Annual Utilization Research Articles

Utilization of marine taxa within an artisanal shellcraft sector of the Indo-Pacific region

Sustainable utilization of marine taxa is critical for maximizing social and economic goals of livelihood development within the Indo-Pacific. Yet, despite an increasing importance of shellcraft as a livelihood activity within the Indo-Pacific, information on the taxa utilized within shellcraft sectors remains scant. To address this knowledge gap, our study examined diversity, in terms of composition and quantities, of marine taxa utilized by artisan households and, collectively, within an artisanal shellcraft sector of Papua New Guinea. For each taxon, critical source habitats were identified, and the geographic scale of exploitation established. Critically, presented data revealed 73 taxa, representing at least 77 species, were utilized within the studied sector. Many of the taxa utilized had not previously been linked to shellcraft sectors, demonstrating that a broader composition of taxa is utilized than previously acknowledged. In terms of quantity, annual utilization within the sector was close to 500,000 individuals, the majority being mollusks of either class Gastropoda (83.6%), represented by 37 genera, or class Bivalvia (9.6%), represented by four genera. There was a strong bias towards a particular species, Chrysostoma paradoxum (78.5% of all individuals), as indicated by indices for the diversity utilized (H′ = 1.23; D = 0.38). However, substantial variation was evident in the diversity of taxa utilized among households (n = 36) engaged in shellcraft (H′ = 1.09 ± 0.71; D = 0.43 ± 0.27), with each household utilizing a unique composition of 19.1 ± 10.6 taxa. Source habitats for taxa ranged from pelagic to benthic intertidal and subtidal substrates, with the geographic scale of exploitation extending to 34 discrete locations up to 417 km away. The array of sector, household, and taxon-specific information presented provides a basis for supporting greater sustainability within shellcraft sectors across the Indo-Pacific, which is discussed within a context of informing community-based resource management, further developing marine aquaculture, and strengthening existing governance.

Red Blood Cell Utilization Among Patients with Sickle Cell Disease: A Single Center Experience

Introduction: Red blood cell (RBC) transfusion remains a mainstay of treatment for both acute and chronic complications of sickle cell disease (SCD). RBC transfusions improve oxygen-carrying capacity of blood, decrease hemoglobin S levels, and are indicated for the treatment of complications such as stroke, acute chest syndrome, sickle cell hepatopathy and multiorgan failure syndrome. RBC transfusions may also be considered to reduce the frequency of pain crises for those intolerant or non-responsive to hydroxyurea. Prior practice surveys havedemonstrated significant practice variation in the management of patients with SCD with respect to RBC transfusions. The utilization of both simple RBC transfusions and red cell exchange (RCE) is poorly described, and unknown in the Canadian context, including at our center. The objective of this study is to describe RBC utilization at our center in a cohort of patients with SCD. Methods: All adult patients with SCD who have received care [inpatient, outpatient, or emergency department (ED)] at the Ottawa Hospital, from January 2006 to May 2019 were identified for study inclusion. Transfusion and health care utilization data was obtained through to December 2021 from clinical, administrative and laboratory databases at the Ottawa Hospital. Results: A total of 273 patients with SCD were identified. The median age for the cohort was 25 years (IQR 19,33) at first visit, with females comprising 53.9% of the cohort. The median duration of follow-up was 8.1 years (IQR 5,12.4). O-positive was the most frequent blood type (41.8%), and 8 (2.9%) individuals were O-negative. The annual RBC and health care utilization for the study cohort is depicted in Figure 1. The total number of hospital visits during the study period was 23127, with a median of 45 visits (IQR 18,100) per patient. 165 patients (60.4%) received 22538 RBC units with a median of 2 units (IQR 1,19) per patient, per year. 86.5% of the RBC units were infused in the outpatient setting, 12.1% in the inpatient setting and 0.8% in the ED. 40.3% of inpatient hospital visits were associated with an RBC transfusion event, compared to 2.4% of ED encounters. The proportion of RBC units transfused that were O-negative was 29.1% (6557 units). 147 patients received 2205 (9.7%) as simple RBC transfusions. The median number of simple RBC units transfused per patient, per year was 1 unit (IQR 1,2). 88 patients received 20333 RBC units during 2702 RCE sessions (median of 14.5 RCE sessions per patient), with 91.5% occurring in the outpatient setting. Of the 88 patients who received RCE, 64 patients (72.7%) had more than one RCE session, 54 patients (61.4%) had more than 5 RCE sessions and 48 patients (54.5%) had more than 10 RCE sessions. The median number of RBC units transfused per RCE session was 7 (IQR 6,9), with a median duration of 30 days (IQR 28,40) between RCE sessions. Conclusions: RBC transfusion was common in our cohort, with the majority of patients having received at least one RBC transfusion. The largest proportion of transfused RBC units stem from RCE use, which represents a small proportion of on our SCD cohort. O-negative units represented a large proportion of units transfused, despite the predominance of non-group O patients, likely due to both differences in donor and patient blood group phenotypes, and recommendations for extended phenotype matching. With pressure on transfusion medicine to provide appropriately matched units and the scarcity of O-negative units, further data accrual on RBC utilization, particularly assessment of indications, requirements for matching, and review of RCE procedures will define further quality improvement interventions to ensure optimal utilization of RBCs. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Healthcare costs and utilization associated with pain among breast cancer survivors: a propensity score matched cohort study using SEER-Medicare data.

To assess healthcare costs and utilization of treatment-related pain among breast cancer survivors. A retrospective matched cohort study using Surveillance Epidemiology and End Results SEER-Medicare linked data was conducted. The study population included older breast cancer survivors continuously enrolled in Medicare parts A, B, and D in the baseline and 1-year follow-up periods. Survivors with pain were matched to survivors without pain using PSM. Incremental all-cause healthcare costs associated with pain were calculated using a two-part model. Incremental healthcare utilization of inpatient hospitalizations, ER, outpatient, and physician services were estimated using the negative binomial model. The study included 101,120 non-metastatic breast cancer patients between July 2007 and September 2013. The final analytical cohort after matching included 5891 survivors in both groups. The incremental annual all-cause total healthcare costs per patient were higher in survivors with pain as compared to survivors without pain (Δ = 4379.00 (95% CI: 4308.00-4448.80). The main cost drivers were hospitalizations at 71%, followed by ER at 16% and physician services at 9% for survivors diagnosed with pain. Annual all-cause healthcare resource utilization was also found to be higher in survivors with pain as compared to survivors without pain across all categories of use. Similar trends were observed when stratified by surgery type and subgrouped by pain type and pain-related costs. This study provided baseline data that can be used for future cost-effectiveness analysis studies and burden of illness studies. Treatment-related costs have a substantial burden on healthcare costs andthe utilization of Medicare.

Comparison of crop yield and solar thermal utilization among different rice–wheat cropping systems

AbstractPlanting patterns have significant effects on rice growth. Nonetheless, little is known about differences in annual crop yield and resource utilization among mechanized rice planting patterns in a rice–wheat cropping system. Field experiments were conducted from 2014 to 2017 using three treatments: pot seedling transplanting for rice and row sowing for wheat (PST-RS), carpet seedling transplanting for rice and row sowing for wheat (CST-RS) and row sowing for both crops (RS-RS). The results showed that, compared with RS-RS, PST-RS and CST-RS prolonged annual crop growth duration by 25–26 and 13–15 days, increased effective accumulated temperature by 399 and 212°C days and increased cumulative solar radiation by 454 and 228 MJ/m2 because of the earlier sowing of rice by 28 and 16 days in PST-RS and CST-RS, respectively. Compared with RS-RS, the annual crop yield of PST-RS and CST-RS increased by 3.1–3.8 and 2.0–2.6 t/ha, respectively, because of the increase in the number of spikelets/kernels per hectare, aboveground biomass, mean leaf area index and grain–leaf ratio. In addition, temperature production efficiency, solar radiation production efficiency and solar radiation use efficiency were higher in PST-RS, followed by CST-RS and RS-RS. These results suggest that mechanized rice planting patterns such as PST-RS increase annual crop production in rice–wheat cropping systems by increasing yield and solar energy utilization.

Primary Preventive Care of Hematopoietic Stem Cell Transplantation Survivors: Time to Educate and Empower Recipients and Providers

Increasing use of hematopoietic stem cell transplantation (HCT) and improvements in recipient outcomes have led to a steady increase in the number of allogeneic HCT survivors. In addition to complications specific to the transplantation process, HCT recipients are at increased risk of developing cardiovascular disease (CVD) and subsequent neoplasm (SN). Strict surveillance of risk factors for CVD and cancer in the general population is recommended as an essential component of long-term follow-up (LTFU) care of HCT survivors, but implementation of this has been suboptimal. Various models for improving the provision of survivorship care have been proposed, including a hybrid/combined care approach wherein the HCT provider manages transplantation-specific complications and the primary care physician (PCP) provides general medical care, including surveillance and aggressive management of CVD risk factors and screening for SN. This model also offers a practical approach to LTFU care for HCT survivors who live at a distance from the HCT center, which is a reality for many recipients of HCT at The Ottawa Hospital (TOH). As the success of such a hybrid approach to survivorship care depends on the engagement of HCT recipients with their PCP and compliance with recommended general population surveillance, the aim of the present study was to assess the rates of PCP attendance and adherence to recommended preventive medicine interventions in the years immediately before and after HCT. We hypothesized that rates would be suboptimal and planned to use these results as a baseline for an educational initiative aimed at increasing awareness of HCT recipients and their PCPs about embracing preventive survivorship care. This was a single-center cohort study of allogeneic HCT recipients who underwent transplantation at TOH with linkage to population-based health administrative data. Published clinical practice guidelines were used to define recommended screening for CVD risk factors and cancer. The rates of annual PCP visits and utilization of recommended preventive care interventions in the 5 years before and after HCT were calculated for all eligible patients. Between 2014 and 2020, 409 patients with provincial health care coverage underwent allogeneic HCT at TOH. The median patient age was 51 years (range, 15 to 73 years), with a male predominance (60.9%). Approximately one-quarter of recipients did not attend a PCP visit in the 5 years before and after transplantation, and this proportion increased to one- third in the fifth year post-HCT. Among those recipients who were eligible, only 20% to 25% underwent recommended screening for dyslipidemia and diabetes. Cancer screening rates were also low, at 16% to 18% for cervical cancer, 18% to 22% for colon cancer, and 30% to 31% for breast cancer. These results highlight the need to increase awareness of HCT recipients and their PCPs about the risk of developing CVD and SN post-transplantation and to emphasize the potential to mitigate this risk by adhering to recommendations for surveillance to enable prompt intervention. Patient education should incorporate this information and empower HCT survivors to actively engage in their follow-up care and optimize their long-term outcomes.

Debris Flow Susceptibility Assessment of Sichuan-Tibet Railway Based on GIS and CF-LR Coupling Model

Sichuan-Tibet Railway is an important transportation system in China, which is of great significance to promote the communication between Tibet and the mainland. This paper takes the lin-chang section of the Sichuan-Tibet railway with a width of 2km on both sides as the research area. The occurrence of debris flow must have appropriate solid source, water source and topographic conditions. In this paper, ten disaster-causing factors are selected, including relief degree of land surface, profile curvature, silty soil, distance to the rive, distance to the fault, elevation, slope aspect, NDVI, average annual rainfall and land utilization rate. The information of disaster-causing factors was extracted from Arcgis and evaluated by the certainty factor model. The probability of debris flow in the study area was calculated by the coupling model of binary Logistic regression model combined with certainty factor model. ROC curve analysis of the CF-LR model shows that AUC is 0.89, indicating that the model has a good effect. The distribution map of debris flow susceptibility in the study area was obtained by using grid calculator in GIS. The results show that under the CF-LR model, extremely low, low, medium and high prone areas cover 2547km₂, 235km₂, 246km₂ and 1099km₂ respectively, accounting for 61.72%, 5.69%, 5.96% and 26.63% of the total area of the study area, respectively. The high risk areas are mainly in Milin, Nyingchi and Bomi counties. This study provides an important reference for assessing the risk of debris flow geological disaster on Sichuan-Tibet Railway.

The Utilization, Expenditure, and Price of Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers in the US Medicaid Programs: Trends Over a 31 Year Period

BackgroundAngiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) are used for several indications including hypertension. Our aim is to evaluate the utilization, expenditure, and drug price of ACEIs and ARBs in the US Medicaid population. MethodsA retrospective descriptive trend analysis was conducted using Medicaid State Drug Utilization outpatient pharmacy summary files managed by the Centers for Medicare and Medicaid Services from 1991 to 2021. Study drugs included ACEIs (e.g., captopril) and ARBs (e.g., losartan). Annual reimbursement and utilization were calculated for both classes. The average reimbursement per prescription was calculated as a proxy for drug prices. Market share competition between ACEIs and ARBs was analyzed over time. ResultsACEI and ARB utilization rose by 25% from 1991 to 2021. Brand ACEIs utilization peaked in 2002 with 28 million prescriptions while brand ARBs utilization continued to increase until 2005 with over 23 million prescriptions. However, generic products took the lead and exceeded brand ACEI and ARB utilization in 2006 and 2012 respectively. Medicaid spent over $ 33.7 billion on ACEIs and ARBs over 31-year. Brand ACEIs and ARBs average prices increased sharply to $8,104 and $6,908 respectively in 2021. The total prescription market share for ACEIs was 68% compared to 32% of ARBs over the entire study. ConclusionACEIs and ARBs utilization increased over the last 31 years. Brand utilization switched over to generic resulting in less reimbursement. The average prices of brand ACEIs and ARBs continue to increase even after generics were introduced to the market.

Implementation of artificial neural network in a building benefits from radiant floor heating /cooling enhanced by phase change materials

In this study, the numerical analysis of the radiant floor system was investigated for a building in the presence of PCM inside the external walls as well as the roof at a thickness of 2 cm. By injecting cold/warm fluid into the radiant tubes inside the roof, the cooling/heating requirements were met. Several PCMs with identical thermal properties (except melting point) were selected and based on numerical analysis, the energy utilization in the heating/cooling sections was evaluated by comparison with the simple building (without PCM). Four main variables were defined for the neural network, and energy consumption was trended for two climate zones, Shenyang (41.7922°N, 123.4328°E), and Zhengzhou (34.7578°N, 113.6486° E). For each region, the PCM with the best phase transition was selected and it was realized that for the first region, energy consumption was diminished by 12.6% and for the second region by 15.9%. According to the temperature conditions and radiation intensity in the environment, the ANN could forecast annual energy utilization with an error of less than 6%.

Performance analysis and modelling of a 50 MW grid-connected photovoltaic plant in Spain after 12 years of operation

This study aims to estimate the performance and losses of a 50 MW photovoltaic (PV) utility-scale after 12 years of operation. The PV plant has monocrystalline and polycrystalline silicon modules and is located in the central region of Spain with an annual insolation of 1976 kWh/m2. Monitoring data over the entire year 2020 has been analyzed and filtered to assess the performance results following the IEC 61724 standard guidelines. The annual average reference yield, final yield, performance ratio and capacity utilization factor are of 5.44 h/d, 4.28 h/d, 79.24%, and 19.77%, respectively. Besides the experimental analysis, this work improves the estimation of the daily performance ratio, especially in days with low insolation. Two different modelling approaches have been assessed and compared. In first place, a physical model has been adopted, based on the most common losses, and including an exponential expression to account for low irradiance losses. In second place, statistical models have been used, with either multiple linear regressions or random forest algorithms. In contrast with other published models which require many inputs, the best accuracy has been reached with the random forest model using only the ambient temperature and solar irradiance as predictors, obtaining a RMSE of 1% for the PR and for the energy production.

The Economic Burden Associated with Depressive Symptoms among Middle-Aged and Elderly People with Chronic Diseases in China.

Coexisting physical diseases and depressive symptoms exacerbate morbidity and disability, but their incremental economic burden remains unclear. We used cross-sectional data from the China Health and Retirement Longitudinal Study (CHARLS) survey in 2018 to estimate the economic burden associated with depressive symptoms among middle-aged and elderly people with chronic diseases. A multivariable regression model was used to assess the annual health care utilization, expenditures, and productivity loss of depressive symptoms among people with 12 common chronic diseases. We found that depressive symptoms were associated with higher incremental economic burdens, as the total health care costs increased by 3.1% to 85.0% and annual productivity loss increased by 1.6% to 90.1%. Those with cancer or malignant tumors had the largest economic burden associated with depressive symptoms, with CNY 17,273.7 additional annual health care costs and a loss of CNY 2196.2 due to additional annual productivity loss. The effect of depressive symptoms on the economic burden of patients with chronic conditions did not increase by the number of chronic conditions. Considering the high economic burden associated with depressive symptoms among patients with chronic conditions, it is important to consider the mental health of patients in chronic disease treatment and management.

Primary and Revision Cervical Disc Arthroplasty from 2010–2020: Patient Demographics, Utilization Trends, and Health Care Reimbursements

Despite lack of nationwide Medicare Coverage by the Centers for Medicare and Medicaid Services, the utilization of cervical disc arthroplasty (CDA) has risen in popularity. The purpose was to compare primary and revision cervical disc arthroplasty (CDA) from 2010 to 2020 with respect to: 1) utilization trends, 2) patient demographics; and 3) healthcare reimbursements. Using the PearlDiver database, we studied patients undergoing primary and revision CDA for degenerative cervical disc pathology from 2010 to 2020. Endpoints of the study were to compare patient demographics (including Elixhauser Comorbidity Index (ECI)), annual utilization trends, lengths of stay (LOS), and reimbursements. Chi-square analyses compared patient demographics. T-tests compared LOS and reimbursements. A linear regression was used to evaluate for trends in procedural volume over time. P values <0.05 were statistically significant. In total, 15,306 patients underwent primary (n= 14,711) or revision CDA (n= 595). Patients undergoing revisions had a greater comorbidity burden (mean ECI= 4.16 vs 2.91; p<0.0001). From 2010 to 2020, primary CDA utilization increased by 413% (447 vs 2297 procedures; p<0.001); comparatively revision CDA utilization increased by 141% (32 vs 77 procedures; p<0.001). Mean LOS were greater for revision cases (1.37 vs 3.30 days, p<0.001). Reimbursements for revisions were higher on the day of surgery ($5,585 vs $13,692) and within 90 days of surgery ($7,031 vs $19,340), all p<0.0001. There is a high rate of annual growth in CDA utilization and revision CDA in the United States. Reimbursements for revision CDA were more than double primary cases.

Temporal trends of pharmacologic treatments for tuberculosis and multidrug resistant tuberculosis following dissemination of treatment guidelines in South Korea.

The World Health Organization (WHO) released treatment guidelines for multidrug resistant tuberculosis (MDR-TB) in 2008, with subsequent revisions in 2011; Korea disseminated corresponding guidelines in 2011 and 2014, respectively. Thus, we aimed to investigate the temporal trends of and the updated guideline's impact on the prescription patterns of anti-TB drugs. We conducted a time-series study using Korea's nationwide healthcare database (2007-2015), where patients with TB or MDR-TB were included. Only anti-TB drugs prescribed during the intensive phase of treatment for TB (two months) or MDR-TB (eight months) were assessed. We estimated the annual utilization of TB treatment regimens and the relative difference (RD) in the proportion of MDR-TB treatment medications between the following periods: before the first Korean guideline (June 2008 to March 2011); between the first and revised guidelines (April 2011 to July 2014); after the revised guideline (August 2014 to December 2015). Of 3523TB (mean age 54.1 years; male 56.8%) patients, treatment regimens for TB complied with guideline recommendations as >80% of patients received either quadruple (mean 66.8%) or triple (14.5%) therapy of first-line anti-TB drugs. Following the WHO's guideline update, prescription patterns changed accordingly among 111 MDR-TB (mean age 46.0 years; male 67.6%) patients, as use of pyrazinamide (RD +20.3%) and prothionamide (+11.5%) increased (recommended to be compulsory), and streptomycin (-43.1%) decreased (ototoxicity risks). Anti-TB drug prescription patterns for both TB and MDR-TB well reflected WHO's treatment guideline as well as corresponding domestic guidelines of South Korea.

Impact of a selective narrow network with comprehensive patient navigation on access, utilization, expenditures, and enrollee experiences.

To examine the effect of enrollee switching from a broad-network accountable care organization (ACO) health maintenance organization (HMO) to a "high performance" ACO-HMO with a selective narrow network and comprehensive patient navigation system on access, utilization, expenditures, and enrollee experiences. Secondary administrative data were obtained for 2016-2020, and primary interview and survey data in 2021. Fixed-effects instrumental variable analyses of administrative data and regression analyses of survey data. Outcomes included access, utilization, expenditures, and enrollee experience. Background information was gathered via interviews. We obtained medical expenditure/enrollment and access data on continuously enrolled members in a broad-network ACO-HMO (n=24,555), a subset of those who switched to a high-performance ACO-HMO in 2018 (n=7664); interviews of organizational leaders (n=13); and an enrollee survey (n=512). Health care effectiveness data and information Set (HEDIS) access measures were not different across plans. However, annual utilization dropped by 15.5 percentage points (95% CI: 18.1, 12.9) more in the high-performance ACO-HMO, with relative annual expenditures declining by $1251 (95% CI: $1461, $1042) per person per year. High-performance ACO-HMO enrollees were 10.1 percentage points (95% CI 0.001, 0.201) more likely to access primary care usually or always as soon as needed and 11.2 percentage points (95% CI 0.007, 0.217) more likely to access specialty care usually or always as soon as needed. Plan satisfaction was 7.1 percentage points (95% CI: -0.001, 0.138) higher in the high-performance ACO-HMO. Interviewees noted the comprehensive patient navigation system was designed to ensure patients remained in the narrow network to receive care. ACO and HMO contracts with selective narrow networks supported by comprehensive patient navigation can reduce expenditures and improve specialty access and patient satisfaction compared to broad-network plans that lack these features. Payers should consider implementing narrow networks with comprehensive support systems.

A Decision-Support System for Economic Feasibility of Subsurfaced Poultry Litter

Cattle (Bos spp.) producers routinely spread fertilizer or broadcast poultry (Gallus gallus L.) litter to improve forage production. With poultry litter widely available across the southeastern United States and being a cheaper source of plant nutrition than commercial fertilizer when proximal to application sites, the novel application of litter below the soil surface, while costly, allows for greater nutrient retention than broadcasting. Since quantifying costs and benefits of subsurfaced litter is complex, we develop and present a decision support spreadsheet for automated farm-scale model comparisons across modes of nutrient management. We compare subsurfaced litter to commercial fertilizer and broadcast litter in user-specific scenarios involving equipment choices (new, used, custom), desired nutrient needs for crops grown, litter nutrient concentration, and interval between litter application given the slow-release nature of litter compared to commercial fertilizer. Using Visual Basic for Applications programming available with Microsoft Excel®, we develop a decision aid that collects relevant user-specific farm parameters that allow customization of output. Performance data of the innovative subsurface application equipment as observed during field operation and published engineering equipment performance standards, combined with cost information, allow estimation of relative performance metrics. Break-even and sensitivity analyses are performed to identify key equipment modifications or subsidies needed to speed adoption of subsurfacing poultry litter to minimize odor and nutrient runoff externalities experienced with broadcast litter. Results showed that subsurfaced litter can compete with commercial fertilizer on a cost/return basis and especially so in situations where organic farming practices may be targeted. With a longer interval between litter application, enhanced annual capacity utilization of the applicator, and a good match between nutrient needs of crops fertilized and litter nutrient content, the decision aid demonstrated cost savings with subsurfaced litter over commercial fertilizer while being more or less cost-neutral in comparison to broadcast litter. The decision aid lends itself to estimating operation-specific subsidies needed to encourage adoption of subsurface application of litter with the intent to reduce nutrient runoff and odor externalities. Alternatively, the sensitivity analyses pinpointed the need to enhance the performance rate of subsurface application that may be achievable by increasing the implement’s width.

Childhood Obesity and Health Care Utilization: Empirical Evidence from Austrian Administrative Data.

Background: Increases in pediatric obesity have been associated with higher levels of health care utilization. There is currently a lack of knowledge on the therapeutic drivers of increased health care use. Objective: To examine the association between different measures of health care utilization and BMI among children. Methods: We linked cross-sectional administrative data from a regional health insurance fund in Austria with objectively measured BMI from routine school health examinations in 6-15-year-old children (n = 13,493). Differences in probabilities of annual health care utilization (drug prescriptions by therapeutic classification, physician visits by medical specialty, and hospitalizations) were compared between children with normal weight, overweight, or obesity using Probit regressions. Results: Children with obesity had a 1.6 and 8.6 percentage points (pp) higher probability of outpatient doctor visits and prescribed medication, respectively (all p < 0.05). Children with overweight were intermediate. There was a higher probability of consulting a general practitioner, pediatrician, or orthopedist, and higher levels of prescribing for children with obesity across most common drug groups. Children with obesity were ∼40% more likely to receive medication for musculoskeletal and for mental health problems. This was reflected in orthopedic clinic appointments but not in psychology clinics. There were no major differences by gender or age, or parental socioeconomic status. Conclusions: Our data show clear and objective evidence of higher health care utilization by children with obesity. This highlights the importance of policy interventions to curb obesity in children and young people.

The Clinical and Economic Burden of Tardive Dyskinesia in Israel

Purpose/BackgroundTardive dyskinesia (TD) is a hyperkinetic movement disorder caused by exposure to dopamine-receptor blockers. Data on TD burden in Israel are scarce. This analysis assesses the clinical and economic burden of TD in Israeli patients.Methods/ProceduresThis retrospective analysis used a national health plan database (Maccabi Healthcare Services), representing 25% of the Israeli population. The study included adults alive at index date with an International Classification of Diseases, Ninth Revision, Clinical Modification TD diagnosis before 2018 and more than or equal to 1-year enrollment before diagnosis. Tardive dyskinesia patients were matched to non-TD patients (1:3) by underlying psychiatric condition, birth year, and sex. Treatment patterns and 2018 annual health care resource utilization and costs were assessed.Findings/ResultsOf 454 TD patients alive between 2013 and 2018, 333 alive on January 1, 2018, were matched to 999 non-TD patients. At baseline, TD patients had lower socioeconomic status and higher proportion of chronic kidney disease and antipsychotic medication use; all analyses were adjusted accordingly. Tardive dyskinesia patients had significantly more visits to general physicians, neurologists, psychiatrists, physiotherapists, and emergency departments versus non-TD patients (all P < 0.05). Tardive dyskinesia patients also had significantly longer hospital stays than non-TD patients (P = 0.003). Total healthcare and medication costs per patient were significantly higher in the TD versus non-TD population (US $11,079 vs US $7145, P = 0.018).Implications/ConclusionsIsraeli TD patients have higher clinical and economic burden than non-TD patients. Understanding real-world health care resource utilization and costs allows clinicians and decision makers to quantify TD burden and prioritize resources for TD patients' treatment.

106. Usage trends and safety profile of recombinant human bone morphogenetic protein-2 for spinal column tumor surgery: a national matched analysis

<h3>BACKGROUND CONTEXT</h3> Achieving arthrodesis after spinal tumor surgery remains a significant challenge. Patients in this vulnerable cohort commonly experience poor bone quality, malnutrition and concurrent use of chemotherapy or radiotherapy—all of which interfere with proper bone formation and healing. To augment fusion efforts, recombinant human bone morphogenetic protein-2 (rhBMP-2) emerged as a powerful osteogenic factor after its FDA approval in 2002 but its use has remained a persistent concern. Although most recent evidence does not seem to suggest significantly increased rates of complications or carcinogenicity due to rhBMP-2 use, these findings remain poorly defined in the spinal oncology subcohort. <h3>PURPOSE</h3> To investigate national rates of rhBMP-2 utilization in spinal tumor surgery and examine its association with postoperative complications, revisions, and carcinogenicity. <h3>STUDY DESIGN/SETTING</h3> Retrospective national database analysis. <h3>PATIENT SAMPLE</h3> All patients diagnosed with primary or metastatic spinal tumors who underwent subsequent surgical intervention involving a spinal fusion recorded in Medicare, Medicaid, and commercial administrate claims databases in PearlDiver from 2005-2020. <h3>OUTCOME MEASURES</h3> Utilization rates; postoperative rates of complications, revisions, and failures; survivorship. <h3>METHODS</h3> Patients were organized into two cohorts according to rhBMP-2 usage and 1:1 matched based on age, gender, and Charlson Comorbidity Index. rhBMP-2 utilization trends were compared via a Pearson correlation across calendar years. Postoperative complications and revisions were examined at 1 month, 3 months, 6 months, and 1 year after spinal fusion. New cancer incidence following spinal tumor surgery was assessed until 5 years postoperatively. Post hoc comparisons were characterized using chi-squared analysis, and threshold for significance was established at P < 0.05. <h3>RESULTS</h3> A total of 11,198 patients underwent fusion surgery after resection of spinal tumors between 2005 and 2020, with 909 cases reporting the use of rhBMP-2 (8.1%). An annualized analysis revealed that the proportion of spine tumor fusion procedures utilizing rhBMP-2 has been significantly decreasing (R2 = 0.859, P < 0.001), with the most recent annual utilization rate at 1.1%. The final matched cohorts each comprised 894 patients. At least 6 months after surgery, significantly increased incidences of surgical site (7.3% vs 1.6%, P = 0.05) and systemic infections (13.8% vs 4.1%, P = 0.01) were observed in patients who underwent fusion with rhBMP-2. Across all time points, no significant differences were observed between the groups in survival, implant removal, or revision rates. In addition, incidence of new cancer diagnoses after fusion surgery was comparable between the two groups. <h3>CONCLUSIONS</h3> rhBMP-2 has been widely used off-label to promote arthrodesis; however. its role in spinal fusion procedures involving spinal tumors remains controversial. This analysis demonstrated significantly declining national utilization rates, and while rhBMP-2 usage was not associated with new cancer incidence postoperatively, its impact on local and metastatic progression remains unknown and requires further investigation. Compared with nonusers, spinal tumor cases utilizing rhBMP-2 sustained greater rates of surgical site and systemic infections. Furthermore, rhBMP-2 usage did not significantly reduce the risk of mortality, implant failure, or reoperation–suggesting it may not be essential to fulfilling the needs of this specific patient population. <h3>FDA DEVICE/DRUG STATUS</h3> BMP-2: not approved for this indication.

Capacity configuration and economic evaluation of a power system integrating hydropower, solar, and wind

Determining the economic feasibility and optimal capacity scheme of a hybrid system is the premise of its development. This study proposed a framework for capacity configuration and economic evaluation of the hydro-solar/photovoltaic-wind power system. First, a hydro-solar-wind power system capacity configuration and economic evaluation mathematical model aiming at the maximum net present value was presented. Then, an economic dispatch model of cascade hydropower plants considering flood control level and water supply demand was established, and its target is to maximize the hydropower annual electricity revenues. Finally, the framework was examined by a practical project in China. The results indicated that (1) the hydro-solar-wind power system in Qinghai Province is economically feasible; (2) the hydro-solar-wind complementation leads to the increase of multi-year average water abandonment rate and transmission line utilization hours. Through the regulation of cascade reservoirs, the multi-year average water abandonment rate can be obviously reduced and the hydropower annual electricity revenues can be increased; (3) the hydro-solar-wind power system capacity configuration and economic evaluation model is most sensitive to feed-in tariff, social discount rate, and annual average utilization hours of solar/wind. Thus, this study has important guiding value for the economic development of the hydro-solar-wind power system.

The impact of a national formulary expansion on diabetics.

This paper estimates the causal effect of the expansion of Colombia's national prescription drug formulary to include five new types of insulin on the healthcare utilization and costs of type I diabetics and explores the mechanisms through which outpatient cost reductions are realized. We find that expanded coverage generates an increase in the cost of insulin for type I diabetics equal to 17% of their baseline healthcare costs. At the same time, their annual outpatient care utilization falls by 1.9 claims. We devise tests to explore the relative importance of two mechanisms by which the expansion may have lowered type I diabetics' non-drug healthcare utilization: spillovers from drug to non-drug spending and rationing of care. We find no evidence that the formulary expansion reduces the rate of complications from diabetes and find substantial declines in non-drug costs even among the subset of diabetics with no scope for spillovers. We find large reductions in the utilization of discretionary care including diagnostic tests, but no such declines for the use of essential drugs, suggesting that rationing of care is the primary driver of observed cost savings.

Joint Operation Modes and Economic Analysis of Nuclear Power and Pumped Storage Plants under Different Power Market Environments

Given the continuous promotion of power market reforms, the joint operation modes and economic analysis of nuclear power and pumped storage hydropower under different market mechanisms are the key to ensuring the low-carbon and economic operation of the power system. First, this study constructed the power expansion optimization model and put forward the allocation ratio by combining the operation characteristics of nuclear power and pumped storage. Second, a simulation model for the joint operation was established to optimize their operation modes. Finally, the joint operation modes and a method for calculating profitability under different power market mechanisms were proposed. A case study in the FJ power grid reveals that the joint operation of nuclear power and pumped storage can increase the annual utilization hours of nuclear power by 1000 h, reduce the operation cost of pumped storage, and increase the market competitiveness of the system. With the improvement in the power market, the joint financial internal rate of return of the system would increase gradually to 11.40% in the long-term mature market. This indicates that the power market reforms would ensure the profitability of the joint operation of nuclear power and pumped storage.