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We explored the early impact of changes to the UK alcohol tax system, implemented in August 2023, on the strength and price of alcoholic products available for sale on the website of the largest supermarket in England. Our comparative descriptive study using longitudinal brand-level data was not preregistered and should be considered exploratory. Data were collected weekly (May to October 2023) using automated web scraping tools. Outcomes were product strength (% alcohol by volume [ABV]) and price (per 10 mL of pure alcohol and per litre of product). We undertook paired t -tests, two-sample Kolmogorov–Smirnov tests, and quantile regression to compare outcomes before and after the tax changes. Beer, cider, spirits, and ready-to-drinks (RTDs) were analysed separately. There was a reduction in the mean strength of beer, driven by manufacturers reformulating a small number of weaker beers, moving them into a lower tax band (<3.5%ABV). The mean price per 10 mL of alcohol and per litre of product was significantly higher after the new tax system for beer, cider, and spirits and significantly lower for RTDs. Increases in the price of beer tended to occur across the entire distribution, whereas increases in the price of cider occurred among more expensive products. Changes to product strength tended to occur among weaker products near the new lowest tax band, suggesting tax bands may be a potential stimulus for change. Reformulation of stronger products would have better public health potential. Longer term monitoring, including data on purchasing/consumption, is required. [ABSTRACT FROM AUTHOR]

To assess the outcomes, total healthcare utilization, and cost savings for same-day discharge (SDD) vs inpatient robotic-assisted partial nephrectomy (RAPN) and robotic-assisted radical nephrectomy (RARN). We compared 146 RAPNs and 65 RARNs consecutively performed as SDD (RAPN = 21, RARN = 9) vs inpatient (RAPN = 125, RARN = 56) from April 2015 to May 2023 at two academic medical centers. We collected baseline demographics, perioperative characteristics, and 30-day complications. We applied the Time-Driven Activity-Based Costing analysis to compare total costs of RAPN and PARN throughout the cycle of care, including inpatient vs SDD. Baseline demographics and comorbidities were similar between patients undergoing inpatient vs SDD RAPN and RARN. One Clavien-Dindo grade II complication (3.3%) requiring readmission due to wound infection for antibiotics occurred after SDD RAPN; no complications occurred after SDD RARN. Two unscheduled office or emergency department visits (6.7%) occurred after SDD RAPN for surgical-site infection and urinary retention. SDD vs inpatient RAPN and RARN demonstrated a $3091 (18%) and $4003 (25%) overall cost reduction, respectively. SDD RAPN and RARN result in cost savings of 18%-25% without a difference in complications, and thereby improves value-based care for appropriately selected patients. [ABSTRACT FROM AUTHOR]

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

A previous cost-effectiveness analysis published in 2022 found that the Total Posterior Spine (TOPSTM) system was dominant over transforaminal lumbar interbody fusion (TLIF). This analysis required updating to reflect a more complete dataset and pricing considerations. To evaluate the cost-effectiveness of TOPSTM system as compared with TLIF based on an updated and complete FDA investigational device exemption (IDE) data set. Cost-utility analysis of the TOPSTM system compared to TLIF. A multicenter, FDA IDE, randomized control trial (RCT) investigated the efficacy of TOPSTM compared to TLIF with a current population of n=305 enrolled and n=168 with complete 2-year follow-up. Cost and quality adjusted life years (QALYs) were calculated to determine our primary outcome measure, the incremental cost-effectiveness ratio. Secondary outcome measures included: net monetary benefit as well at willingness-to-pay (WTP) thresholds. The primary outcome of cost-effectiveness is determined by incremental cost-effectiveness ratio. A Markov model was used to simulate the health outcomes and costs of patients undergoing TOPSTM or TLIF over a 2-year period. alternative scenario sensitivity analysis, one-way sensitivity analysis, and probabilistic sensitivity analysis were conducted to assess the robustness of the model results. The updated base case result demonstrated that TOPSTM was immediately and longitudinally dominant compared with the control with an incremental cost-effectiveness ratio of −9,637.37 $/QALY. The net monetary benefit was correspondingly $2,237, both from the health system's perspective and at a WTP threshold of 50,000 $/QALY at the 2-year time point. This remained true in all scenarios tested. The Alternative Scenario Sensitivity Analysis suggested cost-effectiveness irrespective of payer type and surgical setting. To remain cost-effective, the cost difference between TOPSTM and TLIF should be no greater than $1,875 and $3,750 at WTP thresholds of $50,000 and 100,000 $/QALY, respectively. This updated analysis confirms that the TOPSTM device is a cost-effective and economically dominant surgical treatment option for patients with lumbar stenosis and degenerative spondylolisthesis compared to TLIF in all scenarios examined. [ABSTRACT FROM AUTHOR]

The demands for efficiency and stability in space missions have necessitated the development of sequence planning schemes for on-orbit robotic assembly of space structures. A sequence planning method is proposed in this work based on robotic kinematic analysis and Symbiotic Organisms Search (SOS) algorithm with a diversification strategy. With feasibility as the constraint and assembly cost as the objective function, the assembly sequence planning is regarded as an optimization problem. The assembly relationship constraint is depicted as the dependency between assembly steps represented by a directed acyclic graph. An abstract modeling method based on robotic kinematics is proposed to construct geometric feasibility constraint, accommodating the interference stemming from the multi-degree-of-freedom motion of the robotic system. A diversification strategy is exploited to address the issue of local optima arising from solving the optimal sequence based on SOS. A cost prediction method using previously calculated populations as samples is proposed to reduce the reliance on robotic dynamic analysis for cost calculation. Finally, simulations are carried out to validate the practicability of the proposed method. • The on-orbit robotic assembly sequence planning is modeled as an optimization problem with feasibility constraints. • The dependencies and priorities between steps are considered in the feasibility constraints of multi-DOF robotic motions. • The optimal sequence determination based on Symbiotic Organisms Search is speeded up by a cost prediction method. [ABSTRACT FROM AUTHOR]

With global policies targeting greenhouse gas emission reduction, renewable hydrogen produced by water electrolysis powered with renewable electricity appears a promising alternative to fossil fuels. However, still high capital costs, reliance on intermittent renewable electricity sources, and high electricity cost hinder the economic viability of electrolyzers. This work develops a comprehensive analysis for assessing the need of an incentive to make renewable hydrogen economically viable, identifying different archetypes of electrolysis plant representative of a wide range of applications. A techno-economic optimization model is set up that minimize the average hydrogen production cost and compute the cost gap that makes hydrogen economically competitive with the fossil alternative, defining the optimal size and operation of the plant components while satisfying the hydrogen demand. The model is applied to the Italian case study. Sensitivity analyses investigate the impact of economy of scales, renewable electricity availability and introduction of the emission trading system. Cost gaps ranging between 8.1 €/kg and 29.9 €/kg highlights the need of an incentive to allow the deployment of this technology, thus meeting the hydrogen penetration targets. • A cost optimization model was developed to evaluate the Levelized Cost Of green Hydrogen (LCOH). • Archetypal study cases for the hydrogen value chain were identified. • Cost gap making renewable hydrogen competitive with fossil fuels is evaluated in different scenario. • Model application to the Italian case study shows the need of a financial support to launch the hydrogen market. [ABSTRACT FROM AUTHOR]

The cost effectiveness of childhood varicella vaccination is uncertain, as evidenced by variation in national health policies. Within the European Economic Area (EEA), only 10 of 30 countries offer universally funded childhood varicella vaccination. This study estimates the cost effectiveness of universal childhood varicella vaccination for one EEA country (Ireland), highlighting the difference in cost effectiveness between alternative vaccination strategies. An age-structured dynamic transmission model, simulating varicella zoster virus transmission, was developed to analyse the impact of three vaccination strategies; one-dose at 12 months old, two-dose at 12 and 15 months old (short-interval), and two-dose at 12 months and five years old (long-interval). The analysis adopted an 80-year time horizon and considered payer and societal perspectives. Clinical effectiveness was based on cases of varicella and subsequently herpes zoster and post-herpetic neuralgia avoided, and outcomes were expressed in quality-adjusted life-years (QALYs). Costs were presented in 2022 Irish Euro and cost effectiveness was interpreted with reference to a willingness-to-pay threshold of €20,000 per QALY gained. From the payer perspective, the incremental cost-effectiveness ratio (ICER) for a one-dose strategy, compared with no vaccination, was estimated at €8,712 per QALY gained. The ICER for the next least expensive strategy, two-dose long-interval, compared with one-dose, was estimated at €45,090 per QALY gained. From a societal perspective, all three strategies were cost-saving compared with no vaccination; the two-dose short-interval strategy dominated, yielding the largest cost savings and health benefits. Results were stable across a range of sensitivity and scenario analyses. A one-dose strategy was highly cost effective from the payer perspective, driven by a reduction in hospitalisations. Two-dose strategies were cost saving from the societal perspective. These results should be considered alongside other factors such as acceptability of a new vaccine within the overall childhood immunisation schedule, programme objectives and budget impact. [ABSTRACT FROM AUTHOR]

Spine surgeons are often unaware of drivers of cost variation for anterior cervical discectomy and fusion (ACDF). We used time-driven activity-based costing to assess the relationship between body mass index (BMI), total cost, and operating room (OR) times for ACDFs. Total cost was divided into direct and indirect costs. Individual costs were obtained by direct observation, electronic medical records, and through querying multiple departments. Timestamps for all involved personnel and material resources were documented. Total intraoperative costs were estimated for all ACDFs from 2017 to 2022. All patients were categorized into distinct BMI-based cohorts. Linear regression models were performed to assess the relationship between BMI, total cost, and OR times. A total of 959 patients underwent ACDFs between 2017 and 2022. The average age and BMI were 58.1 ± 11.2 years and 30.2 ± 6.4 kg/m2, respectively. The average total intraoperative cost per case was $7120 ± $2963. Multivariable regression analysis revealed that BMI was not significantly associated with total cost (P = 0.36), supply cost (P = 0.39), or personnel cost (P = 0.20). Higher BMI was significantly associated with increased time spent in the OR (P = 0.018); however, it was not a significant factor for the duration of surgery itself (P = 0.755). Rather, higher BMI was significantly associated with nonoperative OR time (P < 0.001). Time-driven activity-based costing is a feasible and scalable methodology for understanding the true intraoperative costs of ACDF. Although higher BMI was not associated with increased total cost, it was associated with increased preparatory time in the OR. [ABSTRACT FROM AUTHOR]

Burn injuries pose a significant burden on both patients and healthcare systems. Yet, costs arising from the consumption of resources by these patients are rarely examined in Canada. The objective of this study was to assess real-world costs resulting from the initial hospitalization of patients admitted to a major burn unit in Quebec, Canada. A cost study based on a retrospective cohort was undertaken using in-hospital economic data matched to hospital chart data. Our cohort included all burn-injured patients admitted between April 1, 2017, and March 31, 2021, to the hospital's major burn unit during their initial hospitalization. Descriptive statistics were tabulated for sociodemographic and economic data. Costing data were analyzed unstratified and stratified according to burn severity (i.e., ≥ 20% of total body surface area [TBSA] vs. < 20%). Costs were presented in CAD 2021. Our cohort included 362 patients, including 65 (18%) with TBSA ≥ 20%. The average initial hospitalization cost was $32,360 ($22,783 for < 20% TBSA and $76,121 for ≥ 20% TBSA). Conclusion: Findings reveal that the total cost of the initial hospitalization, from a public hospital perspective, was $11,714,348. Our study underlines the substantial burden associated with burns and highlights the need for long-term cost evaluations. • Burn injuries are resource intensive but their exact cost is unknown in Canada. • Real-world cost of the index hospitalization was estimated at $32,360 (CAD 2021). • Heterogeneity of burn patients contributed to a high variability in costs. • Cost of long-term burn injury care remains unknown. [ABSTRACT FROM AUTHOR]

Little is known about the partnerships formed between early care and education (ECE) programs and the Child and Adult Care Food Program (CACFP) and other organizations to continue to feed young children during the COVID-19 pandemic. Such information can provide important lessons to build ECE capacity for feeding children during future emergencies and has the potential strengthen the ECE food systems. This study aimed to identify the unique partnerships that CACFP state agencies established to provide nutrition to young children during the COVID-19 pandemic Qualitative semi-structured interviews with 24 participants representing 21 states across the United States. Virtual interviews with CACFP directors from December 2020 through May 2021. Following the realist method, transcripts were analyzed using thematic analysis. Codes were developed inductively and grouped to identify themes and subthemes. Four themes were identified: (1) CACFP partnerships that supported children and families directly; (2) CACFP partnerships that built the capacity of ECE providers to provide food to children in their own settings; (3) CACFP systems-level partnerships that improved coordination of efforts to continue to feed children in ECE; and (4) CACFP directors encouraged other CACFP state agencies to build nontraditional, diverse partnerships that can be leveraged during pandemics and other natural disasters. Within these themes (subthemes), the purpose of the partnerships focused on improving waiver utilization (eg, Department of Transportation, state health departments), improving food access (eg, Summer Food Service Program [SFSP], food banks, grocery stores, dairy councils), supporting ECE programs to participate in food reimbursement programs (eg, SFSP, CACFP sponsors), and resource sharing (eg, coalitions, CACFP sponsors). The CACFP state directors reported that existing and new partnerships between CACFP state agencies and external entities successfully facilitated feeding young children in ECE during the COVID-19 pandemic. States may consider developing a road map to proactively explore potential partners in their state to meet specific needs such as accessibility, availability, and affordability for feeding young children in ECE. [ABSTRACT FROM AUTHOR]

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

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

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

This study explores the effects of using industrial-grade raw materials on the hydrogen storage properties of body-centered cubic (BCC) solid solution alloys. Industrial scrap metals were chosen as the raw material, and the desired alloys were synthesized using a vacuum arc melting furnace. Instead of using pure vanadium (V), different inexpensive industrial substitutes such as low-grade vanadium (V), vanadium nitride (VN), vanadium oxide (VO), and ferrovanadium (FeV) were utilized. The crystal structure, morphology, first hydrogenation, thermodynamics, and cyclability of the prepared alloys were analyzed by using XRD, SEM-EDS, and XPS methods. The crystal structure and morphology analysis revealed multiphase alloys in all the prepared alloys and a Ti rich third phase in the VN sample, which was absent otherwise. The first hydrogenation was performed at room temperature under a hydrogen pressure of 2 MPa without any prior heat treatment. The VO alloy displayed negligible hydrogen absorption during first hydrogenation, while the V, VN, and FeV alloys showed maximum hydrogen storage capacities of 3.49 wt%, 2.47 wt%, and 2.18 wt%, respectively. The presence of oxygen hinders the activation of the VO alloy and requires two activation cycles to activate the sample. A short-term cyclability analysis showed a reversible hydrogen storage capacity of 2 wt%. The change in enthalpy of hydrogen absorption and desorption for V alloy were calculated to be −36.73 ± 8.6 and 57.34 ± 8.3 kJ/mol H 2, respectively. One of the prominent advantages of utilizing scrap raw materials was the substantial reduction in overall raw material costs, which saw an impressive 95% decrease when compared to using pure raw materials. These results highlight the economic benefits of incorporating recovered industrial scrap into hydrogen storage alloys. • 52Ti–12V–36Cr + 4 wt% Zr alloy was prepared from industrial-grade raw material using arc melting. • Effect of the substitution of V with industrial scrap metal VN, FeV, and VO was studied. • Hydrogen storage capacity and the incubation period are affected by the impurities present. • Substitution with industrial raw materials can reduce the cost of hydrogen storage alloy by up to 95%. [ABSTRACT FROM AUTHOR]

• This research examined the effectiveness of the point-to-point speed cameras in Thailand. • After speed detection through point-to-point cameras had been employed together with warning tickets, the 85th percentile average speed in the controlled area decreased by 10 km/hr. • Drivers commuting passed the area with point-to-point cameras would drive at a constant speed throughout the average speed detection area. • The cost-effectiveness of a point-to-point camera was determined and found that it the camera is quite cost-effective. Introduction : This research examines the effectiveness of point-to-point speed cameras in Thailand compared with spot speed camera enforcement, which is widely used in the country. Method: The evaluation includes the speed control's efficiency by observing the 85th percentile average speed of drivers on the road; the speed detection rate; conducting a comparison with spot speed camera enforcement; and a cost effectiveness analysis of this measure. Results: After speed detection using point-to-point cameras were employed during which warning tickets were issued in many days of experiment, the 85th percentile average speed in the controlled area decreased by 10 km/hr, with a maximum decrease of 20 km/hr. When comparing the detection rate of the two camera models, point-to-point cameras could detect 95% of drivers' driving speed, with 45% of the detected drivers identified as speeding drivers, while spot speed cameras were only able to detect 10% to 20% of speeders. Drivers traveling through the area with point-to-point cameras were more likely to drive at a constant speed throughout the average speed detection area. Practical Applications: The point-to-point camera system is determined to be quite cost-effective. [ABSTRACT FROM AUTHOR]

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

The transition towards carbon-free transportation is only possible by the adoption of renewable energy alternatives. Hydrogen-based transportation is an attractive option considering the availability of the required refuelling infrastructure. A well-established network of hydrogen refuelling infrastructure is important for the widespread commercialization of fuel-cell electric vehicles. The most expensive H 2 refuelling components originate from hydrogen compression. Due to their ability to run on solar thermal energy, a metal hydride hydrogen compressor is used in this study. In this communication, the aim is to present a study on solar thermal based hydrogen compressors for a hydrogen refuelling station. An analytical study is presented on the energy assessment of a metal hydride compressor by considering three candidate pairs of metal hydrides (Pair 1: Ti 0.95 Zr 0.05 Cr 0.8 Mn 0.8 V 0.2 Ni 0.2 /Ti 0.8 Zr 0.2 Cr 0.95 Fe 0.95 V 0.1 ; Pair 2: TiCr 1.55 Mn 0.2 Fe 0.2 /Ti 0.9 Zr 0.1 Mn 1.4 Cr 0.35 V 0.2 Fe 0.05 , Pair 3: La 0.35 Ce 0.45 Ca 0.2 Ni 4.95 Al 0.05 /Ti 0.8 Zr 0.2 Cr 0.95 Fe 0.95 V 0.1) to achieve refuelling pressure of 700 bar. The variation in thermal efficiency of the compressor and thermal energy requirements with changes in heat source temperature, supply pressure and heat losses are presented. Furthermore, the economics of three pairs of alloys for high-pressure compression is compared. It was found that Ti 0.95 Zr 0.05 Cr 0.8 Mn 0.8 V 0.2 Ni 0.2 /Ti 0.8 Zr 0.2 Cr 0.95 Fe 0.95 V 0.1 pair has the maximum compressor efficiency of 7.2% at supply pressure and heat source temperature of 25 bar and 150 °C, respectively. In addition, the study revealed that heat losses from the reactor could reduce efficiency by around 12.5%. The economic study revealed that the Ti 0.95 Zr 0.05 Cr 0.8 Mn 0.8 V 0.2 Ni 0.2 /Ti 0.8 Zr 0.2 Cr 0.95 Fe 0.95 V 0.1 pair has the least cost for hydrogen compression among the other chosen pairs. • Energy analysis of a solar based metal hydride compressor for refuelling station is presented. • Three candidate alloy pairs are compared for compression in the temperature range of 150–170 °C. • Effect of key parameters on the performance of solar thermal based compressor is investigated. • Maximum thermal efficiency of metal hydride compressor is reported to be 7.2%. • Economic study shows that pair 1 is a cheaper alternative for hydrogen compression in refuelling stations. [ABSTRACT FROM AUTHOR]

Different strategies to prepare H 2 -selective composite-membranes demonstrate promising performances, although the selection of the optimum alternative must consider environmental and economic concerns. These aspects, scarce in the available literature, are addressed here to analyze the convenience of using diverse CeO 2 -based intermediate layers in composite Pd-membranes and recommend a maximum membrane length for scaling-up. The replacement of raw dense-CeO 2 by porous or Pd-doped particles in the intermediate layer clearly improves the membrane performance, saving around 50% of required Pd-thickness while increasing the H 2 -permeance. However, porous-CeO 2 almost doubles the major environmental impacts and support modification costs, overcoming the potential saving costs in palladium. On the contrary, dense Pd-doped CeO 2 mitigates the environmental impacts by 27% and simultaneously saves 24% of expenses. Further reductions in environmental impacts and costs were reached after increasing the membrane-length up to 25 cm, becoming further improvements almost negligible for longer membranes. • Environmental impacts and costs for diverse Electroless Pore-Plating membranes. • Porous CeO 2 improves membrane performance and cost but not the environmental impacts. • Dense Pd–CeO 2 improves membrane performance, cost, and environmental impacts. • Reduction of environmental impacts if scaling-up membrane length up to 25 cm. [ABSTRACT FROM AUTHOR]

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

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

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

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

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

Frontotemporal dementia (FTD) may impose substantial psychological and social burdens on caregivers and family members that are unique from other forms of dementia due to its distinctive clinical characteristics. This systematic review investigated these impacts on caregivers and family members. A systematic search was conducted in the PubMed, Cochrane Library and Embase databases for relevant articles published from database inception to 23 March 2023. The methodological quality of the articles was evaluated using a checklist. Thirty-six articles (six qualitative and thirty quantitative), including 5129 participants, were included in this review. Like other forms of dementia, FTD caregivers had significant caregiver burden levels and psychological impacts. Caregiver burden was associated with behavioural symptoms (e.g., apathy and disinhibition) and motor symptoms. The costs of caring for a patient with FTD were found to be higher than those for Alzheimer's disease. FTD patients often face challenges in obtaining a correct diagnosis and experience significant delays and multiple misdiagnoses. Healthcare professionals may also be less familiar with FTD than with Alzheimer's, leading to delayed diagnosis. This can cause considerable stress and deprive patients and caregivers of early intervention. FTD is associated with significant costs and caregiver burden levels, and the difficulties faced by caregivers and family members can be unique and challenging in different aspects when compared to other forms of dementia. Better education about FTD for family members and healthcare professionals is required to improve the quality of life for both patients and caregivers, and more support needs to be provided at all stages of the disease. [ABSTRACT FROM AUTHOR]

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

Frequent intake of sugar-sweetened beverages (SSBs) among US adults is a public health concern because it has been associated with increased risks for adverse health outcomes such as obesity, type 2 diabetes, and cardiovascular disease. In contrast, drinking plain water (such as tap, bottled, or unsweetened sparkling water) instead of drinking SSBs might provide health benefits by improving diet quality and helping prevent chronic diseases. However, there is limited information on estimated expenditures on SSBs or bottled water among US households. This study examined differences in SSB and bottled water purchasing according to household and geographic area characteristics and estimated costs spent on purchasing SSB and bottled water from retail stores among a nationally representative sample of US households. This study is a secondary analysis of the 2015 Circana (formerly Information Resources Inc) Consumer Network Panel data, which were merged with the US Department of Agriculture nutrition data using the US Department of Agriculture Purchase-to-Plate Crosswalk-2015 dataset (the latest available version of the Purchase-to-Plate Crosswalk at the time the study began), and the Child Opportunity Index 2.0 data. A total of 63,610 households, representative of the contiguous US population, consistently provided food and beverage purchase scanner data from retail stores throughout 2015. The included demographic and socioeconomic variables were household head's age, marital status, highest education level, race and ethnicity of the primary shopper in the household, family income relative to the federal poverty level, and presence of children in the household. In addition, descriptors of households' residential areas were included, such as the county-level poverty prevalence, urbanization, census region, and census tract level Child Opportunity Index. Annual per capita spending on SSB and bottled water and daily per capita SSB calories purchased. Unadjusted and multivariable adjusted mean values of the main outcome measures were compared by household demographic, socioeconomic, and geographic characteristics using linear regression analysis including Circana's household projection factors. Nearly all households reported purchasing SSBs at least once during 2015 and spent on average $47 (interquartile range = $20) per person per year on SSBs, which corresponded to 211 kcal (interquartile range = 125 kcal) of SSBs per person per day. About seven in 10 households reported purchasing bottled water at least once during 2015 and spent $11 (interquartile range = $5) per person on bottled water per year. Both annual per capita SSB and bottled water spending, and daily per capita SSB calories purchased was highest for households whose heads were between 40 and 59 years of age, had low household income, or lived in poor counties, or counties with a low Child Opportunity Index. Annual per capita spending was also higher for households with never married/widowed/divorced head, or at least 1 non-Hispanic Black head, and households without children, or those living in the South. Daily per capita SSB calorie purchases were highest for households where at least 1 head had less than a high school degree, households with at least 1 Hispanic or married head, and households with children or those living in the Midwest. These findings suggest that households that had lower socioeconomic status had higher annual per capita spending on SSBs and bottled water and higher daily per capita total SSB calories purchased than households with higher socioeconomic status. [ABSTRACT FROM AUTHOR]

In this study, an integrated energy system is deployed to generate electricity, heating, cooling, and domestic hot water for a community considering three fully renewable energy source scenarios: biofuel (Case I), solar-biofuel (Case II), and geothermal energy (Case III). The proposed systems are modeled, assessed, optimized, and compared thermodynamically, economically, and environmentally; in addition, a proton exchange membrane electrolyzer (PEME) is utilized to convert the surplus electricity to stored hydrogen to raise the exergy efficiency and package value-added. Mathematical models are fully developed from thermodynamic and economic perspectives, taking a cumulative inflation rate into account via the Consumer Price Index (CPI). The novelty of the study is to focus on the comparison of the proposed renewable resources as energy inputs for the same condition (community loads), as there is a gap in this regard in the literature. Presented systems are optimized using Non-dominated Sorting Genetic Algorithm-II (NSGA-II) for minimum net costs as well as maximum exergy efficiency to reach the optimum operating conditions for each case during the peak cooling and heating loads. Moreover, for a more precise comparison of the proposed cases from an exergetic, economic, and environmental point of view, dynamic (hourly) behaviors of systems are analyzed over a year. A comprehensive parametric study is carried out to reckon the influence of borehole drilling depth, geofluid mass flow rate, and soil temperature gradient on case III to appraise its competitiveness in different locations, as well as the effects of the number of collectors on total cost rate and exergy efficiency for case II. Results indicate the annual net costs of $107.1k, $99.5k, and -$505.1k (where the negative sign stands for "income" instead of "cost") and average exergy efficiencies of 19.1 %, 26.3 %, and 41.3 % for cases I, II and III respectively. [ABSTRACT FROM AUTHOR]

Incidental finding (IF) follow-up is of critical importance for patient safety and is a source of malpractice risk. Laboratory, imaging, or other types of IFs are often uncovered incidentally and are missed, not addressed, or only result after hospital discharge. Despite a growing IF notification literature, a need remains to study cost-effective non–electronic health record (EHR)–specific solutions that can be used across different types of IFs and EHRs. The objective of this study was to evaluate the utility and cost-effectiveness of an EHR-independent emergency medicine–based quality assurance (QA) follow-up program in which an experienced nurse reviewed laboratory and imaging studies and ensured appropriate follow-up of results. A QA nurse reviewed preceding-day abnormal studies from a tertiary care hospital, a community hospital, and an urgent care center. Laboratory values outside preset parameters or radiology over-reads resulting in clinically actionable changes triggered contact with an on-call emergency physician to determine an appropriate intervention and its implementation. Of 104,125 visits with 1,351,212 laboratory studies and 95,000 imaging studies, 6530 visits had IFs, including 2659 laboratory and 4004 imaging results. The most common intervention was contacting a primary care physician (5783 cases [88.6%]). Twenty-one cases resulted in a patient returning to the ED, at an average cost of $28,000 per potential life-/limb-saving intervention. Although abnormalities in laboratory results and imaging are often incidental to patient care, a dedicated emergency department QA follow-up program resulted in the identification and communication of numerous laboratory and imaging abnormalities and may result in changes to patients' subsequent clinical course, potentially increasing patient safety. [ABSTRACT FROM AUTHOR]

We perform a systematic comparison of various numerical schemes for the approximation of interface problems. We consider unfitted approaches in view of their application to possibly moving configurations. Particular attention is paid to the implementation aspects and to the analysis of the costs related to the different phases of the simulations. [ABSTRACT FROM AUTHOR]

Diesel generators used for off-grid power generation and other applications waste a significant amount of input power as heat (about 65%), contributing to global warming. To mitigate this, waste heat recovery and utilization systems can be employed. The current study, focuses on utilizing waste heat from a 2.5 MW diesel generator for freshwater production through integrated humidification dehumidification (HDH) systems. Four different HDH system layouts are investigated, considering factors such as dehumidifier and humidifier effectiveness, temperature differentials, mass flowrate ratio, and ambient temperature. The aim is to analyze and optimize the system's pure water productivity, recovery ratio, specific entropy generation, and gained output ratio. The results show that the layout featuring an air heated – air heated cycle (AH-AH) performs the best, with the highest productivity and gained output ratio of 234.48 m3/day and 3.01, respectively. On the other hand, the water heated – water heated cycle (WH-WH) layout exhibits lower performance. The study demonstrates the potential to recover 46–70% of the waste heat, significantly improving the diesel engine's utilization factor from 36% to 68%. The proposed system also proves cost-effective, with freshwater production costing as low as 0.62 $/m3 when utilizing waste heat, compared to 4.11 $/m3 and 13.96 $/m3 when using steam or electric heating elements. Furthermore, the integrated system helps reduce the environmental impact by minimizing waste heat discharge into the environment and thus contributes to mitigating global warming. • Waste energy between 46% and 50% from a diesel Engine can be recovered by desalination systems to produce freshwater. • The energy efficiency (utilization factor) of the Diesel Engine improved from 36% to 68%. • A maximum freshwater productivity of 85,585 m3/per annum can be achieved by the desalination systems. • Freshwater price as low as 0.62 $ per cubic meter can be attained from proposed integration. [ABSTRACT FROM AUTHOR]

To identify perceived facilitators and barriers to implementing culturally inclusive foods into hospitals and long-term care (LTC) from the perspectives of registered dietitians and food service directors. Cross-sectional survey. Online nationwide survey of registered dietitians and food service directors working in hospitals or LTC. We analyzed and compared participants' perceived barriers to implementing culturally inclusive foods in hospitals and LTC, assessed through a question in which we provided respondents with 13 different barriers and asked them to report the top 3. Then, we conducted a qualitative analysis of perceived facilitators, which respondents described in open-ended comments. The most common perceived barriers to implementing culturally inclusive foods were cost of ingredients (44%) and staff cultural knowledge and competence (44%). LTC respondents perceived barriers including (1) willingness of staff to adopt new practices, (2) time, (3) staff burnout, and (4) local/facility-level regulatory barriers more frequently than hospital respondents. Administrative buy-in, staff diversity, and patient considerations (eg, feedback and demand) were perceived facilitators to implementing culturally inclusive foods. Implementing culturally inclusive foods into hospitals and LTC requires administrative buy-in, willingness to change, and resources including staff diversity and cultural knowledge and awareness. Incorporating patient feedback and preferences into decisions related to dietary offerings could further motivate menu modifications. Further examination of organizational and state policies regulating diet, particularly in LTC settings, is necessary to understand both how to implement culturally inclusive foods and further, to inform investigation of health outcomes (physical and mental) associated with increasing culturally inclusive food offerings in these facilities. [ABSTRACT FROM AUTHOR]

To determine cost drivers of endothelial keratoplasty (EK) through evaluation of surgical costs and procedure length based on type of EK, use of preloaded grafts, and performance of simultaneous cataract surgery. This study was an economic analysis of EKs at a single academic institution using time-driven activity-based costing (TDABC) methodology. Endothelial keratoplasty surgical cases, including Descemet membrane endothelial keratoplasty (DMEK) and Descemet stripping automated endothelial keratoplasty (DSAEK), at the University of Michigan Kellogg Eye Center from 2016 to 2018 were included in the analysis. Data and inputs were obtained via the electronic health record (EHR) and from prior literature. Simultaneous cataract surgeries were included and separately categorized for analysis. Endothelial keratoplasty expenses were determined with TDABC, a method for cost calculation that incorporates the time that key resources are used and each resource's associated cost rate. Main outcome measures included surgery length (in minutes) and day-of-surgery costs. There were 559 EKs included: 355 DMEKs and 204 DSAEKs. Fewer DSAEKs had simultaneous cataract extraction (47; 23%) than DMEK (169; 48%). Of the DMEKs, 196 (55%) used preloaded corneal grafts. Descemet membrane endothelial keratoplasty cost $392.31 less (95% confidence interval, $251.05–$533.57; P < 0.0001) than DSAEK and required 16.94 fewer minutes (14.16–19.73; P < 0.0001). Descemet membrane endothelial keratoplasty cases that used preloaded corneal grafts cost $460.19 less ($316.23–$604.14; P < 0.0001) and were 14.16 minutes shorter (11.39–16.93; P < 0.0001). In multivariate regression, preloaded graft use saved $457.19, DMEK (compared with DSAEK) saved $349.97, and simultaneous cataract surgery added $855.17 in day-of-surgery costs. Cost analysis of TDABC identified a day-of-surgery cost and surgical time reduction associated with the use of preloaded grafts for DMEK, DMEK compared with DSAEK, and isolated EK compared with EK combined with cataract surgery. This study provides an improved understanding of surgical cost drivers and margin incentivization, which may explain trends and indirectly influence patient care decisions in cornea surgery practices. Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article. [ABSTRACT FROM AUTHOR]

Federal food assistance programs are working towards online grocery shopping. Online ordering in Special Supplemental Nutrition Program for Women, Infants and Children (WIC) is emerging following successful implementation in Supplemental Nutrition Assistance Program (SNAP). To identify anticipated challenges, potential solutions, and expected costs of WIC online ordering. Cross-sectional, mixed-methods, web-based, survey research. Data were collected from December 2020 to January 2021. Purposeful and snowball sampling included WIC stakeholders involved in developing processes and systems required for WIC online ordering. Respondents represented diverse geographic areas, levels of intraorganizational authority, and WIC benefit card types. The research team used a rapid analysis and lean coding approach to identify emergent themes from open-ended survey responses. Descriptive statistics were used to describe the distribution of responses across themes and stakeholder types. Respondents (n = 145) described 812 anticipated challenges within 20 themes grouped into five topic areas: rules and regulations; shopping experience; security, confidentiality, fraud, and WIC State agency processes; training, assistance, and education; and equitable access and buy-in. Addressing anticipated regulatory issues were among the few concrete potential solutions described. The two most frequent costs reported were increased staff time and start-up and ongoing technology costs. This study identified several, critical anticipated challenges and considerations that will help prepare WIC state agencies for opportunities to expand online ordering to WIC participants. [ABSTRACT FROM AUTHOR]

Skin cancers are a major source of morbidity in lung transplant recipients, but the relative costs associated with their treatment are unknown. We prospectively followed 90 lung transplant recipients from enrollment in the Skin Tumors in Allograft Recipients study in 2013–2015, until mid-2016. We undertook a cost analysis to quantify the health system costs relating to the index transplant episode and ongoing costs for 4 years. Linked data from surveys, Australian Medicare claims, and hospital accounting systems were used, and generalized linear models were employed. Median initial hospitalization costs of lung transplantation were AU$115,831 (interquartile range (IQR) $87,428–$177,395). In total, 57 of 90 (63%) participants were treated for skin cancers during follow-up at a total cost of AU$44,038. Among these 57, total government costs per person (mostly of pharmaceuticals) over 4 years were median AU$68,489 (IQR $44,682–$113,055) vs AU$59,088 (IQR $38,190–$94,906) among those without skin cancer, with the difference predominantly driven by more doctors' visits, and higher pathology and procedural costs. Healthcare costs overall were also significantly higher in those treated for skin cancers (cost ratio 1.50, 95%CI: 1.09, 2.06) after adjusting for underlying lung disease, age on enrollment, years of immunosuppression, and the number of treated comorbidities. Skin cancer care is a small component of overall costs. While all lung transplant recipients with comorbidities have substantial healthcare costs, those affected by skin cancer incur even greater healthcare costs than those without, highlighting the importance of skin cancer control. [ABSTRACT FROM AUTHOR]

Present work covers the treatment of lignin enriched paper industry wastewater (LEPIW) using electrocoagulation (EC) process with stainless steel (SS) electrodes. In this study, EC operation is optimized in term of % chemical oxygen demand (COD) removal and treatment cost (USD/kg COD removed). Single parameter study has been performed to study the effect of process parameters on % COD removal and treatment cost. Central composite design (CCD) of design of expert (DOE) has been used to corelate the input (time, initial COD, solution pH and current) and output parameters (% COD removal and treatment cost). Single parameter study states that maximum % COD removal of 84.4 & 77% is achieved in 40 & 60 min for initial COD:500 &1000 mg/L while 74, 66.7 & 58% can be achieved in 100 min for initial COD of 2000, 3000 & 4000 mg/L, respectively under optimum condition (solution pH:7, current: 1 A). Cost analysis summarizes that treatment cost decreases with increase in initial organic load (2.036, 2.075, 1.554, 1.247 & 1.127 USD/kg COD removed for initial COD of 500, 1000, 2000, 3000 & 4000 mg/L, respectively) at optimum condition. The caloric study states 2.31and 3.25 J/mg can be generated from the sludge and scum produced during EC process. DOE software suggests − 6.66–6.79% & − 16.73–7.95% error between experimental and designed value for % COD removal and treatment cost. [Display omitted] • COD removal range 84.4–58% is noticed for initial COD 500–4000 mg/l. • Treatment time increases from 60 to 100 min for initial COD range of 500–4000 mg/l. • Treatment cost 1.12–2.07 USD/kg COD R is noted for COD range of 500–4000 mg/l. • 2.31 and 3.25 J/mg energy is found from generated sludge and scum respectively. • Model predicts − 6.66–6.79% & − 16.73–7.95% error for COD removal & treatment cost. [ABSTRACT FROM AUTHOR]

Hydrogen (H 2) is a clean energy carrier and has recently gained significant attention. Efforts are being made to promote liquid hydrogen (LH 2) owing to its long-time storage, transportation, and high-purity end-use requirements. LH 2 storage and regasification is an essential step in the H 2 supply chain. This study proposes a novel integrated energy system that produces liquefied natural gas (LNG), natural gas liquids (NGL), and liquid helium (LHe) utilizing the cold energy of LH 2. A well-known process simulation software (Aspen Hysys® v11) is employed to simulate the integrated process. The optimal design variables are found through the Aspen Hysys® built-in Mixed optimization technique. The optimal design shows a specific energy consumption of 0.347 kWh/kg with exergy destruction of 43.3 MW. The required volume of the spherical tank for LH 2 storage is 6.3 m3. The results of the lifecycle cost analysis show that the Levelized cost of producing LNG, NGL, and LHe is 0.50 USD/kg, 0.56 USD/kg, and 98.0 USD/kg, respectively. The conclusion of this study suggests that the proposed process can improve the overall H 2 supply chain by effectively utilizing LH 2 for LNG, NGL, and LHe production. [Display omitted] [ABSTRACT FROM AUTHOR]

Underground hydrogen storage will be an essential part of the future hydrogen infrastructure to provide flexibility and security of supply. Storage in porous reservoirs should complement storage in salt caverns to be able to meet the projected high levels of required storage capacities. To assess its techno-economic feasibility, a case study of hydrogen storage in a depleted gas field in the Netherlands is developed. Subsurface modelling is performed and various surface facility design concepts are investigated to calculate the levelized cost of hydrogen storage (LCOHS). Our base case with hydrogen as cushion gas results in an LCOHS of 0.79 EUR/kg (range of 0.58–1.04 EUR/kg). Increasing the number of full-cycle equivalents from 1 to 6 lowers the storage cost to 0.25 EUR/kg. The investment cost of the cushion gas represents 76% of the total cost. With nitrogen as cushion gas, LCOHS is reduced to 0.49 EUR/kg (range of 0.42–0.56 EUR/kg). [Display omitted] • The Roden gas field is a potential case for seasonal and short-term H2 storage. • A two-stage reciprocating compressor is required to inject H2 into the reservoir. • Pressure Swing Adsorption unit is selected to separate H 2 from gas impurities. • The levelized cost of H 2 storage for the base case is below 1 EUR/kg. • Uncertainty analysis in different cost elements for the levelized cost is studied. [ABSTRACT FROM AUTHOR]

The association between socioeconomic status (SES) and chronic disease has recently become more evident in middle- and low-income countries. We hypothesized that poor socioeconomic conditions, such as food insecurity, low educational level, or low SES, may restrict access to a healthy diet and may be associated with cardiometabolic risk independently of body fat. This study examined the relation between socioeconomic indicators, body fat, and cardiometabolic disease risk markers in a random sample of mothers living in Queretaro, Mexico. Young and middle-aged mothers (n = 321) answered validated questionnaires to determine SES, food insecurity, and educational level and a semiquantitative food frequency questionnaire to determine dietary patterns and the cost of individual diet. Clinical measurements included anthropometry, blood pressure, lipids profile, glucose, and insulin. Obesity was present in 29% of the participants. Women with moderate food insecurity had higher waist circumference, glucose, insulin, and homeostasis model assessment of insulin resistance than women with food security. High triglyceride concentration and lower levels of high-density lipoprotein and low-density lipoprotein cholesterol were associated with lower SES and lower educational level. Women who consumed a lower carbohydrate diet had higher SES, higher education, and better cardiovascular risk markers. The higher carbohydrate diet profile was the least expensive diet. There was an inverse association between the cost and energy-density of foods. In conclusion, food insecurity was associated with glycemic control markers, and lower SES and education were related to a low-cost, higher carbohydrate diet and to a greater cardiovascular risk. The influence of the social environment on obesity and cardiovascular diseases needs to be further explored. In Mexican mothers, food insecurity (FI) and socioeconomic status (SES) relate differently to cardiometabolic risk. The higher SES group is associated with lower body fat, lower body mass index (BMI), and a higher-cost lower carbohydrate (CH) diet, which we consider the healthiest. The lower CH diet is related with lower triglycerides, lower insulin, and higher cholesterol concentrations (HDL and LDL) compared with the higher CH diet. FI is linked with more abdominal fat and higher glucose. Abbreviations: HDL, high-density lipoprotein; LDL, low-density lipoprotein. [Display omitted] [ABSTRACT FROM AUTHOR]

Hot-climate countries, like Egypt, have an energy surplus while suffering water scarcity. Energy surplus causes frequent part load operation of Integrated Solar Combined Cycle (ISCC) power plants. The present work proposes a cycle that combines an ISCC with a Multi Stage Flash (MSF) desalination unit. The brine heater of the MSF desalination unit acts as a steam condenser for the ISCC. The condenser pressure/top brine temperature of the MSF desalination unit controls the ISCC part load operation. A simulation model for an actual ISCC in Kuryamat-Egypt was developed and validated. A validated model for the MSF unit was integrated with the developed ISCC model. The proposed cycle (ISCC-MSF) was simulated under different operating and geometric conditions. The simulation results were used to optimize the MSF desalination unit and achieve a performance ratio of 11.65 and a 7.7% reduction in the stage area. Cost analysis was performed for the unit production cost of fresh water (UPC MSF), where a reduction of UPC MSF to 0.77$/m3 was achieved. Further reduction of UPC MSF down to 0.54$/m3 can be attained by reducing the interest rate from 5% to 1%. Detailed part load performance investigation of the proposed cycle is recommended for future work. [ABSTRACT FROM AUTHOR]

• Evaluating environmental suitability of IBA from column leaching test. • Determination of geotechnical characteristics of IBA for RSS. • Assessment of pullout behavior of IBA with polymeric reinforcements. • Comparative evaluation of IBA characteristics with standards for reuse in RSS. • Economic feasibility of using IBA in MSE walls. The study presents the geoenvironmental and geotechnical characterization of MSW incineration bottom ash (IBA) and examines its reuse as structural fill in reinforced soil structures (RSS). The suitability of reuse has been assessed with regard to international regulatory standards. The prime focus of the work remains on evaluating the pullout response of geosynthetic reinforcements through IBA fill to determine the interaction coefficient, which has never been addressed in the literature. The economic viability of using IBA instead of locally available river sand for a 12 m high MSE wall is also established. The column leaching test results confirm that IBA can be utilized in RSS with suitable design measures. The geotechnical investigation shows that IBA is a well-graded, non-plastic lightweight material with adequate drainage and high shear strength. The pullout test results demonstrate that the interaction coefficient of polymeric strips and geogrid in IBA (0.73–1.53 and 0.79–1.91, respectively) is comparable or higher to materials conventionally used as structural fill in RSS, indicating adequate bondage between IBA and geosynthetic reinforcement. Further, it is estimated that using IBA as a substitute for available river sand in the vicinity can potentially reduce the overall RSS project cost by 15–20%, even if IBA has to be transported 50 km away from the project site. [ABSTRACT FROM AUTHOR]

Every fiscal year, academic libraries must decide how to fairly allocate funds for their collection of one-time materials. A common approach is to divide these one-time funds between subject areas based on historic, quantitative, or expressed needs. A less mainstream approach is to combine all these funds into a single source of funds for one-time purchases. This article examines librarian response after transitioning from a subject-based allocation to a one-pot allocation approach for its one-time acquisitions. Methods of expenditure analysis and semi-structured interviews were used to assess the approach's effectiveness and librarian attitudes. The results of this study provide a better understanding of how librarians perceive one centralized source of one-time funds and how it influences collection spending behavior. [ABSTRACT FROM AUTHOR]

Identification of recombinant gene integrations sites in the Chinese hamster ovary (CHO) cell genome is increasingly important to assure monoclonality. While next-generation sequencing (NGS) is commonly used for the gene integration site analysis, it is a time-consuming and costly technique as it analyzes the entire genome. Hence, simple, easy, and inexpensive methods to analyze transgene insertion sites are necessary. To selectively capture the integration site of transgene in the CHO genome, we applied splinkerette-PCR (spPCR). SpPCR is an adaptor ligation-based method using splinkerette adaptors that have a stable hairpin loop. Restriction enzymes with high frequencies in the CHO genome were chosen using a Python script and used for the in vitro spPCR assay development. After testing on two CHO housekeeping genes with known loci, the spPCR-based genome walking technique was successfully applied to recombinant CHO cells to identify the transgene integration site. Finally, the comparison with NGS methods exhibited that the time and cost required for the analysis can be substantially reduced. Taken together, the established technique would aid the stable cell line development process by providing a rapid and cost-effective method for transgene integration site analysis. • Identification of transgene location is critical to assure monoclonality of CHO cells. • spPCR-based genome walking assay was developed and applied to recombinant CHO cells. • Python script-assisted selection of restriction enzyme can improve spPCR success rate. • spPCR saves required analysis time and cost substantially compared to current methods. • spPCR may aid cell line development by providing a simple and rapid analysis platform. [ABSTRACT FROM AUTHOR]

The interest in non-electric applications of nuclear energy is rising ranging from hydrogen production, district heating, seawater desalination, and various industrial applications to provide long-term answers for a variety of energy issues that both present and future generations will confront. Hydrogen is a dynamic fuel that can be used across all industrial sectors to lower carbon intensity. This study, therefore, aims at estimating the cost of nuclear hydrogen production from some light water reactors using International Atomic Energy Agency (IAEA) Hydrogen Calculator (HydCalc) program and comparing the result with similar existing studies conducted by other scholars using the Hydrogen Economic Evaluation Program (HEEP) program. The study employs six existing Light Water Reactors (LWRs) comprised of Korea Advanced Power Reactor 1400 MW electricity (APR1400), Russian VVER-1200, Davis-Besse Nuclear Power Plant in Ohio, Prairie Island NPP in Minnesota, Nine Mile Point NPP in New York, and Arizona Public Service's Palo Verde NPP to evaluate the Levelized cost of nuclear hydrogen production. Estimation of hydrogen demand was performed without carbon dioxide (CO 2) tax since nuclear power has zero CO 2 emission. The Levelized costs obtained using IAEA HydCalc and HEEP Programme were compared as follows; APR1400 cost are 2.6$/kg and 3.18$/kg, VVER1200 cost are 3.8$/kg and 3.44$/kg; Exelon cost are 1.7$/kg and 4.85$/kg; Davis Besse cost are 3.9$/kg and 3.09$/kg; Parlo Verde cost are 3.5$/kg and 4.77$/kg; Xcel Energy cost are 3.63$/kg and 0.69$/kg. The cost of hydrogen production using HEEP for Xcel Energy's Prairie Island NPP is 0.69 $/kg. This is because the reactor utilizes High Temperature Steam Electrolysis, method of hydrogen production, while the other methods employs Low Temperature Electrolysis. The results shows that the final price of the hydrogen for each reactor technology depends not only on the production method but also on the cost of the nuclear power plant and the production rate of the hydrogen plant. [Display omitted] • Hydrogen Production, District Heating, Seawater Desalination are some non-electrical applications of nuclear energy. • Nuclear energy has significant potential benefits for producing hydrogen than other conventional methods. • Cost analysis of hydrogen production using nuclear reactors are based on the economics of scale. • HydCalc and HEEP are IAEA program for estimating cost of nuclear hydrogen production. [ABSTRACT FROM AUTHOR]

The increasing penetration of photovoltaic technology in the electricity market requires the development of a methodology that facilitates the optimisation of photovoltaic plants with single-axis trackers. This paper presents an optimisation methodology that takes into account the most important design variables of single-axis photovoltaic plants, including irregular land shape, size and configuration of the mounting system, row spacing, and operating periods (for backtracking mode, limited range of motion, and normal tracking mode). Equations for the determination of the optimal row spacing and operating periods have been developed and is presented in detail. A packing algorithm that takes into account the irregular land shape and the possible configurations of the mounting systems is also presented. The objective function is the total area of the photovoltaic field and the optimisation is performed by a packing algorithm. As the economic aspect of energy generation also plays a key role in decision-making, the levelised cost of energy has been used to assess the economic viability of the optimal layout of the mounting systems. The results show that the proposed methodology and packing algorithm are able to optimise the photovoltaic plant with single-axis solar tracking and provide reliable results after a reasonable computation time. The methodology was demonstrated in detail for a Spanish photovoltaic plant (Granjera photovoltaic power plant), including the optimal layout of the mounting systems and the cost analysis for this layout. The optimal layout of the mounting systems could increase the amount of energy captured by 91.18% in relation to the current of Granjera photovoltaic power plant. The mounting system configuration used in the optimal layout is the one with the best levelised cost of energy efficiency, 1.09. The presented optimisation methodology can be utilised to facilitate the optimal design of commercial photovoltaic plants with single-axis trackers. Therefore, questions such as: what is the optimal distribution of mounting systems?, how much energy will this distribution produce?, and at what cost will it produce it?, can be answered by using the proposed methodology. • The optimal layout of single-axis solar trackers in large-scale PV plants. • A detailed analysis of the design of the inter-row spacing and operating periods. • The optimal layout of the mounting systems increases the amount of energy by 91%. • Also has the best levelised cost of energy efficiency, 1.09. [ABSTRACT FROM AUTHOR]

• There was no statistically significant difference in complications associated between patients first and contralateral second hip fracture. • Patients with a second hip fracture had higher rates of cognitive impairment. • Surgical costs and operative times were not significantly different between patients first and contralateral second hip fracture. Hip fractures are an increasingly common occurrence among the aging population. With increased life expectancy and advancements in medicine, patients sustaining a hip fracture are at an increasing risk of sustaining a contralateral hip fracture. Efforts are being made to better understand the environment of these hip fractures so that secondary prevention clinics and guidelines can be made to help prevent recurrent osteoporotic hip fractures. The estimated incidence of a contralateral hip fracture varies from 2 to 10% and is reportedly associated with a higher incidence of complications. Previous studies evaluating contralateral hip fractures compared a single cohort of patients sustaining a second hip fracture with patients who sustained only one hip fracture. We aimed to investigate the overall complications and associated costs as it relates to a patients first hip fracture and contrast this to the same patient's contralateral, second hip fractures. We performed a retrospective review of all patients in our health systems electronic database who were found to have surgically treated hip fractures between January 2004 and July 2019. Patients with surgically treated hip fractures (CPT Codes: 27235, 27236, 27245, 27244), who sustained a second contralateral hip fracture were included. Medical complications within 30 days of either procedure (such as pneumonia, UTI, altered mental status and others), length of stay, orthopedic complications (such as wound complications, infection, hardware failure, nonunion), type of implants, costs, comorbidities, and ASA Class as well as Mortality were reviewed. A total of 4,870 hip fractures were identified during the study period where 137 (2.8%) patients sustained a second hip fracture, and 47 (0.9%) of which were sustained within the first year after their index hip fracture. There was no statistical difference in length of stay (p = 0.68), medical (p >0.99) or orthopedic complications (p >0.99) between patients first and second hip fractures. There was an increased incidence of cognitive impairment with the second hip fracture (P = 0.0002). For patients that underwent operative treatment of a second hip fracture, the total cost of care was higher for the second surgery (mean difference 757. 38 USD) however the difference wasn't statistically significant (p = 0.31). The overall 1-year mortality rate was 14.9 percent. Our study demonstrates there is no statistical difference between the first and second surgery regarding length of stay, medical or orthopedic complications and cost. [ABSTRACT FROM AUTHOR]

Substantial changes in the energy system are necessary to achieve greenhouse gas neutrality. Green hydrogen is a key to defossilisation. Politicians frequently mention the use of hydrogen in the building sector to supply decentrally produced heat as a potential field of application. An advantage repeatedly mentioned is that the existing gas distribution network infrastructure is an important asset that could still be used in the future. However, there is a lack of analyses of the conversion of gas distribution networks to hydrogen focussing on the economic implications on the costs of the distribution network infrastructure. The paper provides insights using a techno-economic model network analysis (MNA) tool called gas Distribution grId modelliNg tOol (DINO). The analysis is carried out for Germany and considers hydrogen use in all counties. The results are compared to a synthetic methane and electrification scenario. In the hydrogen scenario, the total need for distribution grids is decreasing until 2050 by at least 130,000 km. The network length of the synthetic methane scenario is slightly lower and that of the electrification scenario drops to zero. The annual operation costs are lower in all scenarios as gas demand and infrastructure are reduced. Nevertheless, the total annual cost in the hydrogen scenario is potentially two times higher than in the case of the synthetic methane scenario and more than four times higher than in the electrification scenario. Based on the present results, it is questionable whether an advantage of the continued use of the existing gas distribution grid infrastructure in case of synthetic gas or hydrogen scenarios exists. • Impact of the energy transition on gas distribution networks by comparing three defossilisation pathways. • Application of a model network analysis to the use of hydrogen to derive the cost-optimal gas distribution networks. • First nationwide analysis of hydrogen in gas distribution grids based on the German case at the county level. • Decreasing demand for gas distribution infrastructure in all scenarios and highest costs in the case of hydrogen use. • Questionable advantage of continued infrastructure use in case of conversion of existing gas distribution networks. [ABSTRACT FROM AUTHOR]

To assess the cost impact of switching from contrast-enhanced magnetic resonance imaging (CE-MRI) to contrast-enhanced spectral mammography (CESM) for loco-regional staging of breast cancer from a public healthcare perspective. The CE-MRI cost was obtained from the NHS reference cost. The CESM cost was calculated using a bottom-up approach including use of the machine, pump injector, contrast medium, image storage, and time allocation for staff reporting and cannulation. The cost of upgrading existing machines to CESM or purchasing new mammographic machines was obtained via national procurement. Other costs were obtained from local pharmacy, published unit cost data, or estimated based on surveys. For large health boards in Scotland (≥500 cancers diagnosed per annum), the cost savings of switching from CE-MRI to CESM range from £64,069 to £81,570. For small health boards (<500 cancers diagnosed per annum), the cost savings of switching from CE-MRI to CESM range from £6,453 to £23,953. The cost savings are most sensitive to the number of tests conducted per year, and whether the existing mammography machine can be upgraded to CESM or not. Switching from CE-MRI to CESM for loco-regional staging of breast cancer is likely to be cost saving for both large and small health boards in Scotland. Further research is urgently needed to confirm the non-inferiority of CESM to CE-MRI as a locoregional staging technique. The input data of this analysis can be updated when such results become available. • Switching from CE-MRI to CESM for locoregional staging is likely to be cost saving. • For large health boards, estimated annual savings range from £64,069 to £81,570. • For a small health boards, estimated annual savings range from £6,453 to £23,953. • Cost is driven by number of imaging studies and equipment upgrade vs replacement. • Research to confirm the non-inferiority of CESM for locoregional staging is needed. [ABSTRACT FROM AUTHOR]

Despite the unprecedented therapeutic potentials of extracellular vesicles derived from mesenchymal stem cells, it is still early in their development and transition towards clinical applications. Integrating scalable upstream and downstream cGMP-compatible technologies is critical for developing reliable and cost-effective EV manufacturing pipelines that meet commercial and clinical demands. We have developed an EV bioprocess economic model to support the bioprocess optimization while minimizing financial and technological risks in EV manufacturing. To develop any economic model, an actual bioprocess run is required as the base case. Therefore, we performed an end to end and scalable 2L bioprocess run for EVs derived from MSCs as the base case. In summary, the upstream included MSCs expansion, growth, and collection phases (10 days total) in a 2L bioreactor. Downstream processing consisted of a combination of clarification/filtration, tangential flow filtration, and anion exchange chromatography steps. From the experimental recovery data, %15 total EV recovery and production of 1000 EVs per cell were used as inputs for the model at different scales (2, 15, 50 and 150L). Since, a wide range of EV doses have been reported in different pre-clinical and clinical data, we performed our cost analysis based on 3 different EV doses, 2E8,1E9, and 1E10 EVs. Downstream processing is around 10% of the total cost and the upstream processing is the main contributor (90%) with media costing 50% of that. We also compared the cost of MSC-EV therapy with MSC therapy alone. At the highest dose (EVs), the cost of MSC-EV therapy is 10 times higher than MSC therapy, but it becomes comparable or cheaper at the lower doses. We studied the effect of total EV recovery on the cost. Our analysis suggested that increasing the recovery from 15% to 30% drops the cost to 50%. However, the cost reaches almost a plateau beyond 40% total EV recovery. In conclusion, this model is a fundamental tool to guide researchers in the EV bioprocess design. Furthermore, this model will allow us to compare EV based therapeutic approaches against viral vector based and lipid nanoparticle-based drug delivery systems. [ABSTRACT FROM AUTHOR]

Patients requiring neuromuscular block for anaesthesia have a higher risk of adverse postoperative outcomes. The choice of reversal drug and its corresponding dose is critical for improving clinical outcomes. Although drug costs are higher for sugammadex relative to neostigmine, additional factors need to be considered when choosing one drug over the other. New data from a recent study in the British Journal of Anaesthesia indicate cost advantages for sugammadex in low-risk and ambulatory patients, but for neostigmine in high-risk patients. These findings highlight the need to take local and temporal factors into consideration in addition to clinical effectiveness when performing cost analyses for administrative decision-making. [ABSTRACT FROM AUTHOR]

Spent caustic is a highly contaminated wastewater from critical industries with complicated chemistry and different environmental adverse effects. Conventional wastewater remediation approaches are not effective enough for the remediation of spent caustic. Hence in this study, Electro-Fenton (EF) technology as a subsection of Advanced Oxidation Processes (AOPs) was applied for the removal of chemical oxygen demand (COD) in spent caustic effluent. For statistical analysis and experimental design of each factor including H 2 O 2 /COD, current density, pH, and treatment time on the COD removal (response), the Box Behnken Design (BBD) was used. The optimal conditions for operating factors were as the following: H 2 O 2 /COD = 0.73, pH= 5.46, current density = 18.83 mA/cm2 and treatment time= 69.88 min. In these conditions, the actual and predicted COD removal was 93.0% and, 94.38%, respectively. Finally, it concludes that Electro-Fenton technology was reliable and outstandingly efficient for COD removal in spent caustic wastewater. The kinetic studies confirmed that the removal of COD tracked the first-order kinetic model and the constant reaction rate and half-life of COD removal kinetic were 0.0257 min−1 and 27 min, respectively. The operating costs analysis showed that the Electro-Fenton process had lower operating costs and it can be a good opportunity for the treatment of spent caustic wastewater on an industrial scale. The operational cost for this process was found to be 1.562$ M−3kg−1COD removal. [ABSTRACT FROM AUTHOR]