Average Fees Research Articles

2025~2028년 AI 디지털교과서 구독료 재정소요에 따른 지방교육재정부담 추계

The purpose of this study is to estimate the fiscal requirements for AI digital textbook subscriptions, which will be introduced with a subscription-based pricing model from 2025 to 2028, and to forecast the burden on local education finance for provincial and municipal education offices. It also aims to present policy considerations regarding future funding allocation that should be taken into account in legislative decision-making. Based on the 2025-2028 schedule for AI digital textbook implementation announced by the Ministry of Education in June 2023, the number of students by grade, and the set price ranges, the results show that applying Scenario S1-1 (an average monthly subscription fee of 5,000 KRW with a 12-month subscription for semester-based textbooks) would require a total of 4.7255 trillion KRW in student subscription fees over four years. Furthermore, it is expected that the fiscal requirements will range from 1.9252 trillion KRW under the minimum scenario (S2-2) to 6.6156 trillion KRW under the maximum scenario (S1-3). Given that the introduction of AI digital textbooks will significantly increase local education finance burdens due to the substantial fiscal requirements involved, potentially causing major changes in the existing textbook system, it is deemed appropriate that this initiative be pursued based on prompt and clear legislative decisions by the National Assembly under the principle of the rule of law for education systems as stipulated in the Constitution of the Republic of Korea. When these premises are clear, the following funding options can be considered: ① extending the effective period or removing the sunset clause for special grants that increase national support for high school tuition-free policies, including textbook costs, ② abolishing the temporary special grant system for digital education innovation needs to secure additional ordinary grant funding, ③ inducing investment from the central government’s general budget to secure additional funding for AI digital textbooks, and ④ utilizing temporary national project special grants in 2025.

A Cost Analysis of Enucleation and Evisceration Surgeries for Treatment of Blind, Painful Eyes.

The purpose of this study is to assess the surgical costs of enucleations and eviscerations and their relation to current reimbursement rates using time-driven activity-based costing. This is a retrospective study of patients undergoing enucleation and evisceration surgeries with attachment of muscles (Current Procedural Terminology 65105 and 65093) for a diagnosis of blind, painful eye, from January 1, 2019, to December 31, 2023, at a single, tertiary level, teaching hospital. A time-driven activity-based cost analysis for day of surgery was performed. Operative reports, perioperative times, and supply costs were extracted from the electronic medical record, and average reimbursement fees were taken from Center for Medicare and Medicaid Services data. In the 5-year study span, 110 patients underwent enucleation and 52 underwent evisceration for a primary indication of blind, painful eye by 10 different surgeons. The average operating room time and surgical time for enucleation was approximately 9 minutes longer compared with evisceration (p < 0.01). Both surgeries on average resulted in a negative margin with enucleations costing on average $624 more than eviscerations. The breakeven total operating room time for enucleation and evisceration surgery was approximately 86.3 and 83.1 minutes, respectively. From the sample, approximately 79% of enucleation and 60% of evisceration surgeries resulted in a net negative margin. On average, the cost of enucleation and evisceration surgeries exceeded the reimbursement amount set by the Center for Medicare and Medicaid Services. Compared with enucleation, evisceration was more time and cost-effective by only a modest margin.

Transitional Care Support for Medicaid-Insured Patients With Serious Mental Illness: Protocol for a Type I Hybrid Effectiveness-Implementation Stepped-Wedge Cluster Randomized Controlled Trial.

People diagnosed with a co-occurring serious mental illness (SMI; ie, major depressive disorder, bipolar disorder, or schizophrenia) but hospitalized for a nonpsychiatric condition experience higher rates of readmissions and other adverse outcomes, in part due to poorly coordinated care transitions. Current hospital-to-home transitional care programs lack a focus on the integrated social, medical, and mental health needs of these patients. The Thrive clinical pathway provides transitional care support for patients insured by Medicaid with multiple chronic conditions by focusing on posthospitalization medical concerns and the social determinants of health. This study seeks to evaluate an adapted version of Thrive that also meets the needs of patients with co-occurring SMI discharged from a nonpsychiatric hospitalization. This study aimed to (1) engage staff and community advisors in participatory implementation processes to adapt the Thrive clinical pathway for all Medicaid-insured patients, including those with SMI; (2) examine utilization outcomes (ie, Thrive referral, readmission, emergency department [ED], primary, and specialty care visits) for Medicaid-insured individuals with and without SMI who receive Thrive compared with usual care; and (3) evaluate the acceptability, appropriateness, feasibility, and cost-benefit of an adapted Thrive clinical pathway that is tailored for Medicaid-insured patients with co-occurring SMI. This study will use a prospective, type I hybrid effectiveness-implementation, stepped-wedge, cluster randomized controlled trial design. We will randomize the initiation of Thrive referrals at the unit level. Data collection will occur over 24 months. Inclusion criteria for Thrive referral include individuals who (1) are Medicaid insured, dually enrolled in Medicaid and Medicare, or Medicaid eligible; (2) reside in Philadelphia; (3) are admitted for a medical diagnosis for over 24 hours at the study hospital; (4) are planned for discharge to home; (5) agree to receive home care services; and (6) are aged ≥18 years. Primary analyses will use a mixed-effects negative binomial regression model to evaluate readmission and ED utilization, comparing those with and without SMI who receive Thrive to those with and without SMI who receive usual care. Using a convergent parallel mixed methods design, analyses will be conducted simultaneously for the survey and interview data of patients, clinicians, and health care system leaders. The cost of Thrive will be calculated from budget monitoring data for the research budget, the cost of staff time, and average Medicaid facility fee payments. This research project was funded in October 2023. Data collection will occur from April 2024 through December 2025. Results are anticipated to be published in 2025-2027. We anticipate that patients with and without co-occurring SMI will benefit from the adapted Thrive clinical pathway. We also anticipate the adapted version of Thrive to be deemed feasible, acceptable, and appropriate by patients, clinicians, and health system leaders. ClinicalTrials.gov NCT06203509; https://clinicaltrials.gov/ct2/show/NCT06203509. DERR1-10.2196/64575.

Land plot as a kind of monetary capital. Land market and cadastral value of agricultural land

The basis for determining payments for the use of agricultural land plot is land rent – the excess value of agricultural products over the average profit. Rent is a "surplus", the taxation of which does not affect the incentives for production. The rent tax does not lead to distortions in the economy and does not reduce its efficiency, unlike destructive taxes on productive capital and labor - a tax system that punishes achieving high results in hard work and entrepreneurship. The amount of tax rate established by the Tax Code of the Russian Federation for land plots classified as agricultural lands for agricultural production - 0.3% of the cadastral value of a land plot - leads to speculative enrichment through the purchase of state land with the subsequent leasing at a rental price ten times higher than the average nominal land fee and the refusal of regional and municipal authorities to provide state and municipal lands for ownership to citizens and legal entities, as authorities prefer to lease these lands. This is how land has become a source of unearned wealth. Social, economic and environmental consequences of this clearly affect the welfare of society. The article presents a simple model for the annual calculation of land rent based on data from commodity producers of the agro-industrial complex on production, expenses, cost price, and profitability of crop products.

The declining affordability of dental care in New Zealand from 1978 to 2023.

In the early 2020s, nearly half of New Zealand adults reported that cost of treatment had prevented them from accessing dental care, with higher rates among Māori, Pasifika and individuals living in the most deprived areas. Unaffordable dental care may be explained by a rise in dental service fees over time relative to personal income, as documented in New Zealand between 1978 and 1993. However, there have been no contemporary estimates in New Zealand of how the affordability of dental care has changed. The aims of this study were to analyse the change in dental treatment fees and the personal income of New Zealanders from 1978 to 2023 and to explore differences in affordability of dental care by ethnicity. Average fees for dental treatments were sourced from surveys completed by practising New Zealand dentists. Earnings (from 1978) and personal income data (full population from 2000 and by ethnicity from 2008) were sourced from Statistics NZ and NZ Official Yearbooks. Inflation-adjusted changes in average fees, weekly personal earnings and income were calculated as a percentage change from 1978 levels for fees and earnings and from 2000 for personal income. For the five dental treatments with data available from 1978 to 2023, fees increased in the range of 75%-236%, while earnings increased by 46% over the same period. Fees for other treatments (with data available from 1981 to 2009) similarly increased and mostly surpassed changes in earnings. From 2008 to 2023 the overall increase in personal income (about 21% across all ethnic groups) kept pace with the rising cost of most treatments. However, due to persistent income inequalities, in 2023, Māori and Pasifika would need to spend a higher proportion of their weekly income (approximately 16% and 23% respectively) to receive the same dental treatments as NZ Europeans. Fees for dental treatments have risen markedly in recent decades, more sharply than the price of other goods and services.

Bitcoin Ordinals: Determinants and impact on total transaction fees

Bitcoin Ordinals are on-chain non-fungible assets native to the Bitcoin blockchain. As the data is stored on-chain, by opposition to Ethereum-like NFTs, creating an ordinal (i.e. “inscribing” it) can be expensive. We analyze the initial wave of Ordinals from December 14th 2022 until April 16th 2023. We show that ordinal inscriptions tend to have a lower fee rate than regular transactions. We also show that a high average block transaction fee rate is associated with lower ordinal inscriptions. These effects are larger for large inscriptions. This suggests that ordinal users are careful when setting the fee rate of their inscriptions. We also show that both the transaction fee rate for non-inscription transactions and total block fees have increased with the popularity of Bitcoin Ordinals, increasing miners’ revenue.

Reducing CO2 emissions in a peer-to-peer distributed payment network: Does geography matter in the lightning network?

Bitcoin, Ethereum and other blockchain-related globally distributed peer-to-peer networks have become an important payment infrastructure. Because they are naturally decentralized and distributed, they can consume resources unevenly, raising some sustainability concerns. The Lightning Network (LN) is a growing but understudied second layer network built on blockchain infrastructure and designed to make fast and anonymous global multi-pass payments. At a conservative estimate, this infrastructure produces about 1.4 million tons of carbon dioxide (CO2) per year. Thus, in this paper, we aim to justify a general approach to consider topology and the geographical distribution of this type of network in the design and investigate ways to prevent excessive CO2 emissions. While the LN itself shows great promise as a scalable and widely adopted solution, there has been limited research exploring its structure, distribution, and performance from a sustainability perspective. This study contributes to analyzing the LN’s topology, geospatial distribution, and pathfinding algorithms. By examining real-world data snapshots of the LN, we investigate the relationship between payment routes that are produced by native pathfinding algorithms, geographical distribution of the network and the carbon intensity of electricity in the countries involved in the final payment paths. Our analysis highlights the important structural and geospatial characteristics of the LN and reveals a significant correlation between the length of payment paths, geographical distance, carbon intensity of electricity and other features. To tackle sustainability concerns, we propose an original pathfinding heuristic that effectively prevents excessive carbon dioxide emissions in LN infrastructure. Our computational experiments have shown that, under optimal parameters, such a heuristic can prevent the associated CO2 emissions both directly – by limiting path lengths, number of intercountry and intercontinental hops – and indirectly — by giving more weight to channels covering places with lower carbon intensity of electricity. Technically, the highest result it achieves is as follows: the average path length reduced by 28.7%, the average number of intercontinental hops by 28.7%, the average number of intercountry hops by 21.3%, and the average carbon intensity by 9.4%. This solution also maintains a compromise between the average locktimes and fee ratios. In conclusion, we discuss that geographic distribution is a rather important characteristic of decentralized peer-to-peer payment networks, which is usually underestimated at the network design stage.

Reconstruction of Caesarean Section Service Rates for National Health Insurance Patients

RSIA Permata Bunda as a JKN provider is paid according to the INA-CBG rate by BPJS Kesehatan, the amount of which does not match the costs incurred by the hospital so that there is a negative difference between the hospital section caesarea (SC) rate and the INA-CBG rate which reached 2 billion in 2021. The aim of this study was to reconstruct the SC service rate for JKN patients so that efficiency occurs. This study was an explanatory sequential mixed method design, preceded by quantitative research with unit cost calculation using the activity based costing (ABC) method and the average fee for service rate for hospital SC services and then qualitative research for interviews with informants. The unit cost calculated using the ABC method is lower than hospital package rates, fee for service rates but higher than INA-CBG rates for SC severity level I services in treatment classes I, II and III which causes losses for the hospital. Efficiency efforts that can be carried out by hospitals are through tariff reconstruction by adjusting LOS (length of stay), optimizing drug use and supporting examinations according to clinical pathways and changing the calculation of medical services from fee for service to a package system.

Outpatient service tariff determination based on unit cost analysis mixed with community ability and willingness to pay

Purpose: The study aims to calculate the rational outpatient tariff based on unit cost analysis, ability and willingness to pay. &#x0D; Method: The research is an observational study with a qualitative approach. Secondary data are obtained retrospectively to calculate unit costs and tariffs. Primary data is collected through questionnaires to see the ability and willingness to pay (WTP). &#x0D; Result: The calculation using the step-down method obtained the unit cost for general practice IDR 79,337, dental care IDR 151,635, psychologist consultation IDR 115,283, and fitness center IDR 236,555. The respondent's ATP value is IDR 138,808, with an average examination fee of IDR 56,093. When coupled with an improvement in service and facility quality, 58.1% of respondents agreed to a 10% rate increase. With a 20% rate increase, the willingness to pay decreases to 40.6%. In the bivariate analysis using the chi-square test, the variables significantly affecting WTP are patient perceptions of the suitability of service costs (p = 0.000). In contrast, age, gender, occupation, education, income, number of family members, and insurance ownership do not significantly influence WTP. &#x0D; Conclusion: The service rate is lower than the unit cost calculation. By looking at the ability and willingness to pay, it is possible to evaluate the tariff.

Cost-savings of short stay sleeve gastrectomy and walk-in hydration clinic versus conventional inpatient care.

We aim to evaluate the cost-saving of the short stay ward (SSW) versus conventional inpatient care following sleeve gastrectomy (LSG). We also compared the readmission rates pre- and post-inception of the intravenous hydration clinic and analyzed the cost-savings. Patients who underwent LSG between December 2021 to March 2022 with SSW care were compared with standard inpatient care. Total costs were analyzed using univariate analysis. Withaseparate cohort of patients, 30-day readmission rates in the 12-months preceding and following implementation of the IV hydration clinic and associated cost-savings were evaluated. After matching on the propensity score to within ± 0.1, 20-subjects pairs were retained. The total cost per SSW-subject was significantly lower at $13,647.81 compared to $15,565.27 for conventional inpatient care (p = 0.0302). Lower average ward charges ($667.76 vs $1371.34, p < 0.0001), lower average daily treatment fee per case ($235.68 vs $836.54, p < 0.0001), and lower average laboratory investigation fee ($612.31 vs $797.21, p < 0.0001) accounted for the difference in costs between the groups. Thirty-day readmission rate reduced from 8.9 to 1.8% after implementation of the hydration clinic (p < 0.01) with decreased 30-day readmission cost (S$96,955.57 vs. S$5910.27, p < 0.01). SSW for LSG is cost-effective and should be preferred to inpatient management. Walk-in hydration clinics significantly reduced readmission rates and result in tremendous cost-savings.

Unanticipated costs associated with interscalene nerve catheters for shoulder surgery.

Regional anesthesia has become a mainstay of analgesia following shoulder arthroscopic and reconstructive procedures. Local anesthetic can be injected in the perineural space of the brachial plexus by a single shot or continuously by an indwelling catheter. Although previous studies have compared efficacy and direct cost of single shot to catheters, few have evaluated unanticipated costs of ongoing care or complications. Pulmonary complications can lead to unexpected admissions and emergency department visits. The purpose of the study was to identify unplanned hospital admissions or emergency department visits related to regional anesthesia after shoulder surgery and determine the additional associated costs. A series of 1888 shoulder surgeries were identified in 1856 unique patients at a single, large academic center. As part of an interscalene nerve catheter program, a continuous interscalene block (CIB) was given to 1728 patients, whereas 160 patients had a single-shot interscalene block (SSIB). A hospital-employed quality control nurse contacted all patients receiving a CIB at 1, 2, 7, and 14 days following surgery. All emergency department visits and readmissions were recorded, and the associated billing charges were reviewed for the inpatient and any outpatient visits immediately preceding or immediately following the readmission. The regional average Medicare fee schedule was used to determine a cost for these episodes of care. Of the 1728 patients who had CIB, 10 patients were readmitted following open or arthroscopic surgery or presented to the emergency department in the immediate postoperative period for pulmonary compromise. No patient in the SSIB group had an emergency department visit or readmission. The average age of the 10 patients with readmission was 60 years (7 females, 3 males). The majority were diagnosed with hypoxemia on admission (R09.02). Length of stay during readmission ranged from 0 to 4 days, with 1 patient requiring admission to the intensive care unit. The average cost of admission to the hospital or visit to the emergency department was $6849 (range, $1988-$19,483). These costs were primarily related to chest radiographs and electrocardiogram (9/10), chest computed tomography (CT) with contrast (3/10), and head CT (2/10). Although uncommon, unanticipated pulmonary complications after CIB can result in significant cost compared to SSIB. The indirect costs of pulmonary workup after readmission or emergency department workup may be overlooked if only considering direct costs, such as medication charges, medical supplies, and physician fees.

Model-based estimation of the health care expenditure and out-of-pocket payment for assisted reproductive technology: A retrospective linkage study using the Japanese national ART registry.

From April 2022, the Japanese government funding system for assisted reproductive technology (ART) has shifted from government subsidies to universal health insurance. To date, studies estimating the health care expenditure for ART are scarce. We estimated health care expenditures for ART cycles and compared the proportion of patients' out-of-pocket payment by ovarian stimulation protocols under the Japanese government subsidy system. We linked payment information for government subsidies in Saitama Prefecture during 2016 and 2017 with the Japanese ART registry. Health care expenditures for all treatment cycles in Japan during 2017 among women aged <43 years (n = 369 757) were estimated using a generalized linear model. We linked 6269 subsidy applications to the Japanese ART registry. The average treatment fee for a fresh cycle was 376 434 JPY (standard deviation = 159 581). However, significant variation was observed across ovarian stimulation protocols. The estimated health care expenditure for ART during 2017 was 101 278 629 888 JPY (920 714 817 USD), leading to a 0.24% increase in the national health care expenditure for fiscal year 2017. Fresh cycles accounted for 70% of the expenditure. The proportion of the average patient out-of-pocket payment for one treatment cycle was smaller for natural (0%) and mild ovarian stimulation using clomiphene citrate (4.5%-20.7%) than those of conventional stimulation (30.3%-32.4%). Health insurance coverage for ART would increase national health care expenditure by 0.24%. Under the subsidy system, the proportion of the average patient out-of-pocket payment was smaller for natural and mild ovarian stimulation than conventional stimulations.

What shapes student intentions? The interplay between policy, social and personal factors in postgraduate education

ABSTRACT The Master’s Loan Scheme in England was initially designed to support widening access to postgraduate education. However, the general increase in the average fees has posed a risk of reducing these schemes’ effectiveness in promoting social mobility, especially for debt adverse students. We use a multidisciplinary framework to build a model of postgraduate intentions to review the Fast Forward (FF) Master Scheme at the University of Greenwich in the UK. This framework underpinned the development of an online survey for this observational study. The results suggest that the FF allowed some graduates who, without the FF intervention, would have disregarded undertaking postgraduate taught studies (PGT) to consider studying for a PGT degree. Many of these graduates are from previously under-represented communities in the sector. We found that financial concerns could deter some students, but the intervention design allowed students to consider PGT study when they had a positive undergraduate experience. Alleviating the credit constraint may not be enough to widen access at the PGT level. Better information about PGT courses, more flexible delivery of PGT, and employment support, such as mentorship and work experience, and social and personal factors considerations could help widen access to PGT studies.

Removal of Hydrus® microstent due to uveitis-glaucoma-hyphema syndrome.

Regional anesthesia has become a mainstay of analgesia following shoulder arthroscopic and reconstructive procedures. Local anesthetic can be injected in the perineural space of the brachial plexus by a single shot or continuously by an indwelling catheter. Although previous studies have compared efficacy and direct cost of single shot to catheters, few have evaluated unanticipated costs of on-going care or complications. Pulmonary complications can lead to unexpected admissions and emergency room visits. The purpose of the study was to identify unplanned hospital admissions or emergency room visits related to regional anesthesia after shoulder surgery and determine the additional associated costs.A series of 1888 shoulder surgeries were identified in 1856 unique patients at a single large academic center. As part of an interscalene nerve catheter program, a continuous interscalene block (CIB) was given to 1728 patients; whereas, 160 patients had a single shot interscalene block (SSIB). A hospital-employed quality control nurse contacted all patients receiving a CIB at one, two, seven, and fourteen days following surgery. All emergency room visits and readmissions were recorded, and the associated billing charges were reviewed for the inpatient and any outpatient visits immediately preceding or immediately following the readmission. The regional average Medicare fee schedule was used to determine a cost for these episodes of care.Of the 1728 patients who had CIB, ten patients were readmitted following open or arthroscopic surgery or presented to the emergency department in the immediate postoperative period for pulmonary compromise. No patient in the SSIB group had an emergency room visit or readmission. The average age of the ten patients with readmission was 60 years (7 females, 3 males). The majority were diagnosed with hypoxemia on admission (R09.02). Length of stay during readmission ranged from 0 to 4 days with one patient requiring admission to the ICU. The average cost of admission to the hospital or visit to the emergency room was $6,849 (range, $1,988 to $19,483). These costs were primarily related to chest X-Rays and EKG (9/10), chest CT with contrast (3/10), and head CT (2/10).Although uncommon, unanticipated pulmonary complications after CIB can result in significant cost compared to SSIB. The indirect costs of pulmonary workup after readmission or emergency room work-up may be overlooked if only considering direct costs, such as medication charges, medical supplies, and physician fees.

Обязательный аудит, инициативный аудит, иные формы подтверждения отчетности: ситуация и перспективы

The article builds time series of the main indicators of mandatory and initiative audit in recent years; at the same time, cost indicators are given both in current and constant prices. Based on the results of the analysis of the volume of revenues and average fees for mandatory and initiative audits, it is shown that the first one has been declining significantly in recent years, while the second one is growing slightly; the predominance of the first in the market of audit services leads to the fact that the market as a whole falls. Th e proposal to expand and improve the mandatory audit as a necessary condition for increasing demand for initiative audit and other audit services is argued. Other forms of mandatory confirmation of reporting (information) are considered as a special case of work requiring subsequent external verification, as well as part of a future system of socio-economic information for the population of the country.

LITERATURE REVIEW: GAMBARAN PEMERIKSAAN TES WIDAL DENGANPEMERIKSAAN PERTUMBUHAN KULTUR BAK-TERI SALMONELLA TYPHI PADA PASIEN DEMAM TIFOID ANAK

Typhoid fever is a systemic contamination because of Salmonella typhi micro organism, with unfold via the fecal-oral route. Currently, the diagnosis of typhoid fever in Indonesia remains broadly utilized by the Widal take a look at method. From a few data, the sensitivity and specificity values of the Widal take a look at aren't as accurate because the Tubex ™ take a look at. Therefore, this has a look at will investigate a literature assessment that examines the assessment of the Widal take a look at with blood culture in pediatric typhoid fever patients. The layout of this studies is a literature review. Search for posted articles on google schoolar the usage of decided on keywords, namely: evaluate of the Widal take a look at with exam of the boom of Salmonella typhi microorganism in kids with typhoid fever. Based at the assessment results, the av-erage fee of sensitivity is 69.5%, specificity is 67.9%, fantastic predictive fee is 37.9% and poor predictive fee is 86.0%. Widal's exam of the 11 calculated journals has a low common PPV fee and an excessive common NPV fee. Sensitivity and Specificity values are within side the variety of 60%. Conclusion primarily based totally on evaluations from sev-eral journals, the Widal take a look at can not be used to verify a prognosis however to rule out the opportunity of a diagnosis of different diseases

The impact of COVID-19 on coaching practice: results from a global coach survey

ABSTRACT This paper presents the results from a global coach survey of 1266 coaches from 79 nations conducted in Summer 2021, when the world emerged from global lockdowns and the 18-month COVID-19 pandemic. In addition to sharing data on the composition of the global coach community (national residence, gender, race, ethnicity, sexual orientation and disability), this study focuses on the impact of the global pandemic on the coaching industry using a quantitative analysis. The findings indicate that age, platform association, pre-pandemic online coaching experiences and average fee were significant predictors of the total impact of the COVID-19 pandemic on coaches. Those least able to adjust and transition to an online environment, or with the least experience working online, reported the greatest detrimental impact. Moreover, the data confirm coaching’s transition towards online delivery, with the pandemic accelerating this process to a point where we believe that this trajectory will continue post-pandemic. To enable the success of this shift, coach supervisors, peer support and professional coach training need to recognise the need for this digital transition and adjust training, support and practices to reflect this new reality.

Do hedge funds with above average fees really outperform?

Do hedge funds with above average fees really outperform?

The optimal asset trading settlement based on Proof-of-Stake blockchains

The Proof-of-Stake (PoS) protocol is booming in blockchain networks because of excessive energy consumption and slow block generation associated with the Proof-of-Work (PoW) protocol. In terms of transaction settlement, does the PoS protocol perform better than PoW? We build a transaction settlement model based on the PoS blockchain, describing how the staking income and costs affect settlement performance, and put forward a Successful Settlement Factor (SSF) to determine whether the settlement will be successful given the block size and block time. In addition, the system developers can adjust block size and block time according to SSF to achieve the best settlement performance. Finally, using historical data for a real-world blockchain network, our model demonstrates that the optimal block time, average settlement time, average settlement fees, and total settlement lag of the PoS blockchain are 23.41%, 23.29%, 23.23%, 23.31%, respectively, less than that of the PoW blockchain.

Triaging of Bone Marrow for Esoteric Testing – Cost-effective and Patient-centric Approach Utilizing WHO Nomenclature for Hematolymphoid Malignancies

Abstract Introduction/Objective Esoteric testing (ES) plays a major role in bone marrow (BM) evaluation. Providers usually order tests considering differential diagnoses based on clinical history. Hematopathologists (HP) while reviewing the BM consider modifying the standing orders. Knowledge and simple guidelines for triaging BM for ES are limited in the literature. Methods/Case Report Between 2015-2021, a total of 2560 BMs were selected. Initial tests that were ordered by providers were reviewed by HP considering clinical history, medical necessity, and preliminary BM morphology. Average Medicare fee schedule for 2022 was used for cost analysis. Types of ES were evaluated for Flow Cytometry (FC); Cytogenetics (CG); Fluorescence In-Situ Hybridization (FISH) and Molecular Genetics (MG). Immunostains were excluded in this study. Results (if a Case Study enter NA) Cases were evaluated and categorized as cytopenias, cytosis, staging, MPN, MDS, myelomas, treatment follow-up and miscellaneous indications. ES were modified based on medical necessity and blinded with insurance plans or payment status. Initial clinical orders were modified by HP as follows: FC-reduced 15%; CG-reduced 38%; FISH-modified 25%; MG-modified 40% (single assays or NGS). Overall healthcare savings by modifying tests were close to $1.2M. Conclusion Effective triaging of BM is a complex decision and can result in significant cost savings. Factors positively impacting these savings are: 1) expertise training in hematopathology, 2) personalized order of ES considering clinical indication, 3) peer-to- peer interaction with providers, and 4) the types of samples obtained. Collaborative efforts among pathologists and clinicians may lead to appropriate ordering of tests, cost- saving effective patient care with relevant diagnostic, therapeutic and prognostic information obtained as recommended by WHO nomenclature for hematolymphoid malignancies. In addition, established practice guidelines with personalized medicine will reduce the burden for pre-authorization when challenged with time sensitive samples obtained from cancer patients obtained thru invasive procedures.