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The impact of increased patient comorbidities on the cost-effectiveness of total hip arthroplasty (THAs) is lacking. This study aimed to compare revenue, costs, and short-term (90 days) surgical outcomes between patients who have and do not have a high comorbidity burden (HCB). We retrospectively reviewed 14,949 patients who underwent an elective, unilateral THA between 2012 and 2021. Patients were stratified into HCB (Charlson Comorbidity Index ≥ 5 and American Society of Anesthesiology scores of 3 or 4) and non-HCB groups, and were further 1:1 propensity matched based on baseline characteristics. Perioperative data, revenue, costs, and contribution margins (CMs) of the inpatient episode were compared between groups. Also, 90-day readmissions and revisions were compared between groups. Of the 11,717 patients who had available financial data (n = 1,017 HCB, n = 10,700 non-HCB), 1,914 patients were included in the final matched analyses (957 per group). Total (P <.001) and direct (P <.001) costs were significantly higher for HCB patients. Comparable revenue between cohorts (P =.083) resulted in a significantly decreased CM in the HCB patient group (P <.001). The HCB patients were less likely to be discharged home (P <.001) and had significantly higher 90-day readmission rates (P =.049). Increased THA costs for HCB patients were not matched by increased revenue, resulting in decreased CM. Higher rates of nonhome discharge and readmissions in the HCB population add to the additional financial burden. Adjustments to the current reimbursement models should better account for the increased financial burden of HCB patients undergoing THA and ensure access to care for all patient populations. III. [ABSTRACT FROM AUTHOR]

In recent years, the use of Building Information Modeling (BIM) with Building Energy Modeling (BEM) has become the primary research focus for reducing the energy consumption of buildings in the planning and operational phases. The combination of BIM and BEM offers advantages for the various phases of a construction project. However, there are currently very few studies that can integrate multi-objective optimization algorithms into the BIM-BEM process to achieve automatic optimization and effectively manage many aspects of building development. In this study, an EnergyPlus integrated multi-objective jellyfish search (EP-MOJSO) system was developed, utilizing an optimization algorithm to find the best thermal insulation layers for an Aluminum composite material (ACM) wall. The goal is to reduce the energy consumption and total cost in a BIM-BEM environment. In the case study, the authors successfully applied the system to a real building, resulting in a 10.7% reduction in total cost and a 65 kWh/m2/year reduction in EUI. It is expected that the results of the study will open up new ways of using algorithms for multi-criteria optimization in BIM models to optimize various project factors such as energy and total cost and thus make an important contribution to sustainable building design. [ABSTRACT FROM AUTHOR]

Financial analyses of simultaneous bilateral total knee arthroplasty versus staged bilateral total knee arthroplasty (simBTKA and staBTKA, respectively) have shown improved cost-effectiveness of simBTKA, though revenue and contribution margin (CM) for these procedures have not been investigated. Our analyses compared surgical outcomes, revenues, and CMs between simBTKA and staBTKA. We retrospectively reviewed all patients who underwent simBTKA (both procedures done on the same day) and staBTKA (procedures done on a different day within one year) between 2012 and 2021. Patients were 1:1 propensity matched based on baseline characteristics. Surgical outcomes, as well as revenue, cost, and CM of the inpatient episode were compared between groups. Of the 2,357 patients evaluated (n = 595 simBTKA, n = 1,762 staBTKA), 410 were included in final matched analyses (205 per group). Total (P <.001) and direct (P <.001) costs were significantly lower for simBTKA procedures compared to overall costs of both staBTKA procedures. Significantly lower revenue for simBTKA procedures (P <.001), resulted in comparable CM between groups (P =.477). Postoperative complications including 90-day readmission (P = 1.000), 90-day revision (P = 1.000) and all-cause revision at latest follow-up (P =.083) were similar between groups. In our propensity-matched cohort, lower costs for simBTKA compared to staBTKA were matched by lower revenues, with a resulting similar CM between procedures. Given that postoperative complication rates were similar, both procedures had comparable cost-effectiveness. Future research is needed to identify patients for whom simBTKA may represent a better surgical intervention compared to staBTKA with respect to clinical and patient reported outcomes. [ABSTRACT FROM AUTHOR]

Online quality control methods emphasize manufacturing processes to attain maximum conformance with respect to the specifications of the concerned quality characteristics of a product. One key factor that affects the effectiveness of these methods is the diagnosis interval. In this paper, the existing cost model along with its cost components for online quality control methods has been revisited and modified by incorporating new variables like the rate of production, the loss due to false alarm, the loss due to non-detection of process abnormalities, and considering a workable break-up of diagnosis cost for finding the optimal diagnosis interval from the perspective of present-day manufacturing engineering. As already mentioned, the proposed cost model has not ignored the loss due to the generation of defective items as well as the adjustment cost available in the pertinent literature. The modified cost function thus proposed has been appropriately minimized to obtain the corresponding optimal diagnosis interval. The proposed methodology has been compared numerically with other methodologies to establish its effectiveness. The cornerstone of the proposed methodology lies in reinforcing its effectiveness through a real-life case example in manufacturing. Sensitivity analysis has also been carried out for the real-life case example to fortify the proposed methodology. [ABSTRACT FROM AUTHOR]

Abstract In recent years, the use of Building Information Modeling (BIM) with Building Energy Modeling (BEM) has become the primary research focus for reducing the energy consumption of buildings in the planning and operational phases. The combination of BIM and BEM offers advantages for the various phases of a construction project. However, there are currently very few studies that can integrate multi-objective optimization algorithms into the BIM-BEM process to achieve automatic optimization and effectively manage many aspects of building development. In this study, an EnergyPlus integrated multi-objective jellyfish search (EP-MOJSO) system was developed, utilizing an optimization algorithm to find the best thermal insulation layers for an Aluminum composite material (ACM) wall. The goal is to reduce the energy consumption and total cost in a BIM-BEM environment. In the case study, the authors successfully applied the system to a real building, resulting in a 10.7% reduction in total cost and a 65 kWh/m2/year reduction in EUI. It is expected that the results of the study will open up new ways of using algorithms for multi-criteria optimization in BIM models to optimize various project factors such as energy and total cost and thus make an important contribution to sustainable building design.

Abstract The paper focuses on the economic design of group chain sampling plans (GChSP) for the Weibull distribution using Bayesian methodology. The GChSP is a technique to accept or reject a product based on a sample from a lot. The study addresses situations where destructive testing is costly and utilizes the Bayesian approach to make informed decisions. The research outlines the methodology of developing GChSP including the stages of construction, performance evaluation, and cost estimation. The study compares the proposed plans with an existing one and demonstrates that the Bayesian approach generally yields lower costs. We will provide tables, figures, and calculations related to various aspects of the proposed plans and their comparison with existing methods.

Natural disasters, which are the major causes of large-scale power outages, have become far more common in recent decades. Therefore, this study evaluates the importance and relevance of optimal Tie-line construction in improving the service restoration performance of power distribution systems following high-impact, low-probability occurrences. In doing so, an improved genetic algorithm (GA) is developed to find the optimal locations for the construction of new Tie-lines in distribution systems. In particular, the restoration process of distribution systems, including fault isolation and system reconfiguration, is planned to deploy Tie-lines in the most appropriate locations to improve distribution system resilience and reliability according to considerations related to the costs of constructing new Tie-lines. To validate the effectiveness of the proposed model, it is tested and verified on the RBTS standard network and the results of the proposed approach have been compared with other optimization algorithms such as particle swarm optimization, gravitational search (GS) and shuffled frog leaping. Examining the simulation results shows the efficiency of the proposed performance compared to other evolutionary methods. For instance, the value of the total cost function resulting from the proposed GA in the first and third scenarios has decreased by about $1589 and $946, compared to the GS method, respectively. [ABSTRACT FROM AUTHOR]

The paper focuses on the economic design of group chain sampling plans (GChSP) for the Weibull distribution using Bayesian methodology. The GChSP is a technique to accept or reject a product based on a sample from a lot. The study addresses situations where destructive testing is costly and utilizes the Bayesian approach to make informed decisions. The research outlines the methodology of developing GChSP including the stages of construction, performance evaluation, and cost estimation. The study compares the proposed plans with an existing one and demonstrates that the Bayesian approach generally yields lower costs. We will provide tables, figures, and calculations related to various aspects of the proposed plans and their comparison with existing methods. [ABSTRACT FROM AUTHOR]

The aims of this study untuk mengetahui Can Demand Forecasting Help Supply Chain? Evidence from Beer Distribution Game. One of complex process known nowadays which involves production, delivery and services to consumers is supply chain. Supply chain often can be simplified and analyzed with simulations like Beer Distribution Game. This research uses simulation experiment method by designing electronic version of BDG. The objective of this simulation is similar to the original version, which is minimizing the total cost spent on a distribution process. In this research, we use an extended version of Beer Distribution Game, built by AnyLogic, and equipped with additional feature such as information sharing. This research uses a simulation experiment method, and from the experiment's result we draw a conclusion based on the effect of SMA forecasting. It is shown that by adding SMA forecasting only at the Retailer unit, does not conclusively reduce the BDG's Total Cost. [ABSTRACT FROM AUTHOR]

As global concerns about climate change and environmental sustainability escalate, the construction industry is shifting significantly towards eco-resilient and sustainable building practices. This paper comprehensively explores integrating Building Information Modelling (BIM) with eco-resilient principles to create a framework for designing and constructing sustainable buildings. This research introduced a practical approach for evaluating the embodied carbon from building construction, drawing insights from a residential building in Yangon City, Myanmar. The method developed in this study aims to assess the carbon footprints associated with distinct stages of the construction process, including raw material production and material transportation. Additionally, the proposed method compares the material embodied carbon, transportation embodied carbon, and total cost in the residential building, considering two cases of traditional and low-carbon materials. The results indicate that material embodied carbon contributes merely 84% to the overall, while material transportation makes up the remaining 16% for both cases. Utilising low-carbon materials yields remarkable reductions, with a 40% decrease in material embodied carbon and a 39% decrease in transportation carbon footprint compared to conventional materials. However, adopting low-carbon materials incurs a modest increase of approximately 6.7% in total cost. This study underscores the imperative of integrating low-carbon materials into the design of future passive buildings, advancing the pursuit of a net-zero strategy. This research underlines the potential for BIM-driven eco-resilient practices in mitigating carbon emissions and the need for continued innovation and collaboration in sustainable building design and construction.

In this paper, we consider a Markov decision process (MDP) with a Borel state space X⊔ {Δ}, where Δ is an absorbing state (cemetery), and a Borel action space A. We consider the space of finite occupation measures restricted on X\times A and the extreme points in it. It is possible that some strategies have infinite occupation measures. Nevertheless, we prove that every finite extreme occupation measure is generated by a deterministic stationary strategy. Then, for this MDP, we consider a constrained problem with total undiscounted criteria and J constraints, where the cost functions are nonnegative. By assumption, the strategies inducing infinite occupation measures are not optimal. Then our second main result is that, under mild conditions, the solution to this constrained MDP is given by a mixture of no more than J +1 occupation measures generated by deterministic stationary strategies. [ABSTRACT FROM AUTHOR]

This study mainly focuses on tractor maintenance and replacement strategies to assess the impact of various parameters on the economic life of tractors in order to improve the value of a profitable management choice on selected tractor samples. Considering the preventive replacement policy, the total annual costs were estimated taking into account the repair and depreciation costs. At a 95% level of confidence for each approach, the statistical analysis program "IBM SPSS Statistics 26" was used. An empirical relation based on multiple regression analysis has been generated to predict the economic operational life of a tractor using per-unit repair cost and annual usage (hours). From the analysis, John Dear 333, SAME 130, New Holland 80, and Massy Ferguson 150 are not supposed to be used economically in the field after the fifth, seventh, sixth, and eighth years respectively at Wonji Shoa Sugar Factory due to increasing maintenance cost in present condition. [ABSTRACT FROM AUTHOR]

In order to study the economy of carbon dioxide catalytic hydrogenation large-scale methanol production plants, three representative processes (one methanol tower with circulation process, two methanol towers with circulation process and two methanol towers with circulation and small synthesis process) were taken as the research object, and 10 x 104 t/a methanol production capacity was taken as an example from three aspects: fixed asset investment, public engineering consumption and total cost. The economic efficiency of the three processes was analyzed and compared. The results show that the total cost of two methanol towers with circulation process is reduced by 5.3% compared to one methanol tower with circulation process and the total cost of two methanol towers with circulation and small synthesis process is reduced by 9.0% compared to one methanol tower with circulation process. In the total cost, hydrogen accounts from 46% to 52%, so hydrogen is the decisive factor affecting the total cost. When the price of methanol is 2696.9 CNY/t, the price of carbon dioxide is less than or equal to 0.4 CNY/m³ and the price of hydrogen is less than or equal to 0.7 CNY/m³, two methanol towers with circulation and small synthesis process is economically feasible. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to evaluate the effect of geriatric surgical pathway (GSP) implementation on inpatient cost of care. Background: Achieving high-value care for older patients is the goal of the American College of Surgeons Geriatric Verification Program (ACSGSV). We have previously shown that implementation of our geriatric surgery pathway, which aligns with the ACS-GSV standards, resulted in a reduction in loss of independence and complications. Methods: Patients ≥65 years who underwent an inpatient elective surgical procedure included in the American College of Surgeons National Quality Improvement Program (ACS NSQIP) registry from July 2016 through December 2017 were compared with those patients from February 2018 to December 2019 who were cared for on our GSP. An amalgamation of Clinformatics DataMart, the electronic health record, and the ACS NSQIP registry produced the analytical dataset. We compared mean total and direct costs of care for the entire cohort as well as through propensity matching of frail surgical patients to account for differences in clinical characteristics. Results: The total mean cost of health care services during hospitalization was significantly lower in the cohort on our GSP ($23,361±$1110) as compared with the precohort ($25,452±$1723), P<0.001. On propensity- matched analysis, cost savings was more evident in our frail geriatric surgery patients. Conclusions: This study shows that high-value care can be achieved with the implementation of a GSP that aligns with the ACS-GSV program. [ABSTRACT FROM AUTHOR]

Objectives: Non-traumatic lower extremity amputation (LEA) is associated with significant morbidity and mortality. Diabetes mellitus (DM) and peripheral vascular disease (PVD) are associated with increased risk for LEA. As such, DM and PVD account for 54% of all LEA's, performed in the United States annually. As obesity is highly associated with both DM and PVD, our study sought to explore the relationship between LEA and obesity defined by BMI. Methods: Using the National Inpatient Sample (NIS) database, a retrospective review of patients who underwent non-traumatic LEA (LEA) between 2008 and 2014 was performed. The International Classification of Diseases 9th edition (ICD-9) codes were utilized to determine the diagnoses, comorbidities, and procedures. Patient BMIs were classified as follows: Non-obese [BMI <30], Obesity class I [BMI 30–34.9], Obesity class II [BMI 35–39.9], and Obesity class III [BMI ≥40]. Predictors for LEA were compared between groups using chi-square test and binary logistic regression to identify possible underlying factors associated with LEA. We also conducted a multivariate analysis to measure the effect of multiple variables on LEA. Results: We identified 16,259 patients with non-traumatic LEA and a mean age of 59.9 years. Rate of amputation in females was lower than males at 0.35% vs 0.87% respectively (p < 0.001). Of patients that underwent amputation there was a V-shape trend based on BMI, with 30.4% in non-obese patients, 18.2% in obesity class I, 17.3% in obesity class II, and 34.1% in obesity class III. The incidence of diabetes increased with obesity class, while the incidence of PVD decreased. Interestingly, of those with DM there was an inverse relationship between amputation rate and BMI class, with LEA rates in non-obese versus obesity class III patients were 1.63% vs 0.98% respectively (p < 0.001). Similarly, patients who had both diabetes and PVD showed a downward trend in LEA rate as obesity class increased; non-obese patients had a LEA rate of 8.01%, while obesity class III had 4.65% (p < 0.001). Patients in higher income bracket have lower odds of LEA (OR 0.77, p < 0.001) compared to the lowest income patients. Also, patients with comorbidities such as PVD (OR 10.78), diabetes (OR 5.02), renal failure (OR 1.41), and hypertension (OR 1.36) had higher odds to get an LEA (p < 0.001). Individuals with obesity class III are almost at half the odds (OR 0.52) to get an LEA compared to non-obese (p < 0.001). Conclusions: Higher BMI and female gender are protective factors against lower extremity amputation. Factors that predisposing to LEA include lower household income and certain comorbidities such as PVD, diabetes, renal failure, and hypertension. These findings warrant further research to identify patients at high risk for LEA and help develop management guidelines for targeted populations. [ABSTRACT FROM AUTHOR]

This study mainly focuses on tractor maintenance and replacement strategies to assess the impact of various parameters on the economic life of tractors in order to improve the value of a profitable management choice on selected tractor samples. Considering the preventive replacement policy, the total annual costs were estimated taking account into the repair cost and depreciation costs. At a 95 % level of confidence for each approach, the statistical analysis program "IBM SPSS Statistics 26" was used. An empirical relation based on multiple regression analysis has been generated to predict the economic operational life of a tractor using per-unit repair cost and annual usage (hours). From the analysis, John Deere (9330R), SAME (SAME130), New Holland (NH 80), and Massey Ferguson (MF150) are not supposed to be economical to use in the field after the fifth, seventh, sixth, and eighth years respectively at Wonji Shoa sugar factory due to increasing maintenance cost in present condition.

Background: Tobacco is a major cause of preventable morbidity and mortality, with a considerable economic burden. The purpose of this systematic review was to summarize the evidence on the economic burden of tobacco use by searching national and international databases so as to generate useful information about the costs of tobacco use globally. Methods: A systematic search was conducted in Scopus, PubMed, EMBASE, ProQuest, and Web of Science (ISI) databases to identify relevant studies from 1990 to June 2021 using keywords like burden, productivity, indirect cost, direct cost, economic, monetary, expenditure, tobacco, smoking, and cigarettes. Cost estimates were converted into 2020 international dollars per adult. Findings: A total of 1,781 articles were identified, of which 361 were deemed to be eligible for inclusion. Eventually, 23 articles were found eligible. In most studies, cost estimates were provided using a prevalence-based approach. The highest total cost, as a percentage of gross domestic product (GDP), was reported for South Korea (1.19%). Noteworthy, in all studies, indirect costs accounted for the highest proportion of all costs. The mean total cost amounted to 5,866 million dollars. The direct costs ranged from 179 million dollars in South Korea to 8,156 million dollars in Israel. Meanwhile, the indirect costs ranged from 289 million dollars in Hong Kong to 9,808 million dollars in India. Conclusion: The evidence demonstrated the considerable economic burden of tobacco use in various countries, ranging from 0.33 to 1.19% of the GDP of the investigated countries, indicating the necessity of taking immediate measures. Hence, policies are needed to address the economic burden of smoking.

Industrial ecology is the identification and application of solutions aimed at reducing the environmental effects of products and processes of industrial systems. Industrial symbiosis is a practical application of industrial ecology where manufacturing companies cooperate by creating a network in the field of local exchange of water, energy, or industrial waste recycling. Industrial symbiosis plays an important role in reducing total costs in green supply chain management and its sustainability. Previous researches in the field of green supply chain management have somehow improved its performance by using different tools, but less on the impact of the new and effective industrial symbiosis concept has been discussed. In the current research, for the first time, a mathematical model is presented to apply the concept of industrial symbiosis in green supply chain management to minimize total costs with minimal carbon emissions. The proposed model is a multi-period single product and the lack of demand is allowed. To validate, the proposed model was used in the steel industry with 30 factories during 22 planning periods and with 15 types of raw materials. GAMS software is used to solve the model. The results of the numerical solution of the model have the greatest reduction of carbon emissions and adverse environmental effects with minimum total costs in factories. The sensitivity analysis showed that the value of the objective function of the model is high in relation to the changes in the parameters of the amount of the reproduced product, the rate of the collected return product, the amount of the returned product, the rate of the final disposed product, and the penalty for exceeding the permitted carbon emission limit. The results showed the alignment of green supply chain management policies and industrial coexistence. [ABSTRACT FROM AUTHOR]

In order to promote low-carbon fuels such as hydrogen to decarbonize the maritime sector, it is crucial to promote clean fuels and zero-emission propulsion systems in demonstrative projects and to showcase innovative technologies such as fuel cells in vessels operating in local public transport that could increase general audience acceptability thanks to their showcase potential. In this study, a short sea journey ferry used in the port of Genova as a public transport vehicle is analyzed to evaluate a "zero emission propulsion" retrofitting process. In the paper, different types of solutions (batteries, proton exchange membrane fuel cell (PEMFC), solid oxide fuel cell (SOFC)) and fuels (hydrogen, ammonia, natural gas, and methanol) are investigated to identify the most feasible technology to be implemented onboard according to different aspects: ferry daily journey and scheduling, available volumes and spaces, propulsion power needs, energy storage/fuel tank capacity needed, economics, etc. The paper presents a multi-aspect analysis that resulted in the identification of the hydrogen-powered PEMFC as the best clean power system to guarantee, for this specific case study, a suitable retrofitting of the vessel that could guarantee a zero-emission journey. [ABSTRACT FROM AUTHOR]

Renewable energies are clean alternatives to the highly polluting fossil fuels that are still used in the power generation sector. The goal of this research was to look into replacing a Heavy Fuel Oil (HFO) thermal power plant in Limbe, southwest Cameroon, with a hybrid photovoltaic (PV) and wind power plant combined with a storage system. Lithium batteries and hydrogen associated with fuel cells make up this storage system. The total cost (TC) of the project over its lifetime was minimized in order to achieve the optimal sizing of the hybrid power plant components. To ensure the reliability of the new hybrid power plant, a criterion measuring the loss of power supply probability (LPSP) was implemented as a constraint. Moth Flame Optimization (MFO), Improved Grey Wolf Optimizer (I-GWO), Multi-Verse Optimizer (MVO), and African Vulture Optimization Algorithm (AVOA) were used to solve this single-objective optimization problem. The optimization techniques entailed the development of mathematical models of the components, with hourly weather data for the selected site and the output of the replaced thermal power plant serving as input data. All four algorithms produced acceptable and reasonably comparable results. However, in terms of proportion, the total cost obtained with the MFO algorithm was 0.32%, 0.40%, and 0.63% lower than the total costs obtained with the I-GWO, MVO, and AVOA algorithms, respectively. Finally, the effect of the type of storage coupled to the PV and wind systems on the overall project cost was assessed. The MFO meta-heuristic was used to compare the results for the PV–Wind–Hydrogen–Lithium Battery, PV–Wind–Hydrogen, and PV–Wind–Lithium Battery scenarios. The scenario of the PV–Wind–Hydrogen–Lithium Battery had the lowest total cost. This scenario's total cost was 2.40% and 18% lower than the PV–Wind–Hydrogen and PV–Wind–Lithium Battery scenarios. [ABSTRACT FROM AUTHOR]

The usage of CFC and HCFC gases, which are extensively used in ship refrigeration and air conditioning systems, has been restricted due to harmful effects on the ozone layer and global warming. Thus, the use of alternative refrigerants becomes a possible solution. In this study, the performance parameters, environmental and economic effects of the system for various refrigerants were analyzed comparatively for marine refrigeration systems. For this purpose, the refrigerants R407C, R1234yf, R245fa, R152a, R513a, R450a, R161, R453a, and R717 are investigated as alternatives to the most commonly used R22 and R134a refrigerants on board ships. The results show that the best alternatives -in terms of performance, environment and economy-for R22 are R717 (new) and R453A (drop-in) and for R134a are R717 (new) and R152a (drop-in). In addition, drop-in, retrofit or new system suitability of the analyzed refrigerants for replacement of R22 and R134a are presented. [ABSTRACT FROM AUTHOR]

Revision total hip arthroplasty (rTHA) is a costly procedure, and its prevalence has been steadily increasing over time. This study aimed to examine trends in hospital cost, revenue, and contribution margin (CM) in patients undergoing rTHA. We retrospectively reviewed all patients who underwent rTHA from June 2011 to May 2021 at our institution. Patients were stratified into groups based on insurance coverage: Medicare, government-managed Medicaid, or commercial insurance. Patient demographics, revenue (any payment the hospital received), direct cost (any cost associated with the surgery and hospitalization), total cost (the sum of direct and indirect costs), and CM (the difference between revenue and direct cost) were collected. Changes over time as a percentage of 2011 numbers were analyzed. Linear regression analyses were used to determine the overall trend's significance. Of the 1,613 patients identified, 661 were covered by Medicare, 449 by government-managed Medicaid, and 503 by commercial insurance plans. Medicare patients exhibited a significant upward trend in revenue (P <.001), total cost (P =.004), direct cost (P <.001), and an overall downward trend in CM (P =.037), with CM for these patients falling to 72.1% of 2011 values by 2021. In the Medicare population, reimbursement for rTHA has not matched increases in cost, leading to considerable reductions in CM. These trends affect the ability of hospitals to cover indirect costs, threatening access to care for patients who require this necessary procedure. Reimbursement models for rTHA should be reconsidered to ensure the financial feasibility of these procedures for all patient populations. [ABSTRACT FROM AUTHOR]

Copyright of Modern Economic Science is the property of Modern Economic Science Editorial Office and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Due to introduction of the 5G NR standard, an estimation of the total cost of ownership for 5G networks is required, as well as expenses optimization. This paper provides a comparative analysis of the total cost of ownership for 5G networks of various architectures. Various deployment scenarios for D-RAN (Distributed RAN), C-RAN (Centralized RAN) and Open RAN of the radio access network provided by this standard are considered. The results of the work were obtained using mathematical modeling in the Matlab environment.

Simple Summary: In order to capture the complexity and dynamics of bovine mastitis, which has multiple effects, such as milk losses, increased risk of culling, or a higher likelihood of reproductive failure, a simulation model was developed. The economic evaluation of the mastitis control was performed considering different interventions combining a basic control plan with either segregation or culling of chronically infected cows. Changes in transmission probability, milk price, and strategies efficacy were evaluated. Several economic parameters in the model could be adjusted to represent farm-specific situations. This is a flexible tool that may support the decision-making of producers and veterinarians. The economic evaluation of mastitis control is challenging. The objective of this study was to perform the economic evaluation of mastitis control, under different intervention scenarios, quantifying the total cost of mastitis caused by S. aureus in Holstein cows in Argentina. A model was set for a dairy herd of Holstein cows endemically infected with S. aureus. A basic mastitis control plan including proper milking procedures, milking machine test, dry cow therapy, and treatment for clinical mastitis, was compared against other more complex and costly interventions, such as segregation and culling of chronically infected cows. Sensitivity analysis was performed by modifying the intramammary infection transition probabilities, economic parameters, and efficacy of treatment strategies. The basic mastitis control plan showed a median total cost of USD88.6/cow per year, which was close to the infected cows culling scenarios outputs. However, the segregation scenario was the most efficient, in which the total cost was reduced by about 50%. Such cost was more sensitive to probabilities and efficacy than the economic parameters. The model is flexible and can be customized by producers and veterinarians according to different control and herd settings. [ABSTRACT FROM AUTHOR]

Copyright of Journal of the Cukurova University Institute of Social Sciences is the property of Cukurova University Institute of Social Sciences and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Forest industries manage their wood supply chains for sustainability, efficiency, and value creation. Roundwood measuring is a crucial part of wood procurement to achieve the best total value and sharing of benefits between business partners in the supply chain. Industrial measurement is the dominant measuring technique used in Sweden, but the use of harvester measurement has gained increasing interest over the last decade. In this study, we analyzed how harvester measurement affects the wood procurement process regarding operations, supplier relationships, and total costs. The data was gathered through interviews with the analysis being supported by theoretical frameworks of lean thinking, supplier relationship management, and total cost of ownership. Harvester measurement has the potential to increase incentives for the purchaser to preserve the value created and improve control of the supply chain, thus leading to more efficient resource use. It also improves supplier relationships due to a simpler price list, which ultimately increases transparency. Lastly, forest industries may increase their profitability levels and competitiveness due to increased supply chain surplus and reduced total costs. Further research on quantitative measures is required to assess the significance of these effects, as well as the entire sustainability impact on the wood supply chain. [ABSTRACT FROM AUTHOR]

Background: Tobacco is a major cause of preventable morbidity and mortality, with a considerable economic burden. The purpose of this systematic review was to summarize the evidence on the economic burden of tobacco use by searching national and international databases so as to generate useful information about the costs of tobacco use globally. Methods: A systematic search was conducted in Scopus, PubMed, EMBASE, ProQuest, and Web of Science (ISI) databases to identify relevant studies from 1990 to June 2021 using keywords like burden, productivity, indirect cost, direct cost, economic, monetary, expenditure, tobacco, smoking, and cigarettes. Cost estimates were converted into 2020 international dollars per adult. Findings: A total of 1,781 articles were identified, of which 361 were deemed to be eligible for inclusion. Eventually, 23 articles were found eligible. In most studies, cost estimates were provided using a prevalence-based approach. The highest total cost, as a percentage of gross domestic product (GDP), was reported for South Korea (1.19%). Noteworthy, in all studies, indirect costs accounted for the highest proportion of all costs. The mean total cost amounted to 5,866 million dollars. The direct costs ranged from 179 million dollars in South Korea to 8,156 million dollars in Israel. Meanwhile, the indirect costs ranged from 289 million dollars in Hong Kong to 9,808 million dollars in India. Conclusion: The evidence demonstrated the considerable economic burden of tobacco use in various countries, ranging from 0.33 to 1.19% of the GDP of the investigated countries, indicating the necessity of taking immediate measures. Hence, policies are needed to address the economic burden of smoking. [ABSTRACT FROM AUTHOR]

In this paper, we study a two- dimensional Maintenance Service Contract (MSC) characterized by two limits (dimensions) of age and usage. It is considered that an agent offers a two-dimensional MSC by guaranteeing a certain level of equipment available to consumers. The agent needs to reduce the total maintenance cost to offer competitive MSC prices. Preventive maintenance actions (PM) are periodically carried out, and each PM action is considered to improve reliability modeled by reducing the failure rate function. Two decision variables (the PM interval (T) and the reduction in the intensity function (δ)) are obtained by considering two performance measures that are relevant to agents and consumers (i.e., availability and total maintenance cost). A numerical example is presented by considering three types of equipment usage rates: low, medium, and high. The optimization of the two performance measures can ensure availability targets and, at the same time, minimize total maintenance costs. [ABSTRACT FROM AUTHOR]

Abstract Background Diabetes has emerged as one of the most serious health issues of the twenty-first century. Diabetes and its complications expose individuals and their families to catastrophic healthcare costs, which have a severe impact on the country's economy. Though the prevalence of diabetes is rising quicker in Ethiopia, little is known about its economic impact. Hence, this study aimed to determine the total cost of diabetic mellitus and associated factors among patients attending hospitals in Southwest Shewa zone, Central Ethiopia. Methods The study was conducted among diabetes patients who were on care and treatment from September to October 2020. Direct costs were calculated using the micro-costing technique, while indirect costs were calculated using the human capital approach. The statistical significance of cost difference between the groups of patient characteristics was determined using Wilcoxon and Kruskal-Wallis mean rank sum tests, and the factors associated with a total cost of illness were identified with Generalized Linear Model (GLM). Results Out of the planned patients, 398 have responded and were included in the analysis; making a response rate of 98.5%. The mean monthly total cost of diabetic mellitus was US$ 37.7(95% CI, 23.45–51.95). Direct and indirect costs constituted 76.2% and 23.8% of the total cost, respectively. The mean direct and indirect cost of diabetic mellitus per patient per month was US$ 28.73(95% CI, 17.17–40.29) and US$ 9.50 (95% CI, 1.99–16.99) respectively. Statistical mean cost differences were observed by gender, age groups, family size, and comorbidities. The total cost of illness was associated with residence (p=0.007), family size (p=0.001), presence of co-morbidities (p=0.04), and history of ever-stopping treatments (p

This study presents the results of economic and environmental analysis for two types of zero-emission ships (ZESs) that are receiving more attention to meet strengthened environmental regulations. One of the two types of ZES is the ZES using only the energy storage system (All-ESS), and the other is the ZES with fuel cell and ESS hybrid system (FC–ESS). The target ship is a tug operating in South Korea, and the main parameters are based on the specific circumstances of South Korea. The optimal capacity of the ESS for each proposed system is determined using an optimization tool. The total cost for a ship's lifetime is calculated using economic analysis. The greenhouse gas (GHG) emission for the fuel's lifecycle (well-to-wake) is calculated using environmental analysis. The results reveal that the proposed ZESs are 1.7–3.4 times more expensive than the conventional marine gas oil (MGO)-fueled ship; however, it could be reduced by 1.3–2.4 times if the carbon price is considered. The proposed ZESs have 58.7–74.3% lower lifecycle GHG emissions than the one from the conventional ship. The results also highlight that the electricity- or hydrogen-based ZESs should reduce GHG emissions from the upstream phase (well-to-tank) to realize genuine ZESs. [ABSTRACT FROM AUTHOR]

Study Design.: A retrospective cohort study. Objective.: To assess whether patient outcomes and cost-effectiveness of adult spinal deformity (ASD) surgery have improved over the past decade. Background.: Surgery for ASD is an effective intervention, but one that is also associated with large initial healthcare expenditures. Changes in the cost profile for ASD surgery over the last decade has not been evaluated previously. Materials and Methods.: ASD patients who received surgery between 2008 and 2019 were included. Analysis of covariance was used to establish estimated marginal means for outcome measures [complication rates, reoperations, health-related quality of life, total cost, utility gained, quality adjusted life years (QALYs), cost-efficiency (cost per QALY)] by year of initial surgery. Cost was calculated using the PearlDiver database and represented national averages of Medicare reimbursement for services within a 30-day window including length of stay and death differentiated by complication/comorbidity, revision, and surgical approach. Internal cost data was based on individual patient diagnosis-related group codes, limiting revisions to those within two years (2Y) of the initial surgery. Cost per QALY over the course of 2008–2019 were then calculated. Results.: There were 1236 patients included. There was an overall decrease in rates of any complication (0.78 vs. 0.61), any reoperation (0.25 vs. 0.10), and minor complication (0.54 vs. 0.37) between 2009 and 2018 (all P <0.05). National average 2Y cost decreased at an annual rate of $3194 (R 2=0.6602), 2Y utility gained increased at an annual rate of 0.0041 (R 2=0.57), 2Y QALYs gained increased annually by 0.008 (R 2=0.57), and 2Y cost per QALY decreased per year by $39,953 (R 2=0.6778). Conclusion.: Between 2008 and 2019, rates of complications have decreased concurrently with improvements in patient reported outcomes, resulting in improved cost effectiveness according to national Medicare average and individual patient cost data. The value of ASD surgery has improved substantially over the course of the last decade. [ABSTRACT FROM AUTHOR]

Removal of primary total knee arthroplasty (TKA) and primary total hip arthroplasty (THA) from the inpatient-only list has financial implications for both patients and institutions. The aim of this study was to evaluate and compare financial parameters between patients designated for inpatient versus outpatient total joint arthroplasty. We reviewed all patients who underwent TKA or THA after these procedures were removed from the inpatient-only list. Patients were statistical significance into cohorts based on inpatient or outpatient status, procedure type, and insurance type. This included 5,284 patients, of which 4,279 were designated inpatient while 1,005 were designated outpatient. Patient demographic, perioperative, and financial data including per patient revenues, total and direct costs, and contribution margins (CMs) were collected. Data were compared using t -tests and Chi-squared tests. Among Medicare patients receiving THA, CM was 89.1% lower for the inpatient cohort when compared to outpatient (P <.001), although there was no statistical significance difference between cohorts for TKA (P =.501). Among patients covered by Medicaid or Government-managed plans, CM was 120.8% higher for inpatients receiving THA (P <.001) when compared to outpatients and 136.3% higher for inpatients receiving TKA (P <.001). Our analyses showed that recent costs associated with inpatient stay inconsistently match or outpace additional revenue, causing CM to vary drastically depending on insurance and procedure type. For Medicare patients receiving THA, inpatient surgery is financially disincentivized leaving this vulnerable patient population at a risk of losing access to care. Retrospective Cohort Study. [ABSTRACT FROM AUTHOR]

Access to inexpensive, clean energy is a key factor in a country's ability to grow sustainably The production of electricity using fossil fuels contributes significantly to global warming and is becoming less and less profitable nowadays. This work therefore proposes to study the different possible scenarios for the replacement of light fuel oil (LFO) thermal power plants connected to the electrical network in northern Cameroon by renewable energy plants. Several scenarios such as the combination of solar photovoltaic (PV) with a pumped hydro storage system (PHSS), Wind and PHSS and PV-Wind-PHSS have been studied. The selected scenarios are evaluated based on two factors such as the system's total cost (TC) and the loss of load probability (LOLP). To achieve the results, metaheuristics such the non-dominated sorting whale optimization algorithm (NSWOA) and non-dominated sorting genetic algorithm-II (NSGA-II) have been applied under MATLAB software. The optimal sizing of the components was done using hourly meteorological data and the hourly power generated by the thermal power plants connected to the electrical grid. Both algorithms provided satisfactory results. However, the total cost in the PV-PHSS, Wind-PHSS, and PV-Wind-PHSS scenarios with NSWOA is, respectively, 1%, 6%, and 0.2% lower than with NSGA-II. According to NSWOA results, the total cost for the PV-Wind-PHSS scenario at LOLP 0% is 4.6% and 17% less than the Wind-PHS and PV-PHSS scenarios, respectively. The profitability study of all three scenarios showed that the project is profitable regardless of the scenario considered. [ABSTRACT FROM AUTHOR]

This article solves the scheduling problem in vegetable processing and packaging facility, where multiple types of vegetable consignments need to be packed using dissimilar parallel machines. The problem considers the real-life complexities, such as arrival and discharge time of consignments and setup time for the pre-processing requirement between consecutive consignments. The objective is to identify optimal schedules with minimum total cost and minimum makespan by satisfying the associated constraints. This study proposes an optimization framework incorporating metaheuristic techniques and heuristic mechanism to determine optimal solution for the scheduling problem. The heuristic mechanism assists metaheuristic techniques in reducing constraint violations by rescheduling vegetable consignments assigned to the machine. The efficacy of the proposed framework is analyzed by solving a case study using multiple single and multi-objective metaheuristic techniques. All metaheuristic techniques are able to determine a better schedule for optimizing total cost and makespan using the proposed framework than their naive metaheuristic technique on solving the single objective model. Differential Evolution with Multi-Population Based Ensemble of Mutation Strategies provided a better solution than other techniques for the single objective model of both objectives. Non-dominated Sorting Teaching Learning Based Optimization, with heuristic mechanism, provided strictly dominating solutions compared to the other techniques. [ABSTRACT FROM AUTHOR]

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Due to introduction of the 5G NR standard, an estimation of the total cost of ownership for 5G networks is required, as well as expenses optimization. This paper provides a comparative analysis of the total cost of ownership for 5G networks of various architectures. Various deployment scenarios for D-RAN (Distributed RAN), C-RAN (Centralized RAN) and Open RAN of the radio access network provided by this standard are considered. The results of the work were obtained using mathematical modeling in the Matlab environment. [ABSTRACT FROM AUTHOR]

Ensuring the safe production of food and oil crops in soils with elevated cadmium (Cd) content in karst regions is crucial. We tested a field experiment to examine the long-term remediation effects of compound microorganisms (CM), strong anion exchange adsorbent (SAX), processed oyster shell (POS), and composite humic acids (CHA) on Cd contamination in paddy fields under a rice-oilseed rape rotation system. In comparison to the control group (CK), the application of amendments significantly increased soil pH, cation exchange capacity (CEC), and soil organic matter (SOM) content while markedly decreasing the content of available Cd (ACd). During the rice cultivation season, Cd was predominantly concentrated in the roots. Relative to the control (CK), the Cd content in each organ was significantly reduced. The Cd content in brown rice decreased by 19.18–85.45%. The Cd content in brown rice following different treatments exhibited the order of CM > POS > CHA > SAX, which was lower than the Chinese Food Safety Standard (GB 2762–2017) (0.20 mg/kg). Intriguingly, during the oilseed rape cultivation season, we discovered that oilseed rape possesses potential phytoremediation capabilities, with Cd mainly accumulating in roots and stems. Notably, CHA treatment alone significantly decreased the Cd content in oilseed rape grains to 0.156 mg/kg. CHA treatment also maintained soil pH and SOM content, consistently reduced soil ACd content, and stabilized Cd content in RSF within the rice-oilseed rape rotation system. Importantly, CHA treatment not only enhances crop production but also has a low total cost (1255.230 US$/hm2). Our research demonstrated that CHA provides a consistent and stable remediation effect on Cd-contaminated rice fields within the crop rotation system, as evidenced by the analysis of Cd reduction efficiency, crop yield, soil environmental change, and total cost. These findings offer valuable guidance for sustainable soil utilization and safe production of grain and oil crops in the context of high Cd concentrations in karst mountainous regions.

Abstract Purpose Shipping is pivotal for global commerce, yet its externalities are not yet fully set into context, especially with reference to environmental impact. Shipping is a practise developed from the dawn of history. Its manifestation requires the introduction of relevant supporting industries as well, such as port, cargo, and logistics operations. The holistic shipping system has been growing with its main parameter pertaining to accounting cost minimisation. Yet, the shipping ecosystem has been able to exacerbate environmental, social, and health costs that in the end may prove that shipping, in the way that it is conducted, may not be as profitable as it may seem. Method This paper introduces a framework for the total cost of ownership in shipping, which includes a holistic approach as to the true costs associated with shipping practises. Through a structured literature review the relevant costs are identified and assessed, providing a complete framework as to the actual cost of shipping. Findings Shipping may appear to be profitable in some cases, but the bulk of its profit is based on practises that incur a plethora of costs that are externalised. This paper provides a clearer understanding of the total cost of shipping and the subsequent need of a paradigm shift, so that shipping may be able to portray its potential with reference to societal and environmental benefits. Conclusion Through frameworks such as the one presented in this work, activities and practises may be assessed as to their true impact and footprint and claim sustainability through a solid prism of holistic analysis and true profit for humanity, rather than focusing on accounting cost and turning a blind eye at other social, environmental, and health costs.

In this work, the refrigerant R1233zd(E) (A1 ASHRAE safety code) is investigated for the possible substitution of refrigerant R161 (A2 ASHRAE safety code) in a cascade refrigeration system. The high-temperature circuit refrigerant R1233zd(E) is evaluated with the low-temperature circuit refrigerants R41 and R170 for thermo-economic consideration. A comparative analysis of the refrigerant combination R41-R1233zd(E) and R170-R1233zd(E) presents exergy efficiency and total plant cost as evaluation criteria. Pareto solutions are obtained for the thermo-economic objectives for each pair of refrigerants. A decision-making method is adopted to identify the best result from the Pareto solutions obtained. The effects of operating variables such as evaporator temperature, condenser temperature, LTC condensing temperature, and temperature difference of cascade condenser are evaluated. The sensitivity of the operating variables on thermo-economic objectives is also evaluated. The comparative results reveal that for the same total cost rate of the system (68,615 $/year), the exergy efficiencies of the CRS are 63.08% (R170-R161), 64.04% (R41-R161), 64.93% (R170-R1233zd(E)), and 65.81% (R41-R1233zd(E)). Also, the R1233zd(E) based CRS operates with a lower total cost rate than the R161-based system.