Cost-effective Strategy Research Articles

Efficient and eco-friendly carbon dioxide capture with metal phosphate catalysts in monoethanolamine solutions

Efficient and eco-friendly carbon dioxide capture with metal phosphate catalysts in monoethanolamine solutions

Wearable defibrillator to improve accuracy in selecting candidates to implantable defibrillator: A real-world experience.

The indication for implantable cardioverter defibrillator (ICD) for sudden cardiac death (SCD) prevention relies mostly on left ventricular ejection fraction (LVEF)≤35%. The use of a wearable cardioverter defibrillator (WCD) in the case of dynamic alterations of LVEF may help avoid an improper early ICD implant when a favourable evolution in the post-acute phase is observed and may help reduce costs. This parallel cohort retrospective study included patients with heart failure with reduced ejection fraction (HFrEF) at high risk of arrhythmias recruited in the acute phase and divided into an early ICD cohort and a WCD cohort for primary prevention during the waiting period established by European Society of Cardiology guidelines. A total of 41 consecutive patients were enrolled: 26 in the WCD group and 15 in the early ICD group. Age, LVEF at baseline, causes of HFrEF and drug therapy in the two cohorts were similar. During the waiting period after the inclusion, three patients (11.5%) in the WCD cohort and four (26.7%) in the early ICD cohort developed relevant ventricular arrhythmias (P=0.22); none of them had subsequent LVEF recovery. At the end of the waiting period, 13 patients (50%) in the WCD group and 7 (46.7%) in the early ICD group experienced LVEF recovery (P=0.84). The average cost per patient at the end of the waiting period was €23934 in the early ICD cohort versus €19167 in the WCD cohort (-19.9%). This cost savings from WCD use appears even higher when projected over a 10year period (-41.2%). WCD may represent a cost-effective strategy to more accurately select candidates for the primary prevention ICD implant among high-risk patients with HFrEF. ICD use provides effective protection from SCD and reduces costs compared with an extensive early ICD implant.

Cost-effectiveness analysis and return on investment of SunSmart Western Australia to prevent skin cancer.

Each year, malignant melanoma accounts for 57 000 deaths globally. If current rates continue, there will be an estimated 510 000 new cases annually and 96 000 deaths by 2040. Melanoma and keratinocyte cancers (KCs) incur a large societal burden. Using a mathematical population model, we performed an economic evaluation of the SunSmart program in the state of Western Australia (WA), a primary prevention program to reduce the incidence of skin cancer, versus no program. A societal perspective was taken combining costs to the health system, patients and lost productivity. The model combined data from pragmatic trial evidence of sun protection, epidemiological studies and national cost reports. The main outcomes modelled were societal and government costs, skin cancer counts, melanoma deaths, life years and quality-adjusted life years. Over the next 20 years, the model predicted that implementing the WA SunSmart program would prevent 13 728 KCs, 636 melanomas and 46 melanoma deaths per 100 000 population. Furthermore, 251 life years would be saved, 358 quality-adjusted life years gained and AU$2.95 million in cost savings to society per 100 000 population would be achieved. Key drivers of the model were the rate reduction of benign lesions from sunscreen use, the costs of purchasing sunscreen and the effectiveness of reducing KCs in sunscreen users. The likelihood of WA SunSmart being cost-effective was 90.1%. For the WA Government, the estimated return on investment was $8.70 gained for every $1 invested. Primary prevention of skin cancer is a cost-effective strategy for preventing skin cancers.

Predicting Delayed Postoperative Length of Stay Following Robotic Kidney Transplantation: Development and Simulation of Perioperative Risk Factors.

Background and Objective: Early discharge following robot-assisted kidney transplantation (RAKT) is a cost-effective strategy for reducing healthcare expenses while maintaining favorable short- and long-term prognoses. This study aims to identify predictors of postoperative delayed discharge in RAKT patients and develop a predictive model to enhance clinical outcomes. Materials and Methods: This retrospective study included 146 patients aged 18 years and older who underwent RAKT at a single tertiary medical center from August 2020 to January 2024. Data were collected on demographics, comorbidities, social and medical histories, preoperative labs, surgical information, intraoperative data, and postoperative outcomes. The primary outcome was delayed postoperative discharge (length of hospital stay > 7 days). Risk factors for delayed discharge were identified through univariate and multivariate regression analyses, leading to the development of a risk scoring system, the effectiveness of which was evaluated through receiver operating characteristic curve analysis. Results: 110 patients (74.8%) were discharged within 7 days post-transplant, while 36 (24.7%) remained hospitalized for 8 days or longer. Univariate and multivariate logistic regression analyses identified ABO incompatibility, BUN levels, anesthesia time, and vasodilator use as risk factors for delayed discharge. The RAKT score, incorporating these factors, demonstrated a predictive performance with a C-statistic of 0.789. Conclusions: This study identified risk factors for delayed discharge after RAKT and developed a promising risk scoring system for real-world clinical application, potentially improving postoperative outcome stratification in RAKT recipients.

Salt Reduction and Iodine Fortification Policies Are Compatible: Perspectives for Public Health Advocacy.

Cardiovascular diseases account for almost 18 million deaths annually, the most of all non-communicable diseases. The reduction of dietary salt consumption is a modifiable risk factor. The WHO recommends a daily sodium intake of <2000 mg but average consumption exceeds this in many countries globally. Strategies proposed to aid effective salt reduction policy include product reformulation, front of pack labelling, behavioural change campaigns and establishing a low-sodium-supportive environment. Yet, salt for household and processed food use is, in countries wholly or partially adopting a universal salt iodisation policy, the principal vehicle for population-wide iodine fortification. With salt reduction policies in place, there is concern that iodine deficiency disorders may re-emerge. Recognising the urgency to tackle the rising prevalence of NCDs yet not risk the re-emergence and detrimental effect of inadequate iodine intakes, this review lays out the feasibility of integrating both salt reduction and salt iodine fortification strategies. Reducing the burden of health risks associated with an excessive sodium intake or inadequate iodine through population-tailored, cost-effective strategies involving salt is both feasible and achievable, and represents an opportunity to improve outcomes in public health.

Effectiveness and Acceptability of Targeted Text Message Reminders in Colorectal Cancer Screening: Randomized Controlled Trial (M-TICS Study).

Mobile phone-based SMS text message reminders have the potential to improve colorectal cancer screening participation rates. This study assessed the effectiveness and acceptability of adding targeted SMS text message reminders to the standard procedure for those who picked up but did not return their screening kit at the pharmacy within 14 days in a colorectal cancer screening program in Catalonia, Spain. We performed a randomized control trial among individuals who picked up a fecal immunochemical test (FIT) kit for colorectal cancer screening at the pharmacy but did not return it within 14 days. The intervention group (n=4563) received an SMS text message reminder on the 14th day of kit pick up and the control group (n=4806) received no reminder. A 30-day reminder letter was sent to both groups if necessary. The main primary outcome was the FIT completion rate within 30, 60, and 126 days from FIT kit pick up (intention-to-treat analysis). A telephone survey assessed the acceptability and appropriateness of the intervention. The cost-effectiveness of adding an SMS text message reminder to FIT completion was also performed. The intervention group had higher FIT completion rates than the control group at 30 (64.2% vs 53.7%; P<.001), 60 (78.6% vs 72.0%; P<.001), and 126 (82.6% vs 77.7%; P<.001) days. Participation rates were higher in the intervention arm independent of sex, age, socioeconomic level, and previous screening behavior. A total of 339 (89.2%) interviewees considered it important and useful to receive SMS text message reminders for FIT completion and 355 (93.4%) preferred SMS text messages to postal letters. We observed a reduction of US $2.4 per participant gained in the intervention arm for invitation costs compared to the control arm. Adding an SMS text message reminder to the standard procedure significantly increased FIT kit return rates and was a cost-effective strategy. SMS text messages also proved to be an acceptable and appropriate communication channel for cancer screening programs. ClinicalTrials.gov NCT04343950; https://www.clinicaltrials.gov/study/NCT04343950. RR2-10.1371/journal.pone.0245806.

Interpretable prediction model for decoupling hot rough rolling camber-process parameters

The presence of asymmetrical camber defects in reversible hot rough rolling processes significantly impacts the quality of plate shapes. Understanding and quantifying the intricate relationship between process parameters and camber is essential for developing cost-effective strategies to rectify plate shape defects. Previous research predominantly concentrated on specific couplings between process variables and camber, employing simplified mathematical models with physical mechanisms. However, these approaches may overlook critical factors inherent in the entire rough rolling process, which can substantially influence plate shape deformation. Furthermore, heavy reliance on expertise within the rolling domain may limit the capability and accuracy of coupling analysis models. In this paper, we introduce an Interpretable Prediction Model for Decoupling Camber-process Parameters (called IP-DCP), to investigate the process coupling within the entire rough rolling process. IP-DCP employs conditional modeling to integrate the intricate dependencies of process parameters during rough rolling, dynamically shaping composite features that enhance accurate camber predictions. Additionally, we introduce statistical interpretations for camber predictions using SHapley Additive exPlanation (SHAP) models. This enables a comprehensive comparison of critical process factors influencing camber and coupling analysis in various rolling scenarios, including the overall rough-rolled slab and specific steel grades such as Q335B and ST12. Extensive experiments have been conducted on actual rough roughing datasets, demonstrating the superior performance of our camber prediction model compared to baselines. Furthermore, we have conducted a quantitative analysis of their overall effect, main effect, and interaction effect. These coupling analysis results consistently align with established theoretical insights, showing their substantial significance in advancing precise process optimization strategies and cost-efficient measures for controlling camber.

Investigating digitization and digital preservation strategies for theses and dissertations: a case study of Quaid-I-Azam university, Pakistan

Purpose The purpose of this study is to outline the process, procedures and techniques used for digitization and digital preservation of theses and dissertations (TDs) collection at the Central Library of Quaid-I-Azam University, Pakistan. Design/methodology/approach Since the phenomenon under investigation is exploratory in nature, a case study qualitative paradigm was used to conduct this study. Findings The findings of the study offer a brief overview of the cost-effective solution that leveraged in-house expertise for the digital preservation of TDs. This led to the establishment of a knowledge repository hosting a substantial collection of approximately 25,857 electronic theses and dissertations, accessible online since August 2023. This project digitally preserved approximately 9,387 TDs on CDs/DVDs, and scanned about 15,000 print TDs, comprising around 1,399,244 pages. The cost incurred per page, including labor and rent of a photocopy machine, was just Rs 0.548 making it a cost-effective technique. The total cost incurred for this process was just 0.768m Pakistani rupees (equivalent to $2,509.55). The findings revealed key challenges, including administrative, financial, technical and copyright issues, that impede the effective execution of the project. Research limitations/implications This case study is limited to one Pakistani public sector university library. This case study holds significance in terms of practical insights and implications for academic institutions and library administrators in other developing countries like Pakistan, which have similar economic, social and technical circumstances. Originality/value To the best of the authors’ knowledge, this is the first-ever study conducted to elucidate the cost-effective strategy adopted for digitally preserved TDs without additional financial and human resources while creating a knowledge repository.

Type 2 Diabetes Mellitus in Low- and Middle-Income Countries: The Significant Impact of Short-Chain Fatty Acids and Their Quantification.

Globally, type 2 diabetes mellitus (T2DM) is a major threat to the public's health, particularly in low- and middle-income countries (LMICs). The production of short-chain fatty acids (SCFAs) by the gut microbiota has been reported to have the potential to reduce the prevalence of T2DM, particularly in LMICs where the disease is becoming more common. Dietary fibers are the primary source of SCFAs; they can be categorized as soluble (such as pectin and inulin) or insoluble (such as resistant starches). Increased consumption of processed carbohydrates, in conjunction with insufficient consumption of dietary fiber, has been identified as a significant risk factor for type 2 diabetes (T2DM). However, there are still controversies over the therapeutic advantages of SCFAs on human glucose homeostasis, due to a lack of studies in this area. Hence, a few questions need to be addressed to gain a better understanding of the beneficial link between SCFAs and glucose metabolism. These include the following: What are the biochemistry and biosynthesis of SCFAs? What role do SCFAs play in the pathology of T2DM? What is the most cost-effective strategy that can be employed by LMICs with limited laboratory resources to enhance their understanding of the beneficial function of SCFAs in patients with T2DM? To address the aforementioned questions, this paper aims to review the existing literature on the protective roles that SCFAs have in patients with T2DM. This paper further discusses possible cost-effective and accurate strategies to quantify SCFAs, which may be recommended for implementation by LMICs as preventive measures to lower the risk of T2DM.

Comparison of cooling tower blowdown and enhanced make up water treatment to minimize cooling water footprint

When water supply restrictions increasingly escalate to water supply risks, developing strategies to minimize the water footprint of wet cooling systems becomes crucial. This study compares two water engineering approaches to minimize the water footprint of a recirculating evaporative cooling tower (CT): (1) reusing cooling tower blowdown and (2) producing demineralized water to increase the cycles of concentration (CoC) of the CT.Our techno-economic analysis across various scenarios and CT settings reveals that reusing blowdown (option 1) is the most feasible approach for an industrial cooling system currently operating at CoCs of > 3, discharging blowdown with a conductivity of 2 mS/cm and a total organic carbon (TOC) concentration of approximately 20 mg/L. Compared to enhanced make up treatment, blowdown reuse allows higher water savings (13 %) and involves lower implementation and operation costs.Pilot scale trials validated the feasibility of both approaches. Blowdown and enhanced make up treatment included biologically activated carbon filtration, ultrafiltration and reverse osmosis, producing high-quality permeate, suitable for (re)use as CT make up or within other processes. The blowdown treatment reached a product quality of 80 μS/cm conductivity and 70 μg/L TOC, make up treatment 20 μS/cm in conductivity and 60 μg/L TOC, respectively.The study's findings underscore the viability of blowdown reuse as a cost-effective and efficient strategy to minimize the water footprint of cooling systems under increasing water scarcity conditions.

Screening Targets and Therapeutic Drugs for Alzheimer's Disease Based on Deep Learning Model and Molecular Docking.

Alzheimer's disease (AD) is a neurodegenerative disorder caused by a complex interplay of various factors. However, a satisfactory cure for AD remains elusive. Pharmacological interventions based on drug targets are considered the most cost-effective therapeutic strategy. Therefore, it is paramount to search potential drug targets and drugs for AD. We aimed to provide novel targets and drugs for the treatment of AD employing transcriptomic data of AD and normal control brain tissues from a new perspective. Our study combined the use of a multi-layer perceptron (MLP) with differential expression analysis, variance assessment and molecular docking to screen targets and drugs for AD. We identified the seven differentially expressed genes (DEGs) with the most significant variation (ANKRD39, CPLX1, FABP3, GABBR2, GNG3, PPM1E, and WDR49) in transcriptomic data from AD brain. A newly built MLP was used to confirm the association between the seven DEGs and AD, establishing these DEGs as potential drug targets. Drug databases and molecular docking results indicated that arbaclofen, baclofen, clozapine, arbaclofen placarbil, BML-259, BRD-K72883421, and YC-1 had high affinity for GABBR2, and FABP3 bound with oleic, palmitic, and stearic acids. Arbaclofen and YC-1 activated GABAB receptor through PI3K/AKT and PKA/CREB pathways, respectively, thereby promoting neuronal anti-apoptotic effect and inhibiting p-tau and Aβ formation. This study provided a new strategy for the identification of targets and drugs for the treatment of AD using deep learning. Seven therapeutic targets and ten drugs were selected by using this method, providing new insight for AD treatment.

Could minimum grading enhance high school graduation rates and cost-effectiveness across Arkansas?

High school graduation is a pivotal milestone that can shape students' future, offering them opportunities for higher education and gainful employment. Because research shows grade point averages and course failures to be predictive of high school graduation, it is important for students' life outcomes that their teachers assign them equitable grades. However, recent research has scrutinized how schools have traditionally graded students, calling for new approaches such as minimum grading. In this analysis, we simulate the economic impacts of implementing a minimum grading policy statewide during the ninth-grade year of the cohort of students who were in ninth grade in 2015-16 in Arkansas. On average, in Arkansas public schools, we estimate that minimum grading would affect about one (narrow bound) to 3% (broad bound) of students, increase cost-effectiveness by 6% (narrow bound) to 23% (broad bound), largely varying across districts, and have essentially no impact on the return on investment. The application of minimum grading shifted 1% of failing course grades to passing, thereby positioning 10% of previously failing students to pass. These findings suggest that minimum grading could serve as a cost-effective strategy to enhance graduation rates in districts with higher rates of affected students, without necessitating additional educational spending.

Computer Simulation of Catheter Cryoablation for Pulmonary Vein Isolation.

Cryoablation is a well-established medical procedure for surgically treating atrial fibrillation. Cryothermal catheter therapy induces cellular necrosis by freezing the insides of pulmonary veins, with the goal of disrupting abnormal electrical heart signals. Nevertheless, tissue damage induced by cold temperatures may also lead to other complications after cardiac surgery. In this sense, the simulation of catheter ablation can provide safer environments for training and the performance of cryotherapy interventions. Therefore, in this paper, we propose a novel approach to help better understand how temperature rates can affect this procedure by using computer tools to develop a simulation framework to predict lesion size and determine optimal temperature conditions for reducing the risk of major complications. The results showed that a temperature profile of around -40 °C caused less penetration, reduced necrotic damage, and smaller lesion size in the tissue. Instead, cryotherapy close to -60 °C achieved a greater depth of temperature flow inside the tissue and a larger cross-section area of the lesion. With further development and validation, the framework could represent a cost-effective strategy for providing personalized modeling, better planning of cryocatheter-based treatment, and preventing surgical complications.

Simultaneous efficient evaporation and stable electricity generation enabled by a wooden evaporator based on composite photothermal effect

The current solar interfacial evaporators have limited evaporation performance due to their single photothermal mechanism, insufficient light utilization, and improper heat management. Therefore, a novel approach involving polypyrrole (PPy) and Ag nanoparticles (AgNPs) modified wooden evaporator (AgPW) using an in-situ polymerization and growth method was proposed for efficient and sustainable freshwater purification. The composite photothermal effect of PPy and AgNPs led to a significantly enhanced light absorption capacity and superior photothermal conversion efficiency in a wide spectrum range, which coupled with the rapid water transport capacity conferred by the regular vertical channels and superior hydrophilicity of the delignified wood, resulted in remarkable evaporation performance through the coordinated regulation of thermal and water management. The optimized AgPW50 achieved an evaporation rate of up to 2.04 kg m−2 h−1 and an evaporation efficiency of 90.7 % under 1 kW m−2 irradiation. Importantly, this evaporator was highly salt resistant and long-term desalination stability, and can also be extended to the purification of various types of wastewaters while converting the released waste heat into stable electricity generation. The innovative Ag/PPy wooden evaporator integrates biomass resources with solar energy utilization, demonstrating an environmentally friendly, efficient and cost-effective strategy for seawater desalination and energy production, providing a new sustainable development pathway to solve the challenge of balancing water security and energy consumption.

One stone, three birds: Cu2+-substituted chloride electrolyte for high-performance all-solid-state lithium batteries

Emerging solid electrolytes, represented by Li2ZrCl6 (LZC), hold great potential due to their lower costs and superior electrochemical stability compared to sulfide SEs (e.g. Li5.4PS4.4Cl1.6). However, challenges such as relatively low ionic conductivity and instability with lithium hinder its widespread application. This work develops a cost-effective strategy by substituting Cu2+ for Zr4+ in LZC electrolyte. The evolution of electrolyte structure at varying substitution levels is comprehensively investigated by synchrotron X-ray diffraction and Raman spectroscopy. The optimized Cu2+-substituted LZC achieves a notable ionic conductivity of 0.75 mS cm−1 due to a reduced energy barrier for Li+ migration confirmed by first-principles calculations. Symmetric lithium cells with the Cu2+-substituted LZC exhibit enhanced inhibition to lithium dendrites than those with Li5.4PS4.4Cl1.6. X-ray photoelectron spectroscopy unveils the key role of Cu2+ reduction in the inhibition of the lithium dendrite, enabling the cell to stably cycle at 0.5 mA cm−2. Moreover, the Cu2+-substituted LZC exhibits improved electrochemical stability, marked by small anodic current exceeding 4 V, reduced polarization, and rapid lithium-ion diffusion kinetics. All-solid-state batteries fabricated with the Cu2+-substituted LZC and Li/LiNi0.8Mn0.1Co0.1O2 electrodes present a high reversible capacity of 139.2 mAh g−1 with retention rate of 96.9 % after 200 cycles at 0.5 C.

Remote blood pressure management for postpartum hypertension: a cost-effectiveness analysis

Recognizing the importance of close follow-up after hypertensive disorders of pregnancy, many centers have initiated programs to support postpartum remote blood pressure management. This study aimed to evaluate the cost-effectiveness of remote blood pressure management to determine the scalability of these programmatic interventions. This was a cost-effectiveness analysis of using remote blood pressure management vs usual care to manage postpartum hypertension. The modeled remote blood pressure management included provision of a home blood pressure monitor, guidance on warning symptoms, instructions on blood pressure self-monitoring twice daily, and clinical staff to manage population-level blood pressures as appropriate. Usual care was defined as guidance on warning symptoms and recommendations for 1 outpatient visit for blood pressure monitoring within a week after discharge. This study designed a Markov model that ran over fourteen 1-day cycles to reflect the initial 2 weeks after delivery when most emergency department visits and readmissions occur and remote blood pressure management is clinically anticipated to be most impactful. Parameter values for the base-case scenario were derived from both internal data and literature review. Quality-adjusted life-years were calculated over the first year after delivery and reflected the short-term morbidities associated with hypertensive disorders of pregnancy that, for most birthing people, resolve by 2 weeks after delivery. Sensitivity analyses were performed to assess the strength and validity of the model. The primary outcome was the incremental cost-effectiveness ratio, which was defined as the cost needed to gain 1 quality-adjusted life-year. The secondary outcome was incremental cost per readmission averted. Analyses were performed from a societal perspective. In the base-case scenario, remote blood pressure management was the dominant strategy (ie, cost less, higher quality-adjusted life-years). In univariate sensitivity analyses, the most cost-effective strategy shifted to usual care when the cost of readmission fell below $2987.92 and the rate of reported severe range blood pressure with a response in remote blood pressure management was <1%. Assuming a willingness to pay of $100,000 per quality-adjusted life-year, using remote blood pressure management was cost-effective in 99.28% of simulations in a Monte Carlo analysis. Using readmissions averted as a secondary effectiveness outcome, the incremental cost per readmission averted was $145.00. Remote blood pressure management for postpartum hypertension is cost saving and has better outcomes than usual care. Our data can be used to inform future dissemination of and support funding for remote blood pressure management programs.

Tuning of fluorescence in titanium carbide MXene nanosheets with La3+ ion doping for the recognition of creatinine biomarker in biofluids

There is a strong correlation between the concentration of creatinine in human urine and the overall health of the kidneys. Therefore, there has been a persistent need for a rapid, and cost-effective quantitative method to assay creatinine levels in urine. Herein, green fluorescent La3+ doped titanium carbide nanosheets (La3+-doped Ti3C2 NSs) are fabricated via HF etching method by using Ti3AlC2 as MAX phase material and La(NO3)3 as a doping agent. As synthesized fluorescent La3+-doped Ti3C2 NSs are stable, showing green fluorescence under UV light. The as-synthesized La3+-doped Ti3C2 NSs act as a fluorescent sensor for the sensitive recognition of creatinine biomarker. The La3+-doped Ti3C2 NSs-based fluorescence method showed a fluorescence quenching at emission wavelength 518 nm towards creatinine with a linear range of 0.25–7.5 μM and detection limit of 63.44 nM. The paper strip based on La3+-doped Ti3C2 NSs was developed for the visual identification of creatinine. Furthermore, La3+-doped Ti3C2 NSs were used as probes for imaging of Saccharomyces cerevisiae cells. Also, the as-fabricated La3+-doped Ti3C2 NSs propose a quick response giving a cost-effective analytical strategy for the selective assay of creatinine in biofluids (plasma and urine).

Chronic thromboembolic pulmonary hypertension is an uncommon complication of COVID-19: UK national surveillance and observational screening cohort studies.

Pulmonary embolism (PE) is a well-recognised complication of coronavirus disease 2019 (COVID-19) infection, and chronic thromboembolic pulmonary disease with and without pulmonary hypertension (CTEPD/CTEPH) are potential life-limiting consequences. At present the burden of CTEPD/CTEPH is unclear and optimal and cost-effective screening strategies yet to be established. We evaluated the CTEPD/CTEPH referral rate to the UK national multidisciplinary team (MDT) during the 2017-2022 period to establish the national incidence of CTEPD/CTEPH potentially attributable to COVID-19-associated PE with historical comparator years. All individual cases of suspected CTEPH were reviewed by the MDT for evidence of associated COVID-19. In a separate multicentre cohort, the risk of developing CTEPH following hospitalisation with COVID-19 was calculated using simple clinical parameters at a median of 5 months post-hospital discharge according to existing risk scores using symptoms, ECG and N-terminal pro-brain natriuretic peptide. By the second year of the pandemic, CTEPH diagnoses had returned to the pre-pandemic baseline (23.1 versus 27.8 cases per month; p=0.252). Of 334 confirmed CTEPD/CTEPH cases, four (1.2%) patients were identified to have CTEPH potentially associated with COVID-19 PE, and a further three (0.9%) CTEPD without PH. Of 1094 patients (mean age 58 years, 60.4% male) hospitalised with COVID-19 screened across the UK, 11 (1.0%) were at high risk of CTEPH at follow-up, none of whom had a diagnosis of CTEPH made at the national MDT. A priori risk of developing CTEPH following COVID-19-related hospitalisation is low. Simple risk scoring is a potentially effective way of screening patients for further investigation.

Enhancing the environmental and economic sustainability of heterotrophic microalgae cultivation: Kinetic modelling and screening of alternative carbon sources

Heterotrophic microalgae cultivation has been suggested to reduce conventional photo-autotrophic microalgal biomass production costs. In heterotrophic cultivation, the most relevant operational costs are constituted by the supply of pure substrates used as carbon source (e.g., glucose), and the high energy request for culture aeration. In addition, suboptimal conditions of temperature and pH reduce the algal productivity, further increasing production costs. In this work, an attempt was made to define more sustainable and cost-effective strategies for the heterotrophic cultivation of Chlorellaceae and Scenedesmaceae. Several by-products from a local confectionery industry were thus screened as alternative carbon sources. Manufacturing residues from peppermint and liquorice candies production allowed to achieve comparable maximum growth rates (1.44 d-1), biomass yields (0.33 g COD·g COD-1) and biomass productivities (370 mg COD·L-1·d-1) as those achieved using glucose. A preliminary economic evaluation showed that the operational costs could be lowered of up to 85.6% by substituting glucose with the selected industrial by-products. As for fermentation conditions, high growth rates could be maintained at relatively low dissolved oxygen (DO) concentrations, and in a large range of temperature and pH values. In addition, optimal temperatures (37.0 – 37.2°C), pH values (6.8 – 7.4), and DO concentrations (> 0.5 – 1 mg O2·L-1) were identified. On the overall, the study demonstrated the possibility of achieving the reduction of operational costs for heterotrophic microalgae cultivation, while implementing circular economy principles in the framework of resource recovery during the bioremediation of organic waste.

Optimizing Cost-Effective Care for Chronic Constipation in General Gastroenterology Using an Office-Based, Point-Of-Care Test (RED): Cost-Effectiveness and Cost-Minimization Analysis.

We aimed to evaluate the cost-effectiveness/cost-savings of point-of-care anorectal function testing with an investigational device (RED) to triage therapy for chronic constipation in general gastroenterology. A Markov model was constructed to evaluate cost-effectiveness/cost-savings over a 1-year time horizon comparing empiric drug/pelvic floor physical therapy to testing guided care. RED appears to inform the cost-effective strategy for chronic constipation. Compared with usual care without RED, it reduces insurer costs by $810 and patient costs by $6,903. Point-of-care testing using RED appears cost-effective/cost-saving to triage chronic constipation care in general gastroenterology.