Search

Drones are increasingly used for last-mile delivery due to their speed and cost-effectiveness. This study focuses on a novel locker-drone delivery system, where trucks transport parcels from the warehouse to lockers, and drones complete the final delivery. This system is ideal for community and intra-facility logistics. The research optimises the network design by determining the location of lockers, the number of drones at each locker, and the assignment of demands to lockers, minimising operating costs. Both single-parcel and multi-parcel capacity drones are examined. We build an optimisation model for each system, considering drone service capacity as a critical constraint. We design an algorithm combining average sample approximation and a genetic algorithm to address demand uncertainty. The algorithm's efficiency is validated through comparative analysis with Gurobi. Numerical experiments, using real and generated data, optimise the network design. Results show that the multi-capacity drone system requires fewer lockers and drones than the singlecapacity system. Although the single-capacity system yields lower drone delivery costs, it incurs higher truck delivery costs. Additionally, a comprehensive cost analysis compares the cost-efficiency of the locker-drone system with a conventional drone delivery system, revealing the cost-saving advantage of the locker-drone system. [ABSTRACT FROM AUTHOR]

Artificial intelligence (AI) is increasingly considered a source of competitive advantage in operations and supply chain management (OSCM). However, many organisations still struggle to adopt it successfully and empirical studies providing clear indications are scarce in the literature. This research aims to shed light on how AI applications can support OSCM processes and to identify benefits and barriers to their implementation. To this end, it conducts a multiple case study with semi-structured interviews in six companies, totalling 17 implementation cases. The Supply Chain Operations Reference (SCOR) model guided the entire study and the analysis of the results by targeting specific processes. The results highlighted how AI methods in OSCM can increase the companies' competitiveness by reducing costs and lead times and improving service levels, quality, safety, and sustainability. However, they also identify barriers in the implementation of AI, such as ensuring data quality, lack of specific skills, need for high investments, lack of clarity on economic benefits and lack of experience in cost analysis for AI projects. Although the nature of the study is not suitable for wide generalisation, it offers clear guidance for practitioners facing AI dilemmas in specific SCOR processes and provides the basis for further future research. [ABSTRACT FROM AUTHOR]

In terms of utility and technical quality, open-source software solutions have become a common option for many libraries. As barriers to adoption have been reduced and systems such as FOLIO appear poised to change the landscape of LIS technology, it is worth examining how the use of open source can support the normative core values of librarianship and to outline a strategy for critical engagement with the technology that is beneficial to patrons and libraries. Such a strategy will require further codification, institutionalization, and investigation of open source at many levels. [ABSTRACT FROM AUTHOR]

In this paper, we derive a condition-based maintenance strategy for a degradation-shock dependence system subject to two causes of failure, degradation and random shocks. We develop a reliability model for a system under warranty for failure in which we consider the dependence between the degradation process and random shocks and do a warranty cost analysis based on the suggested model. We consider a degradation-shock dependence system that is under warranty with three separate services: repair, replacement, and preventive maintenance. These are triggered when a product degradation crosses one of three predetermined degradation thresholds. We also investigate the dependence between random shocks and degradation modelled by a time-scaled covariate factor. We study the random shock considering fatal shocks that require replacement and nonfatal shocks that require only repair and the degradation caused by nonfatal shocks. The condition-based maintenance strategy for a degradation-shock dependence system is a novel approach to analysing system degradation, with a goal of optimising warranty costs; we also minimise the expected total system cost to find an optimal warranty length. We present several numeric examples and real-world applications to illustrate our proposed approach. [ABSTRACT FROM AUTHOR]

Recent economics of knowledge studies have highlighted the strong positive effects that the limited exhaustibility of knowledge and its cumulability exert on the recombinant generation of new technological knowledge. While existing empirical investigations primarily focus on the knowledge generation and technology production functions, the analysis of the cost of knowledge has received less attention. This paper aims to fill this gap by investigating the dynamics and determinants of patent costs in the European Union in the period 1992–2012. The analysis of patent unit costs in European countries, measured as the amount of research and development (R&D) expenditure per patent application to the European Patent Office (EPO), shows a steady decline and clear convergence toward lower levels, both in time and across countries. We find that a larger stock of patents and a higher technological variety and coherence of its composition are associated with a sharper reduction in patent costs. Our findings suggest that, in Europe, ideas have been getting cheaper. [ABSTRACT FROM AUTHOR]

Background: The loss of gait automaticity is a key cause of motor deficits in Parkinson's disease (PD) patients, even at the early stage of the disease. Action observation training (AOT) shows promise in enhancing gait automaticity. However, effective assessment methods are lacking. We aimed to propose a novel gait normalcy index based on dual task cost (NIDTC) and evaluate its validity and responsiveness for early-stage PD rehabilitation. Methods: Thirty early-stage PD patients were recruited and randomly assigned to the AOT or active control (CON) group. The proposed NIDTC during straight walking and turning tasks and clinical scale scores were measured before and after 12 weeks of rehabilitation. The correlations between the NIDTCs and clinical scores were analyzed with Pearson correlation coefficient analysis to evaluate the construct validity. The rehabilitative changes were assessed using repeated-measures ANOVA, while the responsiveness of NIDTC was further compared by t tests. Results: The turning-based NIDTC was significantly correlated with multiple clinical scales. Significant group-time interactions were observed for the turning-based NIDTC (F = 4.669, p = 0.042), BBS (F = 6.050, p = 0.022) and PDQ-39 (F = 7.772, p = 0.011) tests. The turning-based NIDTC reflected different rehabilitation effects between the AOT and CON groups, with the largest effect size (p = 0.020, Cohen's d = 0.933). Conclusion: The turning-based NIDTC exhibited the highest responsiveness for identifying gait automaticity improvement by providing a comprehensive representation of motor ability during dual tasks. It has great potential as a valid measure for early-stage PD diagnosis and rehabilitation assessment. Trial registration Chinese Clinical Trial Registry: ChiCTR2300067657 [ABSTRACT FROM AUTHOR]

The COVID-19 booster immunization policy is cost-effective, but evidence on additional booster doses and appropriate strategies is scarce. This research compared the cost-effectiveness of annual, twice-a-year, and biennial booster dose policies. We performed stochastic modeling using compartmental susceptible-exposed-infectious-recovered models and a system dynamic model. We evaluated four policy scenarios: (1) hypothetical no-booster immunization policy; (2) twice-a-year vaccination policy; (3) annual vaccination policy; and (4) biennial vaccination policy. In addition, we conducted a one-way sensitivity analysis by adjusting R0 from 1.8 to 3.0 in all scenarios (epidemic stage) and by decreasing the vaccination cost by 50% at the end of the first year to reflect the current policy direction to enhance domestic vaccine production. Compared to non-booster policies, all three booster strategies reduced the number of cases, hospital admissions, and severe infections remarkably. Without a booster, total cases would reach 16,220,615 (95% confidence interval [CI] 6,726,550–29,661,112) by day 1,460, whereas, with a twice-a-year booster, the total cases would reach 597,901 (95% CI 526,230–694,458) in the same period. Even though the no booster scenario exhibited the lowest cost by approximately the first 500 days, by day 1,460 the biennial booster scenario demonstrated the lowest cost at 72.0 billion baht (95% CI 68.6–79.4 billion). The most cost-saving policy was the biennial booster scenario. The annual booster scenario also stood as a cost-effective option for most outcomes. In the epidemic stage and in an assumption where the vaccination costs dropped, all booster policies became more cost-effective or cost-saving compared with the main assumption. This study underscores the significance of the COVID-19 vaccine booster policy. Implementing policies should take into consideration cost-effectiveness, feasibility, and public communication. [ABSTRACT FROM AUTHOR]

Background: Access to cardiovascular medications is severely hampered by their unavailability and high cost, particularly for the poorest households in developing nations. The availability and price range of cardiovascular medications are significantly limited in both hospital and community pharmacies. Objectives: The aim of this study is to assess the availability and price variations of commonly used cardiovascular medicines in hospital pharmacies in Gondar Town, northwest Ethiopia. Methods: From July 13 to August 6, 2022, a mixed cross‐sectional and simulated client survey was carried out at two hospital and 13 community pharmacies in Gondar Town. The analysis and data entry were performed using SPSS Version 25 and EpiData Version 4.2, respectively. The availability and pricing variations of the medications are given as percentages. The significance was examined using paired t tests. Results: On average, community retail pharmacies offered 33.22% of CVD drugs. Aspirin (81 mg), amlodipine (5 mg), atorvastatin (20 mg), and hydrochlorothiazide (25 mg) were the most readily available drugs in community pharmacies. Overall, 28.00% of the hospital pharmacies had available CVD medicines during the course of our analysis. The average cost for the 25 CVD medications in hospital pharmacies was $0.699, with a standard deviation (SD) of 1.513, which was less than the cost at community pharmacies ($2.741 with an SD of 6.015) (p = 0.045). Conclusion: CVD medications were more available in community pharmacies than in hospital pharmacies, although there were fewer CVD medications available than recommended by the WHO/HAI (80%) in both hospital and community pharmacies. There was a statistically significant difference between the two prices. Compared to that at hospital pharmacies, the mean price at community pharmacies was greater. [ABSTRACT FROM AUTHOR]

The developments and innovations in green miniaturized technologies suggest that a complete miniature approach (MA) to determine organic carbon (OC) and phosphorus (P) in soils may enable handling a large number of samples. In comparison to the conventional approach (CA), this approach also reduces waste generation and analysis costs. Here we have miniaturized all the steps of the conventional analytical procedures for OC and P analysis and carried out an in-depth validation of MA on various aspects, including linearity, biases, precision, inaccuracy, and imprecision. This rigorous assessment aimed to delineate the effect of miniaturization on the quality of determination along with its associated benefits and limitations. The findings revealed a strong correlation between the MA and CA in the OC test, indicating an R2 >0.84, with the Deming regression producing a model equation demonstrating a highly significant slope and an intercept closely approximating zero. Similarly, the P values obtained by MA and CA exhibited a correlation with an R2 > 0.99, alongside the Deming regression displaying a minimal intercept and a slope approaching one. The Bland–Altman analysis indicated a mean bias of 0.01 (95% CI, −0.51 to 0.54) for OC values and −1.7 (95% CI, −9.04 to 5.57) for P values. This cross-validation study highlights the applicability and limitations of the MA in estimating OC and P levels across a diverse range of soils. [ABSTRACT FROM AUTHOR]

The Preventive Controls for Human Food Rule regulation under the Food Safety Modernization Act sets new food safety standards. Both food safety educators and small and medium sized food processing businesses that manufacture certain value-added or processed foods lack knowledge regarding costs to prepare, implement, and manage ongoing food safety practices under the new standards. Current food safety training materials do not acknowledge costs or provide content addressing potential costs, and food safety educators do not have information needed to guide development of relevant materials that address costs. We combine economics and food science principles and use mixed methods to identify and estimate cost barriers for food processing businesses through an interdisciplinary research and extension project in the Northeast U.S. We first modify Preventive Controls extension programming to acknowledge costs and test how modified programming improves self-reported knowledge about costs. Materials that acknowledge that costs are associated with meeting standards significantly increases participants' self-reported perceived knowledge of costs by 1.3 points on a 1-to-5-point Likert scale. Compared with programming areas in which detailed content is provided, however, improvements in knowledge of costs lags behind overall knowledge gains (3.2 for costs versus 4.1 for food safety content). To fill this content gap, we next conduct semi-structured group interviews with a subset of participants (N = 10), develop a costs analysis framework, and measure actual costs associated with Preventive Controls. We find that initial costs average $20,000 per business to plan, implement, and manage standards, and almost $8,000 in every subsequent year to manage. We demonstrate that even modest interventions can reduce cost barriers for businesses seeking to meet compliance standards. We provide food safety educators with concrete cost information to support businesses to pursue Preventive Controls standards. Study results imply that low-cost methods could improve food safety in mid-scale supply chains. [ABSTRACT FROM AUTHOR]

Background: Research on Qi Gong (QG) supports promising health benefits. Both interest and use of QG in U.S. adults has increased over the past decade. Shared Medical Appointments (SMAs) are a novel, cost-effective, and time efficient health care delivery approach associated with patient and clinician satisfaction. Objectives: A telehealth delivered QG SMA was pilot tested among a diverse demographic population within an integrative medicine practice at an academic medical center to assess feasibility and acceptability. Methods: This was a feasibility/acceptability pilot study conducted at a large New York City academic medical center's Integrative Health and Wellness center from January to July 2023. A QG instructor-acupuncturist and an integrative medicine physician-acupuncturist co-led 3 separate series (5 Element QG, Eight-Section Brocade, and Joint-Mobilizing/Sinew Strengthening exercises) of weekly 30-45-minute sessions of QG SMA on a weekday afternoon via telemedicine. The first session included an overview of QG and Traditional Chinese Medicine (TCM) research while follow-up sessions included a check-in, didactic demonstration followed by QG practice, and a debrief to answer questions. Video links were provided for home practice. Surveys assessing satisfaction were sent pre/post series. Results: 18 sessions of QG SMA were offered over a 6-month period. A total of 40 unique participants from diverse demographics (gender, race/ethnicity, primary residence) attended, for a total of 197 virtual visits. A total of 20 participants enrolled in Series 1 (8 weeks), 23 enrolled in Series 2 (7 weeks), and 16 enrolled in Series 3 (3cweeks). For each session, group attendance ranged from 8-16 with an average of 11 participants. Attendance was high with participants attending an average of 72% of the sessions. Participants attended 88% of the first 8-week series, 54% of the second 7-week series, and 60% of the third series. Participant interest persisted over time with 35% of the 40 participants attending more than 1 series, and 12.5% attending all 3 series. Participants' diagnoses and health symptoms included pain (62.5%), cancer (45%) anxiety/depression (40%), cardiovascular disease (CVD) or metabolic conditions (32.5%), gastrointestinal (GI) symptoms/diagnoses (27.5%), stress (22.5%), osteopenia/osteoporosis (17.5%), and insomnia (17.5%). Pre-series [n = 27] participants endorsed symptoms including sleep disturbances, fatigue, pain, stress, weakness, GI symptoms, psychological symptoms, hot flashes, and brain fog. Post-program survey results [n = 11] suggested QG program addressed common symptoms including fatigue, insomnia, anxiety, stress, pain, weakness, and gastrointestinal symptoms. Participants reported incorporating QG, breathing techniques, and meditation into their daily routine. All participants reported their goals were met and that they would recommend the program to others. Regarding delivery preferences, 73% preferred telehealth, 27% hybrid, and none preferred in-person. Participants appreciated the format, new skills, community, and instructors. Conclusion: While the Virtual QG SMA series provided to diverse demographic population with mixed diagnoses is feasible, acceptable, and shows promising positive impact in this pilot, caution in interpreting the data is advised due to the low response rate of the post-program survey. Robust studies with longer follow-ups are recommended. [ABSTRACT FROM AUTHOR]

A rare disease is that with a low prevalence in the population. However, it is estimated that there are between 6,000 and 8,000 different types of rare diseases in the world and, generally, they are incurable and deadly. Machado-Joseph's disease (MJD) is one of these cases; of genetic origin, autosomal dominant, with a high chance of transmission between generations and without curative treatment. Given the specificities of MJD and the lack of economic studies associated with it, this article aims to estimate the direct and indirect health-related costs of lost productivity attributable to Machado-Joseph's Disease. The data used were primarily collected at the Hospital de Clínicas de Porto Alegre (HCPA), during the period between October 2019 and March 2020. The bottom-up cost methodology was used, that is to say, to estimate costs across a sample of patients to produce an annual cost per patient. Among the main results, it was found that 90.8% of the sample does not work and of these, 72.73% reported that the reason they had stopped working was due to Machado-Joseph's disease. The average age of men when they stopped working was 39.05 years of age and for women it was 39.64 years of age. In relation to direct non-medical costs, with rehabilitation and transport, it was found that these items affect about 32% of men's income and 36% of women's income, as well as medication and diapers costs affect about 15% of women's income and 14% of the income of men who are no longer able to work. The study also showed that 50% of caregivers, who are generally close relatives of the patient, do not work. Of these, 33.3% reported having left the labor market to provide assistance to the patient, which means that the cost for families is even higher than that estimated for the patient. [ABSTRACT FROM AUTHOR]

Violence across Latin America is an increasingly important factor influencing migration to the US. A particular form of violence that is experienced by many Latinx migrants is extortion. This research analyzes the extortion experiences of Latinx immigrant adults arriving at the US southern border and the impact these experiences have on mental health. We find that on average, participants paid $804 in extortion during their migration. The most common perpetrators of extortion in our study were police followed by immigration officials throughout Latin America. Pregnant participants were less likely to experience extortion and adults traveling with children were more likely to be extorted. Participants who were extorted for money reported significantly greater severity of post-traumatic stress disorder (PTSD) symptoms compared to those who were not extorted. This research is the first of its kind to analyze extortion experiences among Latinx immigrants to the US, quantifying the prevalence, amounts paid, countries where extortion occurs, and perpetrators of extortion. In addition, extortion experiences are associated with negative effects on the mental health of newly arrived Latinx immigrants to the US. Based upon these findings, we recommend that extortion should be considered a significant stressor in the migrant experience, particularly for those adults traveling with children. [ABSTRACT FROM AUTHOR]

Background: "The hidden costs of informal caregiving" is an interdisciplinary concept. While caregivers make a significant contribution to the process of caregiving, they sacrifice their leisure time, and incur risks of dropping out of the job, impaired mental and physical health, and decreased well-being within the context of caregiving. Those invisible sacrifices are often overlooked and described as hidden costs of informal caregiving. However, the conceptualisation of hidden costs of informal caregiving has not yet been clarified and scientifically assessed. The research aimed to clarify the concept of hidden costs of informal caregiving and develop an operational definition. Methods: Walker and Avant's concept analysis was conducted. Databases of CBM, CNKI, WanFang, VIP, PubMed, Embase, CINAHL, Web of Science, MEDLINE, Cochrane Library, Econlit, CINAHL and ProQuest were searched with the term "hidden costs of informal caregiving". Information about the uses of the concept, defining attributes, model cases, antecedents, consequences and empirical referents of hidden costs of informal caregiving was extracted and synthesized. Results: A total of 25 articles were included. The six defining attributes of hidden costs of informal caregiving were identified as including "undertaken by informal caregivers", "the time costs of caregiving", "costs of career development" "physical well-being costs", "mental well-being costs" and "social relationship costs". Personal characteristics of the caregivers and care recipients, along with caregiving attributes, were among the antecedents. The consequences of hidden costs of informal caregiving resulted in negative influences which included poor quality of life, life-altering decisions, options for the type of care, some degree of economic hardship, decreased compliance with treatment plans and monetary value informal caregivers are willing to pay to be replaced. Conclusion: This concept analysis decisively illuminated the hitherto nebulous concept and expanded the contents of hidden costs of informal caregiving, which will foster a deeper appreciation of the invisible cost of caregivers. Moreover, it will provide a reference for the study of the hidden costs of informal caregiving in future, contribute to the development of assessment tools and theoretical models of hidden costs of informal caregiving, and create a basis for designing an evidence-based care program. [ABSTRACT FROM AUTHOR]

Background: Encouraging alternatives to the car such as walking, cycling or public transport is a key cross-sector policy priority to promote population and planetary health. Individual travel choices are shaped by individual and environmental contexts, and changes in these contexts – triggered by key events – can translate to changes in travel mode. Understanding how and why these changes happen can help uncover more generalisable findings to inform future intervention research. This study aimed to identify the mechanisms and contexts facilitating changes in travel mode. Methods: Prospective longitudinal qualitative cohort study utilising semi-structured interviews at baseline (in 2021), three- and six-month follow up. Participants were residents in a new town in Cambridgeshire, UK, where design principles to promote walking, cycling and public transport were used at the planning stage. At each interview, we followed a topic guide asking participants about previous and current travel patterns and future intentions. All interviews were audio recorded and transcribed. Data analysis used the framework approach based on realist evaluation principles identifying the context and mechanisms described by participants as leading to travel behaviour change. Results: We conducted 42 interviews with 16 participants and identified six mechanisms for changes in travel mode. These entailed increasing or reducing access, reliability and financial cost, improving convenience, increasing confidence and raising awareness. Participants described that these led to changes in travel mode in contexts where their existing travel mode had been disrupted, particularly in terms of reducing access or reliability or increasing cost, and where there were suitable alternative travel modes for their journey. Experiences of the new travel mode played a role in future travel intentions. Implications: Applying realist evaluation principles to identify common mechanisms for changes in travel mode has the potential to inform future intervention strategies. Future interventions using mechanisms that reduce access to, reduce reliability of, or increase the financial cost of car use may facilitate modal shift to walking, cycling and public transport when implemented in contexts where alternative travel modes are available and acceptable. [ABSTRACT FROM AUTHOR]

Most healthcare professionals agree on the "why" behind encouraging administrators to embrace Lifestyle Medicine as a means of treating chronic conditions and improving health. It is the "how" that often evades us. How do we build our business case to justify the sustained commitment to this approach to care? Each entity has unique obstacles and opportunities inherent in their business model and organizational culture. Attempts to position Lifestyle Medicine as a fundamental means for reshaping healthcare sometimes fall flat despite the value of the requests. Advance preparation including strategic planning and a well-designed approach can make the difference by addressing barriers and opening doors. Each business case will be unique, but there are critical elements that should be common to every strategic plan. We can identify foundational tactics to substantiate the need for integration of Lifestyle Medicine as a critical part of healthcare institutions and their financial plans. Given the momentum in Lifestyle Medicine as a discipline, recommendations can be based on successful practices in the development of business cases, program pilots, sustained budgets and outcomes that justify expansion. [ABSTRACT FROM AUTHOR]

Wastewater reuse is a proven strategy to mitigate water stress in drought-prone regions. However, this practice is still limited due to high implementation costs, regulatory hurdles, and limited public acceptance. In regions with low reclaim rates, a thorough evaluation of the potential for reuse is needed to support decision-making, focusing on opportunities that address both low-hanging fruit and high-leverage projects. This paper introduces a streamlined, data-centric methodology for assessing wastewater reuse potential, adaptable to various regional contexts. The methodology involves comprehensive data collection and processing to evaluate wastewater treatment plant (WWTP) capabilities and identify potential users, allowing the prioritisation of case studies based on demand alignment. Different treatment and distribution systems are analysed to match WWTP capabilities with user needs, considering volume, quality, and infrastructure requirements. Cost analysis incorporates capital expenditure (CAPEX), operational expenditure (OPEX) and unit costs using novel cost functions for treatment and distribution. Risk analysis adheres to WHO methodology to ensure safety and sustainability. A case study in the Lisbon and Oeste areas in Portugal validates this approach, revealing key insights into the potential and economic viability of water reuse. By comparing tariffs and costs associated with different reuse scenarios, this paper offers benchmarks for the economic feasibility of reuse projects. [ABSTRACT FROM AUTHOR]

Currently, the development of renewable energy products (RES) encourages the search for innovative solutions that take into account key criteria from the point of view of their sustainable development. Despite efforts in this area, there is a lack of approaches and tools to support this process. Therefore, the aim of the research was to develop a decision-making model supporting eco-innovation in products based on the key criteria of sustainable development: quality (customer satisfaction with use), environmental impact in the life cycle (LCA), and the cost of investment incurred in the product development. The functioning of the model was based on the following factors: (i) obtaining the voice of customers (VoC) and processing it into product criteria as part of the development of alternative production solutions (prototypes), (ii) prospective quality assessment and subsequent life cycle assessment of prototypes, (iii) cost analysis taking into account both quality and environmental criteria, (iv) interpretation of results and search for eco-innovative product solutions. Development decision-making is additionally supported by techniques implemented in the model, e.g., the CRITIC method, the LCA method with Ecoinvent database in OpenLCA, the CEA method, and the morphology method. The model was illustrated and tested for photovoltaic (PV) panels, after which a global sensitivity analysis was performed in Statistica. The test results showed that the main factor that influenced the PV development decisions was the investment cost, followed by quality (customer satisfaction) and then environmental impact in LCA. [ABSTRACT FROM AUTHOR]

The strain-hardening geopolymer composite (SHGC) is a new type of fiber concrete with excellent ductility and environmental friendliness. However, the high cost of fibers greatly limits its widespread application. This paper proposes the use of untreated low-cost polyvinyl alcohol (PVA) fibers and polyethylene (PE) fibers to develop a low-cost, high-performance SHGC. Axial compression and axial tension tests were conducted on the SHGC with different PE fiber volume fractions (1%, 1.5%, and 2%) and different PVA fiber replacement ratios (0%, 25%, 50%, 75%, and 100%) to investigate the hybrid effects of fibers with different surface properties and to reveal the mechanism of fiber hybridization on the mechanical behavior of SHGCs. The results show that increasing the PE fiber volume fraction improves the compressive and tensile ductility of the SHGC while increasing the PVA fiber replacement rate impacts the strength indicators positively due to the good interface effect formed between its hydrophilic surface and the matrix. When the PVA fiber replacement ratio is 100%, the compressive strength (93.4 MPa) of the SHGC is the highest, with a 21.1% increase compared to the control group. However, the tensile strength shows a trend of first increasing and then decreasing with the increase in the PVA fiber replacement ratio, reaching the highest at a 25% replacement ratio, with a 12.5% increase compared to the control group. Furthermore, a comprehensive analysis of the economic and environmental performance of the SHGC indicates that a 25% PVA fiber replacement ratio results in the best overall economic benefits and relatively low actual costs, although the effect of fiber hybridization on carbon emission indicators is not significant. This paper provides new ideas and a theoretical basis for designing low-cost SHGCs. [ABSTRACT FROM AUTHOR]

A rotary actuator effectively drives the motion of a power wheelchair, which distinguishes it from manual wheelchairs. For the design and development of a smart robotic power wheelchair (SRPW) prototype, the choice of rotary actuators (RA) is critical. However, the wide range of RA features available commercially make it challenging to choose an appropriate and valuable device for a SRPW prototype. This article employs four multi-criteria decision-making (MCDM) approaches, including (Additive Ratio Assessment) ARAS, (Complex Proportional Assessment) COPRAS, (Evaluation Based on Distance from Solution) EDAS, and (Grey Relation Analysis) GRA, along with the (Criteria Importance through Inter-Criteria Correlation) CRITIC weight assignment technique, to rank 10 alternatives RAs with 7 competing criteria such as cost, weight, voltage, current, power, torque, and speed. Due to the different rankings generated by these methods, Spearman's rank correlation coefficient is used to resolve disagreements and highlight the optimum ranking for the decision matrix. Based on the Copeland voting rule, RA-6 is the most suitable alternative, while RA-10 is found to be the least ideal of the ten alternatives. The rankings have been robustly analyzed with sensitivity analysis on cost parameters and found to be quite helpful in leading future research communities and prototype developers. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to provide an updated European narrative review spanning the last decade, focusing on the cost-effectiveness of cochlear implants (CIs) for adults with severe to profound post-lingual hearing loss. Methods: This review encompasses both prospective and retrospective approaches, as well as cross-sectional and longitudinal trials conducted on CIs in adults. All studies related to European countries (Austria, Germany, Switzerland, the Netherlands, Sweden, the UK and Poland) were conducted in English and were published between 2012 and June 2023. Results: Nine studies were included in the analysis. The patients' ages ranged from 18 years to over 67 years, with sample sizes ranging from 20 to 100 patients; two of these studies were focused on single-sided deafness in adults. The Markov model was identified as the most commonly utilized analysis method. Conclusions: This review identified a general consensus on CI cost-effectiveness, despite substantial variability among countries in factors such as observation time horizons, cost-effectiveness thresholds, methods of cost collection, discount rates, CI eligibility criteria and country-specific health systems. Generally, CIs yield positive societal benefits for working-age individuals, potentially less for seniors. Early unilateral CI enhances cost-effectiveness, highlighting the importance of prompt candidate identification. A consistent undersupply of CIs relative to the percentage of potential recipients emerged across countries. Therefore, further investigation into subcategories such as single-sided deafness is warranted, along with country-specific cost analyses. Emphasizing the significance of detailed information on health systems and associated costs and benefits is crucial for facilitating comparisons across different settings. [ABSTRACT FROM AUTHOR]

Introduction: Sexually transmitted infections (STIs) continue to increase in the United States and pregnant patients who acquire STIs are at risk for serious complications. This study estimated the utilization of preventative STI testing among pregnant outpatients on a national scale. Methods: This was a retrospective, cross-sectional study of outpatient visits in the National Ambulatory Medical Care Survey from 2014 to 2016 and 2018 to 2019. All patients reported as pregnant were included to assess STI testing for chlamydia, gonorrhea, hepatitis, and HIV. STI testing was described per 1,000 total visits overall and by subpopulations. Data weights were applied to generate national estimates. Results: Over 177 million visits were included, of which 87.5 per 1,000 included an STI test. Chlamydia testing was the most common, followed by HIV, gonorrhea, and hepatitis (58.0 vs. 42.3 vs. 41.5 vs. 20.3 per 1,000). STI testing rates varied across subpopulations (72.1–236.6 per 1,000 visits). Patients of Hispanic ethnicity, Black race, age ≤25 years old, and those seen by an obstetrics and gynecology (OB/GYN) provider had the highest rates of STI testing. Independent predictors of STI testing included: Black race (adjusted odds ratio [aOR]: 2.24, 95% confidence interval [95% CI]: 2.23–2.24), first trimester (aOR: 5.15, 95% CI: 5.14–5.16), government and private insurance (aOR: 1.90, 95% CI: 1.89–1.91 and aOR: 1.70, 95% CI: 1.69–1.71), and an OB/GYN provider specialty (aOR: 2.93, 95% CI: 2.93–2.94). Conclusions: STI testing in United States outpatient physician offices varied by subpopulations and across individual test types. Certain patient attributes, such as race, provider specialty, and payment source, were predictive of testing. [ABSTRACT FROM AUTHOR]

Summary: This study evaluated the feasibility of 'Social Workers in Schools', an intervention that involved social workers being based within schools across three local authorities in England (SWIS). Schools make a large number of referrals to Children's Social Care and play an important role in recognizing risks to children and protecting them from harm, but it is unusual for social workers to be based in schools in the U.K. and to do statutory work. We evaluated the pilots on the basis of the feasibility of implementing SWIS, how promising it was in terms of reducing the need for statutory intervention, and the extent to which it be scaled. We used a mixed methods approach, with a process evaluation and a difference in differences analysis of indicative impact on key social care outcomes. In addition, we estimated the cost of implementing and maintaining SWIS. Findings: We found high levels of acceptability among those involved, and examples of how SWIS enhances the way safeguarding issues are addressed. There was also some evidence that it may reduce the need for social care interventions, though this needs ratifying with more and better data. Applications: The study suggests that SWIS is a promising intervention. Both the qualitative and quantitative findings suggest it may have the intended policy impact, but this needs to be tested on a larger scale and with a more rigorous counterfactual comparison. Such a study—a randomized-controlled trial involving 21 local authorities—was commissioned in 2020. [ABSTRACT FROM AUTHOR]

Recent studies consistently showed that making cash visible with a windowed envelope during mail contact increases response rates in surveys. The visible cash aims to pique interest and encourage sampled households to open the envelope. This article extends prior research by examining the effect of additional interventions implemented during mail recruitment to a survey panel on recruitment rates and costs. Specifically, we implemented randomized experiments to examine size (small, large) and location (none, front, back) of the window displaying cash, combined with what part of the cash is shown through the window envelope (numeric amount, face/image), and various prepaid incentive amounts (two $1, one $2, one $5). We used the recruitment effort for NORC's AmeriSpeak Panel as the data source for this study. The probability-based AmeriSpeak Panel uses an address-based sample and multiple modes of respondent contact, including mail, phone, and in-person outreach during recruitment. Our results were consistent with prior research and showed significant improvement in recruitment rates when cash was displayed through a window during mail contact. We also found that placing the window on the front of the envelope, showing $5 through the envelope compared to $2 and $1, and showing the tender amount compared to the image on the cash through the window were more likely to improve the recruitment rates. Our cost analyses illustrated that the cost difference in printing window versus no window envelope is small. There is no difference in printing cost between front window and back window as they both require custom manufacturing. There is also no cost difference in printing envelopes with small windows versus large windows. Lastly, we found no evidence of mail theft based on our review of the United States Postal Service's "track and trace" reports, seed mailings sent to staff, and undeliverable mailing rates. [ABSTRACT FROM AUTHOR]

Objective Despite evidence-based guidelines stating that lipase alone should be used in the diagnosis of suspected acute pancreatitis, health care providers continue to order amylase or amylase and lipase together. The purpose of this study was to assess the utilization of appropriate laboratory testing related to the diagnosis of acute pancreatitis. Methods The study used a retrospective cross-sectional design. The timeframe was from January 1, 2020, to December 31, 2020. A retrospective chart review was used to collect data for the following: patient-provider encounter notes, patient demographics, provider demographics, differential and final diagnosis, and laboratory test results. Data analysis include stratification of categorical variables and calculation of cost savings. Results For the 12-month period, this study found 2567 (9.3%) of all amylase and lipase tests to be unnecessary. Amylase tests (1881; 73.2%) made up the most unnecessary tests followed by lipase tests (686; 26.7%). An analysis of test-ordering behavior by providers revealed that 81.5% of all unnecessary tests were ordered by MDs. Finally, this study estimated a total cost savings of $128,350 if all unnecessary tests were eliminated. Conclusion Our study demonstrated that amylase and lipase tests have been overutilized in the diagnosis of acute pancreatitis. [ABSTRACT FROM AUTHOR]

In the Kashmir region of Pakistan, the presence of Siwalik clays engenders serviceability issues to the infrastructure causing substantial loss of property. In this study, an attempt has been made to address these issues using polypropylene fibres (PPFs) as a sustainable modifier. These fibres were used in five different proportions, namely 0.25, 0.5, 0.75, 1 and 1.25% as partial replacement of base soil to analyse their impact on the engineering behaviour of matrices. Classification, compaction, indirect tensile, unconfined and triaxial compression, swell potential, consolidation and California bearing ratio (CBR) tests were conducted on controlled as well as reinforced-clay samples for comparative analyses. The maximum improvements were observed in unconfined compressive strength (109%), tensile strength (300%), cohesion (13%), friction angle (110%), soaked CBR (800%) and un-soaked CBR (550%). Besides, the reduction in swelling strain by 92% was also recorded corresponding to 1 kPa effective vertical stress. The capital cost analyses showed that PPFs reduced the costs of backfill behind the retaining wall and foundation soil beneath isolated footing by 21 and 44.5%, respectively. Moreover, the modifier had no adverse effect on the aqueous media. Conclusively, PPFs can be used as sustainable modifiers leading to a potential solution for serviceability issues. [ABSTRACT FROM AUTHOR]

Construction robots are expected to address the challenges of the skilled labor shortage and low productivity in the construction industry. However, the development of construction robots is still in its early stages due to the lack of data on their economic performance, uncertainty in costs, and lack of experience and confidence among companies. This study establishes a cost assessment framework for construction robots. Taking the construction market in China as an example, this study compares and analyzes the construction costs of robotic and traditional construction methods from two groups of cases. Results showed that the current cost of robotic construction does not have an advantage over traditional construction. All construction robots that cost less than traditional methods are more than 2.9 times more efficient than human workers. The use of certain construction robots can reduce the number and skill requirements of construction workers. The construction cost of robot groups under a rational arrangement is lower than that of traditional construction. Further research indicated that the high purchase cost and uncertainty of the life-cycle cost are the main barriers to the application of construction robots. In light of the economic, social, and environmental benefits that construction robots can bring in the future, the current high investment is justified. In conclusion, the cost assessment framework proposed in this study provides construction companies with a systematic approach to selecting construction methods. The cost analysis of the actual construction case serves as a basis for construction companies to utilize construction robots. Practical Applications: The results of this case study suggest that the current cost of robotic construction does not have an advantage over traditional construction. Among the four types of construction robots, those for surveying and marking performed the best in terms of construction cost and those for building decoration performed the worst. All types of construction robots are statistically more efficient than traditional construction methods for the same task, and the high efficiency of construction robots can greatly reduce their construction costs. The use of certain construction robots can reduce the number and skill requirements of construction workers, which in turn reduces labor costs. Rationally arranging robot groups for construction can strengthen the linkage between construction sequences, which in turn increases the utilization of construction robots and accelerates the construction schedule. The results can advise construction contractors on the choice of appropriate construction methods and make recommendations to construction robot manufacturers, construction contractors, and governments for the development and application of construction robots. [ABSTRACT FROM AUTHOR]

The enzyme market is growing constantly, and lipases, in their free and immobilized forms, constitute an important part of this market. This study aimed to analyze and discuss current market scenarios using data from the literature, focusing on lipases and the feasibility of their use in the immobilized form. It also compares the cost of biodiesel production using two commercial lipases: Eversa Transform 2.0 (free lipase) and Novozyme 435 (immobilized lipase). The results show that the European and North American enzyme markets are the most prominent worldwide, with Denmark and the USA as the major exporters and importers, respectively. Lipases can be used in a wide variety of fields, and immobilization brings many advantages to this enzyme class. Finally, we show the use of immobilized enzymes and lipases in biorefinery and food industries and carry out a comparative cost analysis to produce biodiesel using a free and immobilized lipase. We concluded that the enzyme market, in which lipases play an important role, is extensive, and that immobilized lipases seem to be excellent biocatalysts with feasible costs for industrial applications. [ABSTRACT FROM AUTHOR]

The purpose of this study is to assess the environmental and economic impacts of the various food packaging systems offered in university food services in Canada. Toronto Metropolitan University's food service was chosen as a test case. Three systems exist in this setting: single‐use polypropylene (PP) containers, reusable PP clamshells and compostable bagasse clamshells. The goal is to understand which system has the most favourable impact regarding the Tool for the Reduction and Assessment of Chemical and other environmental Impacts' (TRACI 2.1) 10 impact categories and which system is the most financially viable through a cost analysis. The scope includes a cradle‐to‐grave life cycle assessment (LCA) consisting of raw material extraction and production, transportation, usage and end‐of‐life disposal. This study investigates the environmental impact of each packaging system for 10 000 meals consumed by students. This research follows two ISO standards, 14044:2006, and 14040:2006. These standards involve defining the goal and scope, completing a life cycle inventory (LCI) analysis, completing a life cycle impact assessment (LCIA) and interpreting the life cycle. LCI information is extracted using SimaPro v9.0. The study results reveal that the reusable PP clamshell has the least environmental impact when compared to the two other single‐use packaging alternatives for nine of the 10 environmental impact categories. The single‐use PP container has the most significant environmental impact due to its harmful material extraction, production processes and end‐of‐life emissions. The sensitivity analysis determined that if reused a minimum number of 37 times, the reusable clamshell (RU) remains favourable to the single‐use formats in nine of the 10 impact categories. Furthermore, the cost analysis reveals that the reusable packaging format is the most financially favourable when reused 16 times or more. This research concludes that single‐use food packaging options have a more significant environmental impact than reusable PP clamshells. Based on the research findings, purchasing a less harmful detergent, sourcing the packaging locally and reducing the loss rate of reusable PP clamshells could produce an even more favourable environmental impact for the reusable food packaging system. [ABSTRACT FROM AUTHOR]

This study compares the costs of a school-based online credit recovery model to more traditional teacher-directed credit recovery using rigorous cost analysis methods. Findings indicate that differences in the comprehensive costs for online and teacher-directed credit recovery classes are small. However, cost differences across the two models of specific types of resources are substantial and statistically significant. Online credit recovery classes resulted in higher district-incurred costs largely due to the purchase of online curricula and required technology. The online model incurred lower opportunity costs to teachers stemming from less out-of-class time devoted to grading, lesson planning, and developing course materials. [ABSTRACT FROM AUTHOR]

In this study, we estimate the overall costs of the youth population, not in education, employment, or training (NEET) in Morocco, focusing on public finance and opportunity costs, focusing on three of the five aspects: unemployment, health, and teenage mothers. The results show that young rural women represent a significant percentage of youths who are not in education, employment, or training in Morocco. In 2019, the total cost of young youth not in education, employment, or training in Morocco was estimated at 60,592,858,600 Moroccan Dirhams in terms of public finance and 55,043,899 000 Moroccan dirhams in terms of opportunity cost. These findings have implications for alleviating financial strain, fostering long-term social inclusion, and economic development. The high rate of young rural women not in education, employment, or training raises the need for targeted interventions in this area. The cost to the country is significant, affecting at the same time the lives of these youth, their families, and the national economy. This study highlights the need to implement policies and programs that integrate youth not in education, employment, or training into education and employment, thus reducing their socioeconomic impact for a sustainable future. This study adds to the literature by providing a detailed cost analysis of not in education, employment, or youth training in Morocco, demonstrating how these findings can be applied to similar contexts worldwide. [ABSTRACT FROM AUTHOR]

Background: Sleeve gastrectomy has become a gold standard in addressing medically refractory obesity. Robotic platforms are becoming more utilized, however, data on its cost-effectiveness compared to laparoscopy remain controversial (1–3). At NYU Langone Health, many of the bariatric surgeons adopted robotic surgery as part of their practices starting in 2021. We present a retrospective cost analysis of laparoscopic sleeve gastrectomy (LSG) vs. robotic sleeve gastrectomy (RSG) at New York University (NYU) Langone Health campuses. Methods: All adult patients ages 18–65 who underwent LSG or RSG from 202 to 2023 at NYU Langone Health campuses (Manhattan, Long Island, and Brooklyn) were evaluated via electronic medical records and MBSAQIP 30-day follow-up data. Patients with prior bariatric surgery were excluded. Complication-related ICD-10/CPT codes are collected and readmission costs will be estimated from ICD codes using the lower limit of CMS transparent NYU standard charges (3). Direct charge data for surgery and length of stay cost data were also obtained. Statistical T-test and chi-squared analysis were used to compare groups. Results: Direct operating cost data at NYU Health Campuses demonstrated RSG was associated with 4% higher total charges, due to higher OR charges, robotic-specific supplies, and more post-op ED visits. Conclusions: RSG was associated with higher overall hospital charges compared to LSG, though there are multiple contributing factors. More research is needed to identify cost saving measures. This study is retrospective in nature, and does not include indirect costs nor reimbursement. Direct operating costs, per contractual agreement with suppliers, are only given as percentages. Data are limited to 30-day follow-up. [ABSTRACT FROM AUTHOR]

Recent studies show two important factors in the nonlinear behavior of cost and profit. The first factor is cost stickiness, which expresses economic asymmetry in the reaction of cost to increase and decrease in sales. The second factor is related to accounting conservatism, which indicates the asymmetry of financial reporting in identifying good news versus bad news. Although conservatism and cost stickiness are conceptually based on two different and separate phenomena, but they create two similar patterns in the temporal asymmetry of profits. This study examines the relationship between cost stickiness, levels of conservatism and firm life cycle. In this research, by using the combined data technique and by using three models of non-operating accrual items, Basu’s model and market value model, and with a sample consisting of 113 companies admitted in the Tehran Stock Exchange during the years 2010-2019, this goal has been investigated. The research results indicate that the stickiness of costs is related to conservatism in all three models. The findings of the research show that in the growth stage between cost stickiness and conservatism of companies, there is a significant negative relationship in all three models, of which Basu’s model has more explanatory power. In the maturity stage, there is a negative and significant relationship between the stickiness of costs and the conservatism of companies in the Basu’s model and non-operating accruals, but no significant relationship has been observed in the market value model. In the recession stage, the effect of cost stickiness on the reduction of conservatism is significant only based on the market value model. Finally, in the decline stage, no significant relationship was found in any of the three models. [ABSTRACT FROM AUTHOR]

India being more focused on its agricultural development requires information on energy input requirements for agro-based industries, where most of the energy is consumed by post-harvest operations. This study evaluates energy consumption by both the conventional method and the non-conventional method of agro-processing of maize on a small scale with the objectives of effective management of the limited resources in the agriculture, finding energy and cost-saving solutions for the two most energy- and cost-intensive post-harvest processes, providing energy-saving recommendations with suggestions for minimizing the involved cost of operation by focusing on the use of eco-friendly renewables in the agro-processing sector. Energy auditing with the help of energy tools and experimentally collected data was used for the energy analysis of the processes, and break-even analysis was used to find out the new selling price of the product using alternate energy sources for processing. The net energy and cost savings obtained through solar drying and solar milling were 545.38 GJ/yr, 50,017.50 GJ/yr, and USD 7,146.68, and USD 3,880, respectively. The findings reveal that drying and milling when accomplished by using solar energy offer perfect solution to much of the problem for small farm holders as well as for the environment by reducing 39.8 kg of CO2 emission. This research work will help to understand the use of energy analysis and the ways of its implementation in agro-based industries for the development of sustainable agriculture strategy. Policy directions provided help to improve policy regarding the integration of renewable energy in post-harvest processing operations. [ABSTRACT FROM AUTHOR]

When loading liquefied natural gas (LNG) onto a dual-fuel LNG container ship fuelled by LNG, there is a considerable temperature difference between LNG and the fuel tank at room temperature. The current solution is to pre-cool the tank with LNG through a spray line but the cooling process, if not correctly handled, can result in excessive cooling rates and Boil-Off Gas (BOG), which can expose the tank to increased temperature stress and gas pressure. Therefore, this paper takes the Mark III fuel tank of a specific type of LNG container ship as the object and realises a real-time predictive control system by writing a UDF (User Defined Function) to simulate and analyse the influence of LNG spray rate on the change of cooling effect, cooling time and cooling cost under the unidirectional LNG spray cooling mode. Compared with the results of the fuel tank gas experiment, the deviation of numerical model simulation results is less than 5%. Under the same cooling rate, the real-time control scheme can achieve a more uniform cooling rate and reduce the total LNG consumption by 25%. With the increase in LNG cooling rate, the cooling time, LNG usage, and the total BOG exhaust volume all decrease; however, the decreased range gradually decreases as well. The results of this paper provide parameters and suggestions for optimising and improving the LNG fuel tank cooling monitoring and control system. [ABSTRACT FROM AUTHOR]

The broiler industry is crucial in Malaysia's agricultural sector, contributing significantly to meat production and the economy. However, the industry faces significant challenges, primarily stemming from high production costs, with feed costs constituting a substantial portion. Therefore, there is a need to improve domestic farm performance and competitiveness by optimizing resources and minimizing expenses to enhance overall productivity. This study aims to estimate the extent of cost efficiency in broiler farming in Peninsular Malaysia and identify key determinants influencing the inefficiency cost. A comprehensive survey involving 241 broiler farms in Peninsular Malaysia was conducted using structured questionnaires and a stratified random sampling technique. Employing the Stochastic Cost Frontier model revealed an operational inefficiency of approximately 5.7% above optimal costs among the surveyed farms, indicating substantial potential for a 5.7% reduction in production costs through enhanced management strategies. Factors such as feed prices, day-old chick prices, price of miscellaneous inputs, production output levels, and capital investment prices emerged as prominent influencers in the broiler cost function. Furthermore, the study indicated that socio-economic factors such as housing system, extension visits, credit access and contract farming are associated with lower inefficiencies, thereby enhancing cost efficiency in broiler farming operations. Conversely, higher bird mortality rates are associated with the increased inefficiency. Gaining insights into these factors is crucial for stakeholders to allocate resources wisely, plan strategically, and enhance competitiveness in broiler farming. [ABSTRACT FROM AUTHOR]

Objective: AIDS Drug Assistance Programs (ADAPs) are state-administered programs that pay for medical care and medication for people living with HIV (PLWH) in the United States. In October 2021, the federal policy requiring that clients recertify for the program every 6 months was repealed, giving states the authority to set their own recertification policies. However, little data exist on the costs and health effects of alternative recertification schedules. We assessed the cost of changing the legacy 6-month recertification to a 12-month schedule in Washington State to inform policy decisions on recertification. Methods: We used a Markov model to simulate the population of PLWH in Washington State who are eligible or enrolled in ADAP. We obtained model inputs and validation data from the Washington State Ryan White database. We estimated the cost of 12-month and 6-month criteria over a 5-year time horizon. Model outputs included annual program costs, population sizes, and number of people virally suppressed, by scenario. Results: Under a continuation of the legacy 6-month recertification criteria, the annual cost of Washington ADAP would be $37 663 000 (95% CI, $34 570 000-$41 686 000) during the next 5 years, with a per-client cost of $7966 (95% CI, $7478-$8494). Under 12-month criteria, the annual cost would be $40 217 000 (95% CI, $36 243 000-$44 401 000) and the per-client cost would be $7543 (95% CI, $7084-$8042). Under the 12-month scenario, 245 more people will have been virally suppressed by the end of 2025. Conclusions: Switching to a less frequent recertification process may improve health outcomes at a modest increase in cost in Washington State. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the current literature on healthcare policies and cost analyses around international Voluntary Assisted Dying (VAD) laws. The study design is a mapping literature review following Preferred-Reporting-Items-for-Systematic-Reviews-and-Meta-Analyses (PRISMA) guidelines. Methods: Original research articles published between January 1990 to March 2023, investigating the financial cost and healthcare budget effect of VAD laws internationally. Citations were screened for relevance and eligibility, and any non-full-text research that did not explore cost analysis was excluded. The following data sources were screened: MEDLINE, PubMed, EMBASE, CINAHL and any relevant international health authority annual reports were also reviewed. Results: Of the 2790 screened articles, eight studies met the inclusion criteria and three were included in the mapping review. The reviewed studies included prospective studies, two Canadian and one US. Only one of the Canadian studies provided a cost analysis using data from current VAD laws. All three studies showed VAD laws would reduce healthcare spending, with the US approximating $627million in 1995. Canada approximating $17.1 to $77.1million in 2017 and $86.9 to $149.0million in 2021, overall, leading to an average percentage reduction in costs of approximately 87% compared to original costs of end-of-life care. Conclusion: This review identifies a scarcity in cost-analysis literature and provides a summary of the latest international VAD laws, from which a potential cost reduction is apparent. The absence of retrospectively collated financial VAD data highlights a need for future research to inform policymakers of the economic factors affecting current policies with a need for annual fiscal reports and to optimise future legislative frameworks internationally. Key points: - This study highlights the absence of cost analysis reports on the provision of VAD globally, at a time when VAD is becoming an evolving part of end-of-life care particularly in developed countries base on the notion of patient autonomy. - The impact of this study is its ability to inform future research and policymakers of the economic factors affecting current VAD policies with a need for annual fiscal reports and to optimise future legislative frameworks internationally. [ABSTRACT FROM AUTHOR]

Background: The management of febrile neutropenia (FN) in pediatric cancer patients has traditionally been conducted in a hospital setting. However, recent evidence has indicated that outpatient management of FN can be equally effective compared to inpatient care. Based on this evidence, we conducted a cost-minimization analysis (CMA) specifically focused on pediatric cancer patients in Mexico. Methods: A piggy-back study was conducted during the execution of a non-inferiority clinical trial that compared outpatient treatment to inpatient treatment for FN in children with cancer. A CMA was performed from a societal perspective using patient-level data. In the previous study, we observed that step-down oral outpatient management of low-risk FN was as safe and effective as inpatient intravenous management. Direct and indirect costs were collected prospectively. The costs were adjusted for inflation and converted to US dollars, with values standardized to July 2022 costs. Statistical analysis using bootstrap methods was employed to obtain robust estimations for decision-making within the Mexican public health care system. Results: A total of 117 FN episodes were analyzed, with 60 in the outpatient group and 57 in the inpatient group; however, complete cost data were available for only 115 FN episodes. The analysis revealed an average savings of $1,087 per FN episode managed on an outpatient basis, representing a significant 92% reduction in total cost per FN episode compared to inpatient treatment. Length of hospital stay and inpatient consultations emerged as the primary cost drivers within the inpatient care group. Conclusion: This CMA demonstrates that the step-down outpatient management approach is cost-saving when compared to inpatient management of FN in pediatric cancer patients. The mean difference observed between the treatment groups provides support for decision-making within the public health care system, as outpatient management of FN allows for substantial cost savings without compromising patient health. [ABSTRACT FROM AUTHOR]

Background: Lack of evidence about the long-term economic benefits of interventions targeting underserved perinatal populations can hamper decision making regarding funding. To optimize the quality of future research, we examined what methods and costs have been used to assess the value of interventions targeting pregnant people and/or new parents who have poor access to healthcare. Methods: We conducted a scoping review using methods described by Arksey and O'Malley. We conducted systematic searches in eight databases and web-searches for grey literature. Two researchers independently screened results to determine eligibility for inclusion. We included economic evaluations and cost analyses of interventions targeting pregnant people and/or new parents from underserved populations in twenty high income countries. We extracted and tabulated data from included publications regarding the study setting, population, intervention, study methods, types of costs included, and data sources for costs. Results: Final searches were completed in May 2024. We identified 103 eligible publications describing a range of interventions, most commonly home visiting programs (n = 19), smoking cessation interventions (n = 19), prenatal care (n = 11), perinatal mental health interventions (n = 11), and substance use treatment (n = 10), serving 36 distinct underserved populations. A quarter of the publications (n = 25) reported cost analyses only, while 77 were economic evaluations. Most publications (n = 82) considered health care costs, 45 considered other societal costs, and 14 considered only program costs. Only a third (n = 36) of the 103 included studies considered long-term costs that occurred more than one year after the birth (for interventions occurring only in pregnancy) or after the end of the intervention. Conclusions: A broad range of interventions targeting pregnant people and/or new parents from underserved populations have the potential to reduce health inequities in their offspring. Economic evaluations of such interventions are often at risk of underestimating the long-term benefits of these interventions because they do not consider downstream societal costs. Our consolidated list of downstream and long-term costs from existing research can inform future economic analyses of interventions targeting poorly served pregnant people and new parents. Comprehensively quantifying the downstream and long-term benefits of such interventions is needed to inform decision making that will improve health equity. [ABSTRACT FROM AUTHOR]

Background: Indoor residual spraying (IRS) is one of the most effective malaria control tools. However, its application has become limited to specific contexts due to the increased costs of IRS products and implementation programmes. Selective spraying—selective spray targeted to particular areas/surfaces of dwellings—has been proposed to maintain the malaria control and resistance-management benefits of IRS while decreasing the costs of the intervention. Methods: A literature search was conducted to find (1) studies that assessed the resting behaviour of Anopheles mosquitoes and (2) studies that evaluated the impact of selective spraying on entomological and malaria outcomes. Additional articles were identified through hand searches of all references cited in articles identified through the initial search. A cost model was developed from PMI VectorLink IRS country programmes, and comparative cost analysis reports to describe the overall cost benefits of selective IRS. Results: In some studies, there appeared to be a clear resting preference for certain Anopheles species in terms of the height at which they rested. However, for other species, and particularly the major African malaria vectors, a clear resting pattern was not detected. Furthermore, resting behaviour was not measured in a standardized way. For the selective spray studies that were assessed, there was a wide range of spray configurations, which complicates the comparison of methods. Many of these spray techniques were effective and resulted in reported 25–68% cost savings and reduced use of insecticide. The reported cost savings in the literature do not always consider all of the IRS implementation costs. Using the IRS cost model, these savings ranged from 17 to 29% for programs that targeted Anopheles spp. and 18–41% for programmes that targeted Aedes aegypti. Conclusions: Resting behaviour is generally measured in a simplistic way; noting the resting spot of mosquitoes in the morning. This is likely an oversimplification, and there is a need for better monitoring of resting mosquitoes. This may improve the target surface for selective spray techniques, which could reduce the cost of IRS while maintaining its effectiveness. Reporting of cost savings should be calculated considering the entire implementation costs, and a cost model was provided for future calculations. [ABSTRACT FROM AUTHOR]

E-cigarette product characteristics are known to influence appeal among young adults. Understanding which characteristics appeal to individuals with (vs. without) a history of combusted tobacco use is essential for developing effective tobacco control policies. Anonymous, self-report data were collected from young adults (18-30 years) who had used e-cigarettes in the past 30 days (n = 295) online via Prolific from September-October 2019. Using a visual analogue scale (range: 0-100), participants rated the importance of ten e-cigarette device and nine e-liquid characteristics. Adjusted linear regression models were used to evaluate the association of combusted tobacco use status (never, former, current) with mean rating scores for each of the nineteen characteristics. The most important e-cigarette device characteristics were price (Mean = 81.1; [SD = 17.9]), size (Mean = 75.5 [SD = 20.9]), and hit strength (Mean = 73.8 [SD = 20.4]) while the most important e-liquid characteristics were flavor (M = 85.1 [SD = 16.3]), price (M = 80.9 [SD = 18.4]), and nicotine level (M = 77.8 [18.9]). Differences by combusted tobacco use status were observed for device brand, temperature/voltage, customizability, color, and popularity, with the highest ratings generally observed among those concurrently using combustible tobacco products. For e-liquids, differences by use status were observed for flavor, price, and bottle type. Notably, those concurrently using combusted products rated flavor as less important than those with no history of combustible tobacco use (B=-5.01[95%CI=-9.97, −0.05]). The self-rated importance of e-cigarette device and e-liquid attributes varies by combustible tobacco use status among young adults which may be used to inform regulatory decisions regarding e-cigarette product characteristics. [ABSTRACT FROM AUTHOR]

Gait dysfunction (GD) is a common impairment of Parkinson's disease (PD), which negatively impacts patients' quality of life. Among the most recent rehabilitation technologies, a lower-limb powered exoskeleton (LLEXO) arises as a useful instrument for gait training in several neurological conditions, including PD. However, some questions relating to methods of use, achievable results, and usefulness compared to traditional rehabilitation methodologies still require clear answers. Therefore, in this review, we aim to summarise and analyse all the studies that have applied an LLEXO to train gait in PD patients. Literature research on PubMed and Scopus retrieved five articles, comprising 46 PD participants stable on medications (age: 71.7 ± 3.7 years, 24 males, Hoehn and Yahr: 2.1 ± 0.6). Compared to traditional rehabilitation, low-profile lower-limb exoskeleton (lp-LLEXO) training brought major improvements towards walking capacity and gait speed, while there are no clear major benefits regarding the dual-task gait cost index and freezing of gait symptoms. Importantly, the results suggest that lp-LLEXO training is more beneficial for patients with an intermediate-to-severe level of disease severity (Hoehn and Yahr > 2.5). This review could provide a novel framework for implementing LLEXO in clinical practise, highlighting its benefits and limitations towards gait training. [ABSTRACT FROM AUTHOR]

There is a large disparity in Pre-exposure Prophylaxis (PrEP) utilization among communities of color compared to White Americans. There is also a lack of theory-based survey instruments to measure the underlying reasons for the disparity among communities of color. The purpose of this study was to create an instrument based on a qualitative approach involving community interviews. Semi-structured interviews guided by the Multi-theory Model (MTM) of health behavior change were performed in a sample of 12 members from communities of color. The analysis entailed a directed content analysis along the themes of MTM constructs to develop a survey instrument. The barriers to PrEP that emerged included the cost of PrEP, lack of protection from other sexually transmitted diseases, reduced trust between partners, and the stigma associated with PrEP. The perceived disadvantages included the potential cost of PrEP, partner mistrust when taking PrEP, discussion of sexual behaviors with a provider, and unclear process of acquiring the PrEP prescription. The results guided the development of a survey tool to further investigate aspects of cost, partner relations, stigma, reassurance of safety, and other factors. The tool can be used for future studies as part of guided interventions to increase PrEP uptake. [ABSTRACT FROM AUTHOR]

A study of 2 health care claims databases (commercial, Medicaid) was undertaken to estimate the episodic cost of lower respiratory tract illness due to respiratory syncytial virus among infants aged <12 months overall, by age, and by birth gestational age. Among commercial-insured infants, mean costs were $28 812 for hospitalized episodes, $2575 for emergency department episodes, and $336 for outpatient clinic episodes. Costs were highest among infants aged <1 month and infants with a gestational age ≤32 weeks and were comparable among Medicaid-insured infants, albeit somewhat lower. The cost of lower respiratory tract illness due to respiratory syncytial virus during the acute phase of illness is high, especially among the youngest infants and those born premature. [ABSTRACT FROM AUTHOR]

This paper tests a multivariate statistical model to simulate rainfall dependent susceptibility scenarios of shallow landslides. To this end, extreme rainfall events spanning from 1977 to 2021 in the Orba basin (a study area of 505 km2 located in Piedmont, northern Italy), have been considered. First of all, the role of conditioning and triggering factors on the spatial pattern of shallow landslides in areas with complex geological conditions is analysed by comparing their spatial distribution and their influence within logistic regression models, with results showing that rainfall and specific lithological and geomorphological conditions exert the strongest control on the spatial pattern of landslide. Different rainfall-based scenarios were then modelled using logistic regression models trained on different combinations of past events and evaluated using an ensemble of performance metrics. Models calibrated on multi-events outperform the ones based on a single event, since they are capable of compensating for local misleading effects that can arise from the use of a single rainfall event. The best performing developed model considers all the landslide triggering rainfall scenarios and two non-triggering intense rainfall events, with a score of 0.90 out of 1 on the multi-criteria TOPSIS-based performance index. Finally, a new approach based on misclassification costs is proposed to account for false negatives and false positives in the predicted susceptibility maps. Overall, this approach based on a multi-event calibration and on a misclassification costs analysis shows promise in producing rainfall dependent shallow landslide susceptibility scenarios that could be used for hazard analyses, early warning systems and to assist decision-makers in developing risk mitigation strategies. [ABSTRACT FROM AUTHOR]

Green sea dykes, also known as ecosystem-based sea dykes, represent a novel type of coastal defense consisting of both traditional structural engineering and coastal ecosystems, designed to cope with the future trends of sea level rise and intensified storms. Here we focus on the mid-latitude mud coasts (eastern China in particular), which face the most prominent risks of storm surge, storm-induced giant waves, and shoreline erosion, and summarizes the scientific basis of green sea dykes and the current status of engineering practices. We show that the basic mechanisms of nearshore wave energy dissipation include bottom friction, sediment transport, and form drag. These explain the wave damping capacity of oyster reefs and salt marshes on mud coasts. In tidal flat environments, oyster growth increases frictional resistance and even causes wave breaking; the resuspension and transport of fine-grained sediments on salt marsh beds and the movement or resistance to hydrodynamic forcing of salt marsh vegetation stems effectively dissipate wave kinetic energy, and their efficiency increases with the elevation of the bed surface. Based on the wave damping capacity of oyster reefs and salt marshes on mud coasts, ecosystem-based sea dykes are being built in combination with traditional structured sea dykes. By utilizing natural tidal flats outside the dykes or implementing artificial modification projects, a certain scale of salt marshes and/or oyster reefs can be maintained, which serve to protect the sea dykes and enhance their wave resistance functions. From the perspective of system optimization, it is necessary to further improve the efficiency and sustainability of green sea dykes under constraints such as regional environment characteristics, ecosystem health, investment capacity, and ecological resilience. Related scientific issues include the theorization of the wave damping process of salt marshes, the niche and scale control of oyster reef and salt marsh ecosystems, the establishment of engineering standards and the design of the optimal form of sea dykes. [ABSTRACT FROM AUTHOR]

Inverted positive‐intrinsic‐negative (p‐i‐n) perovskite solar cells (IPSCs) have attracted widespread attention due to their low fabrication temperature, good stability in ambient air, and the potential for use in flexible and tandem devices. In recent years, self‐assembled monolayers (SAMs) have been investigated as a promising hole‐selective contact for IPSCs, leading to an impressive record efficiency of about 26%, which is comparable to that of the regular n‐i‐p counterparts. This review focuses on the progress of SAM‐based IPSCs from the perspective of energy level matching, defect passivation, interface carrier extraction, and SAMs' stability improvement, as well as the advances in up‐scalable fabrication of SAMs and perovskite layers for efficient solar modules and tandem devices. A cost analysis of the SAMs and other commonly used hole‐selective materials is conducted to evaluate their cost‐effectiveness for photovoltaic applications. Finally, the future challenges are pointed out and the perspectives on how to up‐scale SAM‐based IPSCs and improve their long‐term operational stability are provided. [ABSTRACT FROM AUTHOR]

The past decade has witnessed a significant evolution in the role of the Internet, transitioning from individual connectivity to an integral aspect of various domains. This shift has prompted a move in IP paradigms from hierarchical to distributed architectures characterized by decentralized structures. This transition empowers efficient data routing and management across diverse networks. However, traditional distributed mobility management (DMM) protocols, reliant on tunneling mechanisms, incur overheads, costs, and delays, exacerbating challenges in managing the exponential growth of mobile data traffic. This research proposes Tunnel-Free Mobility for IPv6 (TFMIPv6) as a solution to address the shortcomings of existing DMM protocols. TFMIPv6 eliminates the need for tunneling, simplifying routing processes and reducing latency. A comprehensive cost analysis and performance evaluation are conducted, comparing TFMIPv6 with traditional protocols such as MIPv6, PMIPv6, FMIPv6, and HMIPv6. The study reveals significant improvements with TFMIPv6. Signaling costs are reduced by 50%, packet delivery costs by 23%, and tunneling costs are completely eliminated (100%). Real-world network traffic datasets are used for simulation, providing statistical evidence of TFMIPv6's efficacy in supporting an uninterrupted movement of IPv6 data across networks. [ABSTRACT FROM AUTHOR]

Background: Despite growing interest in delivering high-value orthopaedic care, the costs associated with hip arthroscopy remain poorly understood. By employing time-driven activity-based costing (TDABC), we aimed to characterize the cost composition of hip arthroscopy for labral pathological conditions and to identify factors that drive variation in cost. Methods: Using TDABC, we measured the costs of 890 outpatient hip arthroscopy procedures for labral pathological conditions across 5 surgeons at 4 surgery centers from 2015 to 2022. All patients were ≥18 years old and were treated by surgeons who each performed ≥20 surgeries during the study period. Costs were normalized to protect the confidentiality of internal hospital cost data. Descriptive analyses and multivariable linear regression were performed to identify factors underlying cost variation. Results: The study sample consisted of 515 women (57.9%) and 375 men (42.1%), with a mean age (and standard deviation) of 37.1 ± 12.7 years. Most of the procedures were performed in patients who were White (90.6%) or not Hispanic (93.4%). The normalized total cost of hip arthroscopy per procedure ranged from 43.4 to 203.7 (mean, 100 ± 24.2). Of the 3 phases of the care cycle, the intraoperative phase was identified as the largest generator of cost (>90%). On average, supply costs accounted for 48.8% of total costs, whereas labor costs accounted for 51.2%. A 2.5-fold variation between the 10th and 90th percentiles for total cost was attributed to supplies, which was greater than the 1.8-fold variation attributed to labor. Variation in total costs was most effectively explained by the labral management method (partial R² = 0.332), operating surgeon (partial R² = 0.326), osteoplasty type (partial R² = 0.087), and surgery center (partial R² = 0.086). Male gender (p < 0.001) and younger age (p = 0.032) were also associated with significantly increased costs. Finally, data trends revealed a shift toward labral preservation techniques over debridement during the study period (with the rate of such techniques increasing from 77.8% to 93.2%; Ptrend = 0.0039) and a strong correlation between later operative year and increased supply costs, labor costs, and operative time (p < 0.001 for each). Conclusions: By applying TDABC to outpatient hip arthroscopy, we identified wide patient-to-patient cost variation that was most effectively explained by the method of labral management, the operating surgeon, the osteoplasty type, and the surgery center. Given current procedural coding trends, declining reimbursements, and rising health-care costs, these insights may enable stakeholders to design bundled payment structures that better align reimbursements with costs. [ABSTRACT FROM AUTHOR]