UNASSIGNED: This study aimed to obtain insights from epilepsy specialists on the use of Patient-Reported Outcome (PRO) measures and how they can affect the management of people with epilepsy and healthcare resource utilization.
UNASSIGNED: The heads of two referral units for people with epilepsy at one tertiary care hospital were invited to respond to a structured survey.
UNASSIGNED: Paper-based questionnaires and face-to-face interviews were the main modalities used to measure the quality of life of people with epilepsy. The Quality of Life in Epilepsy Inventory-31 (QOLIE-31), the Adverse Event Profile (adult centre), the Generalized Anxiety Disorder-7, Short-Form Health Survey 36, PSY-Flex, SAFA and Child Behavior Checklist (paediatric centre) were the most used scales. There was consensus about the favourable impact of PRO upon patient management, disease management and measurement of the success of a treatment. Both respondents considered the PRO as important as other main indicators like efficacy and tolerability of the treatment. Lack of time, personnel and economic resources was identified as a barrier on the use of PRO. The PRO could reduce the number of visits, exams and treatments, and increase the time spent on each patient and the number of neuropsychological, psychological and rehabilitation services. The standardized use of PRO was considered useful and the increase in human resources was considered a priority to achieve this goal.
UNASSIGNED: Despite the heterogeneity in the actual collection of PRO, there was a uniform perception about their role to optimize the care of people with epilepsy.

The paper focuses on the failure to account for the value of standing tropical forests, and of ecosystem services in general, in economic decision-making. This blindness to the values of nature has led to overexploitation, degradation and destruction of tropical forests, which, in turn, has also significantly contributed to greenhouse gas emissions. Forest conservation and restoration has a critical role to play in the fight against climate change and brings a vast array of additional benefits, from security in water, energy, food, health and livelihoods to maintaining biodiversity itself as a core component of our living planet. As first Minister of Environment and Energy under President Oscar Arias (1986-1990), I brought these views into societal decision-making in Costa Rica and here I briefly describe how. This article is part of the theme issue \'Bringing nature into decision-making\'.

Circular energy transformation of Turkey is essential to strengthen the national energy security. Turkey will benefit from moving towards a circular economy. Circular economy (CE) has gained much attention due to global warming and climate change which are the most serious issues faced in the world. The United Nations has been struggling with the issues regarding sustainable development by releasing some programs and legislations, which are mostly supported by the EU. The EU\'s CE including both economy and energy within the scope of low-carbon world is binding for Turkey\'s energy transition. Among renewables, solar energy preserved the leading capacity expansion with an increase of 98 GW in 2019 in the world. Solar photovoltaic (PV) has become a mainstream energy source among renewables. Since the PV installation has been growing all around the world, several countries especially China, Germany, and the UK pay special attention to a sustainable PV waste management concept. We present the special case of Turkey within the global CE along with the current status of renewable energy in the global energy transformation. Turkey\'s energy outlook and the EU\'s targets are reviewed, and the significant role of solar energy in the CE transition process of Turkey has been revealed. We suggested adding a vision of \"More Circular\" to her new energy policy \"More Domestic, More Renewable.\"

OBJECTIVE: Care coordination for children and youth with special health care needs and medical complexity (CYSHCN-CMC), especially medication management, is difficult for providers, parents/caregivers, and -patients. This report describes the creation of a clinical pharmacotherapy practice in a pediatric long-term care facility (pLTCF), application of standard operating procedures to guide comprehensive medication management (CMM), and establishment of a collaborative practice agreement (CPA) to guide drug therapy.
METHODS: In a prospective case series, 102 patients characterized as CYSHCN-CMC were included in this pLTCF quality improvement project during a 9-month period.
RESULTS: Pharmacists identified, prevented, or resolved 1355 drug therapy problems (DTP) with an average of 13 interventions per patient. The patients averaged 9.5 complex chronic medical conditions with a -median length of stay of 2815 days (7.7 years). The most common medications discontinued due to pharmacist assessment and recommendation included diphenhydramine, albuterol, sodium phosphate enema, ipratropium, and metoclopramide. The average number of medications per patient was reduced from 23 to 20. A pharmacoeconomic analysis of 244 of the interventions revealed a monthly direct cost savings of $44,304 ($434 per patient per month) and monthly cost avoidance of $48,835 ($479 per patient per month). Twenty-eight ED visits/admissions and 61 clinic and urgent care visits were avoided. Hospital -readmissions were reduced by 44%. Pharmacist recommendations had a 98% acceptance rate.
CONCLUSIONS: Use of a CPA to conduct CMM in CYSHCN-CMC decreased medication burden, resolved, and prevented adverse events, reduced health care-related costs, reduced hospital readmissions and was well-accepted and implemented collaboratively with pLTCF providers.

UNASSIGNED: In 2018, the German Federal Constitutional Court decided that mechanical restraint is the most intrusive coercive measure and its use requires a judge\'s decision after bedside assessment if lasting longer than 30 min. Subsequently, legal changes were realized. The objective of our study was to determine the number of saved coercive episodes and saved hours in seclusion or restraint in 2019 compared to the average of the previous years, 2015-2017, as well as costs per saved episode, hour, and case saved from any coercive measure.
UNASSIGNED: We used data from the Baden-Wuerttemberg case registry for coercive measures, covering all 32 psychiatric hospitals of the Federal State and 435,767 admissions in the study period. Time expenditure was calculated as 3.5 h with an average of 51.95 € per working hour on the side of the justice system and 1.5 h (45.94 €/h) on the side of the hospital per case.
UNASSIGNED: The number of coercive episodes decreased by 10.0% from 28,181 (average 2015-2017) to 25,371 (2019). The number of hours in seclusion or restraint decreased by 17.9% from 321,956 (2015-2017) to 264,423 (2019). This resulted in the cost of 872.33 € per saved episode and 42.61 € per saved hour in seclusion or restraint.
UNASSIGNED: Given the correctness of our estimations, saving 1 h in coercion by less than 1 h of an expert\'s work might be justified from an ethical and economic perspective.

The use of hydroponics to cultivate economic crops is an emerging agricultural practice in Nigeria. There is, however, a paucity of information on the economic viability and valuation of the production systems. This study investigated hydroponics\' profitability and economic viability under small- and medium-scale production systems. The economic viability of ten hydroponic farms were evaluated using the financial metrics: net present value (NPV), internal rate of return (IRR), benefit-cost ratio (BCR), and sensitivity analysis. Sensitivity analysis based on positive and negative changes in the running cost and gross annual revenue was adopted to measure the robustness of the production method. The positive NPVs of the small-scale farmer (€42,895) and medium-scale farmer (€331,465) at a 15% discount rate show that both production scales are economically viable. The ten-year IRR of both production scales was about 83%. Similarly, the BCR showed that both the small-scale farmers (5.07) and the medium-scale farmers (4.91) are significantly profitable. In the sensitivity analysis, the small-scale farmers were more sensitive to recurrent 5% changes in the running cost at the 13% threshold. On the other hand, medium-scale farmers were less sensitive with a threshold value of 58.4%. Similarly, small-scale farmers are more sensitive to a 15% reduction in the gross annual revenue, with a negative net return of -€956. It is imperative to state that, though starting an investment in hydroponics requires a high initial investment, medium-scale farmers would be less sensitive to changes in the running cost of production in the face of uncertainties.

Despite efforts to curb the rise in Mexico\'s child and adolescent overweight and obesity rates, prevalence in Mexico has grown by 120% since 1990 to 43.3% in 2022. This investment case identifies policies that will produce the largest returns for Mexico. The investment case model builds beyond a cost-of-illness analysis by predicting the health and societal economic impact of implementing child and adolescent overweight and obesity interventions in a cohort aged 0-19 from 2025 to 2090. The Markov model\'s impacts include healthcare expenditures, years of life lost, and reduced wages and productivity. We projected and compared costs in a status quo scenario to an intervention scenario to estimate cost savings and calculate return-on-investment (ROI). Total lifetime health and economic costs amount to USD 1.8 trillion-USD 30 billion on average per year. Implementing five interventions can reduce lifetime costs by approximately 7%. Each intervention has a low cost per disability-adjusted life year averted over 30-year, 50-year, and lifetime horizons. The findings demonstrate that a package of interventions mitigating child and adolescent overweight and obesity offers a strong ROI. The novel investment case methods should be applied to other countries, particularly low- and middle-income countries.

UNASSIGNED: The recent Ebola virus disease (EVD) epidemic was one of the most severe public health emergencies in modern times. The economic impact of epidemics has mostly been analysed at the macroeconomic level. Conversely, we aimed to estimate the economic costs of preventive measures of the epidemic to an extractive firm, ArcelorMittal (AM), using data in the epidemic region from March 2014 to December 2015. AM is the world\'s largest steel producer and is particularly important in West Africa, where the extractive industry is economically crucial.
UNASSIGNED: Qualitative methods, in-depth interviews (IDIs) and focus group discussions (FGDs), were used to investigate the events and channels of impact of the epidemic on the firm, as perceived by employees and contractors. Quantitative data regarding these costs were also collected. Retrospective cost analysis estimated the actual cost of preventive methods adopted.
UNASSIGNED: Most respondents indicated the largest cost impact was suspension of the Phase II expansion, a series of projects designed to increase iron ore production in Liberia. The next largest cost was the preventive measures adopted to counter disease spread. Total costs incurred for adopting preventive measures were USD 10.58-11.11 million. The overall direct costs of preventive measures adopted within the fence, meaning within the physical boundary of the firm\'s sites, shared 30-31% of the total costs incurred. The share of external donations supporting humanitarian response was 11-12% of the total costs, followed by 7-12% of relational costs.
UNASSIGNED: The firm\'s response during the EVD epidemic focussed on its employees and operations, which was later expanded to the wider community and then in supporting the international humanitarian response.

This study describes and explains the multifaceted effects of the COVID-19 pandemic on the socio-economic and psychosocial well-being of the artisanal fishing communities in Central Philippines. The state of child labour and their education amidst the COVID-19 lockdown were also explored. Four hundred artisanal fishing households, with 792 children, from the 10 coastal municipalities in Aklan province were surveyed in May-December 2020 through face-to-face household interviews. The COVID-19 pandemic worsened poverty in these highly vulnerable fishing communities primarily through severe disruptions in their fishing and marine tourism-related livelihoods. The proportion of households living below the Philippine poverty threshold of PHP12,030 (USD232.7) monthly for a family of five members increased from 78% pre-COVID to 91% peri-COVID. This economic impoverishment was more pronounced in larger families with limited income, as in the survey sites, where 41% of the households have more than five family members. Furthermore, 57% of the surveyed households believed that learning difficulty increased by 81% among children due to the blended online education modality. Amidst increased impoverishment, child labour intensified, and children stopped schooling. A significant decline in happiness index peri-COVID was also observed in the study sites indicating extreme socio-economic challenges. Contrary to expectations, however, interpersonal relations in most households improved, underscoring women\'s stabilising and nurturing role. This latter phenomenon signifies that cooperative and nurturing actor relationships can be generated even in a crisis. Policies that mainstreamed local communities\' reproductive health, family planning, and programmes that diversify socio-economic, environmental, and technological assets must be renewed and promoted. The goal is to holistically improve human well-being by increasing or sustaining stocks of these assets to promote resilience and sustainability amidst crisis and complexity.

In this work we elaborate a proposal for policy guidelines for the improvement of productivity and competitiveness of the province of Tungurahua -Ecuador-, such proposal is based on the theoretical foundations about the concept of a comprehensive, territorial and sustainable development applied to the territorial diagnosis. Herein three analysis techniques were used as a methodological strategy: The Rasmussen Method, which consists of a multisector model based on the Input-Output Tables-; the technique of focus groups for the analysis of perception on the prioritization of key sectors by the population and by the productive sectors; and the Shift-Share Analysis, to determine the level of growth of some sectors with respect to others. The results have allowed the identification of the strengths and weaknesses, as well as, the opportunities and threats associated with the levels of productivity and competitiveness of the province of Tungurahua. Therefore, strategies have been formulated aimed at the comprehensive, territorial and sustainable development of the province, which are built on the strengthening of endogenous capacities in science, technology and innovation, the encouragement of a coordination and articulation between the actors, the strengthening of the local business web and the internationalization of the territory.