This study examines structural features that may impact the hunting/trapping of small, fur-bearing animals over time. The prior literature suggests a relationship between species, ecological and human well-being that renders hunting trends of social interest. In that view, factors affecting hunting trends have policy relevance related to how species maintenance/health affects ecosystems and human well-being. This study employs data on twelve fur-bearing species taken by hunting/trapping in Wisconsin from 1930 to 2018. Prior research has identified several predictors of hunting trends (e.g., pelt prices, snow and rainfall amounts, temperature, gasoline prices and urbanization). Controlling for the effect of the prior level of hunting, few exogenous factors predicted species-specific hunting trends in Wisconsin. Macro-factors predicted that hunting trends are outside the control of wildlife regulators and may require innovative strategies to address. The results suggest that some omitted processes may be better predictors of hunting trends.
Countries have varying, limited healthcare budgets for emerging disease-modifying therapies. Cost-effectiveness analysis, combined with country-level cost-effectiveness thresholds, can be used to estimate value-based prices (VBPs) for lecanemab and donanemab across 174 countries. The cost-effectiveness of lecanemab and donanemab was estimated using incremental cost and quality-adjusted life years (QALYs) compared to usual care. Published cost-effectiveness thresholds were used to estimate VBPs of these drugs across 174 countries. Compared to usual care, lecanemab and donanemab respectively increased average QALYs by 0.38 and 0.51. By country income status, VBPs for lecanemab and donanemab respectively ranged between $254 to $9434 and $387 to $13,964 (high income), $90 to $1025 and $137 to $1507 (upper middle income), $11 to $623 and $21 to $956 (lower middle income) and $4 to $18 and $9 to $32 (low income). VBPs indicate how much 174 countries should be willing to pay. This framework can also be adapted and refined in the negotiation of country pricing.
Within the World Health Organization's (WHO) healthy ageing framework, older adult's functional ability (FA) is determined by the intrinsic capacity (IC), the living environment, and their interaction. This study aimed to identify candidate environmental factors in relation to FA, both directly and interactively with IC. Data from older adults (mean age = 69.4 years, SD = 7.5; 54.7% women) were obtained from the Longitudinal Ageing Study Amsterdam (n = 1634). FA was assessed using a composite score of (Instrumental) Activities of Daily living ((I)ADLs). IC was measured using IC domain (vitality, locomotion, sensory, cognition, and psychology) scores (0-100). A total of 28 environmental factors was included. Random forest regression was used to model six-year FA, with IC domain scores and environmental factors as predictors. Vitality, cognition and psychology IC domains showed the strongest direct associations with the predicted six-year FA score. Among environmental factors, perceived sufficiency of care, neighbourhood housing prices and airborne particulate matter (PM10) concentration levels demonstrated the strongest direct associations with the predicted FA. The most important interactions were observed between the cognition, vitality and psychology IC domains with environmental factors regarding housing adaptations, household help, perceived sufficiency of care, and emotional support. In addition to the vitality, cognition and psychology IC domains, environmental factors including sufficiency of care, housing prices and PM10 showed important direct associations with FA. Interactions between IC and the environment primarily involved social environmental factors. Further longitudinal research is needed to clarify the mechanisms underlying these direct and interactive associations.
Rapid urbanization in Dhaka has driven significant shifts in food consumption patterns among its residents. Understanding the factors influencing food choice is crucial in making informed decisions by policy makers and enabling the development of targeted interventions to promote healthier food options. This study aims to explore the factors influencing the food choices of consumers in Dhaka city, with a focus on underlying food choice motives and pricing strategies. A cross-sectional study was conducted between August 2023 to February 2025 using written questionnaires. Purposive sampling technique was employed to obtain the sample. The questionnaire was administered in person at various points of food purchase, including grocery stores, local bazars, and supermarkets in Dhaka city. The study evaluated key food choice motives and pricing strategies using validated questionnaires. One-way ANOVA was used for mean comparisons. Tukey's test was employed for post-hoc mean comparisons between income groups. Health emerged as the most significant food choice motive. The middle-income group prioritized health and sensory appeal when making food choices, with mean (SD) scores of 4.4 (0.5) and 4.3 (0.8), respectively. In terms of attractiveness of pricing strategies, this group found healthy products on sale at a cheap rate more attractive. Conversely, the strategy of subsidized prices through TCB-operated open market sales was more attractive to the low-income group, with a mean (SD) score of 4.2 (0.9) than to the middle-income group 3.8 (1.2). To increase the consumption of healthy foods, the middle-income group preferred strategies such as healthy food options at a low VAT rate and healthy products on sale at a cheap rate. This study suggests that health is the most important factor among all food choice motives. The findings offer insights for designing interventions and guiding policymakers in promoting a healthier food environment.
The introduction of biosimilars can lead to substantial price reductions which can alter cost-effectiveness conclusions in health technology assessments. This study, undertaken for the National Institute for Health and Care Excellence (NICE), aimed to pilot a test-and-learn approach for biosimilars appraisals whilst pragmatically assessing the cost-effectiveness of bevacizumab (originator and biosimilars) plus fluoropyrimidine-based chemotherapy versus chemotherapy alone for patients with metastatic colorectal cancer. A partitioned survival model with three health states (progression-free, post-progression and dead) was used. No additional active lines of treatment were modelled assuming that all further treatments were cost-effective and assuming no interaction between bevacizumab and the efficacy of subsequent treatments. Analyses were undertaken independently for the use of bevacizumab plus fluoropyrimidine-based chemotherapy as first-line, and second-line, treatment. Analyses were conducted in line with NICE guidance. The clinical effectiveness of treatments was estimated from reviews of previous NICE technology appraisals, published literature, and expert input. Confidential prices of bevacizumab weighted by the market share were used. The use of bevacizumab plus fluoropyrimidine-based chemotherapy was shown to extend life and increase quality-adjusted life-years (QALYs). Whilst cost per QALY values cannot be reported due to confidentiality reasons, the NICE Appraisal Committee stated that these were below what NICE considers a cost-effective use of resources for both first- and second-line treatment. The pragmatic modelling approach piloted was accepted by NICE and allowed for a quicker, internally funded, appraisal of bevacizumab biosimilars; this approach likely can be extended to other biosimilar appraisals.
The closed chamber method is widely used for measuring greenhouse gas fluxes (CO2, CH4, N2O) in natural and agricultural ecosystems. Automatic chambers are essential for long-term monitoring with high temporal resolution, but their production typically demands significant time, labor and expertise. While ready-to-use commercial solutions are available, many projects avoid them because of their high prices. We present a cost-effective and scalable alternative: modular automatic chambers built from off-the-shelf components. These chambers feature integrated valves and wireless controllers, enabling flexible deployment without the need for multiplexers. Systems can be easily expanded by adding more units. Our modular chambers have been successfully deployed in Arctic and subarctic field studies: north-eastern Greenland, natural wet tundra, two sites, 5 + 5 chambers, three summer seasons, CO2 and CH4 flux monitoring; northern Finland, natural boreal fen, 2-12 chambers, year-round measurements over four years, CO2 and CH4 fluxes; northern Norway, cultivated drained peatland, 30 chambers along a 300 m transect, four growing seasons (May-November), CO2, CH4, and N2O fluxes. Across all sites, the chambers demonstrated reliability, ease of construction, operation and maintenance. While further improvements are always possible, the current design offers a practical and accessible solution for the broader scientific community.
Chronic Obstructive Pulmonary Disease (COPD) is a major health concern in low and middle-income countries. Drug-related problems (DRPs), defined as issues in drug therapy that interfere with desired outcomes, add further challenges. Evidence on the prevalence and costs burden of DRPs in COPD patients is limited. This study assessed the prevalence of DRPs, identified associated factors, and compared prescription costs between patients with and without DRPs. A cross-sectional study was conducted among 156 COPD patients attending a first referral hospital in Dailekh, Nepal, from May to September 2024. Data were collected through in-person interviews using a structured questionnaire and medical record review. DRPs were classified using the Pharmaceutical Care Network 9.1 system. Prevalence and medications costs were reported. Factors associated with DRPs were analyzed using bivariate tests and multivariate logistic regression. Medication costs were calculated using hospital pharmacy prices and mean costs with 95% confidence interval were compared across groups. The prevalence of DRPs was 71.8%, with patients experiencing an average of 1.45 DRPs. Male patients (AOR 3.0; 95% CI 1.2-7.4), those from disadvantaged ethnic group (AOR 3.3; 95% CI 1.1-9.8), and patients with comorbidity (AOR 2.7; 95% CI 1.2-5.9) were more likely to have DRPs. The mean cost per patient was NRs. 6543 ± 1423.4). DRPs are highly prevalent among COPD patients and contribute to significant financial burden. Strengthening the role of pharmacists and other health professionals in identifying and preventing DRPs is essential. Targeted interventions for high-risk groups can help reduce DRPs, improve treatment outcomes, and lessen the economic impact on patients.
Background/Objectives: This regional case study evaluated the affordability and serving accuracy of a publicly available one-week DASH meal plan for single-woman households using Supplemental Nutrition Assistance Program (SNAP) benefits in central Kentucky. Methods: For each food item in the one-week plan, total grocery costs and per-serving costs were calculated using January 2025 prices from two national grocery chains commonly patronized in an urban area in central Kentucky. Calculated costs were compared to the average weekly food cost for women aged 20-50 years in a single household based on the Thrifty Food Plan (TFP). Servings for food groups and categories were calculated using MyPlate and American Heart Association guidelines to compare with those reported in the one-week plan. Results: The total grocery cost was $262.17, including staple foods expected to last more than a week. The adjusted per-serving cost of $82.90 was 21.19% higher than the average weekly food cost based on the January 2025 TFP. All food groups and categories except dairy showed differences of at least one serving between our calculations and the one-week plan. Conclusions: Findings from this case study on grocery costs suggest that the one-week plan may pose affordability challenges in this regional context and continued evaluation of whether SNAP benefit allotments based on TFP adequately reflect regional food cost variations may be warranted. Discrepancies in total servings highlight the need to improve the accuracy of publicly available DASH resources and to review these materials for consistency and accuracy.
Sudden cardiac death and health risks associated with abnormal sleep patterns highlight the urgent need for comprehensive, interference-resistant sleep monitoring technologies. Traditional polysomnography is constrained by complexity and discomfort, while existing flexible sensors often suffer from single-function limitations, signal coupling, and mechanical interference. Herein, we propose a multifunctional sensing patch inspired by the island-bridge structure to address these challenges. The patch integrates temperature sensors and electrocardiogram (ECG) electrodes on low-water hydrogel (islands) and strain sensors for respiratory monitoring on high-water hydrogel (bridges), all based on poly(acrylic acid) hydrogel to eliminate mechanical mismatch and prevent delamination. Low-water and high-water hydrogels are fabricated by regulating glycerol (Gly) and ethylene glycol (EG) ratios to tune water content, achieving strain insensitivity for temperature/ECG regions and strain sensitivity for respiratory detection. The unique material combinations endow the temperature sensor with high sensitivity (4.02 °C-1); the ECG electrode reduces noise interference by over 30% compared to commercial electrodes; the strain sensor achieves a gauge factor (GF, 23.31). When applied to human sleep monitoring, the patch enables precise, synchronous capture of body temperature, ECG signals, and respiratory patterns under various physiological conditions. This work provides a strategy for developing high-reliability, multifunctional sleep monitoring devices.
Biodiversity laws in several European countries rely on official species-level price lists for fauna to enable compensation for biodiversity damage. However, the methods underlying these values are often opaque and poorly justified, raising concerns about consistency, fairness and ecological relevance. To gain insights into the revealed public regulatory patterns embedded in these mechanisms, we investigate how monetary compensation values are assigned to fauna in European biodiversity legislation and what factors influence these values. Here we show that species-level values are implicitly guided by biological traits and taxonomic biases, based on a dataset of 9,971 species across 24 countries. Our analysis reveals that mammals and birds receive disproportionately higher values, while traits such as generation length and protection status also significantly influence values. These findings reveal hidden criteria that shape regulatory decisions and enhance our understanding of conservation priorities. We recommend integrating systematic, science-based criteria into legal valuation practices, supported by collaboration between conservation scientists and legal practitioners.
BackgroundSepsis affects an estimated 166 million people annually. Short-term survival has been the primary focus of research to date, yet individuals who survive acute sepsis face substantial long-term challenges, including chronic illness, physical disability, cognitive impairment, chronic organ dysfunction, cardiovascular events, and psychological disorders. These complications contribute to personal economic hardship, high healthcare utilization, frequent rehospitalization, and significant mortality rates.ObjectivesWe aimed to identify and summarize key interventions for sepsis survivors' post-hospital discharge - including physical rehabilitation, psychological care, provider assessments, monitoring, medication, and education - and to identify gaps in current evidence to elucidate future research priorities.MethodsA systematic scoping review was completed across five databases, supplemented with hand searching. Two reviewers independently screened and extracted data. Eligible studies focused on adult survivors of sepsis, where interventions were implemented after discharge from acute care, and included any research design.ResultsThirteen studies with four follow-up papers were included. Five reported on the impact of simultaneous intervention protocols, four on physical rehabilitation alone, and two on provider assessment and follow-up. The final two focused on psychological care, and pharmacotherapy. Mortality and readmission rates were the most common outcomes measured; satisfaction with care services, mental health outcomes, and cardiovascular event incidence were also evaluated. Qualitative study data was limited. Four studies mentioned intervention costs, but none completed a cost-benefit analysis. Based on a limited pool of evidence, protocolized multi-intervention approaches, provider assessment and follow-up, and physical rehabilitation show some promise in reducing hospital readmissions and improving long-term survival from sepsis. No interventions positively impacted sepsis survivors' mental health. Further, no studies evaluating educational interventions alone were identified.ConclusionsThis review highlights the need for more comprehensive, multidisciplinary post-sepsis care interventions. Future research should focus on patient education, mental health support, and cost-effectiveness analyses to inform evidence-based post-sepsis care strategies.
The rise in online shopping has heightened consumer frustration, as many are reluctant to pay additional charges. Understanding the neural mechanisms of decision-making underlying this resistance could provide key insights into consumer behavior. However, research on these neural correlates remains limited. To address this gap, we conducted a functional magnetic resonance imaging (fMRI) study examining the relationship between shipping fee combinations and purchasing decisions. During fMRI scanning, 40 participants evaluated their intention to purchase shoes with varying shipping fees, while the total price remained constant. Behavioral measures included purchase intention rating, reaction time (RT), and the Rate Intention Score, calculated by dividing the mean purchase intention score by RT. Behavioral data revealed a clear preference for free shipping, with distinct blood-oxygenation-level-dependent (BOLD) responses in free shipping choices across shipping fee conditions. Comparisons between free shipping and the lowest shipping fee showed strong emotional preferences for free shipping, reflected in positive BOLD signals of the medial prefrontal cortex (PFC). fMRI analysis revealed that the most significant differences stemmed from variations in shipping fees, particularly between free shipping and the lowest shipping fee, highlighting the unique appeal of free shipping. As shipping fees increased, emotional influences diminished, shifting cognitive processing to the ventrolateral PFC. Additionally, increased BOLD responses in the precentral gyrus under the free-shipping option indicated its involvement in decision execution. An integrated behavioral and neural data analysis offers valuable insights into the mechanisms that influence real-world purchasing decisions.
Mobile vaccine clinic (MVC) programs represent a significant public health investment, rigorous data on their health, economic, and equity impacts are needed to guide policy for future immunization efforts. We estimated the health and economic outcomes of the State of Utah's 1-year COVID-19 MVC program, stratified by Hispanic and non-Hispanic populations. We used a decision-analytic model combining a susceptible-infected-removed (SIR) model with a decision tree to simulate 3.23 million Utah residents over one year (April 1, 2021, to March 31, 2022). We compared an MVC program scenario with a no-MVC program scenario. Health outcomes included vaccinations, infections, hospitalizations, intensive care unit (ICU) admissions, and deaths. Economic outcomes included direct and total costs (in 2021 US dollars) and return on investment (ROI) from healthcare sector and societal perspectives. All outcomes were stratified by Hispanic and non-Hispanic populations. In this economic evaluation of 3.23 million Utah residents, the 1-year MVC program vaccinated 29,420 additional people, preventing an estimated 41,503 infections, 923 hospitalizations, 240 ICU admissions, and 253 deaths. The MVC program was cost-saving compared with no MVC program from both healthcare sector (net savings, $51.71 million) and societal (net savings, $71.30 million) perspectives. Every $1 invested in the MVC program yielded $9.70 in societal savings. Prevented adverse outcomes per 100,000 persons were 3.2-6.0 times higher in the Hispanic versus non-Hispanic population. The MVC program was a cost-saving and equity-enhancing public health strategy. These findings support investment in MVC programs for future vaccination campaigns. This study was funded by cooperative agreement CDC-RFA-FT-23-0069 from the CDC's Center for Forecasting and Outbreak Analytics.
Medication waste is defined as 'any pharmaceutical product that remains unused or is not fully consumed during the entire pharmaceutical supply chain'. Given the growing recognition of the environmental impact of healthcare waste, an understanding of the scale and sources of medicines waste generated in Ireland is required. This study aims to quantify the amount of patient-returned medicines and pharmacy-generated medication waste in a sample of community pharmacies in Ireland, and to explore underlying causes and potential economic impacts. A medicines waste audit was conducted in four community pharmacies in April/May 2025. The audit tool captured data on the type, form, quantity, ATC code, source and given reason for return or wastage. The value of the waste was calculated based on the wholesaler list price. The majority of wasted medicines was from patient returns (72%), and prescription medicines accounted for 90% of all wasted medicines. Patient death (21%), treatment discontinuation (13%) and non-adherence (13%) were the primary reasons for patient-returned medicines. Amendments to blister-packs (31%), expired medicines (27%) and uncollected medicines (16%) were the main drivers of pharmacy-generated waste. The mean value of medication waste per pharmacy was €1,512 over four weeks or €19,662 annually, extrapolating to a national estimate of €37.5 million. There is a clear need for targeted interventions to minimise medication waste across the medicines use phases involving key stakeholders. Moving towards a more sustainable healthcare system would not only lessen environmental harm, but also promote more efficient resource use and improve patient care.
The dissemination of robotic-assisted surgery (RAS) for benign gynaecological conditions may be delayed due to concerns about incremental system and instrument costs, without considering associated potential efficiencies and cost savings. This retrospective, single-centre study aims to analyse the feasibility, safety, and potential intraoperative financial savings of omitting the assisting physician (AP) and the fourth EndoWrist©-arm (FEWA). Consecutive patients are enrolled and stratified in terms of the omission of AP and FEWA. Console time, cut-seam time, theatre-block time, complications, and the duration of hospitalisation are used to prove feasibility and safety. The personnel and material costs are calculated and interpreted via the InEK (Institut für das Entgeltsystem im Krankenhaus) cost matrix of the Diagnosis-Related Group (DRG). The data of 55 consecutive women were analysed. No differences in terms of feasibility or safety were detected (all p values > 0.05). Omitting the AP results in a significant staff cost reduction of €0.84 (19.1%) per operating room minute (p < 0.001). These savings translate into a total amount of €79.12 per procedure (12.5% of personnel costs of €633.47 within the InEK). The omission of the FEWA saves €115.16 per procedure (23.04% of the material costs of €499.63 within the InEK). The omission of AP and FEWA in RAS for benign gynaecological conditions appears feasible without an immediately detectable signal of harm in this small cohort, justifying a larger prospective evaluation. The potential savings in terms of personnel and material costs represent a relevant portion of the provided amount within the InEK and should thereby facilitate the further dissemination of RAS in this field of gynaecology.
Integrating renewable energy (RE) into power generation systems enhances sustainability by reducing greenhouse gas emissions, strengthening energy security, lowering operational costs, and promoting sustainable development, particularly in remote or underserved areas. This paper investigates the integration of RE into Mosul's power infrastructure through a hybrid renewable energy system (HRES) comprising the electrical grid, photovoltaic (PV) panels, pumped hydro energy storage (PHES), and an electrolyzer. Using HOMER Pro software, three system configurations were evaluated to optimize component sizing and assess techno-economic and environmental performance under the operating conditions of a hot semi-arid climate in northern Iraq. Among these configurations, the PV/grid/PHES/electrolyzer system demonstrated the best performance, achieving a renewable energy penetration of 254%. The proposed system results in a net present cost of $9.75 million and a levelized cost of energy of $0.06673/kWh. Despite modest reductions in operation and maintenance costs, the system demonstrates significant long-term economic efficiency when evaluated over its lifetime and projected revenues. From an environmental perspective, the proposed design achieves an annual reduction of approximately 18,089.31 tons of CO₂, corresponding to an estimated carbon credit value of $271.34 K, thus contributing to both sustainability and economic resilience. The findings confirm that the proposed HRES is a viable, cost-effective, and sustainable energy solution for Mosul and other regions with similar climatic and energy characteristics.
Making a HIIT examined the associations of co-designing and using HIIT workouts within health and physical education lessons on students' enjoyment, autonomous motivation, basic psychological needs, and self-efficacy towards HIIT. Participants (12-14 years) were divided into: 1) a co-design group (n = 122, 48% female), who co-designed the workouts and completed an 8-week intervention using them; 2) a HIIT-only group (n = 100, 44% female), who completed the 8-week intervention; and 3) a control group (n = 86, 52% female), who continued with normal lessons. Questionnaires were completed immediately after the first and last HIIT workout. To understand the association of participating in the co-design process, co-design and non-co-design group responses after the first workout were compared. To understand the effect of using the co-designed workouts, multi-level models compared the responses of the three groups over time. Workout co-design and use were not significantly associated with any outcomes of interest. Enjoyment, autonomous motivation, autonomy, and self-efficacy were rated neutral to positive and remained stable throughout the intervention regardless of group. Perceived competence and relatedness decreased slightly over time irrespective of group (β = -0.36; -0.47). Future studies should continue to support students' basic psychological needs during school-based interventions and consider co-designing aspects of these interventions beyond the workouts.
Background: Long-term diabetes mellitus may precipitate severe complications, including cognitive dysfunction. Existing research has shown that diabetic cognitive impairment (DCI) in rats is characterized by memory deterioration and a disordered arrangement of hippocampal cells. The Shichangpu-Xiyangshen herb pair (SX) effectively improved the pathological changes induced by DCI. However, the role of SX in regulating the physiological and behavioral responses to DCI remains unclear. Methods: We sought to determine the small-molecule metabolites of cerebrospinal fluid (CSF) and delineate the pathways to elucidate the potential mechanism of the effect of SX in the treatment of DCI by metabolomics strategies, focusing on key mechanisms. Behavioral assessments were conducted on DCI rats and the rats treated with SX, as well as an evaluation of neuronal morphology in the hippocampal region. Metabolomics was used to analyze biomarkers in cerebrospinal fluid at different time points during the development of DCI, to uncover the underlying core mechanisms of DCI, and to investigate the regulatory effects of SX on these core mechanisms. The mechanisms of SX on DCI were investigated using quantitative reverse transcription polymerase chain reaction, immunohistochemistry, Western blot, and ELISA. Results: The Morris water maze (MWM) and social interaction test results revealed that SX administration effectively counteracted cognitive impairments in rats with DCI while simultaneously diminishing pathological damage in the CA1, CA3, and DG hippocampal regions. Further analysis showed that SX restored the significantly reduced levels of IL-8, ROX, and TNF-α, and reduced Aβ plaque formation (as indicated by APP and BACE1 protein expression). Simultaneously, SX markedly ameliorated arachidonic acid metabolic disorders in DCI, including significant reductions in arachidonic acid (AA), PGE2, and LTB4 and reduced expression of COX-2 (PTGS2) and 5-LOX (ALOX-5). Conclusions: Our findings indicate that SX effectively counteracted cognitive impairment in rats with DCI by inhibiting AA metabolism through both cyclooxygenase and lipoxygenase pathways, thereby minimizing neuronal damage.
The world is not on track to reach the Sustainable Development Goal nutrition targets. We aimed to estimate the cost, impact and benefit-cost ratio from scaling up 15 evidence-based nutrition interventions among 125 countries and seven world regions. For each country, the Optima Nutrition model was used to project health outcomes over 2025-2034 for pregnant women (anemia, mortality) and children under five (stunting, wasting, anemia, small for gestational age births, children exclusively breastfed). The 15 interventions were identified through systematic reviews. Country-specific demographic, epidemiological and intervention coverage parameters were extracted from large population surveys, World Bank and Institute of Health Metrics and Evaluation estimates. A baseline scenario with current coverage of interventions maintained was compared to an investment scenario where intervention coverage was increased linearly to 90% over 2025 to 2029 and then maintained from 2030 to 2034. Country-specific intervention unit costs were estimated from a health system perspective and used to calculate 10-year intervention costs for each scenario. Health impacts for the 10-year cohort were converted to societal economic benefits from larger and more productive future workforces. Costs and economic benefits are presented in 2023 US$ with 3% per annum discounting. The current coverage of interventions varied widely across countries but was generally low. Compared to the baseline, the investment scenario cost an average additional US$4.87-11.43 per pregnant woman and an average additional US$9.99-20.14 per child under five per annum, depending on world region. Across regions, this investment could reduce child deaths by 7-13%, maternal deaths by 5-9%, stunted children turning age five by 5-9%, wasting episodes by 2-4%, maternal anemia cases by 36-38%, child anemia cases by 16-23%, small for gestational age births by 46-52%, and could increase the number of infants exclusively breastfed by 10-29%. These improved outcomes translated to benefit-cost ratios of 13-54 across regions. The estimated financial needs, distribution of additional costs across interventions and return-on-investment for each country was dependent on population sizes and country-specific epidemiological and economic indicators. Scaling up evidence-based nutrition interventions could have substantive health and economic impacts. For every $1 invested there could be between $13 and $54 in economic benefits.
Unplanned reoperation is a recognized indicator of surgical quality, yet accurately estimating its true clinical and economic burden remains challenging due to inadequate case mix adjustment. This study aims to comprehensively evaluate the impact of unplanned reoperation on hospitalized surgical patients using Diagnosis Related Group (DRG) based adjustment. A retrospective cohort study was conducted on surgical patients between 2022 and 2024, using data from the DRG database of a large tertiary general hospital with four districts. Unplanned reoperation was defined as an unplanned return to the operating room during the same hospitalization due to complications, procedural errors, or misdiagnosis. Primary outcomes were length of stay (LOS) and hospitalization costs; the secondary outcome was discharge to home under physician's order. DRG based frequency matching was performed to balance case mix. Multivariable linear regression and Fine-Gray competing risk models were used to estimate adjusted geometric mean ratios (GMR) and hazard ratios (HR). Subgroup and sensitivity analyses (propensity score matching and excluding short-stay patients) were conducted to assess robustness. Of 301,478 surgical patients, 775 (0.26%) underwent unplanned reoperation. After DRG-based matching, 2,325 patients (775 cases, 1,550 controls) were included. Unplanned reoperation was independently associated with prolonged LOS (adjusted GMR: 1.64; 95% CI: 1.55-1.74), increased costs (adjusted GMR: 1.51; 95% CI: 1.43-1.60), and a 53% lower likelihood of discharge to home (adjusted HR: 0.47; 95% CI: 0.42-0.53). The impact varied significantly by surgical specialty: orthopedics showed the greatest LOS prolongation (GMR: 2.49; 95% CI: 1.78-3.49), while cardiothoracic surgery and urology demonstrated the highest cost increases (GMR: 1.90 and 1.84, respectively). Non-cancer patients and those undergoing level 1-2 surgeries were particularly vulnerable. These findings remained robust in sensitivity analyses. Incorporating DRG-based adjustment enables a more accurate evaluation of the incremental clinical and economic burden associated with unplanned reoperations, including prolonged length of stay and increased hospitalization costs. These findings highlight that mitigating the impact of such reoperations, especially in procedures < 3 h, non-oncologic surgeries, grade 1-2 surgeries, orthopedic and cardiothoracic procedures, remains a crucial challenge that requires special consideration in clinical management.