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The paper addresses the problem of the efficiency of road lighting replacement in a selected municipality. The following question arose: can the replacement of lighting bring measurable financial benefits in the short or long term, and does increasing the comfort of road use in terms of lighting involve higher costs? During the global energy crisis, reducing the operating costs of road lighting has become the goal of many analyses and studies. Professionally selected lighting of streets and sidewalks is a factor that significantly affects the safety of road users. The problem of many studies is the omission of safety considerations, lighting comfort and budgetary possibilities of municipalities. The authors conducted comparative analyses of solution variants, examining both road lighting comfort and costs as an innovative element of research. The DIALux application was used to analyse the changes in road lighting depending on the luminaires used and the changes in pole spacing influenced by the height of the light point. Variant and scenario analyses were incorporated into the efficiency analyses, while the calculations themselves were based on detailed cost analyses with reference to Polish catalogues of material inputs and market prices. The authors conducted cost analyses of lighting dismantling and installation, including the subsequent operating costs over 20 years for seven variants of poles with their systems and four variants of luminaires. The results were compared with the existing lighting system in use. An original element of the study is the use of BIM analyses with design variants, combined with analyses of the technical condition of the existing lighting network and an illuminance analysis with estimates of the height and spacing of poles. Numerous studies indicate that it is very cost-effective to replace old lighting systems, especially those based on high-intensity discharge (HID) sodium lamps, with more modern LED lamps additionally equipped with twilight dimmers. The analyses also demonstrated that cost-efficient lighting replacement could go hand in hand with improved road lighting comfort without the need to incur additional costs, which is often overlooked in various studies. The analysis performed for a model lighting network indicates that savings of nearly 60% are possible over 20 years. [ABSTRACT FROM AUTHOR]

Introduction: Influenza vaccination campaigns have difficulty in reaching the 75% uptake in healthcare workers (HCWs) that public health organizations target. This study runs a campaign across 42 primary care centers (PCCs) where for every HCW vaccinated against influenza, a polio vaccine is donated through UNICEF for children in developing nations. It also analyses the efficacy and cost of the campaign. Method: This observational prospective non-randomized cohort study was conducted across 262 PCCs and 15.812 HCWs. A total of 42 PCCs were delivered the full campaign, 114 were used as the control group, and 106 were excluded. The vaccine uptake in HCWs within each of those PCCs was registered. The cost analysis assumes that campaign costs remain stable year to year, and the only added cost would be the polio vaccines (0.59€). Results: We found statistically significant differences between both groups. A total of 1423 (59.02%) HCWs got vaccinated in the intervention group and 3768 (55.76%) in the control group OR 1.14, CI 95% (1.04–1.26). In this scenario, each additional HCW vaccinated in the intervention group costs 10.67€. Assuming all 262 PCCs had joined the campaign and reached 59.02% uptake, the cost of running this incentive would have been 5506€. The potential cost of increasing uptake in HCWs by 1% across all PCC (n = 8816) would be 1683€, and across all healthcare providers, 8862€ (n = 83.226). Conclusions: This study reveals that influenza vaccination uptake can be innovative by including solidary incentives and be successful in increasing uptake in HCWs. The cost of running a campaign such as this one is low. [ABSTRACT FROM AUTHOR]

For decades, the benefits of utilizing hollow fiber bioreactors for continuous cell culture to produce monoclonal antibodies have been widely recognized. However, the suitability of this technology for laboratories or centers with limited resources and expertise seeking to expand their production capacity is uncertain, mainly due to unknown cost-effectiveness. In this study, a hollow fiber bioreactor with a 4.7-mL culture volume was used to culture a hybridoma clone producing immunoglobulin G antibody specific to hemoglobin F (HbF). The antibody reached a maximum concentration of 1.22 g/L and totaled 21 mg over a 44-day culture period. This preliminary production data was used to estimate the cost of consumables required for using the hollow fiber bioreactor to produce 130 mg of monoclonal antibodies, which was found to be THB35.8k (£880). The cost was slightly more expensive than batch cultivation in typical culture dishes, which ranged from THB27.8 to 30.2k (£680 to 740). Despite the advantages in terms of reduced hands-on time, shorter production duration, and highly concentrated products, the primary challenges associated with using hollow fiber bioreactors were the cost and availability of the cartridges. [ABSTRACT FROM AUTHOR]

The combination of the chemical coagulation-assisted electrocoagulation (CC-EC) process with a solar photovoltaic energy source has attracted increasing attention for the efficient removal of chemical oxygen demand (COD) from pharmaceutical wastewater. In this paper, the CC-EC process has been utilized as an alternative to conventional chemical processes for the treatment of pharmaceutical wastewater. The effects of the various operating parameters, such as coagulant dosage, coagulant type, number of electrodes, the distance between electrodes, electrode configuration, operating time, and current density, on COD removal efficiency were investigated. The results indicated that the optimum conditions were achieved at 500 mg/L of alum dosage, 3.105 mA/cm2 of current density, six electrodes with a distance of 4 cm between electrodes, and the MP-S electrode configuration, where the operating cost of conventional energy was 0.283 $/m3. Indeed, by using the CC process alone, the COD removal efficiency was 26% and 61.5% at the optimal dosages of 750 mg/L of NaOH and 500 mg/L of alum, respectively. In the CC-EC treatment, the removal efficiencies of COD were 88.7, 92.9, 94.4, and 89.4% using six electrodes, 2 cm of distance between electrodes, MP-S electrode configuration, and 20 min with 1.553 mA/cm2 of current density, respectively. The removal efficiencies of COD achieved through CC, EC, and CC-EC processes were 61.5, 85.4, and 94.4%, respectively. [ABSTRACT FROM AUTHOR]

Self-Compacting Concrete (SCC) is a special concrete that can flow easily across congested reinforcements. Also, it is easy to work with and does not segregate. The present investigation aims at the design and development of sustainable SCC with the employment of industrial by-products such as Fly Ash (FA), Ground Granulated Blast Furnace Slag (GGBFS), and Expanded Perlite Aggregate (EPA). Four SCC mixes were developed to attain a target strength of 30 MPa. Workability tests (slump flow, J-ring, and V-funnel tests) were performed following the EFNARC guidelines to ensure fresh SCC properties. Detailed experiments were conducted to evaluate the durability characteristics of the developed SCC, such as water absorption, sorptivity, acid attacks (sulphuric, nitric, sulphate, and chloride), the Rapid Chloride Penetration Test (RCPT), and finally, the elevated temperature test. Weight loss, strength loss, and physical observations of the acid and temperature effects of SCC mixes were evaluated. Also, the study focuses on the cost and sustainable index of SCC mixes and compares them with OPC mixes. From the experimental data analysis, it was observed that the developed SCC showed excellent physical and mechanical properties with a considerable reduction in cement content. SCC specimens with FA and EPA exhibit excellent acid and temperature resistance. Following the sustainable analysis, it was noted that SCC mixes reduce about 15–17.2% of carbon emissions compared to the OPC mix. [ABSTRACT FROM AUTHOR]

Microbial keratitis is the most common cause of infective vision loss. The causative organism varies by region, and most cases require intensive antimicrobial therapy. The purpose of this study was to analyse the causative organisms of microbial keratitis, its presentation and economic burden from a tertiary referral hospital in Australia. A retrospective review of 160 cases of microbial keratitis was performed, over a 5-year period from 2015–2020. A wide variety of costs were considered to determine the economic burden, using standardized data from the Independent Hospital Pricing Authority and the cost of personal income loss. Our study showed the most commonly occurring pathogens were Herpes Simplex (16%), Staphylococcus aureus (15.1%) and Pseudomonas aeruginosa (14.3%). A total of 59.3% of patients were admitted, with a median length of admission of 7 days. Median cost for all presentations of microbial keratitis was AUD 8013 (USD 5447), with costs significantly increasing with admission. The total annual cost of microbial keratitis within Australia is estimated to be AUD 13.58 million (USD 9.23 million). Our findings demonstrate that microbial keratitis represents a significant economic burden for eye-related diseases and the key driving factor for the cost is the length of admission. Minimizing the duration of admission, or opting for outpatient management where appropriate, would significantly reduce the cost of treatment for microbial keratitis. [ABSTRACT FROM AUTHOR]

A bottom-up cost analysis for delivering utility-scale PV-generated electricity as hydrogen through pipelines and as electricity through power is undertaken. Techno-economic, generation, and demand data for California are used to calculate the levelized cost of transmitting (LCOT) energy and the levelized cost of electricity (LCOE) prior to distribution. High-voltage levels of 230 kV and 500 kV and 24-inch and 36-inch pipelines for 100 to 700 miles of transmission are considered. At 100 miles of transmission, the cost of transmission between each medium is comparable. At longer distances, the pipeline scenarios become increasingly cheaper at low utilization levels. The all-electric pathways utilizing battery energy storage systems can meet 95% of the load for as low as 356 USD/MWh, whereas when meeting 100% of load with the hydrogen gas turbine and fuel cell pathways, the costs are 278 and 322 USD/MWh, respectively. [ABSTRACT FROM AUTHOR]

The development of low-carbon technologies that will facilitate the efficient use of hydrogen (H2) as an energy carrier is a critical requirement of contemporary society. To this end, it is anticipated that the cost of H2 production will become a key factor in tandem with production efficiency, process safety, and transport. Much effort has been made to create and develop new, reversible, and sustainable H2 storage systems. Among current techniques, formic acid (FA) has been identified as an efficient energy carrier for H2 storage. Numerous homogeneous catalysts based on transition metals with high activity and selectivity have been reported for selective FA dehydrogenation. In this review, we outline the recent advances in transition-metal molecular catalysts for FA dehydrogenation. Selected catalytic systems that could be implemented on an industrial scale and considered potential materials in fuel cell (FC) technology have been cost-evaluated. We highlight some critical engineering challenges faced during the technology's scale-up process and explain other factors that are frequently ignored by academic researchers. Finally, we offer a critical assessment and identify several system limitations on an industrial scale that are currently impeding future implementation. [ABSTRACT FROM AUTHOR]

Simple Summary: There is a scarcity of economic analysis on the use of non-invasive biomarkers to inform policy-making with respect to their application in population-based colorectal cancer (CRC) screening programs. The objective of this study is to conduct a comparative cost-effectiveness analysis on using M3CRC (m3 + Fn + Ch + Bc + FIT) as a primary test for population-based screening, when compared with FIT and colonoscopy. The study can provide economic analysis regarding the use of non-invasive biomarkers in population-based CRC screening programs. This study aimed to examine the cost-effectiveness of fecal biomarker M3 panel compared to fecal immunochemical test (FIT) and colonoscopy in an Asian population. In a hypothetical population of 100,000 persons aged 50 years who received FIT yearly, M3 biomarker yearly, or colonoscopy every 10 years until the age of 75 years. Participants with positive FOBT or a result of "high risk" identified using the M3 biomarker are offered colonoscopy. We assumed surveillance colonoscopy is repeated every 3 years, and examined the treatment cost. A comparison of various outcome measures was conducted using Markov modelling. The incremental cost-effectiveness ratio (ICER) of FIT, M3 biomarker, and colonoscopy was USD108,176, USD133,485 and USD159,596, respectively. Comparing with FIT, the use of M3 biomarker could lead to significantly smaller total loss of cancer-related life-years (2783 vs. 5279); a higher number of CRC cases prevented (1622 vs. 146), a higher proportion of CRC cases prevented (50.2% vs. 4.5%), more life-years saved (2852 vs. 339), and cheaper total costs per life-year saved (USD212,553 vs. 773,894). The total costs per life-year saved is more affordable than that achieved by colonoscopy as a primary screening tool (USD212,553 vs. USD236,909). The findings show that M3 biomarkers may be more cost-effective than colonoscopy. [ABSTRACT FROM AUTHOR]

Simple Summary: Natural enemies have long been a tool for pest regulation in agricultural systems and other pest-impacted ecosystems. Despite extensive evaluations of integrated pest management programs, they have provided many different benefits that are yet to be documented. Small-scale growers and farmers stand to benefit the most from effective integrated pest management programs, especially with the increasing failures of cheaper insecticide-based control options. Here, we provide a cost analysis for a small-scale farm, the production which will help growers to promote the use of natural enemies and regional integrated pest management. The fall armyworm is a polyphagous lepidopteran pest that primarily feeds on valuable global crops like maize. Insecticides and transgenic crops have long been a primary option for fall armyworm control, despite growing concerns about transgenic crop resistance inheritance and the rate of insecticide resistance development. Global dissemination of the pest species has highlighted the need for more sustainable approaches to managing overwhelming populations both in their native range and newly introduced regions. As such, integrated pest management programs require more information on natural enemies of the species to make informed planning choices. In this study, we present a cost analysis of the production of three biocontrol agents of the fall armyworm over a year. This model is malleable and aimed towards small-scale growers who might benefit more from an augmentative release of natural enemies than a repetitive use of insecticides, especially since, though the benefits of using either are similar, the biological control option has a lower development cost and is more environmentally sustainable. [ABSTRACT FROM AUTHOR]

This study discusses the issue of disposable and reusable medical devices in the context of the circular economy. Its objective is to analyze the opinions of physicians in gynecological practice on the use of disposable and reusable gynecological speculums (GS). A questionnaire survey was carried out in a sample of 206 healthcare facilities in the Czech Republic. In addition to this, the cost of both examination methods was calculated and compared using data provided by a gynecological department of a typical district hospital. The calculations and cost analysis were performed using the life-cycle costing (LCC) method. The economic comparison shows that the use of disposable gynecological speculums is less expensive, having, however, a greater negative impact on the environment. The cost of reusable speculums for 25 examinations per day for 15 years is EUR 51,579, while it is EUR 23,998 for disposable speculums for the same use and time horizon. The questionnaire survey shows that both physicians and patients are more likely to prefer disposable speculums for examination, although without a clear rationale. [ABSTRACT FROM AUTHOR]

This systematic study aims at analyzing the differences between the approach of the European healthcare systems to the pharmaceutical market and the American one. This paper highlights the opportunities and the limitations given by the application of managed entry agreements (MEAs) in European countries as opposed to the American market, which does not regulate pharmaceutical prices. Data were collected from the Organisation for Economic Co-operation and Development (OECD), the European Medicines Agency, and the national healthcare agencies of US and European countries. A literature review was undertaken in PubMed, Scopus, MEDLINE, and Google for a period ten years (2010–2019). The period 2020–2021 was considered to compare health expenditure before and after the SARS-CoV-2 pandemic. Scarce information from national agencies has been given in terms of MEAs related to the COVID-19 pandemic. The comparison between the United States approach and the European one shows the importance of a market access regulation to reduce the cost of therapies, increasing the efficiency of national healthcare systems and the advantages in terms of quality and accessibility to the final users: patients. Nevertheless, it seems that the golden age of MEAs for Europe was during the examined period. Except for Italy, countries will move to other forms of reimbursements to obtain higher benefits, reducing the costs of an inefficient implementation and outcomes in the medium term. [ABSTRACT FROM AUTHOR]

The implementation of lemon laws in America has played an important role in improving the quality of after-sales service. Nowadays, many countries, such as China, Canada, Europe, Australia, Singapore, and South Korea, have adopted lemon laws in various industries to protect the interest of consumers. From the perspective of manufacturers, accurate estimation of the cost of the warranty service is of great importance in guiding product pricing, quality control, and design of warranty policies. According to the terms of different lemon laws, two warranty models considering the repair time and numbers for failures are proposed in this paper. Products under these models are multi-state, and Markov processes are used to model the degradation processes of products. In the first model, a product will be replaced by a new one if the time for a repair or the number of failures exceeds their respective thresholds over the warranty period. Under the second model, both catastrophic and minor failures are considered. A product will be replaced if one of the following three conditions is met over the warranty period: the time of one repair action (regardless of failure type) is longer than a time threshold; the number of minor failures is larger than a preset threshold; a catastrophic failure occurs. The expected warranty cost rates under the two proposed warranty models are derived under the assumption of renewable warranty terms. Numerical examples are given to illustrate the results obtained. [ABSTRACT FROM AUTHOR]

Sulfur-based autotrophic denitrification is a novel biological denitrification process characterized by the absence of an organic carbon source, a short reaction time, a high denitrification rate, a low treatment cost, and a small footprint. However, the technique is facing challenges with respect to engineering applications. In this study, a pilot-scale sulfur-based autotrophic denitrification system was established with an optimal hydraulic retention time (HRT) of 0.21 h, which achieved the highest denitrification load of 1158 mg/(L·d) and a denitrification rate of 164 gNO3−-N/(m3·h). Effective backwashing is the basis for the long-term stable and efficient nitrogen removal performance, which recovered its normal nitrogen removal performance within 0.5 h. In addition, the operation cost is merely 0.013 $/t, indicating that the sulfur-based autotrophic denitrification process presents good economic applicability, and the relatively low operation cost will lay a foundation for practical application. [ABSTRACT FROM AUTHOR]

In standalone microgrids, the Battery Energy Storage System (BESS) is a popular energy storage technology. Because of renewable energy generation sources such as PV and Wind Turbine (WT), the output power of a microgrid varies greatly, which can reduce the BESS lifetime. Because the BESS has a limited lifespan and is the most expensive component in a microgrid, frequent replacement significantly increases a project's operating costs. This paper proposes a capacity optimization method as well as a cost analysis that takes the BESS lifetime into account. The weighted Wh throughput method is used in this paper to estimate the BESS lifetime. Furthermore, the well-known Particle Swarm Optimization (PSO) algorithm is employed to maximize battery capacity while minimizing the total net present value. According to simulation results, the optimal adjusting factor of 1.761 yields the lowest total net present value of US$200,653. The optimal capacity of the BESS can significantly reduce the net present value of total operation costs throughout the project by extending its lifetime. When applied to larger power systems, the proposed strategy can further reduce total costs. [ABSTRACT FROM AUTHOR]

One of the issues associated with the supply of electricity is its generation capacity, and this has led to prevalent power cuts and high costs of usage experienced in many developing nations, including South Africa. Historical research has shown that the annual rate of increase for electricity has grown at an alarming rate since 2008 and, in some years, has grown as much as 16%. The objectives of this study are to estimate the cost analysis of electricity usage at the twenty-nine residences of the University of Johannesburg (UJ-Res) and propose a model for our university, as well as other South African universities, to become more energy-efficient. This was achieved by analyzing the tariffs between 2015 and 2021. A forecast was made for a period of five years (2021 to 2026) using a non-linear autoregressive exogenous neural network (NARX-NN) time-series model. From the results obtained, the better NARX-NN model studied has a root mean squared error (RMSE) of 2.47 × 105 and a determination coefficient ( R 2 ) of 0.9661. The projection result also shows that the annual cost of energy consumed will increase for the projected years, with the year 2022 being the peak with an estimated annual cost of over ZAR 30 million (USD 2,076,268). [ABSTRACT FROM AUTHOR]

With the rapid growth in industrial development, there is a particular need for new environmentally balanced energy source utilization. Ethanol produced from biomass, especially lignocellulosic waste products, represents an attractive, sustainable energy source for fuel production. Until now, in Poland, bioethanol has been produced from edible plants containing sugars susceptible to fermentation. Due to the growing technical and economical needs for alternative biomass source utilization, in the present work, an attempt has been made to identify the most cost-effective strategy to analyze ethyl alcohol production from different lignocellulose sources. The concept of an installation for the first and second stages of bioethanol production was proposed. All of the most relevant elements of the bioethanol production cost analysis were identified and characterized. Cost analyses of all important production process elements showed their relative effects on the production cost and potential for the competitive advantage of applied raw material. The study demonstrates the importance of renewable energy source utilization and the cost-effectiveness of bioethanol production. Furthermore, the proposed less energy- and labor-demanding process, primarily achieved via the implementation of technological medium recovery and recirculation, reduces the production cost and results in higher production efficiency, and therefore has a significant effect on the overall process economy. [ABSTRACT FROM AUTHOR]

Simple Summary: Proton therapy delivers more precise treatment compared with conventional radiotherapy. While this innovation entails investment costs, the information about the treatment costs per patient is limited. This information gap might prevent policymakers from making informed decisions. This study aims to calculate the costs of Proton therapy at a single center during the start-up phase and to provide essential information for the health technology assessment of proton therapy. The total cost of proton therapy varied between EUR 12,062 for eye melanoma and EUR 89,716 for head and neck cancer. Overall, indirect costs were the most significant cost component. The high indirect costs implied the potential of the scale of economics; according to our estimation, the treatment cost could be reduced to 35% of the current cost when maximum treatment capacity is achieved. Nevertheless, to have an estimation that reflects the matured cost of proton therapy which could be used in cost-effectiveness analysis, a follow-up study assessing the full-fledged situation is recommended. However, this study provided insights into the financial situation of a new proton therapy center during its ramp-up period and laid the first stone for future costing studies. Background: Proton therapy (PT) has characteristics that enable the sparing of healthy, non-cancerous tissue surrounding the radiotherapy target volume better from radiation doses than conventional radiotherapy for patients with cancer. While this innovation entails investment costs, the information about the treatment costs per patient, especially during the start-up phase, is limited. This study aims to calculate the costs of PT at a single center during the start-up phase in the Netherlands. Methods: The cost of PT per patient was estimated for the treatment indications, head and neck cancer, breast cancer, brain cancer, thorax cancer, chordoma and eye melanoma. A time-driven activity-based costing analysis (TDABC), a methodology that calculates the costs of consumed healthcare resources by a patient, was conducted in a newly established PT center in the Netherlands (HPTC). Both direct (e.g., the human resource costs for medical staff) and indirect costs (e.g., the operating/interest costs, indirect human resource costs and depreciation costs) were included. A scenario analysis was conducted for short-term (2021), middle-term (till 2024) and long-term (after 2024) predicted patient numbers in the PT center. Results: The total cost of PT in 2020 at the center varied between EUR 12,062 for an eye melanoma course and EUR 89,716 for a head and neck course. Overall, indirect costs were the largest cost component. The high indirect costs implied the potential of the scale of economics; according to our estimation, the treatment cost could be reduced to 35% of the current cost when maximum treatment capacity is achieved. Conclusion: This study estimated the PT cost delivered in a newly operated treatment center. Scenario analysis for increased patient numbers revealed the potential for cost reductions. Nevertheless, to have an estimation that reflects the matured cost of PT which could be used in cost-effectiveness analysis, a follow-up study assessing the full-fledged situation is recommended. [ABSTRACT FROM AUTHOR]

The definition of strategies for forest restoration projects depends on information of the successional stage of the area to be restored. Usually, classification of the successional stage is carried out in the field using forest inventory campaigns. However, these campaigns are costly, time-consuming, and limited in terms of spatial coverage. Currently, forest inventories are being improved using 3D data obtained from remote sensing. The objective of this work was to estimate several parameters of interest for the classification of the successional stages of secondary vegetation areas using 3D digital aerial photogrammetry (DAP) data obtained from unmanned aerial vehicles (UAVs). A cost analysis was also carried out considering the costs of equipment and data collection, processing, and analysis. The study was carried out in southeastern Brazil in areas covered by secondary Atlantic Forest. Regression models were fit to estimate total height (h), diameter at breast height (dbh), and basal area (ba) of trees in 40 field inventory plots (0.09 ha each). The models were fit using traditional metrics based on heights derived from DAP and a portable laser scanner (PLS). The prediction models based on DAP data yielded a performance similar to models fit with LiDAR, with values of R² ranging from 88.3% to 94.0% and RMSE between 11.1% and 28.5%. Successional stage maps produced by DAP were compatible with the successional classes estimated in the 40 field plots. The results show that UAV photogrammetry metrics can be used to estimate h, dbh, and ba of secondary vegetation with an accuracy similar to that obtained from LiDAR. In addition to presenting the lowest cost, the estimates derived from DAP allowed for the classification of successional stages in the analyzed secondary forest areas. [ABSTRACT FROM AUTHOR]

Simple Summary: In stage IV melanoma, the combination of ipilimumab and nivolumab improves outcomes compared to single agents. However, it bears an important financial impact on the healthcare system. In this manuscript, we analyze the costs related to the ipilimumab–nivolumab combination, focusing on the immune-related adverse events (irAE) in a real-world setting. Surprisingly, we found that the toxicity cost of ipilimumab and nivolumab are insignificant compared to the total cost of the treatment. Additionally, patients with a Grade 3–4 toxicity have lower costs and better outcomes than patients with Grade 1–2 irAEs. Finally, medication and disease-related hospitalization costs are the major costs of the treatment. These findings are important information for clinicians and healthcare organizations for treatment decisions in immunotherapy. Combined ipilimumab and nivolumab significantly improve outcomes in metastatic melanoma patients but bear an important financial impact on the healthcare system. Here, we analyze the treatment costs, focusing on irAE. We conducted a retrospective analysis of 62 melanoma patients treated with ipilimumab–nivolumab at the Lausanne University Hospital between 1 June 2016 and 31 August 2019. The frequency of irAEs and outcomes were evaluated. All melanoma-specific costs were analyzed from the first ipilimumab–nivolumab dose until the therapy given subsequently or death. A total of 54/62 (87%) patients presented at least one irAE, and 31/62 (50%) presented a grade 3–4 irAE. The majority of patients who had a complete response 12/14 (86%) and 21/28 (75%) of overall responders presented a grade 3–4 toxicity, and there were no responses in patients without toxicity. Toxicity costs represented only 3% of the total expenses per patient. The most significant contributions were medication costs (44%) and disease costs (39%), mainly disease-related hospitalization costs, not toxicity-related. Patients with a complete response had the lowest global median cost per week of follow up (EUR 2425) and patients who had progressive disease (PD), the highest one (EUR 8325). Except for one patient who had a Grade 5 toxicity (EUR 6043/week), we observe that less severe toxicity grades (EUR 9383/week for Grade 1), or even the absence of toxicity (EUR 9922/week), are associated with higher median costs per week (vs. EUR 3266/week for Grade 4 and EUR 2850/week for Grade 3). The cost of toxicities was unexpectedly low compared to the total costs, especially medication costs. Patients with higher toxicity grades had better outcomes and lower total costs due to treatment discontinuation. [ABSTRACT FROM AUTHOR]

The goal of this study was to improve resource use efficiency in agricultural systems and agro-based industries, reduce wastes that go to landfills and incinerators, and consequently, improve the economics of 2,3-butanediol (2,3-BD) production. This study evaluated the feasibility of 2,3-BD production by replacing the mineral nutrients, and buffers with anaerobic digestate (ADE), poultry-litter (PLBC)- and forage-sorghum (FSBC)-derived biochars. Fermentation media formulations with ADE and 5–20 g/L PLBC or FSBC were evaluated for 2,3-BD production using Paenibacillus polymyxa as a biocatalyst. An optimized medium containing nutrients and buffers served as control. While 2,3-BD production in the ADE cultures was 0.5-fold of the maximum generated in the control cultures, 2,3-BD produced in the PLBC and FSBC cultures were ~1.3-fold more than the control (33.6 g/L). Cost analysis showed that ADE and biochar can replace mineral nutrients and buffers in the medium with the potential to make bio-based 2,3-BD production profitably feasible. [ABSTRACT FROM AUTHOR]

People in the life sciences who work with Artificial Intelligence (AI) and Machine Learning (ML) are under increased pressure to develop algorithms faster than ever. The possibility of revealing innovative insights and speeding breakthroughs lies in using large datasets integrated on several levels. However, even if there is more data at our disposal than ever, only a meager portion is being filtered, interpreted, integrated, and analyzed. The subject of this technology is the study of how computers may learn from data and imitate human mental processes. Both an increase in the learning capacity and the provision of a decision support system at a size that is redefining the future of healthcare are enabled by AI and ML. This article offers a survey of the uses of AI and ML in the healthcare industry, with a particular emphasis on clinical, developmental, administrative, and global health implementations to support the healthcare infrastructure as a whole, along with the impact and expectations of each component of healthcare. Additionally, possible future trends and scopes of the utilization of this technology in medical infrastructure have also been discussed. [ABSTRACT FROM AUTHOR]

Post-installed elevator projects have grown significantly in recent years in response to the problem of insufficient vertical traffic capacity in existing buildings, but research on the seismic performance of post-installed elevator structures has been relatively limited. This study takes a 26-story-frame shear wall structure as an example. The seismic response characteristics of this structure before and after the installation of elevators were analyzed. In order to optimize the design scheme of the post-installed elevator structure, this study further analyzed how factors such as the standard height of the elevator shaft frame, the elevator location, and the way the post-installed elevator is connected to the structure affect the seismic response of the elevator structure. The results show that the post-installed elevators have a small impact on the seismic performance of the existing building and can slightly reduce the seismic response of the structure. In addition, the stiffness of the elevator shaft will be reduced, and its seismic response will be slightly increased as the standard shaft height is increased, but the construction cost can be reduced. The installation location has a greater impact on the seismic response of the post-installed elevator. The seismic response of the post-installed elevator is minimal when it is arranged near the elevator shaft of the existing building. [ABSTRACT FROM AUTHOR]

The correct planning of investment costs and the effective monitoring of implementation process are significant problems in the management of investment projects. At the stage of construction works, it is worth determining the trend of the performed cost curve and periodically testing the fitting to the scheduled course of the budgeted cost curve. The aim of this research was to determine the shape and course of the cost curves for selected construction projects. A procedure was developed to forecast the distribution of cumulative costs at the planning stage of construction projects using envelopes (spaces) and cost curves for three different types of buildings and construction sectors: collective residential buildings, hotel buildings, and commercial and service buildings. An assessment of the actual costs incurred of investment tasks was carried out, the trend of which the cumulative cash flow curves can be estimated with a large match by forecasting the construction process. The article determines the best fit curves and the spaces of cost curves (the banana envelope of the S-curve) using mathematical formulas (third-degree polynomials), along with developed graphs for various construction projects. The analysis of the author's own research was used to determine the best-fit curve and the curve's area, which indicates the area of the correct planning of cumulative costs of construction investments. [ABSTRACT FROM AUTHOR]

Vineyard mechanical winter pruning has been spreading worldwide, and the physiological basis ascribable to it has been consolidated throughout the years. Despite labor savings and reduction of costs having been proven, the demonstration of its economic viability might be challenging. In this context, this work aims to evaluate the vine performances and the costs of different degrees of the mechanization of winter pruning over a five-year trial (2011–2015). In a vineyard of cv. Trebbiano Romagnolo (Vitis vinifera L.) located in northern Italy, three pruning treatments were laid out as follows: (a) manual pruning (MAN); (b) mechanical pre-pruning and simultaneous manual follow-up (MP + F); (c) mechanical pruning without a manual follow-up (MP). The results showed a strong increase in the node number of MP. Nevertheless, the yield compensation factors (i.e., the shoot fruitfulness and cluster weight) limited the increase in productivity. Soluble solids did not differ between the pruning treatments, while titratable acidity resulted slightly higher only on the MP berries. The MP treatment was the most economically convenient, with a vineyard surface of 1.5 hectares, while mechanical pruning with manual finishing resulted more advantageous, compared to manual pruning when the vineyard surface was greater than 2.9 hectares. The agronomic and economic results obtained in this five-year trial suggest that mechanical pruning may be profitably applied also on grapevine varieties characterized by low basal bud fruitfulness, such as Trebbiano Romagnolo. [ABSTRACT FROM AUTHOR]

There are multiple reasons to consider the use of formal childcare: parental employment, child development, fertility choices, elderly health, generational relations, etc. This study explores the relationship between regional differences (urban/rural; eastern/central/western) and demand for childcare services (quantity, price, quality) from birth to three years of age, moderated and mediated by the family childcare contexts among Chinese women. Altogether, 1770 mothers of children aged 0–3 were selected from a national survey and analyzed. There are three major findings: (1) Urban mothers show a willingness to spend on the higher monetary cost of center-based childcare compared to rural mothers, as a result of more severe work–child conflicts faced by urban women. Urban–rural gaps in individual and household income also contribute to the differences in affordability. (2) Mothers in eastern China have a more substantial need to place their infants or toddlers in nurseries before the age of three than their counterparts in central and western China, primarily due to a lack of grandparental and paternal childcare support and an expectation of higher quality programs. (3) There is no significant regional disparity in terms of care-related or education-related quality preferences. The paper proposes regional prioritized strategies and targeted services to address the "3A" problems of childcare provision. [ABSTRACT FROM AUTHOR]

Simple Summary: Synthesised cost-effectiveness evidence is necessary for resource allocation for risk-reducing surgery in breast cancer (BC)/ovarian cancer (OC)/endometrial cancer (EC) prevention strategies. We aimed to review evidence on the cost-effectiveness of surgical prevention for BC/OC/EC in high/intermediate/low-risk populations. From 22 included studies, risk-reducing mastectomy (RRM) and/or risk-reducing salpingo-oophorectomy (RRSO) were cost-effective for BRCA1/2, and RRSO was also cost-effective at a lower lifetime OC risk-threshold of 4–5%. Risk-reducing early salpingectomy and delayed oophorectomy (RRESDO) was cost-effective compared to RRSO in one-study. Hysterectomy with bilateral salpingo-oophorectomy (BSO) was cost-effective in Lynch syndrome women. Opportunistic bilateral salpingectomy (OBS) was cost-effective when conducted with hysterectomy for benign gynaecology surgery or in lieu of tubal sterilisation. This systematic review found that surgical prevention is cost-effective for women who are at high risk of BC, intermediate/high risk of OC and high risk of EC. The results are sensitive to age, disutility and uptake rates regarding RRS along with the effect sizes in terms of OC-risk reduction from salpingectomy. These areas require further research. Key points: Question: What is the evidence on the cost-effectiveness of risk-reducing surgery for breast, ovarian and endometrial cancer prevention? Findings: This systematic review found that surgical prevention is cost-effective for women in high-income countries who are at a high risk of breast cancer, intermediate/high risk of ovarian cancer and high risk of endometrial cancer. The results, while robust for most strategies, are sensitive to certain parameters, especially the disutility from surgery and the effect sizes of ovarian cancer risk reduction from salpingectomy. Implications: Risk-reducing surgery is cost-effective for breast/ovarian/endometrial cancer prevention across most settings, but more research is needed on the disutility from all preventive surgery and the precision in terms of the cancer risk reduction from salpingectomy. Policymakers require robust cost-effectiveness evidence of risk-reducing-surgery (RRS) for decision making on resource allocation for breast cancer (BC)/ovarian cancer (OC)/endometrial cancer (EC) prevention. We aimed to summarise published data on the cost-effectiveness of risk-reducing mastectomy (RRM)/risk-reducing salpingo-oophorectomy (RRSO)/risk-reducing early salpingectomy and delayed oophorectomy (RRESDO) for BC/OC prevention in intermediate/high-risk populations; hysterectomy and bilateral salpingo-oophorectomy (BSO) in Lynch syndrome women; and opportunistic bilateral salpingectomy (OBS) for OC prevention in baseline-risk populations. Major databases were searched until December 2021 following a prospective protocol (PROSPERO-CRD42022338008). Data were qualitatively synthesised following a PICO framework. Twenty two studies were included, with a reporting quality varying from 53.6% to 82.1% of the items scored in the CHEERS checklist. The incremental cost-effectiveness ratio/incremental cost-utility ratio and cost thresholds were inflated and converted to US$2020, using the original currency consumer price index (CPI) and purchasing power parities (PPP), for comparison. Eight studies concluded that RRM and/or RRSO were cost-effective compared to surveillance/no surgery for BRCA1/2, while RRESDO was cost-effective compared to RRSO in one study. Three studies found that hysterectomy with BSO was cost-effective compared to surveillance in Lynch syndrome women. Two studies showed that RRSO was also cost-effective at ≥4%/≥5% lifetime OC risk for pre-/post-menopausal women, respectively. Seven studies demonstrated the cost-effectiveness of OBS at hysterectomy (n = 4), laparoscopic sterilisation (n = 4) or caesarean section (n = 2). This systematic review confirms that RRS is cost-effective, while the results are context-specific, given the diversity in the target populations, health systems and model assumptions, and sensitive to the disutility, age and uptake rates associated with RRS. Additionally, RRESDO/OBS were sensitive to the uncertainty concerning the effect sizes in terms of the OC-risk reduction and long-term health impact. Our findings are relevant for policymakers/service providers and the design of future research studies. [ABSTRACT FROM AUTHOR]

Lavender oil is an important essential oil with many applications. The purpose of this study was to compare different methods of essential oil extraction to determine which method would be the most effective and profitable for commercial-scale production from Lavandula × intermedia ('Margret Roberts') flowers and leaves. The lavender from this variety flowers year-round, providing an extended production season compared to some other lavender varieties. Steam distillation, hydrodistillation, and cellulase-assisted hydrodistillation were used to extract oil. The average extraction times for steam distillation, hydrodistillation, and cellulase-assisted hydrodistillation were 57-, 51-, and 49 min, respectively, and the average energy consumption was 15.0-, 13.4-, and 30.8 kJ/g, respectively. Cellulase-assisted hydrodistillation produced the best quality oils, with a lower camphor content and a sweeter, more pleasant smell, while steam-distilled oils had the highest camphor content, as well as a more plant-like smell. Factors affecting scale-up (surface area of cut plants, equipment loading times, energy efficiencies, safety, mixing) have been discussed, while a basic cost analysis of theoretical large-scale processes showed that hydrodistillation and cellulase-assisted hydrodistillation would be the most and least profitable methods, respectively. Overall, hydrodistillation is recommended as the best method for commercial lavender oil production. [ABSTRACT FROM AUTHOR]

Simple Summary: Malignant pleural mesothelioma is a cancer of the lung lining, normally caused by asbestos, that develops decades after exposure. Chemotherapy, and recently more targeted drugs, show some benefit although only a minority of patients respond and invariably the cancer eventually escapes control. Several key genetic changes in mesothelioma differ from patient to patient, which may influence how their cancer responds to treatments. We have developed a new preclinical model using fertilised hen's eggs as an alternative to laboratory rodents. Mesothelioma cells are labelled to allow monitoring of tumour growth and/or regression using fluorescence and longitudinal bioluminescence imaging in addition to histology. All cell lines tested efficiently form tumour nodules within seven days, supported by a blood supply and stromal chick cells. The model is rapid, cost effective, scalable, and adaptable with multiple potential endpoints, to enable evaluation of drug targets against the range of common mesothelioma genetic backgrounds. Malignant pleural mesothelioma (MPM) has limited treatment options and poor prognosis. Frequent inactivation of the tumour suppressors BAP1, NF2 and P16 may differentially sensitise tumours to treatments. We have established chick chorioallantoic membrane (CAM) xenograft models of low-passage MPM cell lines and protocols for evaluating drug responses. Ten cell lines, representing the spectrum of histological subtypes and tumour suppressor status, were dual labelled for fluorescence/bioluminescence imaging and implanted on the CAM at E7. Bioluminescence was used to assess viability of primary tumours, which were excised at E14 for immunohistological staining or real-time PCR. All MPM cell lines engrafted efficiently forming vascularised nodules, however their size, morphology and interaction with chick cells varied. MPM phenotypes including local invasion, fibroblast recruitment, tumour angiogenesis and vascular remodelling were evident. Bioluminescence imaging could be used to reliably estimate tumour burden pre- and post-treatment, correlating with tumour weight and Ki-67 staining. In conclusion, MPM-CAM models recapitulate important features of the disease and are suitable to assess drug targets using a broad range of MPM cell lines that allow histological or genetic stratification. They are amenable to multi-modal imaging, potentially offering a time and cost-efficient, 3Rs-compliant alternative to rodent xenograft models to prioritise candidate compounds from in vitro studies. [ABSTRACT FROM AUTHOR]

During the beer brewing process, some compounds are formed in the primary fermentation step and may affect the final quality of beer. These compounds, called off flavors, such as diacetyl, are produced during fermentation and are related to a buttery taste. The use of acetolactate decarboxylase (ALDC) in the traditional beer brewing process may significantly increase productivity since it allows for a faster decrease in the adverse flavor caused by diacetyl. However, production costs directly impact its application. For this reason, we analyzed the effect of different cultivation media on ALDC production by Bacillus subtilis ICA 56 and process economics. Different carbon and nitrogen sources, including agro-industrial residues, were evaluated. The best result was obtained using sugarcane molasses and corn steep solids (CSS), allowing a 74% reduction in ALDC production cost and an enzyme activity of 4.43 ± 0.12 U·mL−1. The enzymatic extract was then characterized, showing an optimum temperature at 40 °C and stability at different pH levels, being able to maintain more than 80% of its catalytic capacity between pH values of 3.6 and 7.0, with higher enzymatic activity at pH 6.0 (50 mM MES Buffer), reaching an ALDC activity of 5.30 ± 0.06 U·mL−1. [ABSTRACT FROM AUTHOR]

The economic impact of adverse events (AEs) for poly (ADP-ribose) polymerase inhibitors (PARPis) in ovarian or breast cancer has not been widely evaluated. Compare PARPi-related AE management costs from a US payer perspective. The frequency of treatment-related grade 3–4 AEs was obtained from published clinical trials of PARPis for the treatment of advanced ovarian cancer (AOC), platinum-sensitive recurrent ovarian cancer (PSROC), and metastatic breast cancer (MBC). AE management costs per patient (2020 USD) per treatment course were calculated by multiplying the AE unit costs by the frequency of AEs for each arm of each trial. Sensitivity analyses were conducted according to the lower and upper limits of the 95% confidence interval for AE rates and unit costs, respectively. Scenarios were also performed to explore the uncertainty of outcomes. Total AE management costs in AOC were: $3,904, olaparib; $5,595, olaparib plus bevacizumab; and $12,215, niraparib. In PSROC, total costs were: $3,894, olaparib; $6,001, rucaparib; and $11,492, niraparib, and in MBC: $3,574, olaparib; and $9,489, talazoparib. Hematological toxicities were the key drivers of AE management costs for PARPis. The main AEs among PARPis were hematological. Olaparib was associated with lower AE costs compared to other PARPis. [ABSTRACT FROM AUTHOR]

This paper reports on the physico-chemical removal of NH4+ from the supernatant line in municipal wastewater treatment plants (WWTPs), using zinc-hexa-cyano-ferrate (ZnHCF) beads. The work is divided into three parts: First, the characteristics of three (Zn-, Co-, Ni-) types of HCF beads were determined, with a finding that ZnHCF was the most suitable for the purpose of this work. Second, synthetic and actual supernatant wastewater was passed through a ZnHCF column for many cycles until apparent steady-state results were attained. Due to the very high affinity of the beads toward NH4+ and the much lower affinity toward competing cations, the same regeneration solution could be used for many cycles (20 cycles in this work) without affecting the following adsorption breakthrough curve efficiency and the operational capacity, which was >88% at the end of all adsorption steps. Finally, a cost analysis was performed, revealing that the cost of removing ~500 mg/L of ammonia from the supernatant line is ~$0.02 per m3 of raw wastewater flowing into the plant if the ammonia is recaptured and sold as NH4Cl. This may be cost-effective when the WWTP receives a higher-than-planned load, and an incentive exists for alleviating the ammonia load on the oxidation reactor. [ABSTRACT FROM AUTHOR]

Cataract is a major cause of blindness worldwide. In particular, in low-income countries, the burden of disease as well as its direct and indirect economic cost are a major challenge for the population and economy. In many cases, it would be possible to prevent or cure blindness with a comparably simple cataract surgery, but many countries lack the resources to strengthen healthcare systems and implement broad cataract surgery programs reaching, in particular, the rural poor. In this paper, we analyse whether such an intervention could be cost-effective or even cost-saving for the respective health systems. We calculate the net value of the lifelong costs of cataract with and without surgery. This calculation includes direct costs (e.g., treatment, glasses, surgery) as well as indirect cost of the caregiver and the patient. We total all costs from the year of onset of cataract until death and discount the respective values to the year of onset. We define the surgery as cost-saving if the net-value of costs with surgery is lower than without surgery. If the cost per quality adjusted life year is lower than one gross national product per capita, we define the intervention as highly cost-effective. We find that the cost-effectiveness of cataract surgery depends on the age of onset of the disease and the age of surgery. If the surgery is performed with the beginning of severe impairment, even surgery of a 78-year-old patient is still cost-saving. Almost all possible constellations are highly cost-effective, only for the very old it is questionable whether the surgery should be performed. The simulations show that cataract surgery is one of the most cost-effective interventions. However, millions of people in low-income countries still have no chance to prevent or cure blindness due to limited resources. The findings of this paper clearly call for a stronger effort to reach poor and rural populations with this cost-effective service. [ABSTRACT FROM AUTHOR]

COVID-19 has become a very transmissible disease that has had a worldwide impact, resulting in a huge number of infections and fatalities. Testing is critical to the pandemic's successful response because it helps detect illnesses and so attenuate (isolate/cure) them and now vaccination is a life-safer innovation against the pandemic which helps to make the immunity system stronger and fight against this infection. Patient-sensitive information, on the other hand, is now held in a centralized or third-party storage paradigm, according to COVID-19. One of the most difficult aspects of using a centralized storage strategy is maintaining patient privacy and system transparency. The application of blockchain technology to support health initiatives that can minimize the spread of COVID-19 infections in the context of accessibility of the system and for verification of digital passports. Only by combining blockchain technology with advanced cryptographic algorithms can a secure and privacy-preserving solution to COVID-19 be provided. In this article, we investigate the issue and propose a blockchain-based solution incorporating conscience identity, encryption, and decentralized storage via interplanetary file systems (IPFS). For COVID-19 test takers and vaccination takers, our solution includes digital health passports (DHP) as a certification of test or vaccination. We explain smart contracts constructed and tested with Ethereum to preserve a DHP for test and vaccine takers, allowing for a prompt and trustworthy response from the necessary medical authorities. We use an immutable trustworthy blockchain to minimize medical facility response times, relieve the transmission of incorrect information, and stop the illness from spreading via DHP. We give a detailed explanation of the proposed solution's system model, development, and assessment in terms of cost and security. Finally, we put the suggested framework to the test by deploying a smart contract prototype on the Ethereum TESTNET network in a Windows environment. The study's findings revealed that the suggested method is effective and feasible. [ABSTRACT FROM AUTHOR]

Medication errors and omissions can potentially cause harm, prolong a hospital stay, lead to co-morbidities and even death. Pharmacy interventions (PI) ensure that these errors are identified and addressed, leading to improved patient safety and prescriber practice. Particularly in community hospitals, many only having general practitioners and not specialist doctors in their medical teams, PIs assume a strategic role. The PIs recorded throughout 8 months (between November 2021 and June 2022) in the community hospital wards in Powys, Wales, UK, using xPIRT (Pharmacy Intervention Recording Tool), a new pharmacy intervention record toolkit, were subjected to a retrospective analysis. The data were organised by location, drug, severity, acceptance, cost avoidance and intervention type. Significant prescribing errors were identified, which can potentially be different from those recorded in acute settings. Our results also informed on the need for integrated electronic prescribing systems paired with a PI recording tool to address effectively prescribing inaccuracies. Overall, this study was able to identify pharmacy teams as key to improve patient safety and care while contributing to significant cost-savings, through the recording of PI using xPIRT. [ABSTRACT FROM AUTHOR]

The building sector has slowly but constantly had the largest contribution to global carbon emissions. Thus, business in the building sector has a responsibility to contribute to reducing carbon emissions. One of the ways of doing this has been by developing the concept of a green building, which is one of the solutions for sustainable development. However, the main obstacle for the property developer is a misconception that capital cost spending is more important than the life cycle cost of the building. The majority of property owners and developers are more concerned about the initial cost without taking into consideration that the initial cost is closely related to the operational cost of buildings, especially high-rise buildings. From this phenomenon, there are research opportunities that aim to determine how the concept of green influences the financial decisions of developers in Indonesia that are applied to high-rise buildings. The method used in this research is inferential analysis to determine how the influence of the application of green building factors into the valuation of a building. The valuation is based on one of three methods in a building's valuation, which is the cost approach. Then, a comparison between the building's valuation using green and non-green is conducted in terms of the cost analysis and sensitivity. The result of the analysis is known that according to the developer practitioners in Indonesia with the green building concept, the increase in construction costs is not always accompanied by a decrease in operating and maintenance costs, as well as an increase in property values. These findings can have implications for achieving expectations, that is increasing property values through the use of the green building concept by reducing the operational and maintenance costs. [ABSTRACT FROM AUTHOR]

Solar photovoltaic (PV) technology is a current trend worldwide, offering many environmental benefits. With the flagship SolarNova Programme in Singapore, solar PV has gained its momentum. However, it remains important to explore new avenues to introduce solar PV in the urban settings. The housing development board (HDB) green towns promote sustainable living. Therefore, introducing solar PV is essential. This research study aims to propose and conduct an economic evaluation on solar PV for the HDB's covered linkways. HDB covered linkways connect buildings within the green towns. Hence, installing solar PV systems in covered linkways facilitates to self-produce required energy and export extra electricity to the grid. This research study used PVWatts calculator to calculate the power generation. A thin film solar PV is used for the study with fixed array type and azimuth is 180°. Four solar PV systems, namely (1) 4 kW, (2) 5 kW, (3)10 kW, and (4) 20 kW, were evaluated in this research study. The initial cost ranges from S$7000 to S$38,000 for the four types. For 4 kW and 5 kW systems, the payback period is 6.22 years. The highest payback period is for a 20-kW system, which is 7.4 years. The 10-kW system generates a significant portion of the electricity requirements, and the payback period is 6.04 years. This research contributes to the solar PV domain by proposing a novel grid-connected solar PV system for covered linkways while identifying the most cost-effective solution. [ABSTRACT FROM AUTHOR]

Increasing evidence indicates that endocrine-disrupting chemicals (EDCs) cause a variety of adverse health outcomes and contribute to substantial disease burden. This study summarized the exposure status of polybrominated diphenyl ethers (PBDEs) and phthalates (PAEs) in China and evaluated the disease burden attributable to PBDEs and PAEs in 2015. The results showed that PBDE and PAE concentrations were higher in coastal areas. The disease burden attributable to PBDEs was 0.77 million cases, and the economic costs were CNY 18.92 billion. Meanwhile, 3.02 million individuals suffered from diseases attributable to PAEs, and the economic costs were CNY 49.20 billion. The economic burden caused by PBDEs and PAEs accounted for 0.28% and 0.72% of China's Gross Domestic Product (GDP) in 2015, respectively. When comparing China's results from 2010, it was determined that the GDP ratio of economic costs caused by PAEs in 2015 (0.72%) was lower than in 2010 (1.42%). Finally, compared with the results of the European Union and North America, the GDP ratios of economic costs caused by PAEs in 2015 were 0.19% in Canada (lower than China), 0.29% in the United States (lower than China), and 1.44% in the European Union (higher than China). This study provides important reference values for China's health governance, and further research should be conducted in the future. [ABSTRACT FROM AUTHOR]

Fifth-generation (5G) wireless technology promises to be the critical enabler of use cases far beyond smartphones and other connected devices. This next-generation 5G wireless standard represents the changing face of connectivity by enabling elevated levels of automation through continuous optimization of several Key Performance Indicators (KPIs) such as latency, reliability, connection density, and energy efficiency. Mobile Network Operators (MNOs) must promote and implement innovative technologies and solutions to reduce network energy consumption while delivering high-speed and low-latency services to deploy energy-efficient 5G networks with a reduced carbon footprint. This research evaluates an energy-saving method using data-driven learning through load estimation for Beyond 5G (B5G) networks. The proposed 'ECO6G' model utilizes a supervised Machine Learning (ML) approach for forecasting traffic load and uses the estimated load to evaluate the energy efficiency and OPEX savings. The simulation results demonstrate a comparative analysis between the traditional time-series forecasting methods and the proposed ML model that utilizes learned parameters. Our ECO6G dataset is captured from measurements on a real-world operational 5G base station (BS). We showcase simulations using our ECO6G model for a given dataset and demonstrate that the proposed ECO6G model is accurate within $4.3 million over 100,000 BSs over 5 years compared to three other models that would increase OPEX cost from $370 million to $1.87 billion during varying network load scenarios against other data-driven and statistical learning models. [ABSTRACT FROM AUTHOR]

Purpose: Pediatric head traumas constitute the majority of admissions to emergency departments (ED) due to trauma. This study aims to draw attention to the use of cranial computerized tomography (CT) scans in the evaluation of children with head trauma under the age of 18, and to determine CT scans' usefulness in terms of cost-effectiveness. Materials and Methods: Age, gender, mechanism of trauma and Glasgow Coma Scale (GCS), diagnosis, time of admission to hospital, hospitalization and operation, cranial computerized tomography and hospitalization costs of all cases were retrospectively analyzed. Results: A total of 26,412 patients younger than 18 years old who were admitted to the emergency department due to head trauma and who had a cranial tomography were analyzed. They had a mean age of 7.74 ± 5.66 years. In total, 26,363 (99.8%) of these patients had a GCS greater than 14. Out of these patients, only 402 (1.5%) had brain injury revealed by cranial CT, 41 (0.2%) of these patients were operated and 3 of the patients lost their lives. The total cost of patients admitted to the emergency department with a head injury amounts to USD 583,317. Furthermore, 75.78% of this cost comes from negative cranial CTs. A cost analysis according to different age groups did not show a meaningful difference between 0–2 years and 3–5 years (p = 1.000), but there was a meaningful difference for all the other age groups. Conclusion: Our findings show that applying algorithms to predict traumatic brain injury in children with mild head injury rather than scanning all patients with cranial CT will enable more reliable and cost-effective patient care. Current practices should be reviewed to avoid unnecessary radiation exposure and expense in the ED. It is also necessary to inform and educate parents about the risk/benefit ratio of cranial CT scans. [ABSTRACT FROM AUTHOR]

This paper presents the model for the identification of reference points on the lifetime curve of engineering systems. This curve commonly represents the increase and decline of failure in relation to time. A direct correlation between failure rate and costs is assumed in this paper, therefore, statistical and empirical analysis of costs provided reference points. This approach is used for positioning stages of the engineering system's lifetime with a minimal number of failures and costs, regardless of whether these are acceptable or not. The following three stages are usually identified: the beginning, the stationary part and the end of life. The boundaries between them are recognized on the basis of minimum total lifetime costs and on economic lifetime costs. Model is tested on the dozers, machines frequently used in the mining industry for the earthmoving operations, and which are characterized by high operating and maintenance costs. [ABSTRACT FROM AUTHOR]

This study aims to assess the prevalence and antibiotic-treatment patterns of respiratory tract infections (RTIs), prevalence and types of antibiotic-prescribing errors, and the cost of inappropriate antibiotic use among emergency department (ED) patients. A cross-sectional study was conducted at the ED in King Abdulaziz Medical City, Riyadh, Saudi Arabia. Patient characteristics (age, sex, weight, allergies, diagnostic tests (CX-Ray), cultures, microorganism types, and prescription characteristics) were studied. During the study, 3185 cases were diagnosed with RTIs: adults (>15 years) 55% and pediatrics (<15 years) 44%. The overall prevalence of RTIs was 21%, differentiated by upper respiratory tract infections (URTI) and lower respiratory tract infections (LRTI) (URTI 13.4%; LRTI 8.4%), of total visits. Three main antibiotics (ATB) categories were prescribed in both age groups: penicillin (pediatrics 43%; adults 26%), cephalosporin (pediatrics 29%; adults 19%), and macrolide (pediatrics 26%; adults 38%). The prevalence of inappropriate ATB prescriptions was 53% (pediatrics 35%; adults 67%). Errors in ATB included selection (3.3%), dosage (22%), frequency (3%), and duration (32%). There is a compelling need to create antimicrobial stewardship (AMS) programs to improve antibiotic use due to the high number of prescriptions in the ED deemed as inappropriate. This will help to prevent unwanted consequences on the patients and the community associated with antibiotic use. [ABSTRACT FROM AUTHOR]

The objective of this study was to describe the prevalence of outpatient use and costs for systemic antibacterials by age and sex among adults in Finland from 2008–2019. Data from the Finnish statistical database Kelasto, containing information concerning all reimbursed medicines for 18+-year-olds during 2008–2019, were analyzed. In addition to the decreased (26%) use of systemic antibiotics, decreased use was observed in all antibiotic categories, notably including several wide-spectrum antibiotics. The use of quinolones decreased by 49% and of tetracyclines by 39%. The 10 most frequently used antibiotics covered 89% of all adult antibiotic prescriptions. Antibiotic use also decreased in every age group during the study period. Although the overall yearly costs of outpatient antibiotics during the 10-year study period decreased from EUR 36.4 million to EUR 30.7 million, the cost per prescription increased slightly. In conclusion, according to the findings of this study, concerning adults and the results of our previous study concerning children and adolescents (2008–2016), there has been a decreasing trend of outpatient antibacterial use among the whole Finnish outpatient population over the duration of nearly one decade. However, during the same time period, there has been a specific increasing trend for the Gram-negative AMR threat regarding E. coli resistance. Therefore, based on our important findings in Finland, methods other than the restriction of antibiotic use, such as new anti-infective innovations, including antibacterials, are needed as soon as possible to tackle this major global health threat—a silent pandemic. [ABSTRACT FROM AUTHOR]

Actuator hunting is a widespread and often neglected problem in the HVAC field. Hunting is typically characterized by sustained or intermittent oscillations, and can result in decreased efficiency, increased actuator wear, and poor setpoint tracking. Cascaded control loops have been shown to effectively linearize system dynamics and reduce the prevalence of hunting. This paper details the implementation of cascaded control architectures for Air Handling Unit chilled water valves at three university campus buildings. A framework for implementation the control in existing Building Automation software is developed that requires only a single line of additional code. Results gathered for more than a year show that cascaded control not only eliminates hunting in control loops with documented hunting issues, but provides better tracking and more consistent performance during all seasons. A discussion of efficiency losses due to hunting behavior is presented and illustrated with comparative data. Furthermore, an analysis of cost savings from implementing cascaded chilled water valve control is presented. Field tests show 2.2–4.4% energy savings, with additional potential savings from reduced operational costs (i.e., maintenance and controller retuning). [ABSTRACT FROM AUTHOR]

Featured Application: In this work, a methodology for the quantitative assessment of additive manufacturing and conventional manufacturing technology value chains is presented for the production of injection molding tools. The development of injection molding tools is an expensive, time-consuming, and resource-intensive process offering little to no flexibility to adapt to variations in product design. Metal additive manufacturing can be used to produce these tools in a cost-effective way. Nevertheless, in an industrial context, effective methods are missing for the selection of the most suitable technology for the given tooling project. This paper presents a method to compare process chains based on additive and conventional subtractive technologies for the manufacturing of metal tooling for injection molding. The comparison is based on a technology focused-performance analysis (TFPA) through computer simulation performed using Tecnomatix Plant Simulation developed by Siemens Digital Industries Software combined with a customized cost–benefit economic analysis tool. The analysis of the technology comparison highlights potential bottlenecks for production, such as the printing phase and the heat treatment. It also gives a deeper understanding of the technology maturity level of conventional milling machines against laser powder bed fusion machines. The result is that the total costs for an insert made by AM and CM are indeed rather similar (the cost difference between the two tooling process chains is lower than 5%). The cost analysis reveals major costs drivers in the production of high-performance molding tools, such as the cutting tools employed for the milling steps and their changeover frequency. The industrial case of a 32-cavity mold insert for plastic injection molding is used to perform the study, develop the analysis, and validate the results. [ABSTRACT FROM AUTHOR]

The sustainability index, waste energy ratio and improvement potential of a staggered air jet impingement on the staggered spherical protrusions of a roughened absorber plate were derived for the present study to evaluate exergy losses and irreversibility in the system. The experimental analysis was carried out for selected parameters: relative streamwise pitch, relative spanwise pitch and relative jet diameter to hydraulic diameter ratio. The flow Reynolds number ranged from 4000–18,000. The augmentation in Nusselt number and friction factor compared to a smooth surface was 4.9 and 12.4 times, respectively. The statistical correlation developed determined the maximum thermohydraulic performance parameter and exergetic efficiency be 3.02 and 3.87%, respectively. The magnitude of the sustainability index, waste energy ratio and improvement potential was found to be 1.0347, 0.962 and 10.84, respectively, for the entire range of tested parameters. A cost analysis was also performed to evaluate the cost-effectiveness of the solar thermal system with and without turbulent promoters. [ABSTRACT FROM AUTHOR]

Recycling crushed waste oyster shells (WOS) as a fine aggregate is an attractive method of disposal. However, its use in geopolymer mortar has not been reported. The influence of PVA fibres on the engineering properties of the new geopolymer mortar is still unclear. To bridge the gap, this study investigated the influence of various PVA fibre contents (0–1.05 vol%) on the flowability, compressive, flexural strengths, drying shrinkage, sorptivity, chloride resistance, porosity, fibre dispersion, embodied CO2 emissions (ECO2e), and embodied energy (EE) of the geopolymer mortar. The results indicated that the inclusion of 0.15–1.05 vol% of PVA fibres improved the flexural strength by 10.10–42.31% and reduced the drying shrinkage by 13.37–65.79%. The flowability and compressive strength decreased by 10.78–34.28% and 7.50–27.65%, respectively, but they were sufficient for construction. The sorptivity increased by 1.45–15.16%, and the chloride resistance decreased by 15.09–56.35%, but the geopolymer mortar was still classified as low chloride penetrability. In summary, the optimal content of PVA fibres is 0.45 vol%, and the geopolymer mortar has good engineering properties and eco-efficiency. The cost analysis and high-temperature resistance of the geopolymer mortar are neglected in this study, which should be evaluated in future work. [ABSTRACT FROM AUTHOR]

Direct Digital Manufacturing (DDM) is considered by many as one of the most promising approaches towards cost- and time-efficient mass customization. Compared to conventional manufacturing systems, DDM systems are not as common and incorporate several distinctive features, such as higher flexibility in product form and structure, lower economies of scale and higher potential for decentralized production network. The initial design phase of a DDM production system, where very important in term of efficiency and quality, decisions are made, is a relatively unexplored topic in the relevant literature. In the present study, the corresponding issues are investigated through a case study involving the direct digital production of a customized reusable face mask (respirator) for medical use. Investigated system design aspects include product, process, and facility design. Based on data generated through manufacturing tests, a preliminary cost analysis is performed and several scenarios regarding production throughput and facility planning are examined. According to the results, DDM of custom-made face masks is, to a large extent, technically and economically feasible. Interestingly, considering the whole process, a large part of production cost is associated with labor and materials. Finally, evidence for a fundamental trade-off between manufacturing cost and speed/flexibility is identified, implying that different implementations of DDM systems can be realized depending on strategic operational objectives. [ABSTRACT FROM AUTHOR]

In 2021, the Occupational Safety and Health Administration (OSHA) issued two emergency temporary standard regulations related to COVID-19 hazards in US workplaces. One regulation covered healthcare sector workers, while the second regulation would have covered workers at firms with 100 or more employees. This paper conducts an original mortality risk analysis for these regulations. Mortality risk analysis evaluates the increase or decrease in expected mortality associated with a new policy, such as a rule or regulation, taking into account economic factors like lost income due to regulatory costs. If we accept OSHA's cost and health benefit estimates at face value, we find that the first regulation related to COVID-19 hazards in the healthcare sector reduces risk initially but increases risk over a longer time horizon. We find that the second regulation would reduce risk according to OSHA's main estimates but may not reduce risk after including some ancillary costs and adjusting the agency's prevented hospitalizations estimate based on more reasonable assumptions. Moreover, OSHA's economic analysis for the two regulations in question does not purport to comprehensively evaluate costs; ergo, our mortality risk estimates probably underestimate countervailing mortality risks stemming from these regulations. We review some of OSHA's underlying assumptions that could change the outcomes of our mortality analysis. These estimates demonstrate that OSHA would benefit from more comprehensive consideration of costs in its economic analysis. [ABSTRACT FROM AUTHOR]

A healthcare resource allocation generally plays a vital role in the number of patients treated (pnt) and the patient waiting time (wt) in healthcare institutions. This study aimed to estimate pnt and wt as output variables by considering the number of healthcare resources employed and analyze the cost of health resources to the hospital depending on the cost coefficient (δi) in an emergency department (ED). The integration of the discrete-event simulation (DES) model and machine learning (ML) algorithms, namely random forest (RF), gradient boosting (GB), and AdaBoost (AB), was used to calculate the estimation of the output variables depending on the δi of resources cost. The AB algorithm performed best in almost all scenarios based on the results of the analysis. According to the AB algorithm based on the δ0.0, δ0.1, δ0.2, and δ0.3, the accuracy data were calculated as 0.9838, 0.9843, 0.9838, and 0.9846 for pnt; 0.9514, 0.9517, 0.9514, and 0.9514 for wt, respectively in the training stage. The GB algorithm had the best performance value, except for the results of the δ0.2 (AB had a better accuracy at 0.8709 based on the value of δ0.2 for pnt) in the test stage. According to the AB algorithm based on the δ0.0, δ0.1, δ0.2, and δ0.3, the accuracy data were calculated as 0.7956, 0.9298, 0.8288, and 0.7394 for pnt; 0.8820, 0.8821, 0.8819, and 0.8818 for wt in the training phase, respectively. All scenarios created by the δi coefficient should be preferred for ED since the income provided by the pnt value to the hospital was more than the cost of healthcare resources. On the contrary, the wt estimation results of ML algorithms based on the δi coefficient differed. Although wt values in all ML algorithms with δ0.0 and δ0.1 coefficients reduced the cost of the hospital, wt values based on δ0.2 and δ0.3 increased the cost of the hospital. [ABSTRACT FROM AUTHOR]