wildlife habitat, decreased incidence of pests and diseases, carbon sequestration, and reduced nitrogen leaching. Despite these potential benefits, the adoption of alley cropping remains low. In Tennessee, specifically, only about 2% of the farms have used agroforestry practices, including alley cropping. We surveyed Tennessee fruit and vegetable farmers to assess their willingness to adopt alley cropping and the differences in characteristics of those willing and not willing to use this production practice. In general, those respondents who are willing to adopt alley cropping are more familiar with this production system and are facing or have faced production challenges that could be alleviated by adopting this production practice, such as low organic matter and crop heat stress. Our results also suggest that the type of trees or shrubs incorporated in this system and adequate payment for adoption that covers investment and maintenance costs could affect Tennessee fruit and vegetable farmers’ willingness to use this system.
Camille Boulanguer, Sarah Goldman, Maya Jandah
et al.
In a 2019 New York Times article, Paul Krugman declared himself a “crypto skeptic” and shared his pessimistic predictions for cryptocurrencies. Nevertheless, unbacked cryptomoney is now very important in our societies and has revolutionized the monetary and financial landscape as exemplified by the increased pressure from competent regulators to monitor and regulate it. Cryptocurrencies are described by their high volatility that permits regulators to define them as non-safe financial assets when it comes to energy consumption. The anonymous property of cryptocurrencies opens the door to tax evasion, making it especially susceptible to avoiding environment-related taxes aimed at tackling negative impact of climate change. Against this background, the paper sets a twofold aim: to demonstrate that unbacked cryptomoney is volatile and it may pose a threat to financial and fiscal stability; and to develop the idea that, given their different degrees of anonymity and their decentralisation nature, cryptocurrencies could actively participate in the process of tax evasion and therefore incur high costs for countries. Given the general ecological condition and ensuing concerns, it is clear that avoiding eco-taxes represents a serious issue since money from eco-taxation could have been invested in environmental social and governance projects. Therefore, a clear and compelling legal framework should be implemented worldwide to reduce the tax evasion phenomena via cryptomoney channels.
Brain metastases (BM) are common in patients with non-small cell lung cancer (NSCLC). However, the pure economic burden of BM is unknown. This study aimed to evaluate the impact of BM on healthcare costs and resource utilization in patients with NSCLC by comparing patients with and without BM. This was a retrospective cohort analysis of South Korean health insurance review and assessment claims data. Patients with stage IIIB or IV NSCLC were identified (March 1, 2013 to February 28, 2018). We compared their two-year and per-patient-per-month (PPPM) healthcare costs and resource utilization with 1:3 propensity score-matched patients without the condition. A generalized linear model was used to estimate the impact of BM and other covariates on healthcare costs. After propensity score matching with the 33 402 newly diagnosed cases of stage IIIB or IV NSCLC, 3435 and 10 305 patients were classified as having or not having BM, respectively. Mean healthcare costs were significantly greater in patients with BM for both the two years (US$ 44 692 vs. US$ 32 230, p < .0001) and PPPM (US$ 3510 vs. US$ 2573, p < .0001). The length of hospital stay was longer in patients with BM (79.15 vs. 69.41 days for two years, p < .0001; 7.69 vs. 6.86 days PPPM, p < .0001), and patients with BM had more outpatient visits (50.61 vs. 46.43 times for two years, p < .0001; 3.64 vs. 3.40 times PPPM costs, p < .0001). The costs of drugs, radiology/radiotherapy, and admission comprised the majority of PPPM costs and were higher in patients with BM. The generalized linear model analysis suggested that patients with BM had significantly increased healthcare costs (by 1.29-fold, 95% confidence interval 1.26–1.32). BM is a significant economic burden for patients with NSCLC. Therefore, it is important to prevent BM in patients with NSCLC to reduce their economic burden.
Gloria Sutherland, Caroline Bulsara, Suzanne Robinson
et al.
Abstract Objective: This study explored the healthcare needs and barriers to health services in older homeless women in the Perth metropolitan area, Western Australia. Methods: Twenty‐two older women experiencing homelessness completed a questionnaire and semi‐structured interview. Data were analysed using descriptive statistics and thematic analysis. Results: The study highlighted that these women had complex and inter‐related issues that affected their health. The nine major themes that emerged from the interview data consisted of: safe accommodation; financial insecurity; experience of trauma and abuse; stigma, embarrassment and fear of being judged; the health impact of not fulfilling their role as family nurturer; mental health; complex interaction of physical and mental health issues; healthcare costs; and the need for ongoing psychosocial and healthcare support once housed. Conclusion: Provision of safe and secure accommodation is pivotal to women's health, as is the need for greater understanding of the impact of poverty, women's traditional roles, social disconnection and domestic violence, and ongoing access to healthcare and support services. Implications for public health: A structural and systemic approach based on a social determinants of health framework is required to address the health needs of the increasing numbers of older women becoming homeless in this country.
One of the radical ways to prevent and reduce mycotoxicosis on the animal body is the use of adsorbing feed additives in the diet. Inclusion of complex mineral and vegetable complex additive Nabikat at 0,20% dose and mineral - dry content of Glaukonit substance of 0.25% in enceinte and nursing sows’ full-fledged combined fodder composition showed that they increase the digestibility of crude fiber in the uterus during deep pregnancy by 4.97 and 4.07%, as well as the digestibility of crude fat by 5.24 and 1.71% and deposit nitrogen in it. They amount to 2.54 g and 1.24 g respectively. Compared to Glaukonit, Nabikat has a more positive effect on the anabolic properties of metabolic body processes. As a result, sows’ diversity in this group was 17.3% higher than in the control group, reaching 0.4% in the lazurite group. The difference in piglets’ preservation amounted to 10.9% and 2.2%, as well as in the weight of the litter when weaning. The age amounted to 26.5 and 0.9, respectively.%. Nabikat addition to sows’ diet reduced feed costs per piglet by 19.1 -30.4%, using Glaukonit - by 4.7 -5.8%.
Zhenhua Chen, Andre L Carrel, Christina Gore
et al.
Battery electric vehicles (BEVs) have received increasing attention in recent years as BEV technical capabilities have rapidly developed. While many studies have attempted to investigate the societal impacts of BEV adoption, there is still a limited understanding of the extent to which widespread adoption of BEVs may affect both environmental and economic variables simultaneously. This study intends to address this research gap by conducting a comprehensive impact assessment of BEV adoption. Using demand estimates derived from a discrete choice experiment, the impact of various scenarios is evaluated using a computable general equilibrium model. Three drivers of BEV total cost of ownership are considered, namely, subsidy levels, cash incentives by manufacturers, and fuel costs. Furthermore, in light of current trends, improvements in BEV battery manufacturing productivity are considered. This research shows that changes in fuel price and incentives by manufacturers have relatively low impacts on GDP growth, but that the effect of subsidies on GDP and on BEV adoption is considerable, due to a stimulus effect on both household expenditures and on vehicle-manufacturing-related sectors. Productivity shocks moderately impact GDP but only affect BEV adoption in competitive markets. Conversely, the environmental impact is more nuanced. Although BEV adoption leads to decreases in tailpipe emissions, increased manufacturing activity as a result of productivity increases or subsidies can lead to growth in non-tailpipe emissions that cancels out some or all of the tailpipe emissions savings. This demonstrates that in order to achieve desired emissions reductions, policies to promote BEV adoption with subsidies should be accompanied by green manufacturing and green power generation initiatives.
Las empresas agropecuarias pueden definirse como unidades de organización que producen bienes -agrícolas y/o pecuarios- a través de la gestión de “procesos productivos biológicos”.
En general, los productos de la empresa agropecuaria son colocados en los “mercados de materias primas” a los que concurren como demandantes empresas industriales que las requieren como tales para procesos vinculados con la obtención de alimentos.
La perspectiva tradicional interpreta que la problemática de la empresa agropecuaria culmina en esos “mercados de materias primas”. Aunque real y objetiva, esta visión desatiende una importante variable de contexto, cual es que la producción primaria es siempre parte de complejos productivosmayores, habitualmente denominados “cadenas agroalimentarias”.
Una lectura más actual e integral sobre el tema, extiende el análisis de sus problemáticas hasta los mercados de los bienes finales (alimentos) que se derivan de su propia producción.
A partir de esta concepción ha surgido la necesidad de realizar estudios sistémicos para encontrar solución de los problemas que corresponden a los sistemas productivos en su conjunto. Muchos de estos refieren a la “creación de valor” por parte de las cadenas agroalimentarias y a cómo se distribuye el valor neto creado entre sus eslabones, es decir a la renta de los actores.
Aparece aquí el problema que se pretende abordar: con frecuencia se observa que la información sobre costos ofrecida por un eslabón no resulta confiable para los del otro y viceversa.
Por ejemplo, los estudios sobre costos del sector primario tienen un enfoque, al que denominaremos “agronómico”, no necesariamente alineado con el correspondiente del segmento industrial de la misma cadena agroalimenticia, al que los agrónomos llaman enfoque “contable”. Esto deriva en fuertes tensiones cuando esa información resulta sensible en sus relaciones.
La presente ponencia aborda el tema del análisis del “enfoque agronómico” de los costos con el objetivo de encontrar mecanismos que ayuden a identificar y luego superar las eventuales contradicciones que puedan existir con otros enfoques
empleados en las actividades industriales.
Decline in vulture populations have seriously reported in Nigeria as in other habits around the world. Human pressure from poisoning, hunting and trading for traditional medicine are key factors leading to decline of vulture population in northern Nigeria. This study examines vulture trading for traditional medicine as risk factor for the raptors population decline in Katsina with a view to providing baseline information for reviewing conservation policies in the State and Nigeria at large. The study is a survey research involving questionnaire administration and interview of seventy two stakeholders who were sampled using snowball sampling technique as follows: vulture stall owners (n=58) and abattoir employees (n=10) and traditional healers (n= 4). A total of five locations were surveyed based on the understanding that they possess the most specialized fetish markets and important centres of vulture trading in Katsina State. Percentage and mean were used for data analysis. The study found that trading of vulture is proliferating in the area as more than 50% of the stalls were opened between 2016 and 2019. It also revealed that 80% of the fetish stalls are located outside Katsina town for fear of authorities fighting illicit trade of vulture. Also revealed was that prices of vulture vary in space and depend on relationships with customers: a whole vulture costs N21000 (ca. $55.55) which soars as high as N27000 (ca. $75) outside Katsina town and N30000 (ca. $83) in times of scarcity. This study recommended that there is the need to carry out nationwide comprehensive assessment of trade in avifauna for improving conservation policies and practices in Nigeria.
Keywords: carcasses, fetish stalls, traditional medicine, conservation
For the study on cost of cultivation of groundnut crop in Andhra Pradesh, the data was obtained from Directorate of Economics and Statistics, Ministry of Agriculture, Government of India. The cost of cultivation was found to be Rs. 55142.26. Among the operational costs, labour cost accounted to a major share of 60%, indicating the labour intensive nature of groundnut cultivation. The cost of cultivation and the gross returns analysed during the two periods noted that cost of cultivation (C2) increased by 40% where as A2+FL increased by 52% against the increase of 25% in the gross returns. The cost of production was higher in Andhra Pradesh than other major groundnut producing states Gujarat and Tamil Nadu. The cost of cultivation needs to be reduced by opting good management practices and more mechanization so as to make groundnut cultivation profitable in Andhra Pradesh.
The article discusses the possibilities of generating electricity without burning fuel by expanding high-pressure natural gas at gas distribution stations with lower specific capital costs. It is proposed to reduce the pressure of the transported natural gas using expander-generator units instead of traditional throttle devices.
Background: Major depressive Disorder (MDD) is a severe mental disorder associated with considerable disability and high costs. Over the last decades, various psychotherapies for MDD have been developed and researched, among others Behavioral Activation (BA) and Metacognitive Therapy (MCT). MCT and BA target different maintaining factors of MDD and have not been compared to date. The PRO*MDD randomized controlled trial will compare MCT and BA in the routine clinical setting of an outpatient clinic.Methods and Design: We aim to recruit 128 MDD patients, who will be randomly assigned to either MCT or BA. In both conditions, patients will receive one individual therapy session and one group therapy session per week for a maximum of 6 months. Assessments will take place at baseline, pre-treatment, mid-treatment, post-treatment as well as at 12, 18, and 30 months after start of treatment as follow-up. The primary outcome is reduction of depression severity assessed with the Hamilton Rating Scale for Depression; secondary outcomes address quality of life, psychosocial functioning and participation as well as comorbidity.Discussion: The PRO*MDD study is the first randomized controlled trial to compare the effectiveness of MCT and BA. The outcome of this trial will increase our knowledge on the effectiveness and applicability of both treatment modalities and therefore contribute to the improvement of treatment for depressive patients.Ethics and dissemination: The study has been reviewed and approved on 11 August 2016 by the Ethics Committee of the Lübeck University (reference number: 16–176). The results will be discussed through peer-reviewed publications.Trial registration: German Clinical Trials Register DRKS-ID: DRKS00011536 (retrospectively registered)
A major issue hindering efficient industrial ethanol fermentation from sugar-based feedstock is excessive unwanted bacterial contamination. In industrial scale fermentation, reaching complete sterility is costly, laborious, and difficult to sustain in long-term operation. A physical selective separation of a co-culture of Saccharomyces cerevisiae and an Enterobacter cloacae complex from a buffer solution and fermentation media at dilution rates of 0.1–1 1/h were examined using an immersed membrane bioreactor (iMBR). The effect of the presence of yeast, inoculum size, membrane pore size, and surface area, backwashing and dilution rate on bacteria removal were assessed by evaluating changes in the filtration conditions, medium turbidity, and concentration of compounds and cell biomass. The results showed that using the iMBR with dilution rate of 0.5 1/h results in successful removal of 93% of contaminating bacteria in the single culture and nearly complete bacteria decontamination in yeast-bacteria co-culture. During continuous fermentation, application of lower permeate fluxes provided a stable filtration of the mixed culture with enhanced bacteria washout. This physical selective separation of bacteria from yeast can enhance final ethanol quality and yields, process profitability, yeast metabolic activity, and decrease downstream processing costs.
An instance of a balanced optimization problem with vector costs consists of a ground set X, a cost-vector for every element of X, and a system of feasible subsets over X. The goal is to find a feasible subset that minimizes the so-called imbalance of values in every coordinate of the underlying vector costs. Balanced optimization problems with vector costs are equivalent to the robust optimization version of balanced optimization problems under the min-max criterion. We regard these problems as a family of optimization problems; one particular member of this family is the known balanced assignment problem. We investigate the complexity and approximability of robust balanced optimization problems in a fairly general setting. We identify a large family of problems that admit a 2-approximation in polynomial time, and we show that for many problems in this family this approximation factor 2 is best-possible (unless P = NP). We pay special attention to the balanced assignment problem with vector costs and show that this problem is NP-hard even in the highly restricted case of sum costs. We conclude by performing computational experiments for this problem.
One of the most important parameters for developing Clean Development Mechanism (CDM) project proposals in the electricity sector (both supply and efficiency) is the standard electricity ‘grid emission factor’, which represents the carbon dioxide related to a megawatt hour of electricity supplied or saved on the grid. While there are detailed guidelines from the CDM Executive Board on how to calculate this emission factor, the values used in registered CDM projects in South Africa vary widely, both due to changes in the rules over time and also to misapplication of the rules. This paper shows how the application of the latest guidelines gives a ‘combined margin emission factor’ for South Africa of 0.957 tCO2/MWh in 2009/2010. The variation in emission factors in the literature, as well as the importance of reducing the transaction costs for South African project developers, points to the need for an official published grid emission factor from the CDM host country authority in South Africa, the Designated National Authority (DNA), within the Department of Energy.
Paul A Novick, Oscar F Ortiz, Jared Poelman
et al.
In the face of drastically rising drug discovery costs, strategies promising to reduce development timelines and expenditures are being pursued. Computer-aided virtual screening and repurposing approved drugs are two such strategies that have shown recent success. Herein, we report the creation of a highly-curated in silico database of chemical structures representing approved drugs, chemical isolates from traditional medicinal herbs, and regulated chemicals, termed the SWEETLEAD database. The motivation for SWEETLEAD stems from the observance of conflicting information in publicly available chemical databases and the lack of a highly curated database of chemical structures for the globally approved drugs. A consensus building scheme surveying information from several publicly accessible databases was employed to identify the correct structure for each chemical. Resulting structures are filtered for the active pharmaceutical ingredient, standardized, and differing formulations of the same drug were combined in the final database. The publically available release of SWEETLEAD (https://simtk.org/home/sweetlead) provides an important tool to enable the successful completion of computer-aided repurposing and drug discovery campaigns.
In this work we re-examine a modular multiplication and a modular exponentiation method. The multiplication method, proposed by Hayashi in 1998, uses knowledge of the factorization of both N + 1 and N + 2 to compute a multiplication modulo N. If both N + 1 and N + 2 can be factored into k equally sized relatively prime factors then the computations are done modulo each of the factors and then combined using the Chinese Remainder Theorem. It was suggested that the (asymptotic) computational costs of the method is 1/k of simply multiplying and reducing modulo N. We show, however, that the computational costs of the method is (asymptotically) at least as costly as simply multiplying and reducing modulo N for both squarings and general multiplications when efficient arithmetic is used. The exponentiation method, proposed by Hwang, Su, Yeh and Chen in 2005, is based on Hayashi's method and uses knowledge of the factorization of P + 1 and P – 1 to compute an exponentiation modulo an odd prime P. We begin by showing that the method cannot be used as a general purpose exponentiation method and then modify the method so that it can work as a general purpose modular multiplication method. Like Hayashi's method, however, this method is at best (asymptotically) only as efficient as simply multiplying and reducing modulo P.
<p>Abstract</p> <p>The hypothesis that anatomically modern <it>homo sapiens </it>could have undergone changes akin to those observed in domesticated animals has been contemplated in the biological sciences for at least 150 years. The idea had already plagued philosophers such as Rousseau, who considered the civilisation of man as going against human nature, and eventually "sparked over" to the medical sciences in the late 19<sup>th </sup>and early 20<sup>th </sup>century. At that time, human "self-domestication" appealed to psychiatry, because it served as a causal explanation for the alleged degeneration of the "erbgut" (genetic material) of entire populations and the presumed increase of mental disorders.</p> <p>Consequently, Social Darwinists emphasised preventing procreation by people of "lower genetic value" and positively selecting favourable traits in others. Both tendencies culminated in euthanasia and breeding programs ("Lebensborn") during the Nazi regime in Germany. Whether or not domestication actually plays a role in some anatomical changes since the late Pleistocene period is, from a biological standpoint, contentious, and the currently resurrected debate depends, in part, on the definitional criteria applied.</p> <p>However, the example of human self-domestication may illustrate that scientific ideas, especially when dealing with human biology, are prone to misuse, particularly if "is" is confused with "ought", i.e., if moral principles are deduced from biological facts. Although such naturalistic fallacies appear to be banned, modern genetics may, at least in theory, pose similar ethical problems to medicine, including psychiatry. In times during which studies into the genetics of psychiatric disorders are scientifically more valued than studies into environmental causation of disorders (which is currently the case), the prospects of genetic therapy may be tempting to alter the human genome in patients, probably at costs that no-one can foresee.</p> <p>In the case of "self-domestication", it is proposed that human characteristics resembling domesticated traits in animals should be labelled "domestication-like", or better, objectively described as genuine adaptations to sedentism.</p>