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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]

Background: Chronic obstructive pulmonary disease (COPD) and heart failure (HF) are risk factors for venous thromboembolism (VTE). Enoxaparin and unfractionated heparin (UFH) help prevent hospital-associated VTE, but few studies have compared them in COPD or HF. Objectives: To compare effectiveness, safety, and costs of enoxaparin vs UFH thromboprophylaxis in medical inpatients with COPD or HF. Methods: This retrospective cohort study included adults with COPD or HF from the Premier PINC AI Healthcare Database. Included patients received prophylactic-dose enoxaparin or UFH during a >6-day index hospitalization (the first visit/admission that met selection criteria during the study period) between January 1, 2010, and September 30, 2016. Multivariable regression models assessed independent associations between exposures and outcomes. Hospital costs were adjusted to 2017 US dollars. Patients were followed 90 days postdischarge (readmission period). Results: In the COPD cohort, 114 174 (69%) patients received enoxaparin and 51 011 (31%) received UFH. Among patients with COPD, enoxaparin recipients had 21%, 37%, and 10% lower odds of VTE, major bleeding, and in-hospital mortality during index admission, and 17% and 50% lower odds of major bleeding and heparin-induced thrombocytopenia (HIT) during the readmission period, compared with UFH recipients (all P

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]

Background Methods Results Conclusion The management of acute exacerbations of chronic rhinosinusitis (AECRS) is understudied and the most cost‐effective management of AECRS has not been previously investigated. The aim of this study is to determine the most cost‐effective strategy for the initial management of AECRS.The study design consisted of a decision‐tree economic model comparing three different initial strategies for managing a patient perceived AECRS: observation, upfront rescue medications, or clinic visit with diagnostic nasal endoscopy (DNE). The primary study outcome was the disease burden of a single AECRS, which was determined by the health utility value and the duration of symptoms. Strategies with an incremental cost‐effectiveness ratio < $50,000/quality‐adjusted life year (QALY) or equivalently < $137/quality‐adjusted life day (QALD) were considered cost‐effective.Observation was the most cost‐effective strategy at a willingness to pay of $137 per QALD. One‐way sensitivity analysis demonstrated that observation was more effective than upfront rescue medications when the probability of bacterial infection as the cause of AECRS was <24.0%. Upfront rescue medications wer more cost effective than observation when the probability of bacterial infection exceeded 49.0%. Clinic visit with DNE was the most effective strategy to manage an AECRS, but it was not considered cost‐effective.Observation is the most cost‐effective strategy for the initial management of AECRS when there is a low likelihood of bacterial infection. When the probability of bacterial etiology of AECRS exceeds 49.0%, upfront rescue medications proved to be the most cost‐effective strategy. [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]

Reproduction can reduce energy allocation to other life‐history traits such as survival and growth. Resource constraints give rise to (co)variation in life‐history traits and to heterogeneity in energy acquisition and allocation. At each reproductive opportunity, females face a choice between allocation to current reproduction or to maintenance. Many studies compare reproductive trade‐offs between two consecutive years, but few account for the cumulative effects of reproduction over multiple years, a crucial factor in understanding life‐history evolution in long‐lived iteroparous species. We compared short‐ (interannual) and long‐term (cumulative) reproductive trade‐offs with a 14‐year capture–mark–recapture study of eastern grey kangaroos, where females can have substantial skeletal growth for several years after maturation. We used a multivariate approach to compare how interannual and multi‐annual cumulative reproduction affected growth (n = 378 measurements), mass change (n = 376 measurements) and subsequent reproduction (n = 388 measurements), and to quantify (co)variation between these traits among individuals (n = 107) and years (n = 14). Interannually, young females that reproduced experienced decreased skeletal growth compared to young females that did not reproduce. Reproductive females of all ages experienced reduced mass gain and weaning probability in the following year. The cumulative effects of multiple reproductions included decreased skeletal growth, mass gain and weaning probability in the following year. These effects increased with age and reproductive rate. We found positive trait correlations between mass change, leg growth and subsequent reproduction among individuals and years, though weaker at the cumulative than interannual level. Females experience dynamic interannual and cumulative trade‐offs. Our analyses of cumulative costs of reproduction revealed long‐term trade‐offs as well as cumulative costs that were not apparent when estimating interannual costs. Trait correlations suggested heterogeneity in growth and reproduction among females. Years of increased growth were followed by years of increased reproduction, and years of poor growth were followed by years of poor reproduction. Our exploration of both interannual and cumulative costs of reproduction underscores the need to account for long‐term reproductive histories to better understand reproductive trade‐offs in long‐lived iteroparous species. [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]

Introduction Methods Results Conclusion Sarcopenia has a detrimental impact on patient outcomes following colorectal surgery, increasing financial strain on the healthcare system. Given the absence of specific Australian data, this study aimed to measure the cost of sarcopenia in the context of colorectal surgery in an Australian public hospital.A retrospective cost analysis, following CHEERS guidelines, was conducted on major elective colorectal cancer surgical cases at the Royal Adelaide Hospital between 2018 and 2022. The cross‐sectional psoas area was measured through computed tomography (CT) imaging at the level of the third lumbar vertebrae, and sarcopenia was determined using gender‐specific thresholds. Hospital billing data was used to gather costings (AU$).Out of 271 patients, 57 (21.0%) comprised the sarcopenic group (SG). SG patients were older (74 vs. 69 years, P < 0.001), had a higher American Society of Anaesthesiologists (>II, 71.9% vs. 53.7%, P = 0.014) and a lower median body mass index (24.8 vs. 28.7 kg/m2, P < 0.001). The SG exhibited a greater likelihood of complications (84.2 vs. 68.7%, P = 0.020) and prolonged hospital stay by 1 day (median 7 vs. 6 days, P = 0.027). Despite an increased mean total cost of hospital admission, no statistically significant difference was found (AU$37 712 vs. $34 845, P = 0.296). Multivariate analysis revealed hypoalbuminemia, prolonged operative time, postoperative ileus, return to theatre, Clavien‐Dindo grade ≥3 complications, and prolonged stay increased overall cost (P < 0.05).Sarcopenia was not associated with a significantly increased cost of colorectal surgery in our institution. Future studies examining the cost‐effectiveness of prehabilitation programmes targeting sarcopenia should be considered. [ABSTRACT FROM AUTHOR]

Aims Design Setting Participants Intervention and comparator Measurements Findings Conclusions To evaluate the effectiveness of mobile smoking cessation (SC) treatment with 1‐week nicotine replacement therapy (NRT) sampling on recruitment and quitting outcomes.Two‐arm cluster RCT (1:1 ratio), single‐blinded, at 244 recruitment sessions in Hong Kong outdoor smoking hotspots from October 2018–December 2019.Participant were recruited by ambassadors and treated at the mobile SC truck.834 adult (≥18 years, male 81.3%) daily smokers, Chinese‐speaking, non‐NRT users in the past month, consented after nurse‐led intervention in mobile SC truck were randomized to the experimental (n = 482 male 79.5%) and the control group (n = 352, male 83.8%).The experimental group received a 1‐week free NRT sample, an NRT instruction card, and mobile SC treatment including onsite nurse‐led brief medication advice (about 15 minutes) and referral to SC clinics. The control group received the same mobile SC treatment.Primary outcome was self‐reported quit attempts at 1‐month follow‐up. Secondary outcomes included SC service use at 1 month, and biochemically validated abstinence (exhaled carbon monoxide < 4 ppm; or saliva cotinine < 10 ng/ml) at 6‐month follow‐up. Additionally, a post‐hoc cost analysis was conducted.By intention‐to‐treat, the two groups showed similar prevalence of quit attempts (44·4% versus 43·5%, risk ratio (RR) = 1·04, 95% confidence interval (CI) = 0·79–1·37, P = 0·79). Compared with the control group, the experimental group showed lower SC service use at clinics (32·4% versus 44·9%, RR = 0·72, 95%CI = 0·57–0·91, P = 0·006), but no significant difference in validated abstinence (4·6% versus 2·8%, RR = 1·64, 95%CI = 0·76–3·50, P = 0·21). The experimental recruitment sessions recruited more smokers for onsite medication advice than the control session (mean 6·7 vs 5·0, adjusted incident rate ratio = 1·30, 95%CI = 1·08–1·56, P = 0·005).Mobile smoking cessation treatment with 1‐week nicotine replacement therapy sampling did not increase quit attempts or abstinence outcomes among recruited daily smokers in Hong Kong. The intervention increased smokers' uptake of onsite medication advice but reduced subsequent smoking cessation service use at clinics. [ABSTRACT FROM AUTHOR]

Hydrogen emerges as a promising energy carrier in achieving carbon neutrality, especially in countries such as South Korea and Japan, where renewable energy resources are scarce. Consequently, economically importing hydrogen from overseas is paramount to a stable supply. However, previous studies have often oversimplified the estimation of hydrogen import costs with optimistic assumptions, raising doubts about their reliability. This study comprehensively assesses costs incurred from green hydrogen production to liquefaction and transportation. The cost analysis includes detailed design considerations for hydrogen liquefaction and re-conditioning plants, alongside thermodynamic simulations to estimate the boil-off gas rate of liquid hydrogen during transport. Focusing on a case study of importing liquefied green hydrogen from Australia to South Korea, our findings reveal that the levelized cost of hydrogen is approximately 30.2 USD/kgH 2 as of 2023. Projections suggest a decrease to around 18.3 USD/kgH 2 by 2050, assuming technological advancements, significantly exceeding values reported in the existing literature. Sensitivity analysis highlights the renewable electricity price in Australia and the boil-off rate during shipping as key factors that significantly influence the levelized cost of hydrogen. • Costs for producing and transporting liquified green hydrogen are rigorously analyzed. • Detailed process design and thermodynamic simulation are conducted for realistic analysis. • A case of importing hydrogen from Australia to South Korea is studied. • LCOH for 2023 and 2050 are 30.2 and 18.3 USD/kgH 2 , which exceed literature values. [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: 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]

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]

The clinical impact of the surgical approach in total hip arthroplasty (THA) has been widely reviewed. This study evaluated the total encounter and 90-day costs of THA for 2 surgical approaches (posterior [P] and direct anterior [DA]) in 1 tertiary health system. This is a retrospective review of 2,101 THAs (1,092 P and 1,009 DA) by 4 surgeons (2 with the highest volume of DA and P, respectively) from 2017 to 2022 at 1 academic center. Demographics, comorbidities, operative time, length of hospital stay, 90-day hospital returns, and complications were compared. The total encounter cost and 90-day postoperative cost were itemized. Multivariable regression analyses evaluated associations with increased cost at each time point. The DA cohort had a higher median encounter cost ($8,348.66 versus 7,332.42, P <.01), resulting from higher intraoperative (P <.01) and radiology (P <.01) expenses. Regression analyses demonstrated the DA was independently associated with increased encounter costs (odds ratio 1.1; 95% confidence interval 1.1 to 1.1; P <.01). There was a higher incidence of 90-day emergency department visits in the DA cohort (16 versus 12%, P =.02), with a trend toward increased readmissions. There was no difference in 90-day reoperations. Median 90-day cost was higher in the DA cohort ($126.99 versus 0.00, P <.01), and regression analyses demonstrated the DA had an association with increased 90-day cost (odds ratio 2.2; 95% confidence interval 1.5 to 3.0; P <.01). Despite a younger patient population, the DA was independently associated with increased encounter and 90-day costs in a single academic hospital system. This study may underestimate the cost difference, as capital costs such as specialized tables were not analyzed. [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]

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]

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]

OBJECTIVES: The annual mean spending measures typically used to study longitudinal trends mask distributional and seasonal variation that is relevant to patients' perceptions of health care affordability and, in turn, provider collections. This study describes shifts in the distribution and seasonality of plan and patient out-of-pocket spending from 2012 through 2021. STUDY DESIGN: Analysis of multipayer commercial claims.data. METHODS: Medical spending per enrollee was calculated by summing inpatient, outpatient, and professional services, which comprised plan payments and out-of-pocket payments (deductible, coinsurance, co-payment). To account for the long right tail of the spending distribution, enrollees were stratified by their decile of annual medical spending, and annual mean spending estimates were calculated overall and by decile. Mean spending estimates were also calculated by quarter-year. RESULTS: Inflation-adjusted medical spending grew most quickly among the highest decile of spenders, without proportional growth in their out-of-pocket expenses. Out-of-pocket spending increased for the majority of enrollees in our sample prior to the COVID-19 pandemic, in real dollars and as a share of total medical spending. Out-of-pocket spending was increasingly concentrated in the early months of the calendar year, driven by deductible spending, and was lower in 2020 and 2021, plausibly due to policies limiting cost sharing for COVID-19--related services. CONCLUSIONS: Insurance is working well to protect the highest spenders at the cost of reduced insurance generosity among spenders elsewhere in the distribution. The increasing cross-subsidization among enrollees through cost-sharing design--vs premiums--is a trend to watch among rising public concerns about underinsurance and medical debt. [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]

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]

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]

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]

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]

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]

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]

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]

In recent years small satellites have shifted from being secondary items to dominate the space market thanks to, but not only, the development of the large LEO constellations. For small satellites to be highly effective, particularly when arranged in such constellations, each satellite has to be placed in a specific orbital plane and orbital position. Currently, three main options are available to reach a specific orbit. The first, more straightforward solution is to employ a dedicated launch with a small launch vehicle. Plenty of small launchers are in development around the world (with few already operational); however, their cost per kilogram is predicted to be much higher than for large launchers. The second possibility is the exploitation of a rideshare option, where the satellite is transported by a large launcher together with other payloads on a general predetermined orbit. Afterwards the satellite needs to be transferred to its designed orbit. This can be done in two ways: through the use of a satellite carrier (also called self-propelled dispenser) or with the satellite own propulsion system. In both last cases, the mass transported by the launcher into the release orbit is higher than the final one necessary for the nominal mission, impacting total costs. In this paper these three possibilities are compared considering the need to reach various specific orbits, starting from a different release one in the case of the rideshare options. First of all, the change in velocity for different orbital parameters (altitude, eccentricity, phase, argument of perigee, inclination, RAAN) is computed. Afterwards the propulsion mass budget is calculated. Everything else being equal, it is demonstrated mathematically that a dispenser is inherently less efficient than a group of autonomous satellites, particularly for the RAAN change and a large number of carried satellites. However, it is not always possible or convenient to provide small satellites, particularly the smallest ones (nanosats/cubesats/microsats) with comparable propulsion capabilities of a larger dispenser, making the latter still an attractive option in several situations. A cost analysis also shows that, particularly for sophisticated small satellites, when the final orbit is far from the release one, a dedicated small launch vehicle can be cost competitive with the nominally much cheaper large launcher. • Satellites can reach a specific orbit through dedicated launch or rideshare plus orbital transfer. • Sat carriers are mathematically inherently more inefficient than autonomous propulsion. • Penalty increases particularly as the ΔV and the number of satellites increase. • Small launch vehicles are inherently more responsive and expensive than rideshare options. • Launch cost penalty impacts only a fraction of total costs, particularly for unserved orbits. [ABSTRACT FROM AUTHOR]

Background: Video-assisted thoracoscopic surgery (VATS) is a practical resource in the management of traumatic hemothorax. However, it carries inherent risks and should be mobilized cost-effectively. In this study, we investigated the ideal VATS timing using cost analysis. Methods: 617 cases of unilateral traumatic hemothorax from 2012 to 2022 were identified in our trauma database. We extracted encounter cost, length of stay (LOS), and operative cost information. Using Kruskal-Walli's test, we compared the cost and LOS for patients who underwent VATS or continued nonoperative management in the first 7 days of admission. Additionally, we computed the daily proportion of patients initially managed nonoperatively but ultimately underwent VATS. P -values <.05 were considered significant. Results: The median encounter cost of cases managed operatively before hospital day 4 (HD4) was higher than those managed nonoperatively. This difference was $63k on HD2 (P -value.07) and was statistically significant for HD3 (difference of $65k, P -value.02). The median LOS with operational management on HD2 and 3 was 7 and 6 respectively vs median LOS of 2 and 3 with nonoperative management on those days (P -value <.001,.01 respectively). The proportion of patients who failed nonoperative management did not change from baseline until HD4 (23% (95% CI 19.7, 26.3) vs 33.9% (95% CI 28.3, 39.6), P -value <.001). Discussion: Early mobilization of VATS before hospital day 4 increases the overall hospital cost without offering any length of stay benefit. Continuing nonoperative management longer than 4 days is associated with a high failure rate and a costlier operation. [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]

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]

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]

Purpose This report describes the step-by-step process that led to expansion of ambulatory care pharmacy services at a newly established internal medicine clinic within a patient-centered medical home in North Carolina. Summary Implementation of clinical pharmacist services at the clinic was led by a postgraduate year 2 (PGY2) pharmacy resident and guided by the 9 steps described in the book Building a Successful Ambulatory Care Practice: A Complete Guide for Pharmacists. After a needs assessment and review of the demographics and insurance status of the clinic's target population, it was determined that pharmacist services would focus on quality measures including diabetes nephropathy screening, diabetes eye examination, blood glucose control in diabetes, discharge medication reconciliation, annual wellness visits, and medication adherence in diabetes, hypercholesterolemia, and hypertension. Clinic appointments were conducted under 3 models: a pharmacist-physician covisit model, a "floor model" of pharmacist consultation on drug information or medication management issues during medical resident sign-out sessions with supervising physicians (medical residents could also see patients along with the pharmacist at a covisit appointment), and a covisit model of stacked physician and pharmacist appointments. The pharmacist's services were expanded from 2 half-day clinic sessions per week initially to 5 or 6 half-day clinic sessions by the end of the residency year. Conclusion By the fourth quarter of the first PGY2 residency year in which ambulatory care pharmacy services were provided in the clinic, the clinical and financial impact of those services justified the addition of a second full-time pharmacist to the clinic team. [ABSTRACT FROM AUTHOR]

As value-based health care arrangements gain traction in spine care, understanding the true cost of care becomes critical. Historically, inaccurate cost proxies have been used, including negotiated reimbursement rates or list prices. However, time-driven activity-based costing (TDABC) allows for a more accurate cost assessment, including a better understanding of the primary drivers of cost in 1-level lumbar fusion. To determine the variation of total hospital cost, differences in characteristics between high-cost and nonhigh-cost patients, and to identify the primary drivers of total hospital cost in a sample of patients undergoing 1-level lumbar fusion. Retrospective, multicenter (one academic medical center, one community-based hospital), observational study. A total of 383 patients undergoing elective 1-level lumbar fusion for degenerative spine conditions between November 2, 2021 and December 2, 2022. Total hospital cost of care (normalized); preoperative, intraoperative, and postoperative cost of care (normalized); ratio of most to least expensive 1-level lumbar fusion. Patients undergoing a 1-level lumbar fusion between November 2, 2021 and December 2, 2022 were identified at two hospitals (one quaternary referral academic medical center and one community-based hospital) within our health system. TDABC was used to calculate total hospital cost, which was also broken up into: pre-, intra-, and postoperative timeframes. Operating surgeon and patient characteristics were also collected and compared between high- and nonhigh-cost patients. The correlation of surgical time and cost was determined. Multivariable linear regression was used to determine factors associated with total hospital cost. The most expensive 1-level lumbar fusion was 6.8x more expensive than the least expensive 1-level lumbar fusion, with the intraoperative period accounting for 88% of total cost. On average. the implant cost accounted for 30% of the total, but across the patient sample, the implant cost accounted for a range of 6% to 44% of the total cost. High-cost patients were younger (55 years [SD: 13 years] vs 63 years [SD: 13 years], p=.0002), more likely to have commercial health insurance (24 out of 38 (63%) vs 181 out of 345 (52%), p=.003). There was a poor correlation between time of surgery (ie, incision to close) and total overall cost (ρ:.26, p<.0001). Increase age (RC: -0.003 [95% CI: -0.006 to -0.000007], p=.049) was associated with decreased cost. Surgery by certain surgeons was associated with decreased total cost when accounting for other factors (p<.05). A large variation exists in the total hospital cost for patients undergoing 1-level lumbar fusion, which is primarily driven by surgeon-level decisions and preferences (eg, implant and technology use). Also, being a "fast" surgeon intraoperatively does not mean your total cost is meaningfully lower. As efforts continue to optimize patient value through ensuring appropriate clinical outcomes while also reducing cost, spine surgeons must use this knowledge to lead, or at least be active participants in, any discussions that could impact patient care. [ABSTRACT FROM AUTHOR]

Total shoulder arthroplasty (TSA) is a common orthopedic procedure that can be performed as an anatomic total shoulder arthroplasty (aTSA) or reverse total shoulder arthroplasty (rTSA). These are effective procedures that are being performed with increasing frequency. Understanding the overall 90-day reimbursement variability and their drivers may help the health care systems better understand related considerations to reduce health-care expenditure. The current study predicts there will be large variability in reimbursement highlighting the need for further understanding. Using the 2015-2021 Q1 M151 PearlDiver dataset, patients who underwent aTSA or rTSA were isolated. Patients were excluded if they were aged less than 18 years, had an indication of traumatic, infectious, or oncologic diagnoses within 90-days of surgery, or were not in the dataset for at least 90 days before and after surgery. Patient demographics, comorbidities, 90-day postoperative events, insurance type, and geographic region were abstracted. The overall 90-day reimbursements were then assessed and correlated with these variables having multivariable linear regression. A total of 112,188 TSA patients (aTSA: 36,164 [32.2%]; rTSA: 76,024 [67.8%]) were identified. The average ± standard deviation 90-day overall postoperative reimbursement for aTSA was $6714.26 ± 9587.46 and rTSA was $6246.45 ± 9506.59. The total reimbursement for aTSA was $242,814,515 and for rTSA was $474,836,301. Variables independently associated with greater 90-day overall reimbursement were mostly related to 90-day postoperative events, including hospital readmission [+$6694.51], emergency department visit [+$2129.89], and adverse events [+$2055.84]), geographic region of the country where the procedure was performed (relative to West, South [+$4302.88], Midwest [+$3428.84], and Northeast [+$530.92]), and insurance plan (relative to commercial, Medicare [-$1268.01], and Medicaid [-$901.79]) (P <.0001 for each). Lesser factors included male sex (relative to female +$207.30), Elixhauser-Comorbidity Index (+$51.93 per point increase), age (-$77.16 per year increase), and rTSA surgery type (relative to aTSA -$556.17). The current study leveraged a large, administrative database to evaluate over 100,000 TSA patients and found large variations in 90-day overall reimbursements. The variables mostly associated with increased reimbursement were related to 90-day postoperative events (as might be expected and underscoring the need to minimize such events) and geographic regions and insurance plan (highlighting differences that might be able to be addressed). Interestingly, while patient demographics, comorbidities, and anatomic vs. reverse total shoulder were associated with reimbursements, these were to lesser extents. Understanding these results may help health-care systems further target variables associated with greater cost/reimbursement to the system. [ABSTRACT FROM AUTHOR]

Technology enabling drug serialisation technology was introduced by regulators to enhance security in pharmaceutical supply chain and protect drugs from infiltration by falsified and substandard medicines. The introduction of systems for serialisation required huge financial outlays manufacturers of pharmaceuticals. This study investigated the impact of serialisation on the operational efficiency and productivity in Irish pharmaceutical sites. A qualitative study was conducted with 11 manufacturing sites in Ireland. The participating companies operated a total of 114 pack-lines, representing approximately 65% of the automated packing lines in the country. The study found that serialisation had a negative effect on packaging production line OEE and line availability and on the individuals cost per unit of packaged pharmaceuticals. The research results estimated that the capital costs of serialisation were four times greater than those estimated by the regulators. There was a 4.1 cents average cost per pack for serialisation with high volume sites reporting an annual cost of serialisation of up to €4.5 m per annum and a 2.7% increase in the average cost of goods sold. A pattern whereby where many pharmaceutical manufacturers are transitioning from smaller batch production and moving toward larger batch production sizes in order to increases efficiencies was identified. The research also proposed the use of a serialisation depreciation factor as a method to determine the impact of serialisation on the cost of goods sold. This is the first study of its kind into the cost of serialisation from a manufacturer's viewpoint and studying the effects of serialisation on productivity, line availability and operational efficiency. [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]

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]

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]