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Introduction: Pain assessment in horses presents a significant challenge due to their nonverbal nature and their tendency to conceal signs of discomfort in the presence of potential threats, including humans. Therefore, this study aimed to identify pain-associated behaviors amenable to automated AI-based detection in video recordings. Additionally, it sought to determine correlations between pain intensity and behavioral and postural parameters by analyzing factors such as time budgets, weight shifting, and unstable resting. The ultimate goal is to facilitate the development of AI-based quantitative tools for pain assessment in horses. Materials and methods: A cohort of 20 horses (mean age 15 ± 8) admitted to a university equine hospital underwent 24-h video recording. Behaviors were manually scored and retrospectively analyzed using Loopy® software. Three pain groups were established based on the Pain Score Vetmeduni Vienna : pain-free (P0), mild to moderate pain (P1), and severe pain (P2). Results: Weight shifting emerged as a reliable indicator for discriminating between painful and pain-free horses, with significant differences observed between pain groups (p < 0.001) and before and after administration of analgesia. Additionally, severely painful horses (P2 group) exhibited lower frequencies of feeding and resting standing per hour compared to pain-free horses, while displaying a higher frequency of unstable resting per hour. Discussion: The significant differences observed in these parameters between pain groups offer promising prospects for AI-based analysis and automated pain assessment in equine medicine. Further investigation is imperative to establish precise thresholds. Leveraging such technology has the potential to enable more effective pain detection and management in horses, ultimately enhancing welfare and informing clinical decision-making in equine medicine.

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PREMISE: Whole-genome duplication (WGD, polyploidization) has been identified as a driver of genetic and phenotypic novelty, having pervasive consequences for the evolution of lineages. While polyploids are widespread, especially among plants, the long-term establishment of polyploids is exceedingly rare. Genome doubling commonly results in increased cell sizes and metabolic expenses, which may be sufficient to modulate polyploid establishment in environments where their diploid ancestors thrive. METHODS: We developed a mechanistic simulation model of photosynthetic individuals to test whether changes in size and metabolic efficiency allow autopolyploids to coexist with, or even invade, ancestral diploid populations. Central to the model is metabolic efficiency, which determines how energy obtained from size-dependent photosynthetic production is allocated to basal metabolism as opposed to somatic and reproductive growth. We expected neopolyploids to establish successfully if they have equal or higher metabolic efficiency as diploids or to adapt their life history to offset metabolic inefficiency. RESULTS: Polyploid invasion was observed across a wide range of metabolic efficiency differences between polyploids and diploids. Polyploids became established in diploid populations even when they had a lower metabolic efficiency, which was facilitated by recurrent formation. Competition for nutrients is a major driver of population dynamics in this model. Perenniality did not qualitatively affect the relative metabolic efficiency from which tetraploids tended to establish. CONCLUSIONS: Feedback between size-dependent metabolism and energy allocation generated size and age differences between plants with different ploidies. We demonstrated that even small changes in metabolic efficiency are sufficient for the establishment of polyploids.

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River and atmosphere are traditionally recognized as the primary nutrient sources impacting coastal ecosystems. Despite the increasing attention towards the often-neglected submarine groundwater discharge (SGD), its understanding and significance in highly human-impacted marginal seas remain limited. This study utilizes unprecedented high-resolution data (561 seawater and 282 groundwater radium samples) to provide precise estimates of 226Ra and 228Ra sources and sinks in the Eastern China Marginal Seas. A coupled 226Ra and 228Ra mass balance model enable an integrated SGD flux of (3.7 ± 2.4) × 1012 m3 yr-1, surpassing rivers by 3.4 times. Furthermore, nutrient delivery from SGD exceeds riverine and atmospheric inputs, potentially inducing substantial changes in coastal nutrient cycles. These alterations have profound implications for primary production and biological communities, deviating significantly from the Redfield ratio. Therefore, comprehending the significance of SGD in nutrient budgets is vital for a comprehensive understanding of biogeochemical dynamics and functionality of marginal sea ecosystems.

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Life-history theory predicts that investment in reproduction should decrease survival (the 'cost of reproduction'). It is often assumed that energy allocation drives such trade-offs, with limited energy available for both reproduction and survival. However, the underlying mechanisms remain poorly understood, maybe because survival costs of reproduction are only apparent when resources are limited. Here, we took advantage of a natural experiment created by fluctuating environmental conditions to compare energy expenditure of a seabird, the pelagic cormorant (Phalacrocorax pelagicus), between contrasting population-scale scenarios of survival costs of reproduction. We used multi-state capture-recapture modelling across 16 years to identify which breeding seasons induced high survival costs (survival ratebreeders < survival ratenon/failed breeders) and we concomitantly estimated energy expenditure of chick-rearing males using time-energy budget models across 4 years. Daily energy expenditure (DEE) of chick-rearing pelagic cormorants varied significantly among years. However, survival costs of reproduction were observed in only 1 year, and contrary to our expectations, variation in DEE was not associated with population-level survival costs. Similarly, at the individual level, DEE in 1 year did not predict the probability of being observed again at the colony in following years (apparent survival). Finally, DEE was independent of brood size and brood age, but older individuals tended to expend less energy than younger ones. Given the lack of an apparent energetic 'cost of reproduction', lower DEE in older birds could be due to improved efficiency rather than avoidance of costs in old birds. Although future studies should account for potential sex-specific energetic constraints by including data on female energy expenditure, we conclude that a direct link between the rate of energy expenditure during breeding and subsequent survival is unlikely in this system.

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Beached macrolitter (>2,5 cm) abundance and composition in the Russian (Eastern) part of the Barents Sea and the adjacent part of the Kara Sea was assessed for 2021-2023. Average densities of beach litter on the coasts are 675 items/100 m and 37 kg/100 m (0.27 items/m2 and 0.015 kg/m2). Annual litter budgets for Cape Zhelaniya beaches are 0.49 items/m2 per year and 0.023 kg/m2 per year. The northernmost tip of Novaya Zemlya is shown to be a beach litter accumulation hot-spot on Novaya Zemlya archipelago, where litter is brought by surface currents and trapped by sea ice margins. Up to 80 % of beached marine macrolitter is made of plastics, originating from vessels. A certain accumulation strip of a beach was identified (14 m - 27.5 m distance from the waterline), and significance of the beach backshore was shown in litter accumulation. Beach litter accounting methodologies on the Arctic beaches are discussed.

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Understanding diversity patterns and underlying drivers is one of the central topics in the fields of biogeography and community ecology. Aquatic macroinvertebrates are widely distributed in various wetlands and play vital ecological roles. Previous studies mainly have focused on macroinvertebrate diversity in a single type of wetland. Our understanding of the differences in diversity patterns and underlying drivers between different wetland types remains limited. Here, we compared diversity patterns and community assembly of floodplain wetlands (FWs) and non-floodplain wetlands (NWs) in the Sanjiang Plain, Northeast China. We found that the taxonomic richness and abundance were higher in NWs than those in FWs. Nineteen taxa were identified as habitat specialists in the NWs, whereas only four taxa were designated as habitat specialists in the FWs. In addition, the FW and NW assemblages exhibited contrasting compositions. Spatial and environmental variables explained the largest variations in the macroinvertebrate assemblages of NWs and FWs, respectively. Normalised stochasticity ratios and Sloan neutral models confirmed that the macroinvertebrate community assembly of both wetland types was driven largely by stochastic processes. Stochastic processes were more prominent in shaping macroinvertebrate communities of FWs, whereas a stronger dispersal limitation was detected in NWs. Our results revealed contrasting diversity patterns and assembly mechanisms of macroinvertebrate communities in FWs and NWs. We underscore the importance of flood disturbance in shaping wetland ecosystems in the Sanjiang Plain and highlight that conservation and restoration actions cover different types of wetland habitats.

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The ups and downs of climate policy uncertainty (CPU) cast a captivating shadow over the budgets allocated to renewable energy (RE) technologies, where strategic choices and risk assessment will determine the course of our green environmental revolution. The main intention of this investigation is to scrutinize the effect of CPU on the RE technology budgets (RETBs) in the top 10 countries with the highest RE research and development budgets (the USA, China, South Korea, India, Germany, the United Kingdom, France, Japan, Australia, and Italy). Although former researchers have typically employed panel data tools to contemplate the connection between CPU and RE technology, they repeatedly ignored variations in this connection throughout different economies. In contrast, our research adopts a unique approach, "quantile-on-quantile," to check this association at the country-to-country level. This approach offers a comprehensive worldwide perspective while procuring tailor-made perceptions for individual economies. The outcomes suggest that CPU significantly decreases RETBs across several data quantiles in our sample nations. In addition, the outcomes underscore that the connections between our variables differ among nations. These outcomes highlight the significance of policymakers implementing thorough appraisals and skillfully governing plans relevant to CPU and RETBs.

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An important goal of many studies in molecular ecology is to utilize molecular tools to elucidate how critical traits like metabolism and growth are affected by environmental stressors and how organisms offset these stresses by adaptive molecular-level responses. Stress from food deprivation may be critical for early developmental stages that require a continued supply of substrates for energy metabolism and growth if development is to be completed. In a 'From the Cover' article in this issue of Molecular Ecology, Li et al. (2023) examined the effects of withholding food (unicellular algae) on 10 traits of larvae of the purple sea urchin (Strongylocentrotus purpuratus), ranging from the molecular level (gene expression) to morphology. Overall, this study sheds new light on the plasticity of larval development and the tight linkages that exist among traits as they respond to changes in food availability. Importantly, shifts in the sources of food utilized under different dietary treatments show the plasticity of these larvae to alter reliance on endogenous energy stores and dissolved organic matter (DOM) as algae deprivation continues. The effects of global change on the amounts and phenology of productivity in the seas make this type of integrated, multi-level analysis an important tool for predicting the future states of marine ecosystems.

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The allocation of budgets for renewable energy (RE) technology is significantly influenced by geopolitical risks (GPRs), reflecting the intricate interplay among global political dynamics, social media narratives, and the strategic investment decisions essential for advancing sustainable energy solutions. Against the backdrop of increasing worldwide initiatives to transition to RE sources, it is crucial to understand how GPR affects funding allocations, informing policy decisions, and fostering international collaboration to pursue sustainable energy solutions. Existing work probes the nonlinear effect of GPR on RE technology budgets (RTB) within the top 10 economies characterized by substantial research and development investments in RE (China, USA, Germany, Japan, France, South Korea, India, the United Kingdom, Australia, and Italy). Past research largely focused on panel data techniques to delve the interconnection between GPR and RE technology, overlooking the distinctive characteristics of individual economies. Contrarily, existing investigation implements the "Quantile-on-Quantile" tool to explore this association on an economy-particular basis, enhancing the precision of our analysis and offering both a comprehensive global perspective and nuanced perceptions for entire countries. The findings manifest a significant reduction in funding for RE technology associated with GPR across various quantile levels in the chosen economies. The disparities in results spotlight the necessity for policymakers to perform thorough assessments and carry out competent strategies to address the variations in GPR and RTB.

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This study examined the nutrient budgets and biogeochemical dynamics in the coastal regions of northern Beibu Gulf (CNBG). Nutrient concentrations varied spatially and seasonally among the different bays. High nutrient levels were found in the regions with high riverine inputs and intensive mariculture. Using a three end-member mixing model, nutrient biogeochemistry within the ecosystem was estimated separately from complex physical mixing effects. Nutrient consumption dominated in most bays in summer, whereas nutrient regeneration dominated in winter, likely due to phytoplankton decomposition, vertical mixing and desorption. Through the Land-Ocean Interaction Coastal Zone (LOICZ) model, the robust nutrient budgets were constructed, indicating that the CNBG behaved as a sink of dissolved inorganic nitrogen, phosphorus and silicon. River-borne nutrient inputs were the dominant nutrient source, while residual flows and water exchange flows transported nutrient off the estuaries. This study could help us better understand nutrient cycles and nutrient sources/sinks in the CNBG.

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Restoration is increasingly seen as a necessary tool to reverse ecological decline across terrestrial and marine ecosystems.1,2 Considering the unprecedented loss of coral cover and associated reef ecosystem services, active coral restoration is gaining traction in local management strategies and has recently seen major increases in scale. However, the extent to which coral restoration may restore key reef functions is poorly understood.3,4 Carbonate budgets, defined as the balance between calcium carbonate production and erosion, influence a reef's ability to provide important geo-ecological functions including structural complexity, reef framework production, and vertical accretion.5 Here we present the first assessment of reef carbonate budget trajectories at restoration sites. The study was conducted at one of the world's largest coral restoration programs, which transplants healthy coral fragments onto hexagonal metal frames to consolidate degraded rubble fields.6 Within 4 years, fast coral growth supports a rapid recovery of coral cover (from 17% ± 2% to 56% ± 4%), substrate rugosity (from 1.3 ± 0.1 to 1.7 ± 0.1) and carbonate production (from 7.2 ± 1.6 to 20.7 ± 2.2 kg m-2 yr-1). Four years after coral transplantation, net carbonate budgets have tripled and are indistinguishable from healthy control sites (19.1 ± 3.1 and 18.7 ± 2.2 kg m-2 yr-1, respectively). However, taxa-level contributions to carbonate production differ between restored and healthy reefs due to the preferential use of branching corals for transplantation. While longer observation times are necessary to observe any self-organization ability of restored reefs (natural recruitment, resilience to thermal stress), we demonstrate the potential of large-scale, well-managed coral restoration projects to recover important ecosystem functions within only 4 years.

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Fundamentos: la obesidad infantil representa un grave problema de salud pública y, dado su carácter multifactorial y sus consecuencias, resulta necesario llevar a cabo un abordaje eficaz. El sistema de autonomías español, con competencias delegadas, podría acentuar la desigualdad en su abordaje. El objetivo del estudio fue conocer la existencia o no de dichas desigualdades. Métodos: se llevó a cabo un estudio transversal descriptivo, entre los meses de febrero-abril de 2022, en el que se comparó el abordaje de la obesidad infantil entre las diecisiete comunidades y dos ciudades autónomas, mediante el análisis de los siguientes indicadores: personal de pediatría; enfermería pediátrica; personal de nutrición y su reconocimiento legal; existencia de planes integrales; y gasto sanitario para obesidad infantil. La búsqueda de información se realizó mediante revisión bibliográfica y solicitud de acceso a información pública a las correspondientes consejerías autonómicas. Hubo cálculo de ratios de pediatras y enfermeros por 1.000 habitantes y gasto sanitario por habitante. Resultados: se observó que a nivel nacional los pediatras poseen una ratio acorde a las recomendaciones internacionales (1,21), no así enfermería general y pediátrica (con una ratio de 0,65, que equivale a aproximadamente 1.544 habitantes por cada enfermera), ni el personal de nutrición. Entre comunidades autónomas se apreciaron grandes variaciones para las tres categorías. Los planes integrales de abordaje se encontraron desactualizados o, directamente, ausentes, al igual que el análisis periódico del gasto derivado de la obesidad.Conclusiones: el abordaje de la obesidad infantil parece variar de forma considerable entre autonomías según los indicadores analizados. Por ello, sería recomendable encauzar todos los esfuerzos en homogenizarlo, para mejorar la calidad asistencial e igualar las oportunidades de prevención y tratamiento en todo el ámbito nacional.(au)

Background: childhood obesity represents a serious public health problem and given its multifactorial nature and its con-sequences; it is necessary to carry out an effective approach. The spanish system of autonomies, with delegated powers, could accentuate inequality in its approach. The objective of the study was to know the existence or not of these inequalities. Methods: a descriptive cross-sectional study was carried out between the months of february-april 2022, in which the approach to childhood obesity was compared among the seventeen communities and two autonomous cities, through the analysis of the following indicators: pediatric staff, pediatric nursing, nutrition personnel and their legal recognition, the existence of comprehensive plans and health expenditure on childhood obesity. The search for information has been carried out through a bibliographic review and a request for access to public information to the corresponding regional councils. It were performed ratios of paediatricians and nurses per 1,000 inhabitants and health expenditure per inhabitant were calculated.results: it was observed that in spain paediatricians have a ratio according to international recommendations (1.21), but not ge-neral and paediatric nursing (with a ratio of 0.65, which is equivalent to approximately 1,544 inhabitants for each nurse), and nutrition professionals. Among autonomies there were large variations for the three categories. Comprehensive plans were outdated or absent altogether, as well as the periodic analysis of obesity expenditure. Conclusions: the approach to childhood obesity seems to vary considerably among autonomies according to the analysed indicators. Thus, it would be advisable to lead all efforts to homogenize it, to improve care quality and prevention and treatment choices in all national regions.(AU)

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OBJECTIVE: Childhood obesity represents a serious public health problem and given its multifactorial nature and its consequences; it is necessary to carry out an effective approach. The Spanish system of autonomies, with delegated powers, could accentuate inequality in its approach. The objective of the study was to know the existence or not of these inequalities. METHODS: A descriptive cross-sectional study was carried out between the months of February-April 2022, in which the approach to childhood obesity was compared among the seventeen communities and two autonomous cities, through the analysis of the following indicators: pediatric staff, pediatric nursing, nutrition personnel and their legal recognition, the existence of comprehensive plans and health expenditure on childhood obesity. The search for information has been carried out through a bibliographic review and a request for access to public information to the corresponding regional councils. It were performed ratios of paediatricians and nurses per 1,000 inhabitants and health expenditure per inhabitant were calculated. RESULTS: It was observed that in Spain paediatricians have a ratio according to international recommendations (1.21), but not general and paediatric nursing (with a ratio of 0.65, which is equivalent to approximately 1,544 inhabitants for each nurse), and nutrition professionals. Among autonomies there were large variations for the three categories. Comprehensive plans were outdated or absent altogether, as well as the periodic analysis of obesity expenditure. CONCLUSIONS: The approach to childhood obesity seems to vary considerably among autonomies according to the analysed indicators. Thus, it would be advisable to lead all efforts to homogenize it, to improve care quality and prevention and treatment choices in all national regions.

OBJECTIVE: La obesidad infantil representa un grave problema de Salud Pública y, dado su carácter multifactorial y sus consecuencias, resulta necesario llevar a cabo un abordaje eficaz. El sistema de autonomías español, con competencias delegadas, podría acentuar la desigualdad en su abordaje. El objetivo del estudio fue conocer la existencia o no de dichas desigualdades. METHODS: Se llevó a cabo un estudio transversal descriptivo, entre los meses de febrero-abril de 2022, en el que se comparó el abordaje de la obesidad infantil entre las diecisiete comunidades y dos ciudades autónomas, mediante el análisis de los siguientes indicadores: personal de pediatría; enfermería pediátrica; personal de nutrición y su reconocimiento legal; existencia de planes integrales; y gasto sanitario para obesidad infantil. La búsqueda de información se realizó mediante revisión bibliográfica y solicitud de acceso a información pública a las correspondientes consejerías autonómicas. Hubo cálculo de ratios de pediatras y enfermeros por 1.000 habitantes y gasto sanitario por habitante. RESULTS: Se observó que a nivel nacional los pediatras poseen una ratio acorde a las recomendaciones internacionales (1,21), no así enfermería general y pediátrica (con una ratio de 0,65, que equivale a aproximadamente 1.544 habitantes por cada enfermera), ni el personal de nutrición. Entre comunidades autónomas se apreciaron grandes variaciones para las tres categorías. Los planes integrales de abordaje se encontraron desactualizados o, directamente, ausentes, al igual que el análisis periódico del gasto derivado de la obesidad. CONCLUSIONS: El abordaje de la obesidad infantil parece variar de forma considerable entre autonomías según los indicadores analizados. Por ello, sería recomendable encauzar todos los esfuerzos en homogenizarlo, para mejorar la calidad asistencial e igualar las oportunidades de prevención y tratamiento en todo el ámbito nacional.

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The Pennsylvania Rural Health Model (PARHM) is a novel alternative payment model for rural hospitals that aims to test whether hospital-based global budgets, coupled with delivery transformation plans, improve the quality of health care and health outcomes in rural communities. Eighteen hospitals joined PARHM in 3 cohorts between 2019 and 2021. This study assessed PARHM's impact on changes in potentially avoidable utilization (PAU)-a measure of admission rates policymakers explicitly targeted for improvement in PARHM. Using a difference-in-differences analysis and all-payer hospital discharge data for Pennsylvania hospitals from 2016 through 2022, we found no significant overall reduction in community-level PAU rates up to 4 years post-PARHM implementation, relative to changes in rural Pennsylvania communities whose hospitals did not join PARHM. However, heterogeneous treatment effects were observed across cohorts that joined PARHM in different years, and between critical access vs prospective payment system hospitals. These findings offer insight into how alternative payment models in rural health care settings may have heterogeneous impacts based on contextual factors and highlight the importance of accounting for these factors in proposed expansions of alternative payment models for rural health systems.

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The change in curriculum and increasing need for active healthcare professionals providing quality patient care has emphasised simulation-based regular training, reskilling and simulation centres to deliver these. However, there is limited literature on how to establish a simulation centre and overcome the challenges relating to developing faculty and maintaining the financial viability of these centres. Our review focuses on this gap in the current literature. The findings are presented as 1) identification of the methods of establishing a simulation centre, 2) setting up the resource in a simulation centre and 3) faculty development and curricular integration in a simulation centre. The space of a simulation centre depends on the organisation's or training body's needs. There is no single design which is recommended. Establishing a simulation centre should consider the needs of the organisation, educators and learners along with the available resources and ensure that curriculum integration and standards are met.

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Crabs in mangroves could enhance the transfer of organic carbon (OC) from leaf litter to soils, whose variation with the difference in crab size is, however, not well known. A 32-day laboratory feeding experiment was conducted to explore the effects of different sizes of the crabs Parasesarma plicatum foraging on leaf litter of Kandelia obovata on OC accumulation in mangrove soils. Mean rates of soil OC accumulation due to leaf foraging by large, medium, and small crabs were 21.11, 16.11, and 0.77 mg C ind-1 d-1, corresponding to the rates of OC removal from leaf litter of 62.60%, 51.37%, and 2.19%, respectively. Large and medium crabs ingested larger amounts of leaf litter, and soil OC accumulation rates resulting from leaf foraging by large and medium crabs were approximately 8 times higher than those by leaf litter decomposition and triple those by non-leaf foraging. Small crabs ingested the smallest amount of leaf litter, which was almost used for their growth and metabolism. These results underline the key ecological roles of leaf foraging by crabs, especially those with large and medium sizes, in OC accumulation in mangrove soils, which is conducive to estimating carbon sequestration in mangrove soils.

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Under the dual stress of global warming and human interaction, Liaodong Bay (LDB) and northern Yellow Sea (NYS) are undergoing significant ecological changes. Little is known about the driving nutrients characteristics supporting fishery resource output in these areas. We carried out three field observations in 2019 to investigate nutrient status. Results showed that dissolved inorganic nitrogen (DIN), dissolved inorganic phosphorus (DIP), and dissolved silica (DSi) concentrations changed seasonally, with lowest values in spring, and highest values in autumn. High DIN, DIP, and DSi concentrations were detected in LDB and NYS's estuary areas. The Yellow Sea Cold Water Mass plays a role in the distribution and seasonal variation of nutrients. Exchanges across the sediment-water interface, SFGD, atmospheric deposition, and the adjacent sea input dominated DIN dynamics of these areas. DIP primarily came from the adjacent sea input and DSi mainly originated from sediment release and the adjacent sea input. NYS seawater invasion accounted for 13.8% of DIN, 63.4% of DIP, and 35.1% of DSi in LDB. These results provide new insights to better facilitate the formulation of nitrogen and phosphorus reduction and control policies in these marginal seas.

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Shelley et al. (in Accelerating integration of tobacco use treatment in the context of lung cancer screening: relevance and application of implementation science to achieving policy and practice. Transl Behav Med 2022;12:1076-1083) laid out how implementation science frameworks and methods can advance the delivery of tobacco use treatment services during lung cancer screening services, which until recently was mandated by the Centers for Medicare and Medicaid Services. Their discussion provides an important overview of the full process of implementation and highlights the vast number of decisions that must be made when planning for implementation of an evidence-based practice such as tobacco use treatment: what specific tobacco use treatment services to deliver, when to deliver those services within the lung cancer screening process, and what implementation strategies to use. The costs of implementation play a major role in decision making and are a key implementation determinant discussed in major implementation frameworks. When making decisions about what and how to implement, budget impact analyses (BIAs) can play an important role in informing decision making by helping practitioners understand the overall affordability of a given implementation effort. BIAs can also inform the development of financing strategies to support the ongoing sustainment of tobacco use treatment service provision. More attention is needed by the research community to produce high-quality, user-friendly, and flexible BIAs to inform implementation decision making in health system and community settings. The application of BIA can help ensure that the considerable time and effort spent to develop and evaluate evidence-based programs has the best chance to inform implementation practice.

Integrating the provision of tobacco use treatment services during lung cancer screening can increase the benefits of lung cancer screening. Shelley et al. lay out how implementation science can be leveraged to facilitate this integration and to highlight the vast array of decisions that must be made to plan for implementation. Practitioners must choose which tobacco use treatment services to deliver, when to deliver those services within the process of lung cancer screening, and how to implement services. The resources associated with these choices are a key determinant of decision making and successful implementation. We discuss how budget impact analyses (BIAs) can help organizations understand the likely costs of what it would take to get tobacco treatment services into place and sustain them over time, accounting for context-specific differences like wage rates or available resources. Researchers should strive to develop high-quality, user-friendly, and flexible BIAs to inform decision making around the integration of tobacco use treatment services during lung cancer screening in health system and community settings. Applications of BIAs extend beyond tobacco; regardless of substantive area, building BIAs is a collaborative effort that requires a team science approach.

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OBJECTIVES: Social preference values of health states are a fundamental input for the preparation of studies in health economics. Several countries have undertaken studies to obtain these values. Our objective was to conduct a structured and systematic literature review of articles that calculates this set of representative values at the national level in low- and middle-income countries (LMICs). METHODS: In this systematic review, we searched the Embase, MEDLINE, Ovid, SciELO, and LILACS databases, among others, for studies published up to June 2022 that estimated nationally representative health states preferences values for LMICs. We summarized the information qualitatively and assessed the risk of bias in each article using the consensus-based standards for selecting health measurement instruments checklist tool. RESULTS: Of the 23 663 articles identified, 35 studies were eligible for inclusion. The studies were from 19 countries in Latin-American, Europe, Africa, and Asia. No studies were found for low-income countries. The most commonly applied generic instrument for measuring health-related quality of life was the 5-level version of EQ-5D and 3-level version of EQ-5D. Preference was given to face-to-face administration of these instruments. The sociodemographic variables with the most significant negative correlation versus utility were older adults, marital status (widowed or divorced), and low educational level and income. CONCLUSIONS: Worldwide, there have been few studies that have estimated, in a nationally representative manner, the social values of health states preferences in LMICs. We consider the local estimate of this set of societal values relevant for any society to improve decision making in allocating resources in health budgets.

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Introduction: This study examined the relationship between local board of health authority and local health departments' budget-related activities and performance scores in the Public Health Accreditation Board standards while considering the governance structure under which the local health agencies operate. Methods: Data from 250 local health departments were obtained from the Public Health Accreditation Board and were combined with data from the 2016 National Association of County and City Officials Profile Survey. Multilevel regression analysis was used to examine the relationship between local board of health authority on local health departments' budget-related activities, using the governance structure as the group-level variable. Results: Analyses identified positive associations between local board of health authority on local health departments' budget-related activities and local health departments' aggregate average performance scores in Public Health Accreditation Board accreditation. No apparent association was found between the type of governance structure under which a local health department operates and performance scores in Public Health Accreditation Board accreditation standards, perhaps attributable to variation in the characteristics and roles of their governing bodies. Conclusions: The analyses suggest that local boards of health with authority related to local health departments' budgets appear to have an influential role in budget-related activities and may improve local health departments' performance scores in Public Health Accreditation Board accreditation standards. However, vast variations in more specific local boards of health roles and characteristics exist across local health departments and for which there are no national data. More research is thus needed to control for or examine the influences of specific local boards of health characteristics before the benefits of expanded local boards of health authority over local health departments' budgetary decision making on local health departments' performance can be fully understood.