COVID-19 disease burden in United States (US) adults ≥65 years and persons with underlying medical conditions remains high. This modeling study estimated the cost-effectiveness of the next-generation COVID-19 mRNA-1283 vaccine in persons aged 12–64 at high risk of severe COVID-19 outcomes and all adults ≥65 years. mRNA-1283 was compared with no annual vaccination and originally licensed mRNA vaccines mRNA-1273 and BNT162b2. Analyses were conducted using a static decision-analytic model (1-year horizon). Vaccine effectiveness (VE) against infection and hospitalization for mRNA-1283 versus no vaccination was based on relative VE (rVE) from the Phase 3 pivotal randomized controlled trial comparing mRNA-1283 against mRNA-1273, and mRNA-1273 real-world data. rVE estimates for mRNA-1283 versus BNT162b2 were based on an indirect treatment comparison. The societal incremental cost per quality-adjusted life-year (QALY) gained and the benefit-cost ratio (BCR) were calculated. During the 2025/2026 season, a single dose of mRNA-1283 was estimated to yield an incremental cost per QALY gained of $16,247 compared with no vaccine. The BCR for the base case strategy ranged from $2.16–9.74 returned for every $1 spent for mRNA-1283. mRNA-1283 was estimated to dominate originally-licensed mRNA-COVID-19 vaccines in analyses of the target population. Results were sensitive to COVID-19 incidence, hospitalization rates, post-discharge mortality rates, and VE. The real-world effectiveness and safety of mRNA-1283 have not yet been established, and relative VE estimates should be validated with real-world data. Full year 2025/2026 COVID-19 incidence and vaccine uptake in the US is uncertain. Study results suggest mRNA-1283 may represent a highly cost-effective strategy (considering a $100,000–150,000 per QALY willingness-to-pay threshold) to reduce COVID-19 burden. Based on rVE assumptions made, mRNA-1283 was estimated to dominate originally-licensed mRNA vaccines in this recommended population. mRNA-1283 may provide a valuable option to optimize US COVID-19 immunization programs and protect those most vulnerable.
This paper examines the dynamic interplay between norms, practices, and food environments through the concept of ‘normal food practices’. Drawing on Georges Canguilhem’s theory of vital norms and social practice theory, we distinguish between descriptive (common), evaluative (proper), and creative (norm-generating) dimensions of food practices. We argue that food-related behaviors are not only shaped by existing norms but also actively produce new ones in response to environmental, technological, and socio-political conditions. We develop three empirical case studies that illustrate how norms are negotiated and transformed: playful resistance to food restrictions in hotel quarantine, decolonial food growing in settler-colonial Australia, and contested norms of purity and care in automated food systems. These examples reveal how food practices mediate agency, belonging, and health, challenging disciplinary models of biopolitical governance. We conclude in arguing that normal food practices are not fixed but are continually enacted and reshaped through everyday actions, offering new possibilities for ethical and political engagement with food.
Many studies examine the elements influencing the implementation of circular economy (CE) initiatives in different contexts. Among these elements, the open innovation (OI) paradigm is gaining attention as a potential enabler of specific CE initiatives. In particular, inter-organisational collaboration – a typical form of OI – is often discussed as an enabler of CE initiatives for large enterprises. Remarkably, very few studies deal with CE-related inter-organisational collaborations in the context of small and medium-sized enterprises (SMEs). Particularly obscure are the factors that trigger and influence CE-related inter-organisational collaborations of SMEs. This paper addresses this gap in knowledge by leveraging 21 semi-structured interviews with SME managers and founders. A thematic analysis based on a three-step coding approach – open, axial and selective coding – led to the identification and examination of drivers, enabling factors and challenges for CE-related inter-organisational collaborations of SMEs. Leveraging the institutional theory in the analysis, we identified relevant drivers for CE-related inter-organisational collaborations, including normative forces, formal and informal coercive forces, access to external resources, and providing skills and capabilities. The enabling factors include trust, clear roles and responsibilities, geographical proximity and CE commitment. The challenges identified are the lack of financial resources, different goals among partners, lack of early involvement, regulation and lack of proficiency in CE. This study contributes to the growing body of knowledge about the relationship between OI and CE and triggers future research opportunities about this relationship.
Urban heat island is a well-documented phenomenon with relevant impacts at several levels. The present study investigates the potential of night ventilation for thermal comfort improvements in residential buildings in Rome, Italy, by dynamic analyses at the mesoscale and building level. The atmospheric model is implemented in the Weather Research & Forecasting Model (WRF), a state-of-the-art tool for meso-scale simulations, and validated against air temperature and wind speed. A number of increased urban albedo scenarios are calculated for July and August 2020. The datasets are used to simulate the building thermal performance using the TRNSYS 17 software. Results showed that high albedo can reduce the average city peak temperature by 2 °C, depending on the albedo configuration. The impact on the indoor thermal conditions is a strong reduction of discomfort hours in the urban areas, especially if enhanced by the night ventilation, which also provides to significant reduction of higher temperatures in the built environment.
Medical therapy is crucial in the long-term management of endometriosis, and its clinical efficacy must be balanced with a favorable safety profile. This review aims to provide a comprehensive overview of available drugs for the treatment of endometriosis, with an emphasis on their safety. A literature search was conducted using MEDLINE. EMBASE. and the Cochrane Library. Reference lists of relevant articles and recent book chapters were also examined. First-line therapies include combined contraceptives and progestins, both effective in reducing pain. Combined contraceptives commonly cause breakthrough bleeding, nausea, headaches, breast tenderness, and libido changes. Progestins may lead to depression, decreased libido, weight gain, breast tenderness, and lipid alterations. Gonadotropin-releasing hormone agonists are second-line options but are limited by hypoestrogenic side effects, including vasomotor symptoms, urogenital atrophy, and bone mineral density (BMD) loss. Add-back therapy with norethindrone acetate or low-dose combined contraceptives mitigates these effects. GnRH antagonists provide immediate suppression without flare-up and may improve adherence; however, hot flushes and BMD loss remain concerns. While all hormonal therapies are suppressive rather than curative, optimizing safety and tolerability is essential for sustained use and symptom control.
Dual-process theory suggests that implicit identification with death more strongly predicts self-injurious thoughts and behaviors under certain conditions. As reliance on implicit heuristics to guide behavior may increase in the context of poor sleep, the current study evaluated whether implicit identification with death alone, or in combination with self-reported sleep quality, predicted future levels of suicidal ideation and self-harm. The sample consisted of 100 adolescents ( M age = 16.62; SD = 1.83, 91.0% females; 26.0% racial minority; 25.0% Hispanic/Latino/a/x) with histories of suicidal episodes and repeat self-harm behavior. Implicit identification with death and sleep quality were assessed at baseline. Outcomes (i.e. suicidal ideation and self-harm levels) were assessed at baseline, 6-, and 12-months. Multilevel structural equations were used to assess relations among study variables. At high and/or moderate levels of poor sleep quality, greater implicit identification with death positively predicted suicidal ideation and self-harm levels. Importantly, similar results were found with suicide attempts and non-suicidal self-injury as separate outcomes. As main effects, implicit identification with death and poor sleep quality only positively predicted suicidal ideation and suicide attempts, respectively. The interaction between implicit identification with death and sleep quality may be an important predictor of future adolescent suicidal ideation and self-harm. Assessment of an adolescent’s implicit identification with death and sleep quality may help identify those at greatest future risk.
The estimation of the Floor Response Spectrum (FRS) is fundamental for the characterization of the seismic demand at different heights of a structure, particularly for assessing seismic safety of both local mechanisms and non-structural elements. This paper aims to provide insight into the assessment of floor response spectra in masonry towers by presenting and discussing the results of an investigation carried out on the San Niccolò Tower in Florence, Italy. To determine the tower’s dynamic properties, Ambient Vibration Tests (AVT) and Operational Modal Analysis (OMA) were conducted, that revealed a complex structural behaviour influenced by geometric irregularities and material heterogeneity. The floor response spectra were evaluated using three complementary approaches: ( i ) a simplified analytical formulation provided by the latest Italian Standards, ( ii ) an experimental method based on seismic interferometry, and ( iii ) a numerical approach based on Finite Element (FE) linear time-history analyses. The comparison of results from these procedures shows that, while code-based simplified formulations offer a practical tool for preliminary estimation of floor response spectra, they can be highly sensitive to modal parameters, which may significantly influence the predicted seismic demand. In this respect, this study stresses the importance of integrating experimental and numerical methods for a more reliable evaluation of FRS in slender historic structures.
Recovery capital encompasses internal and external factors that support recovery from substance use disorder, such as employment, social support, and physical and mental health. There is a need for more research on recovery capital among women who are incarcerated, who often face complex barriers to recovery, such as poverty, unemployment, and histories of trauma. Women ( N = 900) were recruited from Kentucky jails as part of the broader NIDA-funded Kentucky Justice Community Opioid Innovation Network (JCOIN) cooperative project. Measures from baseline interviews (during incarceration) were selected in alignment with the Substance Abuse Mental Health Service Administration (SAMHSA)’s four dimensions of recovery ( ‘ health’, ‘home’, ‘purpose’ and ‘community’). Bivariate analyses and multilevel mixed-effects generalized linear models (GLMs) were used to determine correlations between selected measures and women’s scores on the Brief Assessment of Recovery Capital (BARC-10). Women reported an average BARC-10 score of 45.4. Several differences were observed in BARC-10 scores across all four recovery dimensions. Items retained in the full multilevel GLM explained 48% of the variance in recovery capital ( R 2 = 0.479), with the ‘community’ dimension representing the strongest relationship ( R 2 = 0.445). Perceived social support was the strongest individual correlate ( B = 2.40, p < 0.001) of all variables within the model. This sample of incarcerated women reported low recovery capital. However, findings highlight recovery capital as a multidimensional construct, related to factors across all four SAMSHA dimensions of recovery, especially ‘community’. Interventions are needed to build recovery capital across each dimension, particularly leveraging social support, to promote sustained recovery among women who are incarcerated.
Powered mobility devices include any battery-operated and motorized device such as powered wheelchairs or modified ride-on cars. Off-the-shelf and battery-operated ride-on cars are modified through installation of a large and easy-to-press activation switch and custom seating support to facilitate greater accessibility for children with motor disabilities. Powered mobility devices are used in pediatric rehabilitation interventions and may be used during adapted physical education. However, reporting of powered mobility intervention fidelity is largely absent in the literature. This case report uses a multi-dimensional construct for measuring intervention fidelity and includes four key areas (a) adherence, (b) dosage, (c) quality of intervention delivery, and (d) participant responsiveness. The purpose of this case report was to assess initial powered mobility intervention fidelity in a single caregiver–child dyad through adherence, dosage, inter-rater agreement of adherence and dosage, quality of intervention delivery, and participant responsiveness. This case report describes initial powered mobility intervention fidelity that included delivery of three, 2-h intervention sessions over a 3-week period to a caregiver and their child with motor disabilities. Intervention sessions were planned for at least 90 min and included three components: (1) Driving observation (at least 10 min); (2) Problem-solving discussion (at least 20 min); and (3) Education module (at least 60 min). Adherence and dosage and inter-rater agreement of adherence and dosage were assessed through a fidelity checklist. Quality of Intervention Delivery was assessed through a feedback survey that the caregiver completed following each intervention session. Participant Responsiveness was assessed through education module review questions. All fidelity domains were successful when scores and percentiles were averaged across the three intervention sessions: Adherence: 90%; Dosage 100%; Inter-Rater Agreement of Adherence (88%) and Dosage (100%); Quality of Intervention Delivery: 95%; Participant Responsiveness: 100%. Powered mobility intervention fidelity is critical to advance the field across practice settings including clinical, research, and physical education. Powered mobility studies generally lack any measurement or discussion about intervention fidelity. This creates a significant challenge in replicating research studies or translating research to practice when delivery of intervention components is not documented. Powered mobility interventions in young children with motor disabilities provide a foundation of mobility skills for them to participate in physical education during their school-age years. Therefore, an important first step is to understand the fidelity of powered mobility interventions. There remains limited research in the physical education context of students who use powered mobility devices and offers future directions to impact physical educators’ pedagogical strategies for children with motor disabilities.