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Background: To improve patient outcomes and provider team practice, the California Perinatal Quality Care Collaborative (CPQCC) created the Simulating Success quality improvement program to assist hospitals in implementing a neonatal resuscitation training curriculum. This study aimed to examine the costs associated with the design and implementation of the Simulating Success program. Methods: From 2017–2020, a total of 14 sites participated in the Simulating Success program and 4 of them systematically collected resource utilization data. Using a micro-costing approach, we examined costs for the design and implementation of the program occurring at CPQCC and the 4 study sites. Data collection forms were used to track personnel time, equipment/supplies, space use, and travel (including transportation, food, and lodging). Cost analysis was conducted from the healthcare sector perspective. Costs incurred by CPQCC were allocated to participant sites and then combined with site-specific costs to estimate the mean cost per site, along with its 95% confidence interval (CI). Cost estimates were inflation-adjusted to 2022 U.S. dollars. Results: Designing and implementing the Simulating Success program cost $228,148.36 at CPQCC, with personnel cost accounting for the largest share (92.2%), followed by program-related travel (6.1%), equipment/supplies (1.5%), and space use (0.2%). Allocating these costs across participant sites and accounting for site-specific resource utilizations resulted in a mean cost of $39,210.69 per participant site (95% CI: $34,094.52-$44,326.86). In sensitivity analysis varying several study assumptions (e.g., number of participant sites, exclusion of design costs, and useful life span of manikins), the mean cost per site changed from $35,645.22 to $39,935.73. At all four sites, monthly cost of other neonatal resuscitation training was lower during the program implementation period (mean = $1,112.52 per site) than pre-implementation period (mean = $2,504.01 per site). In the 3 months after the Simulating Success program ended, monthly cost of neonatal resuscitation training was also lower than the pre-implementation period at two of the four sites. Conclusions: Establishing a multi-site neonatal in situ simulation program requires investment of sufficient resources. However, such programs may have financial and non-financial benefits in the long run by offsetting the need for other neonatal resuscitation training and improving practice. [ABSTRACT FROM AUTHOR]

To address the disadvantage of poor degradation effect of Fe2+/peroxydisulfate (PDS) system, a co-catalyst was introduced in this study to construct a molybdenum (Mo)/Fe2+/PDS system for the degradation of Acid Orange 7 (AO7), and the degradation rate could reach 95.67%. The effects of different parameters (initial pH, Fe2+ concentration, etc.) on the degradation effect of AO7 in this system were investigated, and the optimal degradation conditions were obtained by combining cost analysis. Cycling experiments showed that Mo had good stability. The co-catalytic mechanism of Mo powder was determined using X-Ray Diffraction, Scanning Electron Microscope, and X-ray Photoelectron Spectroscopy. The effects of different inorganic anions on AO7 were discussed: Cl− and NO3− had little effect on degradation, while SO42− and HCO3− both inhibited the removal of AO7 from the system to different degrees, with HCO3− showing a greater inhibition than SO42−. The main active radicals were identified as sulfate radical (SO4·−) and hydroxyl radical (·OH). In addition, intermediates were identified, and the attack sites were determined by combining the highest occupied molecular orbital/lowest unoccupied molecular orbital energy levels and the Fukui index to hypothesize the degradation pathways. Toxicity indicators such as the mutagenicity of AO7 and intermediates were evaluated, and the overall trend of toxicity was decreasing. This study is expected to provide an efficient treatment process for dye wastewater. [ABSTRACT FROM AUTHOR]

Background: The organisational care needs involved in accessing kidney transplant have not been described in the literature and therefore a detailed analysis thereof could help to establish a framework (including appropriate timing, investment, and costs) for the management of this population. The main objective of this study is to analyse the profile and care needs of kidney transplant candidates in a tertiary hospital and the direct costs of studying them. Methods: A descriptive, cross-sectional study was conducted using data on a range of variables (sociodemographic and clinical characteristics, study duration, and investment in visits and supplementary tests) from 489 kidney transplant candidates evaluated in 2020. Results: The comorbidity index was high (> 4 in 64.3%), with a mean of 5.6 ± 2.4. Part of the study population had certain characteristics that could hinder their access a kidney transplant: physical dependence (9.4%), emotional distress (33.5%), non-adherent behaviours (25.2%), or language barriers (9.4%). The median study duration was 6.6[3.4;14] months. The ratio of required visits to patients was 5.97:1, meaning an investment of €237.10 per patient, and the ratio of supplementary tests to patients was 3.5:1, meaning an investment of €402.96 per patient. Conclusions: The study population can be characterised as complex due to their profile and their investment in terms of time, visits, supplementary tests, and direct costs. Management based on our results involves designing work-adaptation strategies to the needs of the study population, which can lead to increased patient satisfaction, shorter waiting times, and reduced costs. [ABSTRACT FROM AUTHOR]

Background and Aims: Multiple sources of medical oxygen, namely liquid medical oxygen (LMO) tanks, pressure swing adsorption (PSA) plants, concentrators, and gaseous cylinders, are available at different healthcare facilities. These sources of oxygen have varying installation and operational costs. In low-resource settings, it is imperative to utilise these assets optimally. This study investigated the operational costs of multiple oxygen sources available at a healthcare facility. Methods: A Microsoft (MS) Excel-based model was developed to analyse and compare the oxygen manufacturing costs (in ₹/m³) using PSA plants and procurement costs (in ₹/m³) of LMO and third-party vendor-refilled cylinders. Results: The oxygen manufacturing costs for PSA plants of different capacities and running times on electricity and diesel generators (DGs) as a power source were calculated. This study highlights the cost-benefit of using PSA plants over LMO and third-party vendor-refilled cylinders as a source of oxygen. PSA plants are most economical when they are of higher capacity and used to their maximum capacity on electricity as the power source. On the contrary, they are most expensive when used on a DG set as a power source. Furthermore, this study provides evidence of PSA plants being more cost-effective for refilling cylinders using a booster compressor unit when compared to third-party vendor-cylinder refilling. Conclusion: Given their cost-effectiveness and low third-party dependence, they should be utilised to their maximum capacity as medical oxygen sources at healthcare facilities. [ABSTRACT FROM AUTHOR]

Purpose: We have previously published a retrospective matched-case control study comparing the effect of recombinant LH (r-hLH) versus highly purified human menopausal gonadotropin (hMG) supplementation on the follicle-stimulating hormone (FSH) during controlled ovarian hyperstimulation (COH) in the GnRH-antagonist protocol. The result from that study showed that the cumulative live birth rate (CLBR) was significantly higher in the r-hLH group (53% vs. 64%, p = 0.02). In this study, we aim to do a cost analysis between these two groups based on our previous study. Methods: The analysis consisted of 425 IVF and ICSI cycles in our previous study. There were 259 cycles in the r-hFSH + hMG group and 166 cycles in the r-hFSH + r-hLH group. The total cost related to the treatment of each patient was recorded. Probabilistic sensitivity analysis (PSA) and a cost-effectiveness acceptability curve (CEAC) were performed and created. Results: The total treatment cost per patient was significantly higher in the r-hFSH + r-hLH group than in the r-hFSH + hMG group ($4550 ± 798.86 vs. $4290 ± 734.6, p = 0.003). However, the mean cost per live birth in the r-hFSH + hMG group was higher at $8052, vs. $7059 in the r-hFSH + r-hLH group. The CEAC showed that treatment with hFSH + r-hLH proved to be more cost-effective than treatment with r-hFSH + hMG. Willingness-to-pay was evident when considering a hypothetical threshold of $18,513, with the r-hFSH + r-hLH group exhibiting a 99% probability of being considered cost-effective. Conclusion: The cost analysis showed that recombinant LH is more cost-effective than hMG supplementation on r-hFSH during COH in the GnRH-antagonist protocol. [ABSTRACT FROM AUTHOR]

This article, published in the Journal of Neurological Surgery, examines the cost analysis of transsphenoidal pituitary tumor resection in conjunction with otolaryngology. The study focuses on the transition to endoscopic approaches for these tumors in 2018 and the potential cost increases associated with multi-disciplinary collaboration. The researchers analyzed financial data from 2013 to 2022 and found that while there was a rise in direct costs, the overall contribution margin remained stable. This suggests that team-based endoscopic approaches may result in some increased cost to the institution, but they are not a financial liability. [Extracted from the article]

Background: The onset of the COVID-19 pandemic has had an adverse impact on children, youth, and families with eating disorders (EDs). The COVID-19 pandemic exacerbated pre-existing personal and financial costs to youth, caregivers, and health professionals accessing or delivering ED services. The objectives of this mixed methods study were to (1) understand the indirect, direct medical and non-medical costs reported by youth, caregivers, and clinicians; (2) understand how the COVID-19 pandemic may have impacted these costs, and (3) explore implications of these costs with regards to barriers and resources to inform future decisions for the ED system of care. Methods: Youth (aged 16–25 years) with lived/living experience, primary caregivers, clinicians, and decision-makers were recruited with support from various partners across Canada to complete group specific surveys. A total of 117 participants responded to the survey. From those respondents, 21 individuals volunteered to further participate in either a discussion group or individual interview to provide additional insights on costs. Results: Youth and primary caregivers reported costs relating to private services, transportation and impacts of not attending school or work. Additionally, primary caregivers reported the top direct medical cost being special food or nutritional supplements (82.8%). In discussion groups, youth and caregivers elaborated further on the challenges with long waitlists and cancelled services, impact on siblings and effect on family dynamics. Clinicians and decision-makers reported increased work expectations (64.3%) and fear/isolation due to COVID-19 in the workplace (58.9%). Through discussion groups, clinicians expanded further on the toll these expectations took on their personal life. Approximately 1 in 3 health professionals reported contemplating leaving their position in 1–2 years, with greater than 60% of this group stating this is directly related to working during the pandemic. Conclusions: Findings demonstrate the need for increased support for youth and caregivers when accessing ED services both during crisis and non-crisis times. Additionally, attention must be given to acknowledging the experience of health professionals to support better retention and resource management as they continue to navigate challenges in the health care system. Plain English summary: The COVID-19 pandemic has had significant impacts for children, youth and families with eating disorders (EDs) and those who care for them. The objective of this study was to understand the impacts on financial and personal costs to youth, caregivers and clinicians when either accessing or delivering ED services during the pandemic. This study consisted of an online survey and discussion groups with youth (16-25 years old) with lived experience of an ED, primary caregivers, clinicians and decision-makers delivering ED services to understand the costs they experienced. Although many reported costs were financial, including direct medical costs (i.e. private therapy) and direct non-medical costs (i.e. transportation, accommodation costs), there were also significant personal costs to individuals and their families. Healthcare professionals also reported extensive challenges with resources and increased work expectations due to the pandemic context. Acknowledging the costs experienced by young people, families and healthcare professionals during the pandemic allows for the discussion of how we can better support those accessing or delivering ED services in times of crisis and non-crisis. [ABSTRACT FROM AUTHOR]

The standard care for burns is tangential surgical debridement and subsequent covering, but recently enzymatic debridement has appeared as an alternative. The objective of this study, using an individualised cost-per-patient information system, is to compare the cost per patient of these two alternatives and identify their main determining factors. A non-randomised, retrospective, observational study was carried out with 79 patients, 39 of whom were treated with surgical debridement. The average cost per patient for enzymatic debridement is lower, particularly due to a shorter length of stay of critical hospitalisation (13.7 vs. 18.9 days; €26,101 vs. €33,919), a decreased need for surgical procedures (0.45 vs. 1.28) and a shorter use of operating theatres (53 vs. 202 minutes; €904 vs. €3,000). Age, aetiology, evolution length and percentage TBSA are robust determinants of the cost of care for burn patients. The type of procedure does not appear to significantly affect the cost per patient. [ABSTRACT FROM AUTHOR]

Power transmission systems are made up of transmission lines and substations, and the main equipment in a substation are power transformers. Power transformers correspond to about 60% of the total cost of substations and are the most complex, being composed of several thermal, mechanical, electrical, and chemical elements and processes. Due to this complexity, unscheduled shutdowns occur in these transformers, which leads to the need for periodic maintenance and replacement. Within this context, this article proposes a methodology to analyze the costs generated by additional aging in transformers when subjected to an additional load caused by the shutdown of another transformer in the system. The methodology was validated in a case study carried out in a company in southern Brazil. The results show that the cost of unavailability is considerably higher when scheduled outages occur. It should also be noted that the 5 transformers studied are responsible for 93% of the unavailability cost, and the common fact among these is that the average normal load is above 50%. In this sense, it can be concluded that the methodology can assist in decision-making related to the management and maintenance of this critical equipment causing significant economic consequences in the long run. [ABSTRACT FROM AUTHOR]

• Dalbavancin has been shown to be a safe option in the therapy of infective endocarditis. • A lower hospital stay was observed in patients who received dalbavancin. • Dalbavancin use was associated with a reduction in costs and hospital stay. Due to its long half-life, dalbavancin offers benefits for long-duration treatments, especially osteoarticular and infective endocarditis (IE). We evaluated the efficacy and costs of IE treatment, comparing dalbavancin with standard of care (SOC). Retrospective multicenter cohort study of adult patients with Gram-positive cocci definite IE. Dalbavancin was used as a sequential therapy before discharge. Efficacy was a combined variable of clinical cure and absence of recurrence in 12-month follow-up. Length of hospital stay and the associated costs were analyzed in both groups of treatment. Twenty-two patients received dalbavancin and 47 SOC. The efficacy was similar between the groups (dalbavancin 18 [72%] vs SOC 44 [94%], P = 0.198). Hospital stay was shorter in the dalbavancin group (dalbavancin 22 days [16-34] vs SOC 37 days [23-49], P = 0.001), especially in those with E. faecalis IE (dalbavancin 30 days [20-36] vs SOC 65 days [46-74], P <0.001). A reduction of cost was observed between both groups (dalbavancin, 12,206 € [8998-17,283] vs SOC 16,249 € [11,496-22,367], P = 0.032). Dalbavancin could be a safe and effective option in the sequential treatment of patients with IE. Also, a cost reduction was detected, due to a significant shortness of hospital stay. [ABSTRACT FROM AUTHOR]

Introduction: The advantages of single-stage treatment of cholecystocholedocholithiasis are well established, but the conditions for carrying out treatment on an outpatient basis require a review of concepts and practices of medical corporations. Objective: To evaluate the practice of treating cholecystocholedocholithiasis by laparoendoscopy on an outpatient basis with cost analysis. Method: A retrospective study was conducted on patients with cholecystocholedocholithiasis treated by combined laparoscopic cholecystectomy and endoscopic choledocholithotomy from January 2015 to January 2019. After collecting data from physical and digital medical records, the patients were divided into two groups—AR (n = 42)—ambulatory regimen and HR (n = 28)—hospitalization regimen—which were compared in terms of demographic, clinical and treatment variables and their results, as well as in terms of costs. Results: The mean age of the AR group was lower than that of the HR group and the physical status of the AR patients was better when assessed according to the American Society of Anesthesiologists (ASA) (p = 0.01). There was no difference between groups regarding the risk of choledocholithiasis (p = 0.99). For the AR group, the length of stay was shorter: 11.29 h × 65.21 h (p = 0.02), as was the incidence of postoperative complications assessed by applying the Clavien–Dindo classification: 3 (7.1%) × 11 (39.2%) (p < 0.01). The total mean costs were higher for the HR group (USD 2489.93) than the AR group (USD 1650.98) (p = 0.02). Conclusion. Outpatient treatment of cholecystocholedocholithiasis by laparoendoscopy is safe and viable for most cases, has a lower cost and can support the reorientation of training and practice of hepatobiliary surgeons. [ABSTRACT FROM AUTHOR]

In the current study, sulfonic acid functionalized steam-activated char catalyst was prepared from Cocos nucifera (coconut) husk (named as ACH-SO 3 H) at low temperatures for the pre-treatment of Kanuga oil to its methyl ester. This catalyst is attempted reportedly first time for Kanuga oil-derived biodiesel production. An ester yield of 99.51% was achieved over parametric states optimized by response surface methodology of catalyst loading 4.9 wt%, methanol concentration of wt%, for 83 min at 55.75 °C. Based on the proximate analysis, the feedstock Kanuga oil exhibited a high free fatty acid suggesting that the fuel production require the usage of an acid catalyst. Catalyst developed was examined using BET, SEM, EDAX, FTIR, and XRD. Fuel characterization of the produced methyl ester demonstrated that it has physico-chemical properties acceptable for biodiesel according to ASTM standards. The esterification reaction with ACH-SO 3 H exhibited kinetics that resembled pseudo-first-order behaviour, with an Ea of 68.83 kJ mol−1. Endothermic nature and non-spontaneity of the esterification reaction were confirmed through the thermodynamic study. Despite repeated use, the catalyst demonstrated outstanding stability, with the capacity to be reused thrice without notable decay in catalytic action. Catalyst production cost of $6.74/kg was estimated in the work. [Display omitted] • Esterification was carried out to produce biodiesel from Kanuga oil. • Waste Cocos nucifera husk was used for –SO 3 H doped catalyst (ACH-SO 3 H) preparation. • The highest free fatty acid conversion to fatty acid methyl ester was 98.99%. • Esterification was endothermic and non-spontaneous with activation energy of 68.83 kJ mol− 1. • Low catalyst production cost of $6.44/kg validates the economic feasibility of the process. [ABSTRACT FROM AUTHOR]

To perform a cost analysis of generic and brand-name Phosphodiesterase Type 5 (PDE5) inhibitors at different dosages and pharmacies across the US. Using an all-payer retail pharmacy-claims database, we analyzed prescription drug data for three generic and six brand-name oral PDE5 inhibitors at different dosages across US chain and independent pharmacies in 2019. We obtained cash price data from 60,186 pharmacies (35,976 chain and 24,210 independent). The nationwide mean cash price per unit (PPU) ranged from $8.6 ± 5.2 (sildenafil 20 mg at chain pharmacies) to $107.1 ± 71 (Adcirca 20 mg at independent pharmacies) equal to 1145.3% difference. Chain pharmacies provided significantly lower average prices for one brand-name and six generic PDE5 inhibitors. Tadalafil PPU was cheaper at higher quantities, however, PPU increased with quantity prescribed for sildenafil. Looking at the top 10 metropolitan statistical areas, the highest PPUs were observed for tadalafil (Cialis) 10 mg and sildenafil (Viagra) 50 mg in Atlanta ($67.4 ± 8.7) and Los Angeles ($50.3 ± 24.0), while New York ($9.7 ± 2.6) and Miami ($27.9 ± 16.4) had the lowest PPUs for tadalafil (Cialis) 5 mg and sildenafil (Viagra) 100 mg, respectively. A substantial variability in PDE5 inhibitor cash prices exists across manufacturer, dosage, quantity, pharmacy type, and location. In addition, the pricing does not necessarily correlate with the regional socioeconomic factors. This highlights the importance of provider awareness and patient counseling on drug price including potentially assisting patients in identifying opportunities for cost savings. [ABSTRACT FROM AUTHOR]

Computeed tomography (CT) is a cornerstone of the identification and management of acute changes in neurosurgery patients. In addition to the monetary expense of CT scans, further costs are incurred due to the time of patient transport and radiation exposure. Ultrasounds (USs)offer a safe, inexpensive, and bedside alternative to CT but obstacles remain due to decreased penetrance in the adult skull. Sonolucent Cranial Implants (SCIs) offer a window for USs to view intracranial architectures. The authors performed a PRISMA guidelines-based systematic review of the literature. Information was extracted from included articles in regards to illness pathology, US imaging feasibility, comparison to standard imaging, infections, and revisions. Costs were collected in regards to price of implant and follow-up imaging. A total of 226 articles resulted, of which 5 were included in the study. Ninety non-duplicate patients who received SCIs were analyzed. The pathologies of included patients is as follows: 51 patients were after extracranial-intracranial bypass, 37 after ventriculoperitoneal shunt placement for hydrocephalus, 1 after tumor resection, and 1 after cranioplasty following decompressive hemicraniectomy. All studies noted feasibility of US and comparability to standard imaging following SCI placement. Follow-up imaging with trans-sonolucent cranial implant ultrasound was estimated to save up to $4,000 per patient depending on the procedure. Initial studies suggest that US imaging through SCIs is a safe and efficacious alternative to CT imaging in neurosurgical patients. Cost analysis suggests that SCI and subsequent US can offer a cost savings compared with current treatment. [ABSTRACT FROM AUTHOR]

Introduction: Bone conduction devices (BCD) are effective for hearing rehabilitation in patients with conductive and mixed hearing loss or single-sided deafness. Transcutaneous bone conduction devices (tBCD) seem to lead to fewer soft tissue complications than percutaneous BCDs (pBCD) but have other drawbacks such as MRI incompatibility and higher costs. Previous cost analyses have shown a cost advantage of tBCDs. The purpose of this study is to compare long-term post-implantations costs between percutaneous and transcutaneous BCDs. Materials and methods: Retrospective data from 77 patients implanted in a tertiary referral centre with a pBCD (n = 34), tBCD (n = 43; passive (tpasBCD; n = 34) and active (tactBCD; n = 9) and a reference group who underwent cochlear implantation (CI; n = 34), were included in a clinical cost analysis. Post-implantation costs were determined as the sum of consultation (medical and audiological) and additional (all post-operative care) costs. Median (cumulative) costs per device incurred for the different cohorts were compared at 1, 3 and 5 years after implantation. Results: After 5 years, the total post-implantation costs of the pBCD vs tpasBCD were not significantly different (€1550.7 [IQR 1174.6–2797.4] vs €2266.9 [IQR 1314.1–3535.3], p = 0.185), nor was there a significant difference between pBCD vs tactBCD (€1550.7 [1174.6–2797.4] vs €1428.8 [1277.3–1760.4], p = 0.550). Additional post-implantation costs were significantly highest in the tpasBCD cohort at all moments of follow-up. Conclusion: Total costs related to post-operative rehabilitation and treatments are comparable between percutaneous and transcutaneous BCDs up to 5 years after implantation. Complications related to passive transcutaneous bone conduction devices appeared significantly more expensive after implantation due to more frequent explantations. [ABSTRACT FROM AUTHOR]

Nephrotic syndrome (NS) is a commonly encountered chronic kidney disease in pediatric populations, with South Asian children being at high risk and requiring long-term pharmacological management. Thus, identifying medication discrepancies and evaluating the appropriateness of therapy and its economic burden are vital for inpatient management. The aim of the study was to assess medication reconciliation, medication appropriateness, and cost analysis in NS cases. An ambispective cohort observational study was carried out with 150 NS patients where medication discrepancies were identified retrospectively and prospectively using the best possible medication history and following up patients correspondingly. Further, the Medication Appropriateness Index and cost variation analysis were used to assess the prescribed therapy and cost analysis, respectively. Out of 150 patients with NS included, 67.3% were male and the mean age was 7.2 years. In total, 36.7% medication discrepancies were found at baseline and 6% discrepancies at follow-up. The majority of discrepancies were unintentional and due to dosing error both at baseline and follow-up. Further, in only 2% of the patients was there inappropriately prescribed medication, and the majority of patients spent between INR (Indian Rupees) 500 and 1000. Chronic conditions like NS require continuous monitoring by the specialist pediatric clinical pharmacist, who can contribute significantly by minimizing the medication discrepancies, by assessing the appropriateness of therapy, and lessening the economic burden. [ABSTRACT FROM AUTHOR]

The development of the vehicle-road cooperative intelligence can effectively resolve the current technical impediment and cost quandary associated with high-level autonomous driving. Nevertheless, the intelligent infrastructure entails initial deployment costs and ongoing energy consumption and maintenance costs, necessitating a comprehensive and quantitative analysis of the costs of intelligent infrastructure and the corresponding changes in comprehensive costs. The cost evaluation model for the cooperative intelligent system is designed in this paper, considering the corresponding intelligent infrastructure layout scheme for different road types within the technical framework. The intelligent configuration and corresponding cost transfer from roadside to vehicle side under the synergy effect is also analyzed. Using Beijing as a case study, the results indicate that the deployment of intelligent infrastructure will effectively reduce acquisition and usage costs of high-level intelligent vehicles and achieve a greater "reuse" effect by serving more intelligent connected vehicles (ICVs). Compared to the vehicle intelligence, collaborative intelligence will reduce cumulative total costs by more than ¥200 billion from 2023 to 2050, even with the inclusion of intelligent infrastructure's costs. [ABSTRACT FROM AUTHOR]

We estimate construction and operation costs of gigawatt-scale solid oxide electrolysis (SOE) facilities for producing high purity hydrogen gas from water. Manufacturing and assembly costs for two types of SOE cell stacks are estimated using a detailed design for manufacture and assembly (DFMA®) analysis. Modular balance of plant (BOP) process equipment is designed and sized with Aspen®, and cost estimated using equipment vendor quotes. Factory and on-site assembly and installation costs for SOEC stack and BOP equipment integration into modular SOE process units are calculated using a simplified DFMA® method. Total stack costs on a stack input power (SIP) basis reduce to <$100/kW e DC SIP for >500 MW e DC SIP /year production rates with electrode cermet, interconnects, and high-temperature heat treatments dominating the total cost. Integration of stacks with larger BOP equipment operating at higher pressures offers ∼36% cost reduction in total facility capital cost due to an economies of physical scale effect since BOP equipment comprises >50% of facility costs. Optimized H 2 prices decrease from ∼$4/kgH 2 to ∼$2/kgH 2 for 1 GW e DC SIP facilities using $0.025/kWh electricity price. All costs are reported in 2021 US dollars. • Estimation of SOEC stack, BOP, and installation costs of modular SOE facilities. • 50 kW e DC SOEC stack costs <$100/kW e DC at production rates >500 MW e DC/year. • BOP equipment contributes >50% of facility total capital investment. • ∼36% reduction in total capital investment from BOP economies of physical size. • ∼$2/kgH 2 for 1 GW e DC modular SOE facilities with $0.025/kWh e electricity. [ABSTRACT FROM AUTHOR]

To comprehensively analyze the cumulative costs associated with Foley consultations throughout their event lifespan. Urologic consultation for Foley catheter (Foley) management is common. Such consultations are heterogeneous, with some requiring only simple catheter placement. Others (eg, traumatic Foley) necessitate more complex procedural intervention and may also result in downstream care and/or intervention needs. This study analyzed a retrospective database of consecutive urologic Foley consultations at a single academic institution (2017-2019), collecting comprehensive data on patient characteristics, related procedures/materials, and downstream care (eg, hospitalization, laboratory/radiology testing, evaluation and management services). A process map and related modeling were used to assess categorical and cumulative event costs. Allocated costs and charges were utilized for materials/institutional resources and for services rendered, respectively. Statistical analysis performed using SAS and statistical inferences were based on significance level of 10%. A total of 244 patient encounters were included in the analysis. The mean overall cost of all care related to Foley consultation was $2389.23 (±$4045.89). A total of 62 (25.4%) patients required only consultation/Foley without additional intervention, with a total cost of $738.90 (±$94.10). The remaining 182 (75.6%) patients required additional intervention and related cost (total cost $3413.27 (±$4850.41)). Traumatic catheterization was associated with higher cost compared with atraumatic cases ($3201.50 (±$6158.4) vs $1926.40 (±$1776.20), respectively, P =.05). Downstream care comprised a significant portion of overall cost. In 61 (25%) cases no nurse attempt was performed prior to consultation. Urologic Foley consultation is associated with significant health system cost. Quality initiatives to optimizing Foley placement and management are critical to improving quality of care and associated downstream costs. [ABSTRACT FROM AUTHOR]

This study evaluates the logistics cost associated with transporting Wood Pellets (WP) and Torrefied Biomass Pellets (TBP) from Aveiro, Portugal's principal WP exporting port, to Northern European destinations. With increasing emphasis on sustainable energy, understanding the cost dynamics between WP and TBP becomes crucial for market competitiveness. Using data sourced from the Argus Biomass Markets report, we compared the energy in gigajoules per ton of both WP and TBP. Torrefaction results in pellets with superior energy and bulk densities, influencing their transportation logistics costs. The main metrics for comparison were cost per energy unit and the implications of energy and bulk densities on transport costs. Preliminary findings indicate that although torrefied pellets undergo more significant mass loss than energy loss, their enhanced energy and bulk densities present logistical advantages. These advantages manifest as more tons per volume unit and heightened energy per ton, which ultimately lead to reduced transportation cost per energy unit. The insights from this analysis provide valuable input for the biofuel sector. By understanding the cost benefits associated with TBP transportation in contrast to WP, stakeholders can make strategic decisions, bolstering the competitiveness of Portuguese biofuel products in the European domain. [ABSTRACT FROM AUTHOR]

The costs for hydrogen refueling of fleets were calculated by a two‐step approach. Firstly, different hydrogen refueling station (HRS) system configurations were simulated and optimized for various HRS sizes and 350 bar pressure, with the Fraunhofer ISE's toolkit H2ProSim, showing that large‐scale and pipeline‐supplied HRS can reduce the hydrogen refueling costs. Secondly, as customer travel costs to the HRS play an important role, especially in the hydrogen market activation phase, the placement and dimensioning of the HRS network was optimized in a case study for the Upper Rhine region. The analysis shows possible network structure and cost distributions for a set of specific customers. Hydrogen supply costs are highly dependent on the hydrogen demand and spatial distribution of the customers and can drop to values of around € 0.60 kg−1 for depot refueling stations for high‐volume customers. However, some customers cannot be supplied at a reasonable cost. [ABSTRACT FROM AUTHOR]

Background and Objectives: Obstetric haemorrhage is the leading cause of maternal morbidity and mortality worldwide. We aimed to estimate the economic cost of Major Obstetric Haemorrhage (MOH) and the cost of therapeutic blood components used in the management of MOH in Ireland. Materials and Methods: We performed a nationwide cross‐sectional study utilising top‐down and bottom‐up costing methods on women who experienced MOH during the years 2011–2013. Women with MOH were allocated to Diagnostic Related Groups (DRGs) based on the approach to MOH management (MOH group). The total number of blood components used for MOH treatment and the corresponding costs were recorded. A control group representative of a MOH‐free maternity population was designed with predicted costs. All costs were expressed in Euro (€) using 2022 prices and the incremental cost of MOH to maternity costs was calculated. Cost contributions are expressed as percentages from the estimated total cost. Results: A total of 447 MOH cases were suitable for sorting into DRGs. The estimated total cost of managing women who experienced MOH is approximately €3.2 million. The incremental cost of MOH is estimated as €1.87 million. The estimated total cost of blood components used in MOH management was €1.08 million and was based on an estimated total of 3997 products transfused. Red blood cell transfusions accounted for the highest contribution (20.22%) to MOH total cost estimates compared to other blood components. Conclusions: The total cost of caring for women with MOH in Ireland was approximately €3.2 million with blood component transfusions accounting for between one third and one half of the cost. [ABSTRACT FROM AUTHOR]

In the present study, the effect of high-volume fly ash blending in the concentration of 15%, 25%, 35%, 45%, and 55% with different effective water-to-cement (W/C) ratios has been investigated for rheology, compressive strength (CS), and durability of self-compacting mortar (SC-mortar). The rheology of SC-mortar was evaluated in terms of slump flow diameter, v-funnel flow time, and developed yield stress and plastic viscosity. The CS of SC-mortar was evaluated at 7 and 28 days of curing, whereas the water permeability and rapid chloride penetration tests were performed to evaluate the durability of SC-mortar at 28, 90, and 180 days. The consumption of ordinary portland cement was reduced using the k-factor or cementing efficiency factor in mix design, where the value of the k-factor decreases with increasing fly ash content. The experimental study revealed that the addition of a high volume of fly ash has a significant impact on rheology and durability, whereas CS of SC-mortar was affected marginally. Scanning electron microscopic (SEM) examination revealed that the fly ash blending has improved the packing and reduced the pore density to compensate for the loss of CS on account of lower cement content. An increase in W/C has increased the porosity, causing a negative impact on CS and durability. The durability of SC-mortar has increased with increasing fly ash content, and there was an exceptional increment in water ingression time (T25) with an increase in fly ash content from 25% to 35%, but with higher content of fly ash (above 35%) and low value of W/C, SC-mortar become very sticky, thus reduced the workability significantly. Compared with the control mix, there is a significant reduction in the cost of SC-mortar with fly ash blending of 15%, thereafter, the cost reduction is marginal with a further increase in fly ash dosage which is due to the rise in admixture dosage. Based on the rheology (within EFNARC limits), CS, and durability of SC-mortar, the optimized dosage of fly ash has been recommended in the range of 25%–40% with different W/C. [ABSTRACT FROM AUTHOR]

The present work studied electroplating wastewater treatment by the electro-oxidation (EO) method through a new Ti/TiO 2 -GO-SnO 2 electrode in a once-through continuous mode. The Ti/TiO 2 -GO-SnO 2 electrode was synthesized using an anodic oxidation technique and characterized by electrochemical characterizaftion. Response Surface Methodology (RSM) employing a Box-Behnken Design (BBD) model was utilized to optimize pH (3−7), current density (j = 16.72–50.16 mA/cm2), and time (t = 30–130 min) for removal of electroplating effluents and energy consumption. At the optimum condition, the values of the responses R 1 (% Cr(VI) removal), R 2 (% Zn removal), R 3 (% COD removal), and R 4 (energy consumption) were found to be 97.55%, 95.66%, 87.32%, and 14.97 kWh/m3, respectively. The effect of reactive species scavengers on removing electroplating effluents has been studied. The kinetics and cost analysis were also carried out under optimal conditions. Once-through continuous experiments were carried out at different flow rates to determine the viability of the process at industrial or pilot scale applications. The synthesized electrode proved highly reusable, maintaining durability even after sixty cycles of usage. Toxicity analysis showed that EO has the potential to detoxify electroplating effluents. The observed results confirm that the EO with Ti/TiO 2 -GO-SnO 2 electrode is low-cost and effective for removing electroplating effluents. [Display omitted] [ABSTRACT FROM AUTHOR]

Engineering the wettability of functional materials holds significant interest, focusing on the need for superhydrophobic catalysts, crucial for their ability to prevent the poisoning of active sites by water, produced in situ or as a by‐product. Herein, for the first time, a superhydrophobic spherical activated carbon (SSAC@PhSO3H) is engineered as a catalyst via a novel synthetic approach and tailored in Jatropha curcas oil (JCO) biodiesel synthesis. With a large surface area (1461 m2 g−1), high acid density (6.26 mmol g−1), and water contact angle (163.4°), the catalyst demonstrates superior performance and remarkable water repellency, firmly establishing its superhydrophobic characteristics. Response Surface Methodology based on the Central Composite Design (RSM‐CCD) approach predicted a maximal biodiesel yield of 98.8% (80 °C, 5 wt%, 15:1 methanol to oil molar ratio (MOMR), and 40 min). Life cycle cost analysis (LCCA) estimates biodiesel production cost of 0.37 USD ($) per kg emphasizing high commercial viability. Compared with H2SO4‐sulfonated biochar, SSAC@PhSO3H retains its inherent activity (86.8 ± 0.4% yield in 10th run) and spherical morphology even after nine successive reaction cycles indicating high stability. Nevertheless, JCO biodiesel's fuel properties met European Norm, EN 14 212 and American Society for Testing and Materials, ASTM D6757 standards, highlighting its potential for industrial biodiesel production. [ABSTRACT FROM AUTHOR]

Introduction & objectives: To evaluate ureteral stent removal (SR) using a grasper‐integrated disposable flexible cystoscope (giFC—Isiris ®, Coloplast ®) after kidney transplantation (KT), with a focus on feasibility, safety, patient experience, and costs. Material and methods: All consecutive KT undergoing SR through giFC were prospectively enrolled from January 2020 to June 2023. Patient characteristics, KT and SR details, urine culture results, antimicrobial prescriptions, and the incidence of urinary tract infections (UTI) within 1 month were recorded. A micro‐cost analysis was conducted, making a comparison with the costs of SR with a reusable FC and grasper. Results: A total of 136 KT patients were enrolled, including both single and double KT, with 148 stents removed in total. The median indwelling time was 34 days [26, 47]. SR was successfully performed in all cases. The median preparation and procedure times were 4 min [3,5]. and 45 s[30, 60], respectively. The median Visual Analog Scale (VAS) score was 3 [1, 5], and 98.2% of patients expressed willingness to undergo the procedure again. Only one episode of UTI involving the graft (0.7%) was recorded. Overall, the estimated cost per SR procedure with Isiris ® and the reusable FC was 289.2€ and 151,4€, respectively. Conclusions: This prospective series evaluated the use of Isiris ® for SR in a cohort of KT patients, demonstrating feasibility and high tolerance. The UTI incidence was 0.7% within 1 month. Based on the micro‐cost analysis, estimated cost per procedure favored the reusable FC. [ABSTRACT FROM AUTHOR]

[Display omitted] • Up to 88 % of the airport waste generated in public places could be recycled. • Manual sorting in public places limits good material recovery. • Automatic sorting can overcome people's uncertainty and negligence when sorting. • Benefits of automatic sorting can improve the recycling of waste from public areas. • Automatic sorting can provide environmental and economic benefits in waste handling. With the recent advancement in artificial intelligence, there are new opportunities to adopt smart technologies for the sorting of materials at the beginning of the recycling value chain. An automatic bin capable of sorting the waste among paper, plastic, glass & aluminium, and residual waste was installed in public areas of Milan Malpensa airport, a context where the separate collection is challenging. First, the airport waste composition was assessed, together with the efficiency of the manual sorting performed by passengers among the conventional bins: paper, plastic, glass & aluminium, and residual waste. Then, the environmental (via the life cycle assessment - LCA) and the economic performances of the current system were compared to those of a system in which the sorting is performed by the automatic bin. Three scenarios were evaluated: i) all waste from public areas, despite being separately collected, is sent to incineration with energy recovery, due to the inadequate separation quality (S0); ii) recyclable fractions are sent to recycling according to the actual level of impurities in the bags (S0R); iii) fractions are sorted by the automatic bin and sent to recycling (S1). According to the results, the current separate collection shows a 62 % classification accuracy. Focusing on LCA, S0 causes an additional burden of 12.4 mPt (milli points) per tonne of waste. By contrast, S0R shows a benefit (−26.4 mPt/t) and S1 allows for a further 33 % increase of benefits. Moreover, the cost analysis indicates potential savings of 24.3 €/t in S1, when compared to S0. [ABSTRACT FROM AUTHOR]

Climate change and its damaging consequences for ecology and humanity is advancing. Industry and its metals sector are responsible for most greenhouse gas emissions. Current costs of industrial goods do not reflect the true costs caused by the externalized climate damages of its production and thus offer no competitive incentive to decarbonize. Additionally, regional climate regulation can lead to competitive distortion. We therefore aim to investigate the impact of climate cost internalization on the metals industry. Using true‐cost analysis for an exemplary and widely used metal product, the effects of climate true costs depending on production region, technology, and energy mix, CO2e taxation and value chain are examined. Based hereon, the impact of internalizing climate true costs together with the introduction of a carbon‐border tax on the carbon leakage problem, climate protection, and the cost situation for companies in global competition are investigated. The results of the study show that steel and wire production is responsible for most CO2e emissions showing significant decarbonization effects by steel recycling whereas production location and logistics play a minor role. On a competitive level, cost internalization has hardly any effect on the product costs because of the currently low CO2e‐taxation rates. Thus, almost no incentive to produce or consume in a climate‐protective way is generated, incentivizing production in pollution havens versus highly climate regulated regions. Instead, to realize emission efficiency gains and innovations leading to a competitive advantage of decarbonized products and value chains, a significant increase of CO2e‐taxation rates together with a carbon‐border tax is necessary. [ABSTRACT FROM AUTHOR]

Wind energy is widely deployed and will likely grow in service of reducing the world's dependency on fossil fuels. The first generation of wind turbines are now coming to the end of their service lives, and there are limited options for the reuse or recycling of the composite materials they are made of. Current literature has verified that there is no existing recycling pathway (i.e., mechanical, chemical, thermal methods of recovery, etc.) for end-of-life materials in wind blades that can meet cost parity with landfilling in the US. However, to the authors' knowledge there is no study to date that uncovers the cost structures associated with repurposing wind turbine blades in the US. Repurposing could offer a cost-competitive advantage through displacement of higher-value products, rather than materials or chemical constituents alone. This study implements life cycle assessment (LCA) and life cycle cost analysis (LCC) to assess the environmental and financial implications at each stage of repurposing wind turbine blades as the primary load-carrying elements for high-voltage transmission line structures in the United States. This case study contribution to knowledge is based on the successful management of construction waste by analyzing an application for repurposing construction demolition waste. Specifically, this study presents an environmental and financial analysis of repurposing wind turbine blades as transmission line poles. Under this case study, our results show that BladePoles have lower greenhouse gas emissions than steel poles, and we anticipate BladePoles will be less costly than steel poles. Overall emissions are most sensitive to combustion emissions, driven primarily by transportation distance and hours of required crane operations during the installation process. Compared to other evaluated recycling methods, repurposing wind blades as BladePoles has the least overall global warming potential. As renewable energy production grows, managing infrastructure at its end-of-life is increasingly relevant—for example, wind turbine blades. This case study presents a financial and environmental analysis of repurposing decommissioned wind turbine blades as transmission poles, called BladePoles. This paper presents the cost and associated greenhouse gas emissions at each stage of the process. The case study also compares this reuse application to typical steel pole deployment, finding that for the same 60-year life span and 161 kV, 230 kV, and 345 kV transmission line poles, the BladePole cost is lower than the steel pole. Greenhouse gas emissions are most sensitive to transportation distance from the wind farm to the transmission project and the time of crane use for installation are key parameters in this case study and reducing them directly reduces the total greenhouse emissions overall. [ABSTRACT FROM AUTHOR]

Purpose: To analyze differences in union, complication rates and cost from surgical fixation of distal fibula fractures with fibular plating implants. Methods: In total, 380 adult patients from 2012 to 2015 treated with 12 fibular plates from 4 different manufacturers utilized by 9 surgeons were retrospectively reviewed. They were stratified into a conventional one-third tubular fibular plate group, pre-contoured anatomic locking plate group, or a heterogeneous group including 3.5-mm reconstruction, one-third tubular locking, composite, and limited compression plates. The outcomes included failure of fixation, deep infection requiring debridement, time to union, anatomic reduction, superficial infection, hardware removal, and post-traumatic arthritis. Plate and screw costs were calculated from hospital billing records. Results: Pre-contoured locking plates were used in older, female patients with a greater number of comorbidities. Open injuries and OTA 44B fractures were more likely to be an indication for pre-contoured plates. There was no difference noted in time to union between the different plating groups. Risk factors for deep infection requiring debridement included a history of tobacco use, open fractures, and pre-contoured locking plates relative to the conventional plating group. The pre-contoured plating group was on average $586 more expensive compared to the conventional group. Conclusion: Pre-contoured locking plates achieved similar radiographic outcomes compared to conventional plates with an increased risk of complications and higher cost. Surgeons should consider their choice of implant based on the patient's fracture pattern, underlying comorbidities, and risk for infection. [ABSTRACT FROM AUTHOR]

Background: Surgical management of Hirschsprung disease (HD) in low- and middle-income countries is typically a staged procedure, necessitating multiple hospitalizations and clinic visits increasing family financial burden. Currently, there is limited information on the costs borne by caretakers of children with Hirschsprung disease seeking surgical intervention. This study seeks to measure the costs and economic burden of surgical treatment for Hirschsprung disease in western Uganda. Methods: A cross-sectional study using cost analysis was conducted among caretakers of patients who completed surgical treatment of HD between January 2017 and December 2021 at two hospitals in western Uganda. The average direct and indirect costs incurred by caretakers presenting at a public and private hospital were computed. Results: A total of 69 patients (M: F = 7:1) were enrolled in the study. The median age at diagnosis was 60.5 (IQR 3–151.25) days for children and two-staged pull-through procedure was the common surgery performed. The mean overall cost for treatment was US $960 (SD = $720), with the majority of costs coming from direct medical costs. Nearly half (48%) of participants resorted to distress financing to finance their child's surgical care. The overwhelming majority of patients (n = 64, 93%) incurred catastrophic expenditure from the total costs of surgery for HD, and 97% of participants fell below the international poverty line at the time treatment was completed. Conclusion: Despite the availability of 'free care' from government hospital and non-profit services, this study found that surgical management of Hirschsprung disease imposed substantial cost burden on families with Hirschsprung disease patients. [ABSTRACT FROM AUTHOR]

Offshore wind farms are great options for addressing the world's energy and climate change challenges, as well as meeting rising energy demand while taking environmental and economic impacts into account. Floating wind turbines, in specific, depict the next horizon in the sustainable renewable energy industry. In this study, a life-cycle cost analysis for floating offshore wind turbines is developed by combining the most recent data and parametric formulas from databases and relevant papers. The cost analysis models focused on cost minimization with special emphasis on Operation and Maintenance Cost (OPEX), Decommissioning Cost (DECOM), and Levelized Cost of Energy (LCOE), which are important factors in wind power economy. Given that floating wind energy is still developing, the presented scenarios should be beneficial in making future decisions. The cost analysis scenarios include on-site and off-site maintenance scenarios for OPEX. In addition, four alternative scenarios for DECOM have been examined: mechanical recycling, mechanical-incineration, incineration processes, and landfill. According to the findings of these scenarios, OPEX varies from 16.89 to 19.93 £/MWh and DECOM between 3.47 and 3.65 £/MWh, whilst the total LCOE varied from 50.67 to 66.73 £/MWh. [ABSTRACT FROM AUTHOR]

Background: The overall cost of managing chronic diseases is a significant barrier to accessing complete and timely healthcare, especially in rural and geographically isolated areas. This cost disparity becomes more pronounced in the case of children and more so in under-resourced regions of the world. In the era of COVID-19, as the need for physical distancing increased, there was a transition in approach to healthcare provision to telemedicine consultations. This study evaluates the cost saving using teleconsultations in a paediatric nephrology clinic. Methods: This prospective cohort study was conducted at AIIMS Jodhpur, a tertiary care centre in western Rajasthan from March 2021 to October 2022. All consecutive paediatric (29 days–18 years) patients attending telemedicine services for kidney-related illness were enrolled. Basic demographic details were collected. Cost analysis was done after 6 months, regarding perceived cost savings for the patient and family by using telehealth for follow-up during 6 months starting from enrolment. Results: A total of 112 patients were enrolled; 266 teleconsultations attended; 109 patients who could be followed up saved INR 457,900 during 6 months of follow-up. The average cost saving was INR − 1577/patient/visit. Patients saved 4.99% of the family income (median 2.16% (IQR 0.66–5.5)). The highest expenditure per visit was incurred for food and transport. The median distance from the residence to the clinic was 122.5 km (IQR 30–250). Over the 6-month study period, patients saved a travel distance of 83,274 km (743 km/patient). Conclusions: The use of telemedicine as a follow-up method helps save significant costs and distances travelled by patients. A higher-resolution version of the Graphical abstract is available as Supplementary information [ABSTRACT FROM AUTHOR]

Purpose Methods Results Conclusion Level of Evidence The aim of this study is to investigate the cost‐effectiveness of revision total knee arthroplasty compared to primary total knee arthroplasty in terms of cost‐per‐quality‐adjusted life year (QALY).Data were retrieved for all primary and revision total knee replacement (TKA) procedures performed at a tertiary Swiss hospital between 2006 and 2019. A Markov model was created to evaluate revision risk and we calculated lifetime QALY gain and lifetime procedure costs through individual EuroQol 5 dimension (EQ‐5D) scores, hospital costs, national life expectancy tables and standard discounting processes. Cost‐per‐QALY gain was calculated for primary and revision procedures.EQ‐5D data were available for 1343 primary and 103 revision procedures. Significant QALY gains were seen following surgery in all cases. Similar, but significantly more QALYs were gained following primary TKA (PTKA) (5.67 ± 3.98) than following revision TKA (RTKA) (4.67 ± 4.20). Cost‐per‐QALY was €4686 for PTKA and €10,364 for RTKA. The highest average cost‐per‐QALY was seen in two‐stage RTKA (€12,292), followed by one‐stage RTKA (€8982).RTKA results in a similar QALY gain as PTKA. The costs of achieving health gain are two to three times higher in RTKA, but both procedures are highly cost‐effective.Economic level II. [ABSTRACT FROM AUTHOR]

Meeting Germany's climate targets urgently demands substantial investment in renewable energies such as hydrogen, as well as tackling industrial CO2 emissions with a strong CO2 transport infrastructure. This is particularly crucial for CO2-heavy industries such as steel, cement, lime production, power plants, and chemical plants, given Germany's ban on onshore storage. The CO2 transport network is essential for maintaining a circular economy by capturing, transporting, and either storing or utilizing CO2. This study fills gaps in CO2 pipeline transport research, examining pipeline diameters, costs, and pressure drop, and providing sensitivity analysis. Key findings show that the levelized cost of CO2 transport (LCO2T) ranges from 0.25 €/t to 55.82 €/t based on varying transport masses (1000 t/day to 25,000 t/day) and distances (25 km to 500 km), with compression costs pushing LCO2T to 33.21 €/t to 92.82 €/t. Analyzing eight pipeline diameters (150 mm to 500 mm) and the impact of CO2 flow temperature on pressure loss highlights the importance of selecting optimal pipeline sizes. Precise booster station placement is also crucial, as it significantly affects the total LCO2T. Exploring these areas can offer a more thorough understanding of the best strategies for developing cost-effective, efficient, and sustainable transport infrastructure. [ABSTRACT FROM AUTHOR]

Lighting makes up 17% of electrical loads and the largest energy end use in commercial buildings. Linear fixtures are among the largest opportunities for energy efficiency improvement, given their long operating hours. With continued, rapid light-emitting diode (LED) development and more LED replacement products on the market, lighting replacement decisions become more complex and warrant re-examination. With a goal to inform building managers and other decision-makers with practical guidance on lighting replacement, this study is a life cycle cost (LCC) analysis that compares the cost–benefit of six replacement options (one fluorescent and five LED) for a 0.61 m by 1.22 m (2 ft by 4 ft) T8 recessed troffer based on data for 168 lighting products from an online vendor. Results show that direct wire (i.e. unballasted) LED retrofits are the least-cost option to replacing fluorescent lamps in terms of normalized LCC. Plug-and-play lamps suffer from a lock-in with ballasts, but their ease of installation can help spur LED adoption. In cases where an existing ballast is still usable, hybrid LED retrofits provide the least upfront cost option by deferring the cost of rewiring. LED luminaires can offer improved aesthetics and reliability; however, they have high upfront cost. Among them, luminaires with replaceable lamps offer lower cost than those without. [ABSTRACT FROM AUTHOR]

Background: Although breastfeeding is recommended as the optimal form of nutrition in the first six months, it is not sustained as the predominant mode of feeding infants in Scotland. This study estimated the impact of infant feeding choices on primary and secondary healthcare service costs in a 13-year birth cohort. Method: Using linked administrative datasets, in a retrospective cohort design of 502,948 singletons born in Scotland between 1997 and 2009, we estimated the cost of GP consultations and hospital admissions by area deprivation and mode of infant feeding up to 6–8 weeks for ten common childhood conditions from birth to 27 months. Additionally, we calculated the potential healthcare savings if all infants in the cohort had been exclusively breastfed at 6–8 weeks. Discounting of 1.5% was applied following current health economic conventions and 2009/10 used as the base year. Results: Over the study period, the estimated cost of hospital admissions in the cohort was £111 million and £2 million for the 2% subset of the cohort with primary care records. Within each quintile of deprivation, exclusively breastfed infants used fewer healthcare services and incurred lower costs compared to infants fed (any) formula milk. At least £10 million of healthcare costs may have been avoided if formula-fed infants had been exclusively breastfed within the first 6–8 weeks of birth. Conclusions: This study using a representative birth cohort demonstrates how breastmilk can promote equitable child health by reducing childhood illness and healthcare utilisation in the early years. [ABSTRACT FROM AUTHOR]

Our primary objective was to compare the intraoperative costs of 3 different surgical visualization techniques for anterior cervical discectomy and fusion (ACDF). Specifically, we used time-driven activity-based costing (TDABC) methodology to compare costs between ACDFs performed with operative microscopes (OM-ACDF), exoscopes (EX-ACDF), and loupes (loupes-ACDF). Total cost was divided into direct and indirect costs. Individual costs were obtained by direct observation, electronic medical records, and through querying multiple departments (business operations, sterile processing, plant operations, and pharmacy). Timestamps for all involved personnel and material resources were documented. We identified all instances of loupes-ACDF (n = 882), EX-ACDF (n = 26), and OM-ACDF (n = 52) performed at our institution. We performed multivariable linear regression analyses to compare costs between these modalities, accounting for patient-specific factors as well as number of levels fused, surgeon, and hospital site. The average total intraoperative costs per loupes-ACDF, EX-ACDF, and OM-ACDF cases were $7081 +/− $2,942, $7951 +/− $3,488, and $6557 +/− $954, respectively. Regression analysis revealed no difference in intraoperative cost between loupes-ACDF and EX-ACDF (P = 0.717), loupes-ACDF and OM-ACDF (0.954), or OM-ACDF and EX-ACDF (0.217). On a more granular level, however, EX-ACDF was associated with increased cost of consumables, including drapes, compared to both OM-ACDF (β-coefficient: $369 +/− $121, P = 0.002) and loupes-ACDF (β-coefficient: $284 +/− $86, P = 0.001). Although hospitals may be aware of the purchasing fees associated with microscopes and exoscopes, there is no clear documentation of how these technologies affect intraoperative cost. We demonstrate a novel use of TDABC for this purpose. [ABSTRACT FROM AUTHOR]

Precision‐dosing models forecast infliximab doses to achieve targeted trough concentrations in patients with inflammatory bowel disease (IBD). These models have shown to reduce nonresponse and improve patient outcomes. We compared infliximab doses determined by iDOSE precision dosing with standard dosing, and the associated drug costs, in patients with IBD. In this retrospective study, patients with IBD treated with infliximab every 8 weeks at 5 mg/kg were included. An infliximab dose was named dose X if 3 previous infliximab doses, laboratory values including trough infliximab concentrations, and the patient's weight were recorded. The actual dose X was compared to an iDOSE‐predicted dose X. Net drug use and costs were evaluated. A total of 174 patients—56% men; median age, 36 (interquartile range, 29‐47) years; 135 with Crohn disease; and 31 with ulcerative colitis—were included, with 417 dose X recordings. Median prior infliximab therapy was 2 (0‐4) years. Comparing actual dose X with predicted dose X, 52% and 32% of doses were subtherapeutic when aiming for trough concentrations of 5‐10 and 3‐7 μg/mL, respectively. Treatment costs increased by 102% and 29% for the 2 trough ranges, respectively. On multivariate regression analysis, subtherapeutic infliximab concentrations were associated with ulcerative colitis compared with Crohn disease (odds ratio, 9.81; 95% confidence interval, 1.28‐75.40; P =.028) and predose X infliximab trough concentration [odds ratio, 0.07; 95% confidence interval, 0.03‐0.15; P <.001]. Over half of maintenance infliximab drug doses were too low to achieve infliximab blood concentrations of 5 μg/mL or greater. While applying precision dosing may improve patient outcomes, drug costs could be considerably greater. [ABSTRACT FROM AUTHOR]

Introduction: COVID-19 vaccination is considered a primary preventive measure to combat the COVID-19 pandemic. Several types of COVID-19 vaccines were developed, among them the mRNA-based vaccine and the inactivated virus vaccine. Different COVID-19 vaccines have different purchase price and require different logistics system, which translate into different estimated vaccination costs. Therefore, this study aims to estimate the cost of COVID-19 vaccination using the mRNA-based vaccine compared to the inactivated virus vaccine to assist future decision-making related to COVID-19 vaccination. Methods: Direct costs for per-dose vaccination for both vaccines were estimated from the health provider's perspective using the microcosting approach. Vaccination pathways were constructed for both the mRNA-based and the inactivated virus vaccine based on activities involving the acquisition, transportation, storage, and vaccine injection processes. Cost value was obtained from purchase documents, asset records, and market surveys. Results: The estimated costs for COVID-19 vaccination were RM 69.71 per dose for the mRNA-based vaccine and RM 91.68 per dose for the inactivated virus vaccine. The difference in estimated vaccination costs was mainly driven by the difference in the vaccine purchase costs which was higher for the inactivated virus vaccine. Conclusion: COVID-19 vaccination using the mRNA-based vaccine incur was estimated to incur lower total costs to the health provider compared to the inactivated virus vaccine during the pandemic. [ABSTRACT FROM AUTHOR]

Background: Telemedicine has proven successful in relieving the burden of chronic neurological disorders from the national health care systems by ensuring a highly customized and effective management plan. Although many studies focus on assessing telemedicine effectiveness, little is known about the economic implications of telemedicine applications in chronic neurological diseases (CNDs). This issue could account for a lack of widespread implementation. Objective: Our study attempted to fill this gap by systematically reviewing scientific literature on the economic evaluation of telemedicine compared with traditional care in the management of CNDs. Methods: We performed a literature search on PubMed, Google Scholar, Scopus, Embase, and Medline. The inclusion criteria were as follows: (1) studies with a full cost-analysis; (2) randomized controlled trials; (3) studies comparing telemedicine interventions with traditional care; (4) articles focusing only on CNDs. Conversely, the exclusion criteria were as follows: (1) studies focusing on acute neurological conditions or other diseases and (2) study protocols, case report, duplicate articles, abstract only, books, letters to editors, and review articles. Results: Ten articles met the inclusion criteria. Three different approaches of telemedicine intervention could be identified: digital cognitive-behavioral therapy (CBT), motor telerehabilitation, and home monitoring and assessment devices. Conclusion: Cost-analysis showed an overall benefit in terms of both cost and effectiveness from the application of telemedicine instead of in-presence management in CNDs. Among the identified interventions, digital CBT proved to be the most cost-saving. However, promising results were also found in monitoring and assessment devices and in telerehabilitation. Definitely, however, more thorough, comprehensive, and high-quality economic evaluation studies are needed. [ABSTRACT FROM AUTHOR]

In this trial, the effects of early qualitative feed restriction and barrier perch access on some meat quality traits, growth performance, and diet cost analysis of broiler chickens were investigated. A total of 504 1-d-old male chicks (Ross 308) were randomly allocated to four treatments (qualitative feed restriction − QFR; absence-/presence+ and barrier perch − BP; absence-/presence+) with three replicate pens in a completely randomised design involving a 2 × 2 factorial arrangement of treatments. Broiler chickens in the treatment of QFR- were fed with a corn-soybean meal diet containing protein and energy at the level specified in the commercial hybrid catalogue during d 0−42. The treatment of QFR+ was fed with a corn-soybean meal diet containing lower energy (10%) and protein (20%) for the first 21 d, and then between d 22 and 42, they were fed with a diet specified in the commercial hybrid catalogue. In the treatment of BP+, the barrier perch was placed between the feeder and the drinker. Meat quality traits (pH, lightness − L*, redness − a*, yellowness − b*, chroma, hue angle, and cooking loss − CL), growth performance (body weight − BW, body weight gain − BWG, feed intake − FI, and feed conversion ratio − FCR), and diet cost analysis (total diet cost and diet cost per unit weight gain) were recorded. Except for the a* value and hue angle measured at 24-h post-slaughter, the effect of QFR treatments on meat quality traits was insignificant in all measurements. During d 0−42, in the treatments of QFR+, BW, BWG, and FI were lower (P<0.0001, and P=0.005, respectively), and FCR was worse (P=0.014). The QFR treatments did not differ significantly in dietary cost per unit weight gained during d 0−42. As a result, it can be said that early qualitative feed restriction did not significantly affect meat quality traits. The treatment of QFR+ resulted in reduced growth performance. However, diet cost per unit weight gain showed similar values in both QFR treatments (QFR+ €0.75, QFR- €0.76, P=0.511). [ABSTRACT FROM AUTHOR]

Purpose: Sexual violence (SV) and adolescent relationship abuse (ARA) are common in the U. S. and have strong associations with negative health and wellbeing outcomes. Manhood 2.0 is the first U.S. program designed for community settings to build bystander skills while also challenging harmful gender norms. A cluster-randomized trial comparing Manhood 2.0 to Job Skills, a job readiness training control condition, demonstrated that it is a promising strategy to prevent sexual violence and adolescent relationship abuse. Such community-based interventions may be particularly relevant in lower resource urban settings, and the costs of such prevention programs have not been considered previously. Methods: The aim of the present study is to perform systematic and standardized cost calculations associated with implementing Manhood 2.0 among adolescent males. In addition, this study provides detailed cost information of the community-based intervention program, as well as costs associated with implementing the Job Skills control program. Program implementation data were recorded throughout the study period (2015–2019) by the Manhood 2.0 study team. Results: The cost of implementing Manhood 2.0 is $4,771 per complete round of program delivery and $451 per participant, which is approximately the same cost as the control Job Skills program ($4,432 and $453 per participant). The marginal cost per additional round of Manhood 2.0 program is $3,682. Conclusion: Implementation of a community-based program requires substantial resources and collaborations with community partners especially in economically disadvantaged neighborhoods. This study provides a snapshot of the cost information of a community-based intervention program from the implementing agency's perspective, which is essential in helping decision-makers understand the costs they will incur by implementing prevention programs and ensuring program feasibility and sustainability. [ABSTRACT FROM AUTHOR]

Over the last decade, restructuring of railway systems has resulted in infrastructure management assets demanding increased performance and reliability while adopting budget limits and reduced time available for maintenance. In fact, the current routine and major programmed maintenances are such capital-intensive activities that transport operating companies always attempt to optimise the operational procedures and related assets' performances towards minimising the costs. Characteristically, the use of macro synthetic fibre reinforcement is proposed to improve the structural performances and service life of the sleeper component. Accordingly, this study addresses the economic feasibility of implementing macro synthetic fibre reinforced concrete (MSFRC) as an alternative material for railway sleeper applications. Through a life cycle costing (LCC) approach, the study evaluates the impact of different asset phases such as acquisition, operation and maintenance, and end-of-life towards a cost comparison of MSFRC with conventional sleeper materials. Hence, the most financially viable option is identified, although key economic parameters are varied to simulate future market values. [ABSTRACT FROM AUTHOR]

To build highly reliable software products, software testing is required. The software engineer has a problem determining whether to complete the testing process and when to release the software system to the market. As the focus on high software increases, project managers must consider the cost of testing, testing availability time, and release time strategy. This research article utilizes a phase type non-homogeneous Poisson process to investigate the cost analysis and operational availability of a software reliability model. The software failure inter-arrival time is considered to follow a phase type distribution. The phase type software reliability model is valuable in reducing the time and effort required to select the appropriate models for software reliability evaluation. An explicit expression for the expected, bi-criterion cost analysis and operational availability is derived using standard results of the renewal reward theorem. The optimal software release policy T* is obtained analytically. Numerical illustrations and sensitivity analysis have been presented to illustrate the cost and availability analysis's efficiency and demonstrate conformity with the study's observations. [ABSTRACT FROM AUTHOR]

To conduct a comparative cost analysis between single-use and reusable cystoscopes from a national healthcare system perspective and assess the environmental footprint. Single-center micro-cost analysis of reusable vs single-use cystoscopes used institutional data. The cost breakdown included capital, reprocessing, repair, procedure, and environmental impact expenses. Data collection occurred in 2022, utilizing registered data, observations, and expert opinions. Depreciation was applied over 5 years for reusable cystoscopes and 8 years for the automated endoscope reprocessor. Deterministic sensitivity analyses gauged result robustness to input variations. Lastly, an assessment of the environmental footprint, focusing on water consumption and waste generation, was conducted. Per-procedure cost associated with reusable cystoscopes was €332.46 vs €220.19 associated with single-use, resulting in savings of €112.27. When projecting these costs per procedure with the number of procedures performed in 2022 (1186), comparing the costs of procedures performed in 1 year with reusable endoscopes (€394,295.86) to the costs of the exact number of procedures performed with disposable endoscopes (€261,149.37), a saving of €133,146.49 could be achieved. Additionally, after continuous use of single-use endoscopes, procedures were scheduled every 20 minutes instead of every 30 minutes. This adjustment allowed for 15 daily procedures instead of 10 while maintaining the same shift. This suggests potential advantages in terms of improved organizational impact and reduced waiting lists. Ultimately, the decreased environmental impact favored the adoption of single-use cystoscopes. Our study presents an opportunity for organizational development in response to the evolving external environment, considering user needs, market dynamics, and competition with other facilities. [ABSTRACT FROM AUTHOR]

This study describes program implementation through a research-restaurant partnership and assesses participant satisfaction, program costs, and percent body weight changes. Participants (n = 60) in a virtual synchronous (n = 43) or virtual asynchronous (n = 17) 12-week plant-based nutrition program received restaurant vouchers. Class satisfaction data were collected weekly. Assessments were completed at baseline, 3 months, and 9 months, along with interviews (n = 13) between 3 and 9 months. The costing approach estimated costs per participant. Interviews were coded using a content analysis and constant comparative method. Participants rated the intervention favorably. Program costs were $198.63/participant, and participants' willingness to pay postintervention was $101.50 ± $63.90. Participants shared satisfaction with course content, the restaurant partnership, and suggestions for future delivery. No changes in participants' percent body weight were observed between 3 and 9 months (P = 0.98), indicating maintenance of 3-month weight loss. A research-restaurant partnership successfully implemented a nutrition program and generated positive feedback. With the lifting of coronavirus disease 2019 pandemic restrictions, future research can now test alternative implementation methods (in person vs online) in other restaurants. [ABSTRACT FROM AUTHOR]