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Obtaining sub-chemical accuracy (1 kJ mol−1) for reaction energies of medium-sized gas-phase molecules is a longstanding challenge in the field of thermochemical modeling. The perturbative triples correction to coupled-cluster single double triple [CCSD(T)] constitutes an important component of all high-accuracy composite model chemistries that obtain this accuracy but can be a roadblock in the calculation of medium to large systems due to its O ( N 7 ) scaling, particularly in HEAT-like model chemistries that eschew separation of core and valence correlation. This study extends the work of Lesiuk [J. Chem. Phys. 156, 064103 (2022)] with new approximate methods and assesses the accuracy of five different approximations of (T) in the context of a subset of molecules selected from the W4-17 dataset. It is demonstrated that all of these approximate methods can achieve sub-0.1 kJ mol−1 accuracy with respect to canonical, density-fitted (T) contributions with a modest number of projectors. The approximation labeled Z ̃ T appears to offer the best trade-off between cost and accuracy and shows significant promise in an order-of-magnitude reduction in the computational cost of the CCSD(T) component of high-accuracy model chemistries. [ABSTRACT FROM AUTHOR]

Although selected configuration interaction (SCI) algorithms can tackle much larger Hilbert spaces than the conventional full CI method, the scaling of their computational cost with respect to the system size remains inherently exponential. In addition, inaccuracies in describing the correlation hole at small interelectronic distances lead to the slow convergence of the electronic energy relative to the size of the one-electron basis set. To alleviate these effects, we show that the non-Hermitian, transcorrelated (TC) version of SCI significantly compactifies the determinant space, allowing us to reach a given accuracy with a much smaller number of determinants. Furthermore, we note a significant acceleration in the convergence of the TC-SCI energy as the basis set size increases. The extent of this compression and the energy convergence rate are closely linked to the accuracy of the correlation factor used for the similarity transformation of the Coulombic Hamiltonian. Our systematic investigation of small molecular systems in increasingly large basis sets illustrates the magnitude of these effects. [ABSTRACT FROM AUTHOR]

We present a four-component relativistic unitary coupled cluster method for atoms and molecules. We have used commutator-based non-perturbative approximation using the "Bernoulli expansion" to derive an approximation to the relativistic unitary coupled cluster method. The performance of the full quadratic unitary coupled-cluster singles and doubles method (qUCCSD), as well as a perturbative approximation variant (UCC3), has been reported for both energies and properties. It can be seen that both methods give results comparable to those of the standard relativistic coupled cluster method. The qUCCSD method shows better agreement with experimental results due to the better inclusion of relaxation effects. The relativistic UCC3 and qUCCSD methods can simulate the spin-forbidden transition with easy access to transition properties. A natural spinor-based scheme to reduce the computational cost of relativistic UCC3 and qUCCSD methods has been discussed. [ABSTRACT FROM AUTHOR]

Fuel cell-battery electric drivetrains are attractive alternatives to reduce the shipping emissions. This research focuses on emission-free cargo vessels and provides insight on the design, lifetime operation and costs of hydrogen-hybrid systems, which require further research for increased utilization. A representative round trip is created by analysing one-year operational data, based on load ramps and power frequency. A low-pass filter controller is employed for power distribution. For the lifetime cost analysis, 14 scenarios with varying capital and operational expenses were considered. The Net Present Value of the retrofitted fuel cell-battery propulsion system can be up to $ 2.2 million lower or up to $ 18.8 million higher than the original diesel mechanical configuration, highly dependent on the costs of green hydrogen and carbon taxes. The main propulsion system weights and volumes of the two versions are comparable, but the hydrogen tank (68 tons, 193 m3) poses significant design and safety challenges. • Selection of a round trip power profile based on load ramps and power frequency. • A real-time low-pass filter-based controller is employed for power distribution. • Lifetime cost estimation, considering degradation, for varying CAPEX and OPEX. • Hydrogen system NPV between $2.2e6 lower and $18.8e6 higher than diesel system NPV. • The LH 2 tank size (68 tons, 193 m3) poses significant design and safety challenges. [ABSTRACT FROM AUTHOR]

CRISPR/Cas systems are increasingly utilized for sensitive miRNA detection through enzyme-based pre-amplification. To address challenges such as high costs, non-specific amplification, and interference from primer residues in pre-amplification strategies, herein a dual amplification CRISPR miRNA assay was developed by combining enzyme-free HCR with single-particle analysis. Attomolar detection limits, excellent selectivity, and practicability were achieved by applying this method. [ABSTRACT FROM AUTHOR]

Background: Clinical guidelines are widely used to support clinical decision making, so they could also provide economic information about medical interventions to promote cost-conscious health care. We developed a new way to integrate economic information into the Finnish Current Care Guidelines. Methods: Our development team consisted of clinical guideline specialists and health economists. We first looked at integration of economic information in clinical guidelines of other countries. Our key principle was that economic information should be integrated only to mutually exclusive medical interventions where the extensive choice of one the options will yield a significant cost differences on the national level. For the comparative effectiveness information of the interventions, we primarily looked for network meta-analyses. We then combined the effectiveness information presented as number needed to treat with prices or costs for the interventions and present the result as a cost per responder, which reflects both effectiveness and price or costs. Results: We introduce a process to integrate and present the economic information of the selected interventions in tables in the Current Care Guidelines. Conclusions: Our novel way to integrate economic information into the Current Care Guidelines is an effort to support cost-conscious clinical decision making to promote cost-effective health care in Finland. This process is general and could be used in clinical guidelines in other countries as well. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusion Replacing single‐use operating theatre equipment with reusables might be one strategy for reducing the carbon footprint of operating theatres. However, in Australia, where the energy mix is predominantly fossil‐fuel‐based, the re‐sterilization of reusables may increase the carbon footprint. We analyzed the financial and environmental impacts of introducing reusable operating theatre light handles in two NSW hospitals.The effects on cost, waste, and carbon footprint of replacing disposable light handle covers with reusable handles in each hospital were analyzed over 12 months using procurement, waste and sterilization data, and life cycle assessment.Energy requirement for sterilization of reusable handles, increasing alongside weight of the handle, resulted in higher carbon footprint than using disposable covers. At one hospital, using a heavy handle increased carbon emissions sixfold, while the cost of handle sterilization exceeded the cost of disposable covers, resulting in 11% higher cost per use. At the other hospital, using a lighter handle increased carbon emissions by 40% per use, while sterilization cost was less than the cost of disposable covers, resulting in 14.8% lower cost per use. Scenario modelling indicated that sterilizing handles as part of a hollowware set rather than as individual items would significantly reduce cost and carbon footprint. At both hospitals, associated clinical waste was essentially eliminated.Judicious replacement of disposable covers with lightweight yet durable reusable handles can reduce costs, but increases carbon footprint in the current Australian energy context. Adopting predominantly renewable energy and more efficient sterilization practice would mitigate this. [ABSTRACT FROM AUTHOR]

Background: Malaria is a major cause of ill health and death in children in Africa. The disease also imposes a severe social and economic burden on households and health systems and is strongly associated with poverty. This study summarizes the most up-to-date cost of treating severe malaria in children in Africa. Methods: A systematic search was conducted in PubMed, Embase, Cinahl, and Web of Science databases. Google and Google Scholar were searched for grey literature followed by scanning of the reference lists of the previous systematic reviews. The search was limited to children < 12 years, malaria-endemic countries in Africa, and the English language. All costs were adjusted to the year 2023. Results: 19 studies conducted in 12 countries were identified: 14 reported provider costs, and 11 household costs. Out of the 19 studies found, 11 were published before 2018 while 11 reported data that are currently more than ten years old. Studies varied methodologically and in the scope of resources included to estimate the cost. The provider costs ranged from USD 27 in Uganda to USD 165 per patient in Kenya (median value USD 90), while household costs ranged from USD 13 in Kenya to USD 245 per patient in Gabon (median value USD 50). All identified household malaria treatment costs except one represented catastrophic health expenditure, making out more than 10% of the monthly Gross National Income per capita in the respective countries. Conclusion: Evidence on the cost of treating severe malaria in children in Africa is scarce. However, the few existing studies show that severe malaria in children imposes a significant economic burden on the providers and households. More studies are needed, particularly in high-burden high-impact countries, to inform resource allocation decisions. [ABSTRACT FROM AUTHOR]

AbstractA (T,N,n) preventive replacement first (PRF) policy is proposed in this article to investigate a parallel system with two independent parts where the secondary part is in a cold-standby state initially. Before the system fails completely, a preventive replacement is carried out at the planned time T, the time when the system successively completes N jobs or the time when the system suffers the n-th type-I failure, whichever occurs first. The system deteriorates stochastically, and it may experience two types of failures: type-I (repairable or minor) failure and type-II (non repairable or catastrophic) failure. When the system suffers a type-II failure, it’s correctively replaced. This model is widely applied in real-life scenarios, especially in the aviation industry. Under the single-parameter optimization scenario, both cost-minimal N and n exhibit favorable convexity characteristics. This indicates that we can uniquely determine the optimal N and n under the principle of minimizing the mean cost rate. Furthermore, we find that the mean cost rate cannot be minimized as T is less than a certain threshold, which implies that the planned time of the preventive replacement should not be implemented too early. In addition, the optimal multi-dimensional replacement policy that minimizes the mean cost rate can be uniquely obtained by theoretical or numerical analysis. Our proposed model provides a versatile formulation for analyzing a large variety of replacement policies. Compared with previous literature, the PRF policy adopted in this article integrates T-, N- and n- control policies, making it more comprehensive. It’s of practical significance for relevant enterprises to make decisions, assisting them in minimizing the mean cost rate while enhancing system reliability. [ABSTRACT FROM AUTHOR]

Dynamic focusing of electromagnetic (EM) waves is a cornerstone in various applications, encompassing aerospace communication, sensing, and high‐resolution imaging. Recently, the advent of intelligent metasurfaces, hailed as the next evolutionary step, has revolutionized self‐adaptive functionalities. However, their extensive embeddings of active components pose a great challenge associated with escalated costs, heightened power consumption, and increased complexity, thus hindering large‐scale implementation. Here, a cost‐effective approach for dynamic EM focusing utilizing a twisted metasurface is introduced, which integrates a transmissive layer with a reflective layer in a cascade fashion. This innovative design leverages the mutual rotation between two layers to enable the precise manipulation of beam propagation and scanning area, allowing for the flexible localization of the focal point across a wide range, spanning −44.17° to 44.17° in elevation and 0° to 360° in azimuth. This capability is underpinned by the strategic fusion of multiple phase profiles, including gradient and Gaussian phase. In the experiment, a goal‐oriented system is built up whose outcomes demonstrate a striking alignment with the simulated results, achieving a correlation coefficient of 96.7%. This work presents a streamlined pathway toward dynamic EM focusing and the related applications constrained by space and power limitations. [ABSTRACT FROM AUTHOR]

Restricted randomised designs are essential in the pharmaceutical synthesis due to the operational restrictions and their cost‐effectiveness compared to entirely randomised designs. Specifically, the split‐plot designs are very effective in reducing the cost of an experiment in the presence of hard‐to‐change factors and/or of multi‐stage processes. In classical designs, replicated runs for pure‐error estimation are commonly employed, but they are rarely used in the more complex setting of restricted randomisation. The reason is that, in practice, experiments in industry rarely can follow all the assumptions/conditions that are included in the methodological papers. In this work, we demonstrate how a split‐plot design based on a Bayesian D$D$‐optimality criterion built to ensure more precise pure‐error estimation of the variance components can be easily adapted to fit the additional needs, the speedy implementation and the restrictions that a real case scenario in industry often imposes. We focus on the practical aspect of how to modify the complex design in a way that keeps/improves the desired qualities and on how to assess impact of changes that are more arbitrary. [ABSTRACT FROM AUTHOR]

Visual search is guided by mental representations of target‐defining features (attentional templates) that are activated in a preparatory fashion. It remains unknown how many templates can be maintained concurrently, and what kind of costs are associated with multiple‐template versus single‐template search. Here, we compared the operation of attentional templates during three‐color and single‐color search tasks. Preparatory template activation processes were tracked by measuring N2pc components to task‐irrelevant singleton color probes that appeared in rapid succession during the interval between search displays. These probes attract attention (as indexed by an N2pc) if the corresponding color template is active at the time when the probe appears. In a three‐color search task where target identity was fully predictable (Experiment 1), only probes that matched the upcoming target color triggered N2pcs, demonstrating that only a single target template was activated. When three possible color targets appeared randomly and unpredictably (Experiment 2), probes that matched any of these colors triggered N2pcs, demonstrating that all three templates were activated concurrently. However, relative to a single‐color search task, clear costs emerged in this three‐color task for attentional guidance toward search targets and for search performance. These costs appear to be linked to inhibitory interactions between simultaneously active search templates. These findings show that while at least three target templates can be maintained in parallel, multiple‐template search is still subject to capacity limitations which affect both template‐guided attentional guidance and the subsequent selective processing of search targets. [ABSTRACT FROM AUTHOR]

This contribution offers a survey of the field of biblical drama research and of several approaches. It makes a plea for a transnational approach of studying early modern drama, especially biblical drama. Such a transnational approach is a continuation of many of these earlier approaches, makes use of some and breaks with others. The contribution also shows that it is important to include Neo-Latin drama in the study of early modern drama at the cost of losing sight on a crucial constituent part of the development of this drama and this theatre. Neo-Latin drama contributed to the knowledge and reception of the Bible among the elites and among the ordinary people who attended performances of these plays or of one of the many translations and adapations. [ABSTRACT FROM AUTHOR]

Background and Purpose: Cerebral infarction remains an important cause of death or disability in patients with aneurysmal subarachnoid hemorrhage (SAH). The prevalence, trends, and outcomes of cerebral infarction in patients with aneurysmal SAH at a national level are not known. Methods: We identified the proportion of patients who develop cerebral infarction (ascertained using validated methodology) among patients with aneurysmal SAH and annual trends using the Nationwide Inpatient Sample (NIS) from 2016 to 2021. We analyzed the effect of cerebral infarction on in‐hospital mortality, routine discharge without palliative care (based on discharge disposition), poor outcome defined by the NIS SAH outcome measure, and length and costs of hospitalization after adjusting for potential confounders. Results: A total of 35,305 (53.6%) patients developed cerebral infarction among 65,840 patients with aneurysmal SAH over a 6‐year period. There was a trend toward an increase in the proportion of patients who developed cerebral infarction from 51.5% in 2016 to 56.1% in 2021 (p trend p<.001). Routine discharge was significantly lower (30.5% vs. 37.8%, odds ratio [OR] 0.82, 95% confidence interval [CI] 0.75‐0.89, p<.001), and poor outcome defined by NIS‐SAH outcome measure was significantly higher among patients with cerebral infarction compared with those without cerebral infarction (67.4% vs. 59.3%, OR 1.29, 95% CI 1.18‐1.40, p<.001). There was no difference in in‐hospital mortality (13.0% vs. 13.6%, OR 0.94, 95% CI 0.85‐1.05, p =.30). The length of stay (median 18 days [interquartile range [IQR] 13‐25] vs. 14 days [IQR 9‐20]), coefficient 3.04, 95% CI 2.44‐3.52 and hospitalization cost (median $96,823 vs. $71,311, coefficient 22,320, 95% CI 20,053‐24,587) were significantly higher among patients who developed cerebral infarction compared with those who did not develop cerebral infarction. Conclusions: Cerebral infarction was seen in 54% of the patients with a trend toward an increase in the affected proportion of patients with aneurysmal SAH. Patients with cerebral infarction had higher rates of adverse outcomes and required higher resources during hospitalization. [ABSTRACT FROM AUTHOR]

Fused deposition molding (FDM) is a commonly used 3D printing method, and polylactic acid (PLA) has become one of the most important raw materials for this technology due to its excellent warping resistance. However, its mechanical properties are insufficient. Polybutylene adipate terephthalate (PBAT) is characterized by high toughness and low rigidity, which can complement the performance of PLA. The biodegradable polymers produced by blending the two have thus been used to replace petroleum-based plastics in recent years, but the high cost of the blends has limited their wide applications. Introducing plant fibers into the blends can not only maintain biodegradability and improve the overall performance of the plastics but also reduce their costs greatly. In this study, the PBAT/PLA blends with a mass ratio of 70/30 were selected and mixed with wood flour (WF) to prepare ternary composites using a FDM 3D printing technique. The effects of WF dosage on the mechanical properties, thermal properties, surface wettability, and melt flowability of the composites were investigated. The results showed that the proper amount of WF could improve the tensile and flexural moduli of the composites, as well as the crystallinity and hydrophobicity of the printed specimens increased with the content of WF, while the melt flow rate decreased gradually. Compared to PBAT/PLA blends, WF/PBAT/PLA composites are less costly, and the composite containing 20 wt.% WF has the best comprehensive performance, showing great potential as raw material for FDM 3D printing. [ABSTRACT FROM AUTHOR]

Background: Potentially inappropriate medications (PIMs) are medications whereby the harms may outweigh the benefits for a given individual. Although overprescribed to older adults, their direct costs on the healthcare system are poorly described. Methods: This was a cross‐sectional study of the cost of PIMs for Canadians aged 65 and older, using adapted criteria from the American Geriatrics Society. We examined prescription claims information from the National Prescription Drug Utilization Information System in 2021 and compared these with 2013. The overall levels of inflation‐adjusted total annual expenditure on PIMs, average cost per quarterly exposure, and average quarterly exposures to PIMs were calculated in CAD$. Results: Exposure to most categories of PIMs decreased, aside from gabapentinoids, proton pump inhibitors, and antipsychotics, all of which increased. Canadians spent $1 billion on PIMs in 2021, a 33.6% reduction compared with 2013 ($1.5 billion). In 2021, the largest annual expenditures were on proton pump inhibitors ($211 million) and gabapentinoids ($126 million). The quarterly amount spent on PIMs per person exposed decreased from $95 to $57. In terms of mean cost per person, opioids and antipsychotics were highest ($138 and $118 per exposure). Some cost savings may have occurred secondary to an observed decline of 16.4% in the quarterly rate of exposure to PIMs (from 7301 per 10,000 in 2013 to 6106 per 10,000 in 2021). Conclusions: While expenditures on PIMs have declined in Canada, the overall cost remains high. Prescribing of some seriously harmful classes of PIMs has increased and so directed, scalable interventions are needed. [ABSTRACT FROM AUTHOR]

Recently, super-resolution (SR) has achieved superior performance with the development of deep learning. However, previous methods usually require considerable computational resources with a large model size, which hinders practical applications. To achieve real-time inference and high quality for SR, this paper presents an edge-priority-extraction network, which is constructed with our proposed edge-priority blocks (EPB). The EPB utilizes multiple branches with edge information to further improve the network representation. Moreover, it can be re-parameterized for efficient inference. For more effective utilization of edge information, this paper also proposes the mix-priority filter with edge extraction of horizontal and vertical priorities to improve the network performance. The filters can adaptively extract the edge information with multi-direction derivatives. The experimental results show that our models can use less computational cost to meet the real-time demand and have a better SR performance than the recent real-time SR models. [ABSTRACT FROM AUTHOR]

Building and construction projects are associated with the country's internal and external conditions, which exposes them to risks throughout their lifespan; hence, the construction industry is one of the industries influencing the country's economy. Therefore, the study aims to identify and evaluate the risks associated with Egyptian building and construction sector conditions. Consequently, this study explained and examined the risk management concept and its emergence in construction projects, along with the five stages of risk management. On the other hand, the study analyzed and demonstrated the concept, characteristics, and significance of the construction industry, its influential role in development plans, the position of that industry in Egypt, and many other factors that hinder this pivotal industry. Therefore, the study investigated many previous studies to identify the most significant risks facing the Egyptian construction sector due to the lack of a fixed database of risks for all projects and classify them according to quality, cost, performance, and schedule. Finally, to assess the significance of these risks and rank them according to the occurrence probability, the hazard size, and the threat degree relative to the Egyptian building and construction industry. A field study was conducted through interviews and a questionnaire based on the ChiSquare test in light of the architectural, urban, and infrastructure projects Egypt is currently undertaking within Vision 2030. Consequently, it will facilitate dealing with, managing, and treating risks and reducing and preventing their consequences as a standardized database. [ABSTRACT FROM AUTHOR]

In recent years, diversified measurements reflect the system dynamics from a more comprehensive perspective in system modeling and analysis, such as scalars, waveform signals, images, and structured point clouds. To handle such multimodal structured high-dimensional (SHD) data, combining a large amount of data from multiple sites is necessary (i) to reduce the inherent population bias from a single site and (ii) to increase the model accuracy. However, impeded by data management policies and storage costs, data could not be easily shared or directly exchanged among different sites. Instead of simplifying or facilitating the data query process, we propose a federated multiple tensor-on-tensor regression (FedMTOT) framework to train the individual system model locally using (i) its own data and (ii) data features (not data itself) from other sites. Specifically, federated computation is executed based on alternating direction method of multipliers (ADMM) to satisfy data-sharing requirements, while the individual model at each site can still benefit from feature knowledge from other sites to improve its own model accuracy. Finally, two simulations and two case studies validate the superiority of the proposed FedMTOT framework. [ABSTRACT FROM AUTHOR]

Applied nucleation and other spatially patterned restoration methods are promising approaches for scaling up projects to meet ambitious international restoration commitments in an ecologically and economically sound manner. Much of the corresponding literature to date, however, has centered around theoretical discussions and small‐scale studies that are largely divorced from constraints faced by restoration practitioners. We briefly review recent academic literature about applied nucleation and other spatially patterned restoration methods and discuss practical challenges to their implementation. We offer several recommendations to move spatially patterned restoration from an academic conversation to scalable application, including: (1) comparing different planting designs and natural regeneration within the same system at an appropriate scale; (2) monitoring ecological outcomes throughout the restored area over sufficient time to evaluate recovery; (3) quantifying costs and documenting other logistical constraints to implementation; and (4) exploring methods for using unplanted areas to provide benefits to landholders until planted vegetation establishes. [ABSTRACT FROM AUTHOR]

Multispectral long-wave infrared (LWIR) ranging is a technique that estimates the distance to the object based on wavelength-dependent absorption of LWIR light through the air. Prior works require time-consuming measurements for calibration and solve non-linear inverse problems, which sometimes falls into a local minimum. In this paper, we propose a linear representation that connects the measurements and the scene parameters using the affine matrix. In this representation, the distance and the temperature of the object can be obtained as a closed-form solution and the calibration cost can be reduced to at least three observations. In real-world experiments, we demonstrate that our method is effective to reduce the calibration cost while keeping the precision of the depth estimation. [ABSTRACT FROM AUTHOR]

This study presents an innovative approach for developing a reduced-order model (ROM) tailored specifically for nearly incompressible materials at large deformations. The formulation relies on a three-field variational approach to capture the behavior of these materials. To construct the ROM, the full-scale model is initially solved using the finite element method (FEM), with snapshots of the displacement field being recorded and organized into a snapshot matrix. Subsequently, proper orthogonal decomposition is employed to extract dominant modes, forming a reduced basis for the ROM. Furthermore, we efficiently address the pressure and volumetric deformation fields by employing the k-means algorithm for clustering. A well-known three-field variational principle allows us to incorporate the clustered field variables into the ROM. To assess the performance of our proposed ROM, we conduct a comprehensive comparison of the ROM with and without clustering with the FEM solution. The results highlight the superiority of the ROM with pressure clustering, particularly when considering a limited number of modes, typically fewer than 10 displacement modes. Our findings are validated through two standard examples: one involving a block under compression and another featuring Cook's membrane. In both cases, we achieve substantial improvements based on the three-field mixed approach. These compelling results underscore the effectiveness of our ROM approach, which accurately captures nearly incompressible material behavior while significantly reducing computational expenses. [ABSTRACT FROM AUTHOR]

This study examines the strategic choices of enterprises regarding exploitative and exploratory innovation, drawing on the ambidextrous innovation theory and using a case analysis of Ningbo Cixing Co., Ltd in China (referred to as 'Cixing' for short). The study constructs an evolutionary game model to analyse these choices from a micro perspective. The results of the study suggest that when the costs and opportunity costs associated with exploitative innovation are lower, the growth rate of innovation benefit is higher, and enterprises are more likely to adopt an exploitative innovation strategy. On the other hand, when the costs associated with exploratory innovation are lower, the success rate of innovation is higher, and enterprises are more likely to adopt an exploratory innovation strategy. The study also reveals that enterprises alternate between exploitative and exploratory innovation modes in response to changes in the external environment. This dynamic evolution shows a regular and complementary pattern of quantitative and qualitative change that promotes innovation growth. [ABSTRACT FROM AUTHOR]

Background: Evidence describing the types and annual costs of biological treatments for psoriasis in Latin America is scarce. This study aimed to estimate the frequency of use and costs of biologic therapy for psoriasis in Colombia in 2019. Methods: This secondary data analysis uses the International Classification of Diseases terms associated with psoriasis, excluding those related to psoriatic arthritis, based on data from the registry of the Colombian Ministry of Health. We estimated the prevalence of psoriasis per 100,000 inhabitants; then, we retrieved the frequency of use of biologic therapy in patients with psoriasis and estimated the cost per year of each and overall therapies in 2019 in US dollars (USD). Results: There were 100,823 patients with psoriasis in Colombia in 2019, which amounts to a prevalence of 0.2% in the general population. Of those patients, 4.9% received biologic therapy, most frequently males (60%). The most commonly used biological therapies for psoriasis in Colombia in 2019 were ustekinumab (35.2%), with an annual cost per patient of $12,880 USD; adalimumab (26%), with a yearly cost per patient of $7130 USD; and secukinumab (19.8%), with an annual cost per patient of $6825 USD. Conclusion: This is the first study to describe the use and cost of biological therapy for psoriasis in Colombia. It provides valuable cost‐awareness information for the Colombian health system. [ABSTRACT FROM AUTHOR]

Background: Several organizations have proposed guidelines or clinical decision tools for the management of patients with disorders of gut‐brain interactions (DGBI) affecting the lower digestive tract including irritable bowel syndrome and chronic idiopathic constipation. Such algorithms are based on sequential therapeutic trials and modifying the treatment strategy based on efficacy and adverse events. Purpose: The aims of this review are to evaluate the evidence for efficacy of second‐ and third‐line pharmacotherapies and to assess the evidence for the alternative option to manage subgroups of patients with symptoms suggestive of lower DGBI based on diagnostic tests or documented dysfunctions. The preeminent tests to identify such subgroups that present with symptoms that overlap with lower DGBI are detailed: digital rectal examination as well as anorectal manometry and balloon expulsion for evacuation disorders, detailed measurements of colonic transit, and diagnosis of bile acid diarrhea or carbohydrate malabsorption based on biochemical measurements. The review also addresses the cost implications of screening to exclude alternative diagnoses and the costs of therapy associated with the therapeutic options following an algorithmic approach to treatment from the perspective of society, insurer, or patient. Finally, the costs of the diagnostic tests to identify actionable biomarkers and the evidence of efficacy of individualized therapy based on formal diagnosis or documentation of abnormal functions are detailed in the review. [ABSTRACT FROM AUTHOR]

Inspections often perform imperfect outcomes during maintenance processes owing to human errors, management issues and other limitations. In particular, such imperfection affects the maintenance management of multistage deterioration significantly due to both false state identification and measurement errors, whose quantitative analysis, however, is seldom reported in the literature. To fill these gaps, this paper devises a condition‐based maintenance management strategy oriented to two‐stage continuous degradation under two‐dimensional inspection imperfection. Specifically, a threshold‐based replacement is executed under the normal‐working state if the detected degradation value exceeds the preset limit; additionally, preventive replacement is immediately performed once the defective state is identified. Notably, the detection outcome rather than the actual working condition decides how preventive maintenance operates. The long‐run cost rate is minimized via the optimization of the inspection cycle and replacement limit. Besides, numerical experiments conducted on train bogie bearing are provided, showing substantial superiorities over cost‐effectiveness promotion and performance improvement. [ABSTRACT FROM AUTHOR]

Prior research on task switching has shown that the reconfiguration of stimulus–response mappings across trials is associated with behavioral switch costs. Here, we investigated the effects of switching representations of target‐defining features in visual search (attentional templates). Participants searched for one of two color‐defined target objects that changed predictably every two trials (Experiment 1) or every four trials (Experiment 2). Substantial costs were observed for search performance on target switch relative to target repeat trials. Preparatory target template activation processes were tracked by measuring N2pc components (indicative of attentional capture) to a rapid series of task‐irrelevant color singleton probes that appeared during the interval between search displays, and either matched the currently relevant or the other target color. N2pcs to relevant target color probes emerged from 800 ms before search display onset on target repetition trials, reflecting the activation of a corresponding color template. Crucially, probe N2pcs only emerged immediately before target onset on target switch trials, indicating that preparatory template activation was strongly delayed. In contrast, irrelevant color singleton probes did not trigger N2pcs on either repeat or switch trials, suggesting the absence of any target template inertia across trials. These results show that switching the identity of search targets delays preparatory target template activation and impairs subsequent attentional guidance processes. They suggest that performance costs on switch versus repeat trials are associated with differences in the time course of task preparation. Switching between cognitive tasks results in substantial performance costs, but the mechanisms responsible for these costs are not yet fully understood. Using electrophysiological markers of task preparation processes in visual search, we show that preparation is delayed when the identity of an upcoming search target changes. This new finding suggests strong links between switch costs and the time course of activating preparatory attentional task sets. [ABSTRACT FROM AUTHOR]

The performance optimization of Apache Spark, a widely used distributed computing framework, is crucial for the efficient execution of data-intensive workloads. However, the automatic tuning of around 180 internal configuration features of Spark for getting optimum performance can be a complex, expensive, and time-consuming task. This research paper aims to address these challenges along with the task of reducing execution time and tuning cost for benchmark Spark MLlib workloads on a benchmark dataset by automating the tuning process. A grid search based novel approach Reduced Internal Configuration Grid (RICG) is proposed that reduces the Spark's configuration feature values grid levaraging exponential projective sampling. A significant reduction in Spark workload execution time is obtained at a low cost without compromising the performance of the CPU, memory and network resources of the system. Extensive experimentation and evaluation demonstrate the effectiveness of the proposed approach, showcasing notable reductions of around 26–30% in execution time for benchmark workloads. This reduction is achieved by cutting the features tuning cost by approximately 58 to 60% compared to the prior best grid search based approach. The proposed RICG model outperforms existing statistical trial-test approaches, striking a favorable balance between performance optimization and cost optimization. Lastly, the logs generated by the RICG model are used to predict the performance of Spark application workloads by using the boosting algorithms with around 90% accuracy. The findings of this research highlight the potential of automated tuning techniques to enhance the performance of Apache Spark-based applications with cost efficiency. [ABSTRACT FROM AUTHOR]

Verifiable outsourced attribute-based encryption (VO-ABE) enables one-to-many data sharing and fine-grained access control under lower trust, making it suitable for cloud or edge systems involving resource-constrained devices. There is no fully outsourced and fully verifiable attribute-based encryption scheme or key-policy VO-ABE scheme. Moreover, the previous VO-ABE schemes require multiple rounds of interaction or high verification costs to support verifiable outsourced key generation and verifiable outsourced encryption. To address these issues, in this paper, we propose an effective key-policy fully outsourced and fully verifiable attribute-based encryption scheme supporting verifiable outsourced key generation, encryption, and decryption simultaneously. We formally define two new properties: outsourced key generation verifiability and outsourced encryption verifiability. Analysis and simulation show that the proposed scheme performs well and is practical. All local computational overheads of the proposed scheme are constant and do not increase with the number of attributes or the complexity of access structures. [ABSTRACT FROM AUTHOR]

The 30,000+ known Near Earth Objects (NEOs) are some of the closest objects to Earth. A few dedicated missions such as NEAR, Hayabusa-1 and -2, OSIRIS-Rex, and DART have revealed a lot about their nature, with more to come from ESA's Hera mission, and others. Dedicated space missions to individual NEOs are relatively costly, however, so we seek to find a way to reduce costs so that the composition and structure of more NEOs can be fully characterized, and we can continue to explore how to change the trajectory of selected objects, as was done with DART. Here we describe a low-cost approach to NEO missions for small body science and planetary defense that makes use of existing or planned space vehicles. • Low-cost approach to fly by, rendezvous with, or impact Near Earth Objects. • Repurposes existing or planned space vehicles. • Case Study using the Artemis European Service Module. [ABSTRACT FROM AUTHOR]

The proper positioning of Virtual Machines (VMs) on the hosts in a cloud environment reduces the need for the VM migration and its consequences. The positioning becomes more significant when there exists a multi-cloud environment where the hosts exist on multi-site datacenters. Based on user's requests, VMs should be dynamically positioned; however, if the users' future demands can be predicted, the positioning can be adaptively done in advance, which is both more cost-effective for users and more requests are met. To this end, at the request of their users, VMs' providers can reserve VMs for the users' future needs. However, if some users would not like to reserve VMs or if the number of reserved VMs is less than users' needs, VMs should be allocated on demand. However, the reserve or on-demand policy cannot be applied freely if users have constraints and objectives. Among others, cost of using resources and response time are the most important users' objectives, and load balancing hosts and datacenters for the proper resource utilization is the most important providers' objective. To consider the reserve policy, a multi-layered model is presented in this paper where a multi-objective optimization is used to meet the objectives. The proposed model was applied to Google, Wikipedia, and NASA datasets. The results show: (1) The number of predicted VMs for reserve is closer to the real VMs requested in datasets NASA, Wikipedia, and Google than the related work. This was due to the use of a dynamic neural network, called NARX; (2) objective cost is regarded more than the related work, while it respects more trade-off between the user's objectives and provider's one; (3) placement of VMs on hosts is done in a balanced way, leading to the reduction of overloaded hosts and response time. [ABSTRACT FROM AUTHOR]

ABSTRACT This article studies the guaranteed cost extended dissipative stabilization problem of switched IT2 fuzzy systems (SIT2FSs) with switching signal transmission delays and local nonlinear model. The guaranteed cost H∞$$ {H}_{\infty } $$ performance, guaranteed cost strict dissipative performance, guaranteed cost L2$$ {L}_2 $$ − L∞$$ {L}_{\infty } $$ performance and guaranteed cost passivity performance are considered for SIT2FSs in a unified form. First, a novel asynchronous control scheme is proposed for SIT2FSs with local nonlinear model. The controller gains in mismatched interval are designed separately. By using a premise‐variable‐domain‐partition‐dependent switched fuzzy Lyapunov functions (PDSFLFs) approach, the membership‐function‐shape‐independent (MFSI) existence conditions of a class of IT2 fuzzy switched controllers, which can ensure the guaranteed cost extended dissipative performance of SIT2FSs, are established. Then, by utilizing the shape information of membership functions and dividing the premise variable domain into multiple partitions, the membership‐function‐shape‐dependent (MFSD) existence conditions of a class of premise‐variable‐domain‐partition‐dependent (PVDPD) IT2 fuzzy switched controllers are presented. The results indicate that less conservative results can be achieved by using the PVDPD IT2 fuzzy switched controllers, and better system performance can be gotten compared with the Type‐1 fuzzy switched controllers. Finally, the effectiveness of the results is demonstrated through a robot arm model. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to analyze the reliability and characteristics of the non‐series‐parallel network. The illustrative non‐series parallel networks, that is, the Twin T‐Network and the network with six components of resistor and capacitor, have been converted into a series of parallel network combinations by use of the minimal path technique. The stochastic variables related to component failure rate have been demonstrated using exponential decay distribution. We obtain the reliability, mean time to failure, and sensitivity with the use of the exponential decay distribution. The reliability and its attributes are examined by assuming different values of scale and shape parameters at different points of time. Using Owen's methodology, we obtained minimal signature, tail signature, expected time, expected cost, and Barlow‐Proschan index were determined. The performance of all reliability characteristics has been observed graphically for arbitrary values of parameters. A real‐world example is used to introduce the point. [ABSTRACT FROM AUTHOR]

Background and Aims Design Setting Participants Measurements Findings Conclusions During the COVID‐19 pandemic, there was a surge in opioid overdose deaths (OODs) in Massachusetts, USA, particularly among Black and Hispanic/Latinx populations. Despite the increasing racial and ethnic disparities in OODs, there was no compensatory increase in naloxone distributed to these groups. We aimed to evaluate two community‐based naloxone expansion strategies, with the objective of identifying approaches that could mitigate mortality and racial and ethnic disparities in OODs.Individual‐based simulation model. We measured naloxone availability using naloxone kits per OOD and evaluated scenarios of achieving higher benchmarks for naloxone availability (i.e. 40, 60 and 80 kits per OOD) from 2022 levels (overall: 26.0, White: 28.8, Black: 17.3, Hispanic/Latinx: 18.9). We compared two naloxone distribution strategies: (1) proportional distribution: achieving the benchmark ratio at the overall population level while distributing additional kits proportional to the 2022 level for each racial/ethnic group (at 40 kits per OOD benchmark: overall: 40, White: 44.3, Black: 26.6, Hispanic/Latinx: 29.1), and (2) equity‐focused distribution: achieving the benchmark ratio among each racial/ethnic group (at 40 kits per OOD benchmark: 40 for all groups).Massachusetts, United States.People at risk of OOD.Annual number and rate of OODs, total healthcare costs of increasing naloxone availability.Both naloxone distribution strategies yielded comparable predicted reductions in total OODs in 2025 and incurred similar incremental costs. However, the relative reduction in the rate of OODs differed across groups. For achieving an 80 kits per OOD benchmark, proportional distribution resulted in a projected 6.7%, 6.5% and 7.1% reduction in annual OODs in 2025 among White, Black and Hispanic/Latinx populations, respectively. In contrast, equity‐focused distribution achieved a reduction of 5.7%, 11.3% and 10.2% in the respective groups. In all scenarios, the cost per OOD averted was lower than the generally accepted thresholds for cost per life saved.An equity‐focused naloxone distribution strategy designed to reduce racial and ethnic disparities in naloxone availability could improve health equity among racial and ethnic groups while potentially improving overall population health at lower healthcare costs per opioid overdose death averted than a proportional distribution strategy. [ABSTRACT FROM AUTHOR]

Objective: Sarcopenia is linked to escalating health costs, heightened risk of physical disability, diminished quality of life and an increased demand for care services. This study aimed to assess the economic impact of sarcopenia-related disability in Iran. A prevalence-based economic burden study was conducted utilizing the Population Attributable Risk (PAR) method, based on 2022 price index. Prevalence data for sarcopenia, categorized by gender and disease severity, were extracted from recent comprehensive studies. The relative risk of sarcopenia disability was determined from the most robust available evidence. Subsequently, direct medical costs, direct non-medical costs, and indirect costs for each individual with sarcopenia were computed and adjusted to 2022 values to estimate disability costs. Results: Taking into account the prevalence of sarcopenia and the Iranian population across various age groups, 2,192,168 adults aged ≥ 60 years with sarcopenia in Iran were included. The total PAR of sarcopenia for men and women was estimated at 49% and 28%, respectively. The cumulative direct medical costs, direct non-medical costs, and indirect costs amounted to $215.1 million, $7.76 million, and $34.1 million, respectively. Additionally, the average total economic burden of sarcopenia-related disability in Iranian population aged ≥ 60 years was estimated at $257.1 million. [ABSTRACT FROM AUTHOR]

Background: Financial toxicity describes the impairment of financial wellbeing in patients due to the burden of cancer diagnosis and care. The COST: A Functional Assessment of Chronic Illness Therapy Measure of Financial Toxicity (FACIT-COST) is the most widely used cancer-specific measure of subjective financial toxicity, having been validated in multiple languages, but not in Indonesian. This study aimed to validate the Indonesian version of FACIT-COST in a breast cancer sample. Methods: A single-center prospective cohort study was performed in Indonesia. Female breast cancer patients aged ≥ 18 undergoing treatment at baseline were invited to participate and followed for up to six months. The survey included the official Indonesian version of FACIT-COST (v2) which was administered to the patients by interviewers. Clinical information (e.g., metastasis status, disease duration) was provided based on medical records. The following measurement properties of FACIT-COST were tested: distributional characteristics, structural validity (principal component [PCA] and confirmatory factor analyses [CFA]), internal consistency reliability (Cronbach's alpha and McDonald's omega), known-groups validity (Mann-Whitney U or Kruskal-Wallis H test), test-retest reliability, and responsiveness to change. Results: Overall, 300 female patients participated at baseline. No patients reported the best or worst possible FACIT-COST total scores. The PCA proposed a two-factor model structure for the instrument, which was confirmed by the CFA (RMSEA = 0.042, SRMR = 0.049, CFI = 0.99, TLI = 0.99). The internal consistency reliability of the two factors was considered adequate (Cronbach's alpha = 0.774–0.882, McDonald's omega = 0.786–0.888). The FACIT-COST total score significantly discriminated across the following known-groups: age, education, residential setting, income, employment, metastasis status, number of symptoms, and financial coping strategies. The FACIT-COST demonstrated excellent test-retest reliability (intraclass correlation coefficient = 0.96) and satisfactory responsiveness to change (standardized response mean and effect size ranges=|0.39| to |0.92|). Conclusions: This is the first study to validate the FACIT-COST in patients with breast cancer and to present the measurement properties of the Indonesian version of FACIT-COST. The Indonesian FACIT-COST demonstrates acceptable psychometric performance and shows potential as a valid measure of subjective financial toxicity. The instrument may serve as a valuable tool for informing health policies that focus on providing resource support to improve cancer care in Indonesia. [ABSTRACT FROM AUTHOR]

The task of UAV-based maritime rescue object detection faces two significant challenges: accuracy and real-time performance. The YOLO series models, known for their streamlined and fast performance, offer promising solutions for this task. However, existing YOLO-based UAV maritime rescue object detection methods tend to prioritize high accuracy, often at the expense of real-time performance and ease of implementation and expansion. This study proposes a modular plug-and-play optimization approach based on the YOLOv8 framework, aiming to enhance real-time performance while maintaining high accuracy for UAV maritime rescue object detection. The proposed optimization modules are flexible, easy to implement, and extendable. In experiments on the large-scale publicly available SeaDronesSee dataset, our method achieved a 13.53% improvement in accuracy over YOLOv8x while reducing computational cost by 85.63%. Additionally, it surpassed the detection speed of the SeaDronesSee official code's two-stage detector by over 20 times, while maintaining comparable accuracy. Furthermore, our analysis of the experimental results highlights differences in detection difficulty among various objects and potential biases within the dataset. [ABSTRACT FROM AUTHOR]

AbstractIn the event of a disruption at a primary supplier, the manufacturer’s sourcing and production operations are inevitably affected, necessitating a response strategy based on the estimated disruption duration. This paper derives the optimal production policy for each response strategy, aiming to minimize total costs over a planning horizon within a dynamic programming framework. We characterize these production policies across various model parameters, particularly focusing on the estimated disruption duration and initial inventory level. Our analysis identifies when the passive acceptance strategy and the backup strategy each hold an advantage, and how the cost benefits of each strategy vary with different model parameters. Additionally, we examine the consequences of overestimating or underestimating the disruption duration, providing insights into how the chosen response strategy and production policy, based on the estimated duration, diverge from the true optimal ones as the actual duration unfolds. We also highlight the cost implications of these discrepancies. Finally, in scenarios where the true duration follows a probabilistic distribution, our numerical experiments demonstrate how strategy selection and the cost of misestimation are influenced by the mean of the true disruption duration and the initial inventory level. These analyses offer decision-makers valuable guidance on when to act or wait in the face of disruptions. [ABSTRACT FROM AUTHOR]

To explain cross-national variation in the regulation of atypical forms of employment, including measures aimed at protecting the employment conditions of nonstandard workers, existing studies have typically emphasised the importance of labour's relative power resources and insider-outsider dynamics. This article shows that differences in employer stances can also be of key importance in explaining this type of variation. Moreover, it shows that employer support for regulatory efforts to improve quality of atypical employment neither have to result from a perceived need to seek strategic accommodation nor from a positive assessment of the costs and benefits of regulation. It does so by comparing the very different responses of Dutch and German employer groups to regulatory attempts to improve the quality of part-time employment. It illustrates their importance and attributes them to strategic choices that were a logical outcome of the different institutional environments in which Dutch and German employer groups operated. [ABSTRACT FROM AUTHOR]

Where precision is paramount in managing temperature and fluid dynamics, micro heat exchangers (MHXs) emerge as indispensable tools. This review investigates the significance of MHX technology, offering readers a comprehensive roapmap from conceptualization to market application. We dissect the nuances of material selection, shedding light on cutting‐edge advancements poised to revolutionize MHX efficiency. Furthermore, we explore how the geometry of MHX influences heat transfer dynamics and pressure drop, providing insights into enhancing the overall effectiveness. We delve into the various types of control instrumentation, offering a detailed analysis of their applicability. Beyond the technical prowess, the economic landscape plays a pivotal role in the adoption of MHX technology. [ABSTRACT FROM AUTHOR]

Transfer of development rights (TDR) programs have been used in Italy over the last two decades for various purposes, e.g. to avoid expropriation. While previous research shows that implementing TDR programs at a regional level creates considerable transaction costs, there is no study concerning the costs generated by employing these programs at a city level. This paper addresses this gap through an analysis of the city of Milan’s TDR program. Results show that transaction costs in a fully market-based TDR program are mainly related to TDR contracting, monitoring and creation, influencing the efficacy of the program. [ABSTRACT FROM AUTHOR]

Every year, millions die in road accidents globally, imposing significant economic and humanitarian costs. While road traffic accidents are a major health concern, many developing countries, including Ethiopia, struggle to address this issue effectively. Ethiopia ranks second in East Africa for severe road traffic accidents, highlighting the need for improved injury reduction strategies. This study introduces a novel approach by chronologically identifying and prioritizing accident black spots in the studied area, Ethiopia. This method provides a valuable tool for transportation authorities and traffic police to target high-risk areas for immediate intervention. Focusing on the Dembecha-Injibara highway segment, the study employs both descriptive and inferential analyses, using the Zegeer method to calculate accident rates. It also uses factors of weight contributing to road traffic accidents and their severity to rank accident-prone areas. The findings reveal that areas near Finote Selam, Banja, and Burie are highly prone to severe accidents, with specific accident frequencies and priority values identified. Recommendations are offered to address these high-risk areas and mitigate severe traffic accidents in the study region. [ABSTRACT FROM AUTHOR]

ABSTRACT Despite the overall desirability of men's upper body strength, women's preference for such features remains bounded to contexts in which the benefits exceed the potential costs. The relative salience of these costs could be augmented within ostensibly threatening environments, which could include one of ambient darkness. This study sought to determine whether women's interest in strong men would become downregulated in the presence of these cues. A sample of sorority women reported their reactions to meeting a hypothetical man on campus who was manipulated to appear either strong or weak with the image manipulated to be either at night or during the day. Although women reported feeling more comfortable around the weak man in the dark compared to the strong man, no difference emerged in their evaluations of strong men during the day and night. These findings suggest that women functionally shift their interest in strong men based on environmental cues that could implicate men as costly. [ABSTRACT FROM AUTHOR]

[Display omitted] Systemic lupus erythematosus (SLE) is becoming a growing public health concern due to increasing disease and economic burdens. Epidemiological information about SLE, especially its incidence rate, is limited in developing countries. In the current study, we sought to investigate the incidence, prevalence, and economic burdens of SLE in urban China. We conducted a nationwide population-based cohort study using databases from Urban Employee Basic Medical Insurance and Urban Resident Basic Medical Insurance between 2013 and 2017, covering approximately 300 million residents in 23 provincial regions in China. Incidence rate and prevalence were standardized by age and gender to China's 2010 national census data. Additionally, we calculated the average annual costs and hospital visit rates. A total of 132,258 SLE patients were identified during the study period, with a mean age of 43.03 years (standard deviation: 15.29 years). Of these patients, 81.33% were women. In 2017, the standardized incidence rate of SLE in China was 14.09 (95% confidence interval (CI), 11.95–16.41) per 100,000 person-years, with a higher incidence in women than in men (26.41 vs. 5.92 per 100,000 person-years). Standardized prevalence in 2017 was 47.61 (41.77–53.83), 94.16 (80.67–108.69), and 17.86 (13.84–22.38) per 100,000 people in the overall, female, and male populations, respectively. The average annual rates of increase in prevalence were 21.50%, 19.72%, and 25.67% from 2013 to 2017 in the overall, female, and male populations, respectively. The age-specific incidence rates peaked at 30–49 years old in women and 40–59 years old in men. SLE incident and prevalent cases were most common in North-West China and less common in southern and eastern China. Distinct variations in incidence rates across different regions are also consistent with the varying levels of ultraviolet radiation exposure in China. Additionally, the average estimated annual per-capita cost was 1599.34 US dollars in SLE patients, with the highest costs observed in adolescent and young adult patients among different age groups. The SLE population in China is rapidly expanding, and younger at onset, especially in women, which has placed significant burdens on China's healthcare system. [ABSTRACT FROM AUTHOR]

Objective. To evaluate factors associated with the long-term durability of cost-effectiveness (CE) in ASD patients. Background. A substantial increase in costs associated with the surgical treatment for adult spinal deformity (ASD) has given precedence to scrutinize the value and utility it provides. Methods. We included 327 operative ASD patients with five-year (5 yr) follow-up. Published methods were used to determine costs based on CMS.gov definitions and were based on the average DRG reimbursement rates. The utility was calculated using quality-adjusted life-years (QALY) utilizing the Oswestry Disability Index (ODI) converted to Short-Form Six-Dimension (SF-6D), with a 3% discount applied for its decline in life expectancy. The CE threshold of $150,000 was used for primary analysis. Results. Major and minor complication rates were 11% and 47%, respectively, with 26% undergoing reoperation by five years. The mean cost associated with surgery was $91,095 ± $47,003, with a utility gain of 0.091 ±0.086 at one years, QALY gained at 2 years of 0.171± 0.183, and at five years of 0.42 ±0.43. The cost per QALY at two years was $414,885, which decreased to $142,058 at five years. With the threshold of $150,000 for CE, 19% met CE at two years and 56% at five years. In those in which revision was avoided, 87% met cumulative CE till life expectancy. Controlling analysis depicted higher baseline CCI and pelvic tilt (PT) to be the strongest predictors for not maintaining durable CE to five years [CCI OR: 1.821 (1.159--2.862), P=0.009] [PT OR: 1.079 (1.007--1.155), P=0.030]. Conclusions. Most patients achieved cost-effectiveness after four years postoperatively, with 56% meeting at five years postoperatively. When revision was avoided, 87% of patients met cumulative cost-effectiveness till life expectancy. Mechanical complications were predictive of failure to achieve cost-effectiveness at two years, while comorbidity burden and medical complications were at five years. [ABSTRACT FROM AUTHOR]

Here, TS‐tools is presented, a Python package facilitating the automated localization of transition states (TS) based on a textual reaction SMILES input. TS searches can either be performed at xTB or DFT level of theory, with the former yielding guesses at marginal computational cost, and the latter directly yielding accurate structures at greater expense. On a benchmarking dataset of mono‐ and bimolecular reactions, TS‐tools reaches an excellent success rate of 95% already at xTB level of theory. For tri‐ and multimolecular reaction pathways ‐ which are typically not benchmarked when developing new automated TS search approaches, yet are relevant for various types of reactivity, cf. solvent‐ and autocatalysis and enzymatic reactivity ‐ TS‐tools retains its ability to identify TS geometries, though a DFT treatment becomes essential in many cases. Throughout the presented applications, a particular emphasis is placed on solvation‐induced mechanistic changes, another issue that received limited attention in the automated TS search literature so far. [ABSTRACT FROM AUTHOR]

Background: Robotic-assisted technologies have been developed to increase surgical precision and reduce surgical variability in total knee arthroplasty (TKA). Several different robotic systems have been introduced in the last decade for TKA. The DePuy Synthes VELYS™ Robotic-Assisted Solution (VRAS) is an imageless system designed to eliminate the need for preoperative CT scans and is one of the latest entrants in the rapidly evolving field of robotic technology in TKA. This study compared the clinical and economic outcomes associated with VRAS and other robotic-assisted technologies for primary TKA. Methods: A retrospective cohort study using the Premier Healthcare Database included patients who underwent primary TKA with VRAS or other robotic-assisted technologies from January 1, 2022, to April 30, 2023. The primary outcome for the study was hospital follow-up visits (revisits) within 90 days post-TKA. Secondary outcomes included readmission and revision rates within 90 days post-TKA, operating room time, length of stay, discharge status and hospital costs. Cohorts were balanced using propensity score fine stratification, and generalized linear models were constructed to evaluate outcomes. Results: This study included 827 VRAS TKA patients and 16,428 TKA patients treated with other robotic-assisted technologies. The 90-day all-cause and knee-related revisit rates were significantly lower for VRAS than for other robotic-assisted technologies (all-cause 13.9% vs. 22.8% and knee-related 2.8% vs. 5.4%, respectively; p value < 0.01). The all-cause and knee-related 90-day readmission rates were also lower for VRAS, although the differences were not statistically significant. The 90-day revision rates were similar for VRAS and other robotic-assisted technologies (0.48% vs. 0.45%), as was the operating room time (138 vs. 137 min). The 90-day knee-related cost for the VRAS cohort was $15,048 compared to $16,867 for other robotic technologies. Conclusions: This database study demonstrated that early postoperative revisit rates and total cost of care are lower for VRAS than for all other robotic-assisted technologies for TKA, while operating room time and discharge status were similar. These are important findings in ever-evolving healthcare systems that are increasingly cost conscious and cognizant of principles associated with value-based care. [ABSTRACT FROM AUTHOR]

Background: Physical activity (PA) plays a vital role in maintaining the functional ability that enables well-being in older age (healthy aging), potentially also saving costs for the healthcare system and society. The aim of this study was to examine the association between PA and healthcare and societal costs in a sample of very mild to moderately frail older adults. Methods: This cross-sectional study is a secondary analysis using baseline data from the PromeTheus randomized-controlled trial, which included 385 very mild to moderately frail community-dwelling older adults (70 + years) from Germany. Participants self-reported their health-related resource use in the previous 6 months (FIMA questionnaire), which was monetarily valued using standardized unit costs. PA was also self-reported using the German Physical Activity Questionnaire for middle-aged and older adults (German-PAQ-50+) and categorized as 'insufficient'/'sufficient' or 'insufficient'/'moderate'/'high' in accordance with the World Health Organization guidelines for PA. Mean and median healthcare costs (including outpatient, inpatient, rehabilitation, formal care, and medication costs) and societal costs (healthcare costs plus informal care costs) for different PA groups were estimated using generalized linear models and quantile regression, with sociodemographic variables and physical capacity (Short Physical Performance Battery) as covariates. Results: Of the sample, 24% were classified as insufficiently, 23% as moderately, and 54% as highly active. Sufficient PA, especially high PA, was associated with lower costs in the 6 months prior to data collection compared to insufficient PA (-€6,237, 95% CI [-10,656; -1,817] and -€8,333, 95% CI [-12,183; -4,483], respectively). The cost difference between PA intensity groups was largely driven by differences in informal care costs and decreased substantially when physical capacity was accounted for in the analyses; e.g., the mean difference in societal costs between sufficient and insufficient PA decreased from -€7,615 (95% CI [-11,404; -3,825]) to -€4,532 (95% CI [-7,930; -1,133]). Conclusion: Promoting PA throughout the lifespan as a means of promoting healthy aging and reducing dependency in old age could potentially provide economic benefits and help to mitigate the economic consequences of an aging population with increasing health and long-term care needs. Future longitudinal studies should attempt to disentangle the mediating and confounding role of physical capacity and health status in the association between PA and costs. [ABSTRACT FROM AUTHOR]