BACKGROUND: Cost-effectiveness analyses typically ignore healthcare system resource constraints. Ophthalmology is affected by resource constraints because of increasing disease prevalence and the use of resource-intensive treatments. This study evaluated the impact of resource constraints on the cost-effectiveness of faricimab 6 mg, compared with aflibercept 2 mg and ranibizumab biosimilar 0.5 mg, for treating wet age-related macular degeneration (wAMD) or diabetic macular oedema (DMO) over a 5-year horizon.
METHODS: A microsimulation model estimated the impact of resource constraints on patients visits, delays, costs and quality-adjusted life-year (QALY) losses due to treatment delays at a typical UK National Health Service eye hospital treating 1500 patients with wAMD and 500 patients with DMO. Patient characteristics, treatment regimens and treatment intervals were informed using published literature and expert opinion. Resource constraint was represented by limiting the number of available intravitreal injection appointments per week, with growing demand caused by rising disease prevalence. The model compared outcomes across three scenarios; each scenario involved treating all patients with one of the three treatments.
RESULTS: Over 5 years, in a resource-constrained hospital, compared with aflibercept, faricimab use resulted in the avoidance of 12,596 delays, saved GBP/£15,108,609 in cost and avoided the loss of 60.06 QALYs. Compared with ranibizumab biosimilar, faricimab use resulted in the avoidance of 18,910 delays, incurred £2,069,088 extra cost and avoided the loss of 105.70 QALYs, resulting in an incremental cost-effectiveness ratio of £19,574/QALY.
CONCLUSIONS: Accounting for resource constraints in health economic evaluation is crucial. Emerging therapies that are more durable and require less frequent clinic visits can reduce treatment delays, leading to improved QALY outcomes and reduced burden on healthcare systems. Faricimab reduced the number of delayed injections, leading to improved QALY outcomes for patients in a healthcare system with resource constraints. Faricimab is cost-saving when compared with aflibercept and cost-effective when compared with ranibizumab biosimilar.

Contamination of fresh produce with Listeria monocytogenes can occur throughout the supply chain, including at retail, where Listeria spp., including L. monocytogenes, may be introduced and spread via various routes. However, limited tools are available for retailers to assess practices that can enhance control of Listeria transmission to fresh produce. Therefore, we developed an agent-based model that can simulate Listeria transmission in retail produce sections to optimize environmental sampling programs and evaluate control strategies. A single retail store was used as a model environment, in which various routes of Listeria introduction into and transmission between environmental surfaces were modeled. Model prediction (i.e., Listeria prevalence) was validated using a published longitudinal study for all surfaces that were included in both the model and the validation data. Sensitivity analysis using the Partial Rank Correlation Coefficient showed that (i) initial Listeria concentration from incoming produce, (ii) transfer coefficient from produce to employee\'s hands, and (iii) transfer coefficient from consumer to produce were the top three parameters that were significantly (p < 0.0018) associated with the mean Listeria prevalence across all agents, suggesting that the accuracy of these parameters are important for prediction of overall Listeria prevalence at retail. Cluster analysis grouped agents with similar contamination patterns into six unique clusters; this information can be used to optimize the sampling plans for retail environments. Scenario analysis suggested that (i) more stringent supplier control as well as (ii) practices reducing Listeria transmission via consumer\'s hands may have the largest impact on reducing finished product contamination. Overall, we show that an agent-based model can serve as a foundational tool to help with decision-making on Listeria control strategies at retail.

BACKGROUND: Injection-equipment-sharing networks play an important role in hepatitis C virus (HCV) transmission among people who inject drugs (PWID). Direct-acting antiviral (DAA) treatments for HCV infection and interventions to prevent HCV transmission are critical components of an overall hepatitis C elimination strategy, but how they contribute to the elimination outcomes in different PWID network settings are unclear.
METHODS: We developed an agent-based network model of HCV transmission through the sharing of injection equipment among PWID and parameterized and calibrated the model with rural PWID data in the United States. We modeled curative and preventive interventions at annual coverage levels of 12.5 %, 25 %, or 37.5 % (cumulative percentage of eligible individuals engaged), and two allocation approaches: random vs targeting PWID with more injection partners (hereafter \'degree-based\'). We compared the impact of these intervention strategies on prevalence and incidence of HCV infections. We conducted sensitivity analysis on key parameters governing the effects of curative and preventive interventions and PWID network characteristics.
RESULTS: Combining curative and preventive interventions at 37.5 % annual coverage with degree-based allocation decreased prevalence and incidence of HCV infection by 67 % and 70 % over two years, respectively. Curative interventions decreased prevalence by six to 12 times more than preventive interventions, while curative and preventive interventions had comparable effectiveness on reducing incidence. Intervention impact increased with coverage almost linearly across all intervention strategies, and degree-based allocation was always more effective than random allocation, especially for preventive interventions. Results were sensitive to parameter values defining intervention effects and network mean degree.
CONCLUSIONS: DAA treatments are effective in reducing both prevalence and incidence of HCV infection in PWID, but preventive interventions play a significant role in reducing incidence when intervention coverage is low. Increasing coverage, including efforts in reaching individuals with the most injection partners, preventing reinfection, and improving compliance and retention in preventive services can substantially improve the outcomes. PWID network characteristics should be considered when designing hepatitis C elimination programs.

Risk index tools have the potential to assist farmers in making strategic decisions regarding their farm design to manage losses of nutrients. Such tools require a vulnerability framework, and these are often based on scores or rankings. These frameworks struggle to take account of interactions between elements of the physical environment. Process-based simulation models inherently take account of interactions and may be a viable alternative to score-based methods. We describe the method to populate a database of transport factors that covers the agricultural lands of New Zealand that is designed for usage as the susceptibility framework within a risk index tool. The method gives both leaching and runoff transport factors and gives values by month. The simulation model used had already been validated for simulating water and nitrogen balances and the generated spatial patterns of the transport factors was validated via expert assessment. These features allow good representation of the risks posed across a wide range of farming activities.•Use of a simulation model to quantify transport factors.•Captures the interactions between soil and weather factors in the physical environment.•Produces a country-wide database intended as a susceptibility framework for a risk index tool.

OBJECTIVE: To study the published literature for various models used for simulation and training in the field of pediatric colorectal surgery.
METHODS: A PubMed search was conducted for studies of simulation models in anorectal malformation on 24 March 2024 with the search words \'simulation pediatric colorectal surgery\' followed by another search on \'simulation AND anorectal malformation\' that gave 22 and 14 results, respectively (total 36). After removing 4 duplicate publications, 12 were found relevant to simulation and training in colorectal diseases. One publication relevant to the topic was added from literature, thirteen articles were studied.
RESULTS: Of these, 5; 1; 4; and 3 were on inanimate models; animate model; 3D reconstructions; and training, respectively. Simulation models are available for posterior sagittal anorectoplasty. The same inanimate model was used in five articles. The animate model was based on a chicken cadaver. 3D models have been made for personalized preoperative assessment and to understand the imaging in anorectal malformation. One 3D model was made by regeneration of organoid epithelium. Training modules were made to evaluate surgical dissection, standardize surgical techniques, and improve proficiency.
CONCLUSIONS: Simulation models are an important tool for teaching the steps of surgery and discussing the nuances of operative complications among mentors and peers. With advances in this field, the development of high-fidelity models, more training modules, and consensus on surgical techniques will benefit surgical training.

Temperature and light are the key factors affecting the formation of tomato fruit quality in greenhouse cultivation. However, there are few simulation models that examine the relationship between tomato fruit quality formation and temperature and light. In this study, a model was established that investigated the relationships between soluble sugar (SSC), organic acid content (OAC), and SSC/OAC and the cumulative product of thermal effectiveness and photosynthetically active radiation (TEP) during the fruit-ripening period in a solar greenhouse. The root mean square error (RMSE) values were calculated to compare the consistency between the simulated and measured values, and the RMSE values for SSC, OAC, and SSC/OAC were 0.09%, 0.14%, and 0.358, respectively. The combined weights of quality indicators were obtained using the analytic hierarchy process (AHP) and entropy weighting method, ranking as SSC > OAC > SSC/OAC > CI > lycopene > Vc > fruit firmness. The comprehensive fruit quality evaluation value was obtained using the TOPSIS method (Technique for Order Preference by Similarity to an Ideal Solution) and a simulation model between comprehensive tomato fruit quality and TEP was explored. This study could accurately simulate and quantify the accumulation of tomato fruit quality during fruit ripening in response to environmental conditions in a solar greenhouse.

To effectively reduce residual stresses in GH4169 workpieces, thus enhancing fatigue strength and operational lifespan, this study investigates the influence of spray cooling parameters on surface residual stresses during GH4169 turning in spray cooling conditions, utilizing both simulation and experimental approaches. A simulation model of residual stresses was established using finite element analysis when GH4169 was cut in spray cooling. The effects of spray pressure and flow rate on residual tensile stresses were analyzed. The analysis reveals that with increasing spray pressure, residual tensile stresses show a decreasing trend, gradually stabilizing. Conversely, with an increasing spray flow rate, residual tensile stresses initially decrease and then increase. The turning experiments of GH4169 were conducted under different spray parameters. After the experiment, the workpiece was sectioned and analyzed for residual stresses using X-ray diffraction instrumentation. The value residual stress measured closely matched those of simulation, with a relative error within 6%, validating the accuracy of the simulation model and confirming the appropriateness of parameter settings. These results contribute to the further promotion of spray cooling technology and facilitate the rational selection of spray parameters.

Since conventional PID (Proportional-Integral-Derivative) controllers hardly control the robot to stabilize for constant force grinding under changing environmental conditions, it is necessary to add a compensation term to conventional PID controllers. An optimal parameter finding algorithm based on SAC (Soft-Actor-Critic) is proposed to solve the problem that the compensation term parameters are difficult to obtain, including training state action and normalization preprocessing, reward function design, and targeted deep neural network design. The algorithm is used to find the optimal controller compensation term parameters and applied to the PID controller to complete the compensation through the inverse kinematics of the robot to achieve constant force grinding control. To verify the algorithm\'s feasibility, a simulation model of a grinding robot with sensible force information is established, and the simulation results show that the controller trained with the algorithm can achieve constant force grinding of the robot. Finally, the robot constant force grinding experimental system platform is built for testing, which verifies the control effect of the optimal parameter finding algorithm on the robot constant force grinding and has specific environmental adaptability.

With recent outbreaks of foot-and-mouth disease (FMD) in Indonesia and Bali, industry, government and public concern for its incursion into Australia is increasing. The potential impact of an outbreak on the agricultural industry and national economy could be devastating. To date, research conducted in relation to FMD in Australia predominantly concerns simulations and models performed to predict various outcomes. This project critically appraises the current literature regarding the simulated use of vaccination and its effectiveness for controlling the spread of FMD in Australia in the event of an outbreak. Findings from 10 modelling studies suggest that vaccination is effective at controlling the size and duration of an outbreak (under certain conditions), however, there is less clarity about cost-effectiveness.

OBJECTIVE: Magnetic particle imaging (MPI) is an emerging imaging technology in medical tomography that utilizes the nonlinear magnetization response of superparamagnetic iron oxide (SPIO) particles to determine the in vivo spatial distribution of nanoparticle contrast agents. The reconstruction image quality of MPI is determined by the characteristics of magnetic particles, the setting of the MPI scanner parameters, and the hardware interference of MPI systems. We explore a feasible method to systematically and quickly analyze the impact of these factors on MPI reconstruction image quality.
METHODS: We propose a systematic 3-D MPI simulation model. The MPI simulation model has the capability of quickly producing the simulated reconstruction images of a scanned phantom, and quantitative analysis of MPI reconstruction image quality can be achieved by comparing the differences between the input image and output image. These factors are mainly classified as imaging parameters and interference parameters in our model. In order to reduce the computational time of the simulation model, we introduce GPU parallel programming to accelerate the processing of large complex matrix data. For ease of use, we also construct a reliable, high-performance, and open-source 3-D MPI simulation software tool based on our model. The efficiency of our model is evaluated by using OpenMPIData. To demonstrate the capabilities of our model, we conduct simulation experiments using parameters consistent with a real MPI scanner for improving MPI image quality.
RESULTS: The experimental results show that our simulation model can systematically and quickly evaluate the impact of imaging parameters and interference parameters on MPI reconstruction image quality.
CONCLUSIONS: We developed an easy-to-use and open-source 3-D MPI simulation software tool based on our simulation model incorporating all the stages of MPI formation, from signal acquisition to image reconstruction. In the future, our simulation model has potential guiding significance to practical MPI images.