In the aftermath of the COVID-19 pandemic, Uganda witnessed a rapid rise in mobile money usage and digital credit adoption, underscoring the sector's role in post crisis recovery and financial resilience. Against this backdrop, this paper examines the determinants of mobile money loan disbursements in Uganda a global pioneer in mobile financial innovation, using monthly data from July 2021 to December 2024 and applying the Autoregressive Distributed Lag (ARDL) cointegration framework to capture both long-run relationships and short-run dynamics. Results show a long-run relationship linking average loan disbursements with outstanding loan values and lagged inflation. In the short term, past loan disbursements have a significant impact on current loan values. Behavioural proxies are informative, airtime purchases and timely mobile loan repayments are associated with higher disbursement volumes, consistent with lenders interpreting them as signals of reliability and liquidity. By contrast, higher transaction volumes and fees depress disbursements, underscoring the adverse impact of elevated user costs on credit access. These findings highlight actionable levers for expanding responsible digital credit and deepening inclusion.
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This dataset results from a multi-lab replication of Diener et al. (2010) organized by the Collaborative Replication and Education Project (CREP). This project aimed to understand the relationships between different types of needs (basic needs, psychological needs, standard of living, etc.), people's positive and negative feelings, and life evaluations. This dataset includes data collected across each site contributing to the study. It includes predictor variables associated with participants' mood and current financial comfort. It also includes demographic data like education, gender, marital status, residential area and income. The data are stored in a. csv file to be used for additional analysis, as an educational tool, and further interdisciplinary collaboration.
The integration of AI into the workplace is advancing rapidly, necessitating robust metrics to evaluate its tangible impact on the labor market. Existing measures of AI occupational exposure focus primarily on the theoretical potential of AI to substitute or complement human labor based on technical feasibility, offering limited insights into actual adoption. To address this gap, we introduce the AI Startup Exposure (AISE) index, a novel metric based on O*NET occupational descriptions and AI applications developed by venture backed startups worldwide. Our findings indicate that even though white-collar high-skilled occupations are theoretically highly exposed, they are heterogeneously targeted by AI startups. Roles involving routine organizational tasks, such as data analysis and office management, show significant exposure, while occupations involving tasks that are tied to ethical or high-stakes considerations-such as judges or surgeons-present lower AISE scores, despite technical feasibility for automation. Our approach challenges the conventional assumption that high-skilled jobs uniformly face high AI risks, highlighting instead societal desirability and market-oriented choices as critical determinants of AI exposure. Contrary to fears of widespread job displacement, our findings suggest that AI adoption will be gradual and shaped by social factors as much as the technical feasibility of AI applications. This framework provides a forward-looking tool for policymakers to monitor the evolving impact of AI and navigate a fast changing labor market landscape.
Early integration of specialist palliative care (sPC) improves patient-centered outcomes, but its impact on hospital costs during terminal admissions remains insufficiently studied. To compare total and daily hospital costs associated with early versus late initiation of sPC during the terminal hospital admission of patients who died in hospital. Retrospective cohort study using routinely collected administrative and clinical hospital data. Costs were analyzed using generalized linear models adjusted with inverse probability of treatment weighting. Bias-corrected mean ratios with 95% confidence interval (CI) calculated from 2,000 bootstrapped samples were presented. The study was conducted at a single Swiss tertiary care hospital and included adults aged ≥18 years who died during their terminal hospitalization between 2016 and 2022 and received sPC. Early sPC was defined as initiation within three days of admission. Patients with refusal of data use, external causes of death, perioperative death in otherwise healthy individuals, or incomplete cost data were excluded. The cohort comprised 790 patients (397 early sPC; 393 late sPC). Adjusted total hospital costs were substantially lower among patients receiving early sPC (CHF, 22,999; 95% CI: 21,149-25,072) compared with late sPC (CHF, 60,691; 95% CI: 55,186-67,165). Patients receiving early sPC also had lower daily costs. The largest cost differences occurred in pharmacy, laboratory, material, and room categories, whereas staff costs were similar between groups. Early initiation of sPC during terminal hospitalizations is associated with markedly lower hospital costs without increased staff expenditures. Additional studies are needed to establish whether this association is causal. Nonetheless, these findings suggest that providing patients with the benefits of sPC earlier during terminal hospitalization may be possible without increasing overall hospital costs and may have important implications for health care resource utilization.
The illicit drug trade generates billions of dollars in revenue per year, much of which comes from wholesale and retail sales late in the supply chain. Yet, the methods retailers and low-level wholesalers use to launder this revenue remain poorly understood. Using in-depth interviews with illicit drug entrepreneurs in the United States and the United Kingdom, this article analyses laundering strategies among such market actors. Our findings indicate that a significant proportion of their illicit proceeds are disposed of through relatively small-scale 'everyday' cash transactions (< $1,000) that are effectively untraceable. For those generating more substantial revenues, a variety of accessible and uncomplicated laundering strategies are employed, such as reporting such revenues as taxable income, using proxies to launder funds, and using revenues as investment capital within small-scale legal enterprise. Ultimately, we identify uncomplicated, yet largely effective, methods of laundering criminal proceeds amongst our sample of low- to medium-level illicit drug sellers. Though the sums at an individual level are relatively trivial, the 'mass of minor offences' of this nature likely accounts for a significant share of laundered drug revenues in Western consumer drug markets.
Oral mucositis (OM) remains a common and clinically significant complication of chemotherapy and radiotherapy. Current management is largely supportive, and effective local therapies remain limited. Hydrogel-based delivery systems have attracted interest because they may improve mucosal retention, protect ulcerated tissue, and enable sustained local drug release. A systematic review of preclinical animal studies evaluating hydrogel-based interventions for oral mucositis was conducted. PubMed, Embase, and the Cochrane Library were searched, with additional gray literature screening. Data on formulation characteristics, experimental models, therapeutic outcomes, and methodological quality were extracted. Risk of bias was assessed using the SYRCLE tool. Eighteen studies met the inclusion criteria. Most formulations reduced lesion severity, improved histological healing, and attenuated inflammatory or oxidative markers. Multifunctional systems combining mucoadhesion with anti-inflammatory, antioxidant, or antimicrobial activity tended to show broader effects than conventional gels. However, study design, outcome reporting, and translational endpoints were heterogeneous. Current preclinical evidence supports hydrogels as promising local drug delivery platforms for oral mucositis. Greater standardization of models and clinically relevant endpoints will be important to support translation into human studies. https://www.crd.york.ac.uk/prospero/, identifier CRD420251072050.
It is well-known that, in the Bachelier model, when asset prices and volatilities are uncorrelated, the at-the-money implied volatility coincides with the fair value of the volatility swap. Using this identity as a starting point and applying classical Itô calculus and Taylor expansions, we write the price for out-of the-money (OTM) and in-the-money (ITM) options as an expansion with respect to the moneyness, where the coefficients are related to the negative (non-integer) powers of the future mean volatility. As an a application, we use it as a control variate to reduce the variance of Monte Carlo option prices in the correlated case.
Artificial intelligence (AI) smart eyeglasses may have potential uses for patients with low or no vision, but evidence is needed to understand potential benefits and limitations of their use. To evaluate the accuracy of AI smart eyeglasses (Ray-Ban Meta AI eyeglasses [Generation 2]) on single and multiple object identification and description. This case series was a pilot feasibility study involving 6 study authors as the participants. A white tabletop and background were used for all tasks unless otherwise specified. The primary outcome measure was AI model accuracy defined as percentage of correct responses for single object identification, color discrimination, directionality, big and small object counting, reading (medication labels, food labels, handwriting, children's books), and US paper and coin money identification and counting tasks. The participants included 3 males (50%) and 3 females (50%); their mean age was 30 years (median, 29 years); mean height, 67 inches (range, 61-74 inches); and mean age at English acquisition, 3 years (median, 3 years). The smart eyeglasses identified common objects with 99% accuracy (699/700 trials; mean accuracy, 99%; 95% CI, 97%-100%). On object description tasks, color discrimination accuracy was 64% (286/450; mean accuracy, 62%; 95% CI, 51%-73%), object directionality was 83% (249/300 trials; mean accuracy, 81%; 95% CI, 72%-90%), and object counting was 50% (199/400 trials; mean accuracy, 49%; 95% CI, 40%-59%). For reading, standard text accuracy was 59% (59/100; mean accuracy, 59%; 95% CI, 45%-74%), for handwriting, mean accuracy was 88% (median, 93%; mean participant accuracy, 88%; 95% CI, 76%-99%), and for children's books, mean accuracy was 93% (median, 100%; mean participant accuracy, 81%; 95% CI, 60%-100%). Individual money identification accuracy was 91% for paper (181/200; mean accuracy, 91%; 95% CI, 85%-97%) and 2% for coins (3/150; mean accuracy, 3%; 95% CI, 0%-8%). AI smart eyeglasses may offer a unique intervention for patients with low to no vision, performing best for identifying common objects, identifying neutral colors, and reading children's books. AI smart eyeglass users should be aware of current limitations, which might improve as technology evolves in this field. Further studies are needed to define these benefits and limitations with patients who have low to no vision.
NHS Talking Therapies for anxiety and depression is a service that provides people in England with psychological support. There are several referral routes into the service, digital front door technologies being the most recent addition. The aim of this National Institute for Health and Care Excellence early value assessment was to map available evidence, assess potential benefits and costs of NHS Talking Therapies referral pathways with and without digital front door technologies, and identify evidence gaps to help direct future data collection and further research. The External Assessment Group carried out a systematic literature review (December 2024) to gather evidence relating to Limbic Access (Limbic), Wysa Digital Referral Assistant (Wysa), Censeo Digital (Psyomics) and AskFirst (Sensely). Information was collected across four broad outcome categories: accuracy and acceptability, resource and system impact, patient-reported outcomes, and costs. All study types were eligible for inclusion in the systematic literature review, along with evidence provided by the manufacturers of digital front door technologies (via requests for information). In addition, the External Assessment Group interviewed and sent questionnaires to stakeholders, including National Institute for Health and Care Excellence Specialist Committee Members, and carried out exploratory analyses of costs and benefits. Evidence was only available for two digital front door technologies: Limbic Access and Wysa Digital Referral Assistant. Literature meeting the systematic literature review eligibility criteria comprised two published peer-reviewed studies, six unpublished studies and five requests for information responses. The strongest evidence related to accessibility and overall satisfaction with Limbic Access. Results from one peer-reviewed study showed that Limbic Access increased the number of referrals to NHS Talking Therapies versus services that did not implement the technology (odds ratio = 1.10, 95% confidence interval 1.075 to 1.131); this included an increase in access for some minority groups [Asian (odds ratio = 1.29; confidence interval 1.163 to 1.422), Black (odds ratio = 1.35, confidence interval 1.183 to 1.551) and non-binary (odds ratio = 2.95; confidence interval 2.065 to 4.206)]. Overall satisfaction reported by users who completed the Limbic Access referral process was high (≥ 89%). Resource impact evidence was provided by one peer-reviewed study; results showed that Limbic Access reduced clinical assessment duration by 12.7 minutes. No relevant information on quality and accuracy was identified. Respondents were positive about digital front door technologies, suggesting that these tools could lead to better quality and more accurate (1) pre-referral practices and (2) initial clinical assessments; however, experts were unable to clearly define quality or accuracy. The External Assessment Group's exploratory economic analysis results suggested that the amount of clinical assessment time required to notionally offset the Limbic Access or Wysa Digital Referral Assistant licence cost was small (< 3 minutes). Most published evidence was non-comparative. The strength of the evidence provided by the technology companies was difficult to assess due to limited detail. Further evidence is required to better understand the benefits and costs of digital front door technologies for NHS Talking Therapies. Evidence generation should focus on whether digital front door technologies improve the accuracy and quality of clinical assessments and their impact on resources throughout the referral pathway. This study is registered as PROSPERO CRD42025634844. This award was funded by the National Institute for Health and Care Research (NIHR) Evidence Synthesis Programme (NIHR award ref: NIHR171847) and is published in full in Health Technology Assessment; Vol. 30, No. 52. See the NIHR Funding and Awards website for further award information. NHS Talking Therapies provide psychological support to people in England who have anxiety and depression. There are different ways to access these services, and one of the newest methods is by using digital front door technologies. Digital front door technologies are digital tools that gather relevant information (with or without the use of artificial intelligence); they are intended to make the NHS referral process quicker and more efficient. This research explored the potential benefits and costs of using digital front door technologies. An independent research team reviewed published and unpublished evidence, collected information from the companies that created the technologies, and interviewed experts. Robust evidence was lacking for the impact of digital front door technologies on four key outcomes: quality and accuracy of the data collected using digital front door technologies, accuracy of the clinical assessment, impact on administrative burden and time taken to review data collected by digital front door technologies. There was some evidence about the effectiveness of two digital front door technologies (Limbic Access and Wysa Digital Referral Assistant). The Limbic Access evidence was more robust than the Wysa Digital Referral Assistant evidence, particularly in terms of accessibility outcomes; Talking Therapies services that used Limbic Access experienced a larger increase in the number of referrals than services that did not implement Limbic Access. Digital front door technologies were associated with high levels of user satisfaction and may help save time during the initial clinical assessment. None of the evidence reported any harms associated with the adoption of the Limbic Access and the Wysa Digital Referral Assistant digital front door technologies. The adoption of digital front door technologies may provide value for money for the NHS. For the technologies to be considered to provide value for money, < 3 minutes of clinical assessment time need to be saved or the technologies need to provide a very small gain in patient quality of life. Experts were generally positive about using digital front door technologies and felt the technologies could improve the quality and accuracy of referrals to NHS Talking Therapies. However, the experts could not clearly define what ‘quality’ and ‘accuracy’ meant in clinical practice. Overall, while findings are positive, more research is needed to fully understand the benefits, costs and impact of using digital front door technologies to access NHS Talking Therapies.
Financial stress is a widespread and significant problem in the U.S., affecting a variety of populations. The long-term health/well-being effects of financial stress are well-documented (Shippee et al., 2012). The health problems associated with inadequate income are one of the social determinants of health, which refers to a broad range of social and environmental conditions that affect health/well-being (Francis et al., 2018; U.S. Department of Health and Human Services, n.d). Financial stress is also a result of financial exploitation, and a growing public policy and public health concern. In response to financial stress and financial exploitation, the intervention of financial coaching is growing in popularity. However, the effectiveness of financial coaching on financial and health outcomes is unclear. The purpose of this review was to inform policy and practice relevant to financial coaching by analyzing and synthesizing empirical evidence related to its financial outcomes and secondarily, to its health outcomes. The primary objectives of this review were to answer the following research questions:1. What is the extent and quality of financial coaching intervention research?2. What are the effects on financial outcomes of financial coaching embedded within community settings?3. What are the effects on financial outcomes of financial coaching embedded within healthcare settings?4. What are the effects on health/well-being-related outcomes of financial coaching embedded within community settings?5. What are the effects on health/well-being-related outcomes of financial coaching embedded within healthcare settings? We conducted a comprehensive search for published and gray literature in September 2024. We searched for and retrieved published studies from Google, Google Scholar, and 10 Electronic databases. We also searched seven relevant websites and three trial registries for registered studies. We harvested from the reference lists of included studies and conducted forward citation searching using Google Scholar. Lastly, we contacted the first authors of the 11 included studies and requested information about unpublished studies, studies in progress, and published studies potentially missed in the other search activities. Studies eligible for this review met the following criteria. First, studies must have used a prospective randomized controlled trial (RCT) or quasi-experimental (QED) research design with parallel cohorts. Second, studies must have involved an intervention that provided financial coaching. Third, the study must explicitly discuss two of three criteria in their financial coaching intervention: a. client-led goal setting; b. action planning; and c. progress monitoring by the coach. Fourth, the studies must be focused on financial coaching for personal, rather than business, finances. Fifth, the studies must have measured a financial outcome. Health related outcomes were extracted and analyzed but were not required for eligibility. All settings and populations were eligible. Searches were saved in the reference management software EndNote, and duplicates were removed and uploaded to Rayyan. Another round of duplicates were removed in Rayyan. Three reviewers then completed title and abstract screening on 4,635 entries in Rayyan. Three reviewers independently reviewed the 23 articles that were moved forward for full-text screening. A fourth reviewer reviewed discrepancies and made the final decision to include or exclude. Eleven studies that satisfied the inclusion criteria were retained for data extraction using a standardized extraction form. Because the included studies did not measure and report sufficient data to calculate effects sizes for similar outcomes, quantitative synthesis was not possible. Effect sizes were calculated when possible, and author-reported study outcomes were described. Of the 11 unique studies included in this review, eight were randomized control trials and three were quasi-experimental designs. Eight of the 11 studies were conducted in community settings, and all studies involved adults. All studies offered financial coaching, with seven also providing financial education/literacy training. In addition to coaching, six provided credit/debt counseling and five offered budgeting or money management assistance. Seven of the studies combined financial education with financial coaching. All 11 studies reported at least one financial outcome, and four studies reported at least one health-related outcome. The evidence on the financial impacts of financial coaching is limited, as many studies did not report enough data to calculate effect sizes and or measure the same outcomes at the same points in time after the intervention. Most financial effects were small, with a mix of statistically significant and non-significant results. Some studies reported moderate effects on financial stress and financial self-efficacy, as well as small to moderate effects on smoking cessation. There were also some author-reported positive, statistically significant findings on financial and health-related outcomes. However, the risk of bias assessment indicated important methodological weaknesses across the included studies, and overall, the effectiveness of financial coaching remains uncertain. Although financial coaching interventions are becoming popular and have the potential to improve financial and health outcomes, there is an overall lack of evidence about whether financial goals can be achieved through financial coaching. Across studies that met inclusion criteria, outcomes, and measurement time periods varied so widely that we are unable to draw any conclusions regarding intervention effects on finances. In addition, the quality of the studies was only moderate. Given the nascent nature of the research, the high level of enthusiasm for financial coaching seems to be outpacing the evidence about its effectiveness on important outcomes. We advocate that financial coaching settings agree on outcome domains and measurement time periods post treatment, then invest first in rigorous research. Only after these steps are taken can a determination be made about further promoting financial coaching in practice and/or move ahead to integrate coaching into other types of services. Limited evidence of the effectiveness of financial coaching on financial and health outcomes. The review in brief: There is limited evidence about the effectiveness of financial coaching on financial and health outcomes. What is this review about? Financial stress is a common and serious problem in the United States that affects many different people. One approach that has been tried to help reduce this stress is financial coaching. In financial coaching, a person works with a coach to set goals for their money management, take steps to improve their situation, and get support and encouragement along the way. This review examined whether financial coaching can improve people’s financial situations and, when relevant, their health. What is the aim of this review? This Campbell Collaborative systematic review examines whether receiving financial coaching helps improve people’s financial situation and health compared to not receiving coaching. The review summarizes evidence from 11 high-quality studies, including eight randomized controlled trials and three quasi-experimental experiments. What are the main findings of this review? What studies are included? This review includes 11 studies that evaluated the financial and, when relevant, health effects of financial coaching. Most studies were conducted in community settings with adults, and many also offered related financial services. Studies gathered data about a wide range of financial outcomes. Quality of the Studies: The review includes evidence from 11 studies, all of which used strong designs like randomized controlled trials or studies with comparison groups. However, 10 of the 11 studies had important methodological weaknesses, so the results should be interpreted with caution. Research Question #1: Extent and quality of financial coaching intervention research. There are relatively few studies that have examined financial coaching as an intervention. Even though the way the small number of included studies were set up was generally strong, most of them had problems that make it hard to fully trust the results. Research Question #2: Effects on financial outcomes of financial coaching embedded within community settings and Research Question #3: Effects on financial outcomes of financial coaching embedded within healthcare settings. There was no single answer about whether financial coaching works. The programs were quite different from each other, and the results varied too. Some studies showed very small effects, while others showed medium effects. Because the interventions and results were so mixed, we could not combine them into one overall estimate for a more conclusive answer. Overall, the findings suggest that financial coaching might have only limited benefits for people’s finances. Research Question #4: Effects on health/well-being-related outcomes of financial coaching embedded within community settings and Research Question #5: Effects on health/well-being-related outcomes of financial coaching embedded within healthcare settings. There was no clear answer about the effects of financial coaching on health. The programs and measures of health-related outcomes were different across studies, and the results varied from no benefits to small to medium improvements in health outcomes. What do the findings of this review mean? The findings of this review suggest that while financial coaching may hold promise for improving financial and health outcomes, there is currently insufficient robust evidence to support its effectiveness. This lack of clear evidence calls for cautious implementation of financial coaching in community and other types of human service settings until further rigorous research can confirm their benefits. How up-to-date is this review? We searched for the included studies up to September 2024. This Campbell Systematic Review was published in May, 2026.
This analytic essay reviews the transition from unidimensional relative reinforcing efficacy to multidimensional behavioral economic demand analysis in drug reinforcement, focusing on tobacco science. It synthesizes operant laboratory studies in human smokers that use operant demand curve analysis. Reviewed studies used single- and concurrent-commodity sessions in which participants performed operant responses to earn the self-administration of controlled cigarettes puffs, and other commodities included money, and self-administration of denicotinized cigarette puffs, reduced-nicotine cigarette puffs, and nicotine gum. Unlike traditional measures purporting to assess relative reinforcing efficacy, demand curves showed multidimensional reinforcement. Operant demand studies resulted in findings relevant to tobacco science, therapeutics, and regulation. Despite greater demand for money at lower prices, cigarette puffs showed greater resistance to increasing prices. Denicotinized cigarette puffs were more effective substitutes (than nicotine gum) for nicotine-containing cigarettes. Reduced-nicotine and full-nicotine experimental cigarette exposure yielded modest, non-dose-dependent demand reductions. Greenwashing tactics increased demand intensity at low prices, enhancing unconstrained preference. Behavioral economic demand analysis offers a superior framework for understanding and assessing reinforcement over the concept of relative reinforcing efficacy. These findings underscore demand analysis as a versatile tool for investigating abuse liability, therapeutics, and tobacco regulatory science.
Objectives. To explore and quantify the potential effects of financial innovations aimed at increasing investments in social drivers of health (SDH). Methods. We built a simulation model in which individuals in a health care market are served by multiple Medicaid managed care organizations (MCOs). In our model, each MCO can spend money to make SDH investments that improve patient health and reduce costs to the MCO, but patients can switch between different MCOs. Results. While SDH investments improve patient health and increase the profitability of the investing MCO, the benefits also accrue to noninvesting MCOs because of the churn of patients between MCOs, resulting in a "wrong-pocket problem" where investing MCOs bear the costs but share the benefits with competitors, resulting in worse financial returns compared with making no investments and ultimately disincentivizing SDH investments. Outcomes can be improved when all MCOs participate in a financial structure-an SDH bond-which raises money from investors and distributes the proceeds to MCOs to make SDH investments. Conclusions. An SDH bond can improve patient health and increase profits for MCOs because of cost-savings. (Am J Public Health. 2026;116(S3): S210-S217. https://doi.org/10.2105/AJPH.2026.308479).
Loot boxes are virtual chests containing randomized in-game items. Given their structural similarities, loot boxes have been argued to be a form of gambling. Indeed, previous meta-analytic studies suggest that loot boxes are associated with problem gambling severity and act as a "gateway" to gambling. Yet, little is known about loot box purchasing among individuals who already gamble. In the present study, we assessed the demographic characteristics and addictions and mental health comorbidities of adult loot box purchasers, through a nationally stratified sample of regular gamblers who also regularly play video games (N = 3709). We also investigated whether loot box engagement is associated with problem gambling severity and gambling harms when controlling for traditional gambling activities. Of the total sample, 1,922 reported having purchased loot boxes (Mage = 38.72, 61.3% male). Loot box purchasers were more likely to be younger, single, employed, have a college degree or higher, and report upper-middle income. Loot box purchasers were significantly more likely to endorse addictions and mental health comorbidities (e.g., substance use, depression). When controlling for other forms of gambling (e.g., electronic gambling machines, sports betting), both the frequency of loot box purchasing and money spent were associated with problem gambling severity and gambling-related harms. The results from the present study provide further support that loot boxes when purchased with money may be conceptualized as a form of gambling and contribute to problem gambling risk and harms. Given the popularity of loot boxes and relative lack of age restrictions, jurisdictions may wish to regulate the purchase of loot boxes similarly to traditional forms of gambling.
Predicting a diagnosis of pre-eclampsia is based on a combination of clinical assessment of blood pressure, presence of protein in the urine, symptoms and laboratory test abnormalities. Accurately detecting pre-eclampsia is important to avoid false-positive diagnoses which could lead to unnecessary antenatal admissions and/or preterm delivery. Four blood tests that measure the biomarkers of placental growth factor or the ratio of soluble fms-like tyrosine kinase-1 to placental growth factor are available (known as Triage, Elecsys, DELFIA Xpress, and BRAHMS Kryptor tests). Abnormal measurements of these biomarkers can be used as an aid to predict a diagnosis of pre-eclampsia and maternal and fetal outcomes. To evaluate the test accuracy, clinical effectiveness and cost-effectiveness of placental growth factor -based tests used in conjunction with standard clinical assessment for predicting pre-eclampsia and maternal and fetal outcomes in pregnant women who are referred to secondary care with suspected pre-eclampsia in weeks 20-37 of pregnancy. A systematic review of the diagnostic/prognostic accuracy and clinical effectiveness of placental growth factor-based tests with standard clinical assessment. Database included MEDical Literature Analysis and Retrieval System, Excerpta Medica dataBASE and Cochrane Library. Other sources searched included relevant conference proceedings and websites, grey literature and research in progress. The most recent date of searching was 18 March 2021. An independent economic analysis was conducted using a decision tree model. The model includes short-term costs and quality-adjusted life-years for the management of women, maternal and neonatal outcomes and long-term outcomes for severe neonatal complications. The model compared the use of the test alongside standard clinical assessment to standard clinical assessment only. Two different estimates of standard clinical assessment were included, from the INSPIRE study and from National Institute of Health and Care Excellence Diagnostic Guidance 23. Seventeen studies were included in the systematic review. Two large, randomised trials provided the best available evidence to inform the economic model: The PARROT trial (Triage test) and the INSPIRE trial (Elecsys test). When used as rule-out tests for pre-eclampsia (with neonatal outcomes included), all four tests produced higher quality-adjusted life-years and higher costs than both types of standard clinical assessment. The incremental cost per quality-adjusted life-year ranged from £637 (DELFIA test vs. standard clinical assessment from INSPIRE) to £47,393 (Triage test vs. standard clinical assessment from diagnostics guidance 23) per quality-adjusted life-year. Incremental costs and quality-adjusted life-years were always very small, with incremental costs always less than the cost of the test and incremental quality-adjusted life-years always < 0.006. Although the evidence for placental growth factor-based tests is advancing, there remains uncertainty for key parameters, such as diagnostic sensitivity and specificity. This particularly affects the Elecsys test. Despite uncertainties from lack of data, and heterogeneity across studies, the use of placental growth factor-based tests to rule out and rule in pre-eclampsia has the potential to provide improved outcomes at reduced cost when compared with standard clinical assessment. Future research priorities include more rigorous evaluation of the DELFIA and BRAHMS placental growth factor-based tests, more evidence for Triage and Elecsys as rule-in tests, and greater focus on Black, and Asian and Mixed ethnicity groups. This study is registered as PROSPERO CRD42020227085. This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: NIHR132386) and is published in full in Health Technology Assessment; Vol. 30, No. 54. See the NIHR Funding and Awards website for further award information. Pre-eclampsia is a condition that affects some pregnant women and, if not detected or left untreated, can cause serious health complications for the mother and/or the baby. Four tests are now available (Triage, Elecsys, BRAHMS and DELFIA) that can detect abnormal levels of certain proteins in the blood indicating that a pregnant woman may have pre-eclampsia. We investigated the use of these tests in addition to the usual tests done by doctors to diagnose pre-eclampsia. Results of the tests determine whether someone with suspected pre-eclampsia should be admitted to hospital or can be safely monitored as outpatients. We carried out expert medical evidence searches to update our knowledge of the accuracy and cost of these tests and to find out if the tests can help doctors correctly recommend the best form of treatment for each woman. make the best decisions or impact on delivery-related outcomes for mother and baby. We developed an economic computer model that estimated costs of treatment and benefits to the mother and baby, to predict whether the tests would be good value for money for the NHS. Economic modelling shows that placental growth factor-based tests are cost-effective compared with standard clinical assessment when used to help diagnose (rule in) or exclude (rule out) preterm pre‑eclampsia. Cost-effectiveness reflects the amount of money the NHS is willing to pay for health gain. These tests would be useful to help plan safe care and a safe birth for women with pre-eclampsia, and also to identify those unlikely to develop pre-eclampsia, and therefore reduce unnecessary hospitalisation. The tests may work differently in people who are pregnant with more than one baby. There is uncertainty about how effective two of the tests are (the BRAHMS and DELFIA tests) due to lack of research, and on the usefulness and costs of testing women more than once if the previous test was negative but they still have symptoms of pre-eclampsia.
Obtaining market approval and reimbursement are necessary but not sufficient conditions for the implementation of new vaccines in high-income countries to maximize their long-term preventative value. Comprehensive pre-launch and launch-phase economic evaluations of the disease and the vaccine are necessary to support long-term public health improvement by the vaccination program. This review highlights the construction of these evaluations conceived as a plan, methods, and a tool. They can be generated by different stakeholders (e.g., payers, producers, target groups) interested in the value success of vaccination. A Vaccine Launching Value Project (VLVP) has been developed based on the experience gained from helping to launch 10 new vaccines worldwide over 15 years (2005-2020). It comprises information on the following: (1) identification of new vaccines that should require a VLVP approach; (2) country-specific characteristics of healthcare; (3) methods to assess economic values for specific stakeholders; (4) identification of the money flow in managing the disease and infection spread; and (5) optimal implementation strategies at the initiation of new vaccination programs. The benefits of applying the VLVP are illustrated using rotavirus vaccination as an example. The VLVP program starts with the development of a Broad Country Linked Inventory (Brocoli) Plan that interconnects eight baskets of information specifying a framework of activities. This is followed by the Cauliflower and Artichoke Methods to assess the vaccine value for additional key stakeholders (e.g., employers, hospital managers, working mothers, the Ministry of Finance) and the money flow amongst the payers (who pays what to whom, when, for what, and how). The evaluation process finishes with the Total Management Tool (Tomato) to identify the optimal implementation conditions at the start of a new vaccination program necessary to obtain the best long-term value for the stakeholders selected. The critical interconnections between these information blocks are discussed. This improves the positioning of a new vaccine by articulating its total economic value within a societal and public health environment over time, outside the conventional Health Technology Assessment box. The Tomato Tool emerges as the most pivotal component of the VLVP. It provides the best assurance of long-term economic value with strong sustainability support.
Curiosity empowers humans to ask questions about the world and explore it without relying on extrinsic, encouraging rewards such as money. To investigate how this mechanism drives exploration, we implement a curiosity-based approach and test it in a reinforcement learning environment. We define curiosity using a hybrid intrinsic signal based on prediction error and the rarity of state-action pairs. To address the curse of dimensionality in raw pixel inputs, we adopt the Information Bottleneck (IB) principle to learn low-dimensional representations that are both compact and predictive. We introduce two formulations for computing mutual information-one based on entropy decomposition and the other on matrix-based Rényi entropy-and compare their effectiveness. Experiments on Acrobot show substantially improved exploration efficiency over Intrinsic Curiosity Module (ICM), Random Network Distillation (RND), and a k-NN novelty baseline, while results on MountainCar indicate that the proposed method is not uniformly superior in low-dimensional environments. These findings suggest that IB-shaped representations and matrix-based information objectives are most beneficial when observations are high-dimensional or dynamics are structurally complex.
Health services researchers often rely on large surveys to report the quality and cost of nurse practitioner (NP)-delivered care. However, researchers face challenges obtaining sufficient response rates due to constrained federal research funding and difficulty reaching NPs at accurate addresses. NP health services researchers would benefit from feasible, lower cost approaches to conducting surveys. This study reports the outcomes of a low-cost approach to national surveys of NPs. This was a cross-sectional survey of primary care NPs serving older adults across 50 states and D.C. Names, addresses, and phone numbers were obtained for all 10,587 primary care NPs in Medical Marketing Service's NP File. Three recruitment letters were sent to the sampling frame via mail with a QR code and personal identifier. Response rates and costs were calculated to understand utility of the survey approach. The adjusted response rate was 6-15%, depending on assumptions. Survey administration costs totaled $24,775, excluding investigator salaries. This approach to a national NP survey yielded adjusted response rates comparable to federally funded surveys at a fraction of the cost. Savings stemmed from obtaining less expensive, unverified contact information, which included inaccurate addresses and created a need for stricter inclusion criteria screening. Researchers can save money and yield similar adjusted response rates as federally funded NP studies by administering surveys using letters with QR codes to an online survey and using unverified contact information, so long as inclusion screenings are strict and rigorous.
This study investigates how financial and legal empowerment affects women's reproductive health decisions in rural China and Pakistan, both of which face notable patriarchal and socioeconomic challenges. We used a qualitative approach, employing semi-structured interviews to gather in-depth insights from rural women who faced barriers in making reproductive health decisions due to financial and legal constraints. We used purposive sampling to recruit participants. Data were collected from 30 women aged 18-45 years from rural Anhui Province, China, and Khyber Pakhtunkhwa, Pakistan. The results show that women are much better able to make informed choices about their reproductive health when they are financially independent, have control over their money and income opportunities, and are aware of their legal rights. Women who are economically empowered and legally informed have greater autonomy in accessing reproductive healthcare and challenging patriarchal norms. The study concludes that financial and legal empowerment are essential for enhancing reproductive health outcomes and that their integration into policy and practice is crucial for enabling women's independent reproductive decisions. This study contributes to the literature on women's autonomy in reproductive health by highlighting the combined role of financial and legal empowerment, offering insights for policymakers, healthcare providers, and legal reformers seeking to improve reproductive health outcomes in rural marginalized communities. Cette étude examine comment l'autonomisation financière et juridique influence les décisions des femmes en matière de santé reproductive dans les zones rurales de Chine et du Pakistan, deux régions confrontées à d'importants défis patriarcaux et socio-économiques. Une approche qualitative a été utilisée, avec des entretiens semi-directifs, afin de recueillir des informations approfondies auprès de femmes rurales confrontées à des obstacles dans leurs choix en matière de santé reproductive, liés à des contraintes financières et juridiques. Un échantillonnage raisonné a permis de recruter les participantes. Les données ont été recueillies auprès de 30 femmes âgées de 18 à 45 ans, issues des provinces rurales d'Anhui (Chine) et de Khyber Pakhtunkhwa (Pakistan). Les résultats montrent que les femmes sont bien mieux à même de faire des choix éclairés concernant leur santé reproductive lorsqu'elles sont financièrement indépendantes, qu'elles maîtrisent leurs finances et leurs opportunités de revenus, et qu'elles connaissent leurs droits. Les femmes économiquement autonomes et informées juridiquement ont une plus grande autonomie dans l'accès aux soins de santé reproductive et sont plus à même de remettre en question les normes patriarcales. L'étude conclut que l'autonomisation financière et juridique est essentielle à l'amélioration des résultats en matière de santé reproductive et que son intégration dans les politiques et les pratiques est cruciale pour permettre aux femmes de prendre des décisions indépendantes en matière de reproduction. Cette étude enrichit la littérature sur l’autonomie des femmes en matière de santé reproductive en soulignant le rôle combiné de l’émancipation financière et juridique. Elle offre des perspectives précieuses aux décideurs politiques, aux professionnels de santé et aux réformateurs juridiques qui cherchent à améliorer les résultats en matière de santé reproductive dans les communautés rurales marginalisées.