Facility Costs Research Articles

Gianyar Botanical Garden Development Strategy as a Tourism Attraction Based on Local Wisdom in Kerta Tourism Village, Payangan District, Gianyar Regency

Gianyar Botanical Gardens is one of the natural attractions located in Gianyar Regency. The Gianyar BotanicalGardens has beautiful, cool and still beautiful natural potential that provides comfort for visitors to touristattractions, and has supporting potential such as cultural tourism and local wisdom such as the Bali Agatradition, Bali Age Architecture, and Gelagar Dance where this local wisdom is only owned by Kerta TourismVillage. In the development there are problems that hinder its implementation, including budget limitations forthe cost of facilities and infrastructure for tourist objects such as infrastructure, road conditions and otherfacilities that support the existence of the Gianyar Botanical Gardens tourist attraction. Lack of promotion oftourist objects, the need for empowerment of local communities about tourism and tourism development. Thisstudy aims to analyze the right strategy in the development of the Gianyar Botanical Gardens tourism object.The method used in this study is a qualitative method with a descriptive approach. This study uses a theorybased on a SWOT analysis. The results of this study indicate that the right strategy to be used in thedevelopment of the Gianyar Botanical Gardens is a strategy for utilizing natural potential, cultural tourism andlocal wisdom to support the existence of the Gianyar Botanical Garden tourism object to increase touristattraction in Gianyar Regency, a strategy for strengthening local community awareness institutions indevelopment of tourism objects and strategies to increase the capacity and role of rural communities throughthe village government in developing tourism objects of the Gianyar Botanical Gardens.Keywords: Strategy, Development, Garden, Local Wisdom

TECHNICAL AND ECONOMIC ASPECTS OF THE IMPLEMENTATION OF WATER REMOVAL TARIFFS ON DRAINED LANDS OF UKRAINE

The article highlights the main provisions of setting tariffs for water removal services for drainage. The application of tariffs is considered as an economic tool for increasing the efficiency of the use of drained lands when implementing the Strategy of Irrigation and Drainage in Ukraine [1]. An analysis of the provisions of the Law of Ukraine "On the Organization of Water Users and Stimulation of Hydrotechnical Land Reclamation"[2] regarding the provision of water users with water removal services for drainage by water user organizations and the payment of services by water users by the established water removal tariff was carried out. Emphasis is placed on the priority of the efforts in the field of hydraulic reclamation, namely proper operation and restoration of the country's drainage systems. The main point of the study is to realize the role of the status of water users who use water bodies to meet the needs of agriculture. According to the current legislation of Ukraine, the methodology of tariff formation should be based on a single basis - both for water supply and water removal.
 It is necessary to take into account the requirements of EU regulations regarding the consideration of the activities specifics in the field of water policy. Information on the development of water user organizations in Ukraine is provided and the operation costs of reclamation infrastructure facilities on the country's drainage systems are analyzed. The practice of foreign countries regarding the application of tariffs for water removal is given and the factors of the natural environment that were taken into account when selecting the option/options of water management in agriculture on drained lands of the country are outlined. The vision of researchers regarding the method of establishing and applying tariffs is given and a thorough assessment of the reasoning of scientists is provided. The areas for further research in the field of tariff formation for drainage are indicated. The base of tariff formation and methodical approaches to the formation of tariffs for water removal in the drainage area in Ukraine are proposed. The normative legal acts of Ukraine, the UN, EU bodies, the World Bank, data from scientific studies on tariff formation in agriculture on drained lands for 1991-2023, and administrative data were used as the main sources of information for the article.

Comparison of liquid nitrogen-free slow freezing protocols toward enabling a practical option for centralized cryobanking of ovarian tissue

Geographically distributed ovarian tissue cryobanks remain limited due to the high facility and staff costs, and cold transportation to centers is associated with ischemia-induced tissue damage that increases with transport distance. It is ideal to perform the cryopreservation procedure at a tissue removal site or local hospital before shipment to cost-effective centralized cryobanks. However, conventional liquid nitrogen-based freezers are not portable and require expensive infrastructure. To study the possibility of an ovarian tissue cryopreservation network not dependent on liquid nitrogen, we cryopreserved bovine ovarian tissue using three cooling techniques: a controlled rate freezer using liquid nitrogen, a liquid nitrogen-free controlled rate freezer, and liquid nitrogen-free passive cooling. Upon thawing, we evaluated a panel of viability metrics in frozen and fresh groups to examine the potency of the portable liquid nitrogen-free controlled and uncontrolled rate freezers in preserving the ovarian tissue compared to the non-portable conventional controlled rate freezer. We found similar outcomes for reactive oxygen species (ROS), total antioxidant capacity (TAC), follicular morphology, tissue viability, and fibrosis in the controlled rate freezer groups. However, passive slow cooling was associated with the lowest tissue viability, follicle morphology, and TAC, and the highest tissue fibrosis and ROS levels compared to all other groups. A stronger correlation was found between follicle morphology, ovarian tissue viability, and fibrosis with the TAC/ROS ratio compared to ROS and TAC alone. The current study undergirds the possibility of centralized cryobanks using a controlled rate liquid nitrogen-free freezer to prevent ischemia-induced damage during ovarian tissue shipment.

A scoping review on HIV early infant diagnosis among HIV exposed infants, ART use and adherence in Tanzania

BackgroundHIV Early Infant Diagnosis (HEID) is critical for the timely initiation of HIV treatments and improved health outcomes among HIV-infected infants. However, the uptake of HEID remains largely low in Tanzania. This descriptive scoping review of evidence on HEID among HIV-exposed infants in Tanzania seeks to understand the dynamics of HEID, ART use and adherence to inform targeted interventions and promote its uptake.MethodsThe Arksey and O’Malley’s methodological framework guided this scoping review. We searched for peer-published articles on HEID in Tanzania through PubMed and Google Scholar with full-text retrieval from HINAR. We included only English language articles published between 2013 and 2022. Further searches for the materials on the reference lists of the publications yielded additional relevant articles. We carried out an inductive thematic analysis to analyze and synthesize the data.ResultsIn all, nine articles met the inclusion criteria and, hence, qualified for the review. The variations in the uptake of HEID in the empirical literature reviewed indicate an upward trend. HEID increased from 77.2% in 2009 to 97.8% in 2011 in Kilimanjaro, Mbeya and Tanga and from 53.2% in 2014 to 69.2% in 2016 in Dar es Salaam. The median age at the initial test ranged from 5.6 weeks in Kilimanjaro to 8.6 weeks in Mbeya. The uptake of HEID was necessitated by individual, household and health facility factors. Unknown HIV status at conception, low level of education of the household head, and large household size negatively affected uptake of HEID. The health facility factors such as unavailability of the test kits, long distances to the facility and transport costs negatively influenced HEID uptake. The percentage of HIV-positive infants on ART ranged from 52.7 to 61%, and loss to follow ranged from 31 to 61%.ConclusionThe uptake of HEID varied among regions depending on individual, household and health facility factors. Multifaced efforts are needed to address these factors for accelerated uptake of HEID and improved health outcomes and survival among this strategic population group.

Optimization of safety instrumented system performance and maintenance costs in Algerian oil and gas facilities

Gas processing industry is associated with high risks which have the potential to cause catastrophic accidents. Safety Instrumented Systems (SISs) are considered the most effective safety barriers in this sector aiming to prevent undesired events and mitigate their consequences. However, several factors can affect their performance including maintenance strategy in place. In this paper, a Stochastic Petri Net (SPN) model is proposed for evaluating maintenance strategies related to SIS. The model is applied to analyze the performance of an Emergency Shutdown System (ESD) in a Flared Gases Recovery Unit located at south Algerian field. Furthermore, the paper investigates the financial impact of proof tests, including direct costs (such as manpower, equipment, and transportation) and indirect costs (such as production losses and gas flaring tax). These costs can be effectively managed and reduced by optimizing proof test intervals and scheduling tests during planned plant shutdowns. The results demonstrate that the proposed Stochastic Petri Net (SPN) model successfully analyzes the impact of imperfect full and partial proof tests on PFD average values of Safety Instrumented Functions (SIFs). In addition, it has been shown through reliability analysis that the proposed model is able to minimize spare parts expenses leading to significant cost savings while maintaining the required safety integrity levels (SILs), about 60% benefit achieved within two years compared to the actual procurement process over same period.

Comparison between optimal refueling infrastructures for zero emission waste transportation vehicles in Valle Camonica

The aim of this work is to conduct a comprehensive and fair comparison between fleets of vehicles powered by different technologies, namely electricity, compressed hydrogen, and liquid hydrogen. The study followed a well-defined methodology, starting with the development of a mixed-integer linear programming (MILP) model using MATLAB and the YALMIP toolbox. The primary objective of the model is to minimize the total annual cost associated with the infrastructure required for refuelling the fleet of zero-emission vehicles. The battery electric vehicle refuelling infrastructure is used as a benchmark, with a total annual cost of around 200000 €/y. The compressed hydrogen and liquid hydrogen infrastructure are comprehensive of a solar photovoltaic field. The hydrogen refuelling facility are analysed varying the price of the electricity. In the most profitable configuration, the compressed hydrogen refuelling facility cost around 320000 €/y and for the liquid hydrogen 480000 €/y. The sensitivity analysis, performed varying the cost of electricity, shows that it is never convenient to use hydrogen vehicles even in condition of high electricity prices. When it is possible to use electric vehicles and there are no constraints related to payload, range or refueling logistics they must be employed, as they are the most cost-effective solution to cancel the vehicles emissions.

PMFFRC: a large-scale genomic short reads compression optimizer via memory modeling and redundant clustering

BackgroundGenomic sequencing reads compressors are essential for balancing high-throughput sequencing short reads generation speed, large-scale genomic data sharing, and infrastructure storage expenditure. However, most existing short reads compressors rarely utilize big-memory systems and duplicative information between diverse sequencing files to achieve a higher compression ratio for conserving reads data storage space.ResultsWe employ compression ratio as the optimization objective and propose a large-scale genomic sequencing short reads data compression optimizer, named PMFFRC, through novelty memory modeling and redundant reads clustering technologies. By cascading PMFFRC, in 982 GB fastq format sequencing data, with 274 GB and 3.3 billion short reads, the state-of-the-art and reference-free compressors HARC, SPRING, Mstcom, and FastqCLS achieve 77.89%, 77.56%, 73.51%, and 29.36% average maximum compression ratio gains, respectively. PMFFRC saves 39.41%, 41.62%, 40.99%, and 20.19% of storage space sizes compared with the four unoptimized compressors.ConclusionsPMFFRC rational usage big-memory of compression server, effectively saving the sequencing reads data storage space sizes, which relieves the basic storage facilities costs and community sharing transmitting overhead. Our work furnishes a novel solution for improving sequencing reads compression and saving storage space. The proposed PMFFRC algorithm is packaged in a same-name Linux toolkit, available un-limited at https://github.com/fahaihi/PMFFRC.

Estimation of Postinfusion Resource Use and Total Costs of Care for Patients with R/R Follicular Lymphoma (FL) Receiving Lisocabtagene Maraleucel (liso-cel) in the TRANSCEND FL Study

Background: Liso-cel, an autologous, CD19-directed, 4-1BB CAR T cell product administered at equal target doses of CD8 + and CD4 + CAR + T cells, has previously demonstrated clinically meaningful responses in patients with R/R FL in the global phase 2 TRANSCEND FL study (NCT04245839). Limited evidence is published on estimates of health care resource utilization (HCRU) and cost of postinfusion care among patients with large B-cell lymphoma (LBCL) treated with liso-cel (Palomba ML, et al. Leuk Lymphoma 2021), and no evidence is currently available for patients with R/R FL. This analysis evaluated postinfusion HCRU and estimated cost of care across a 6-month period among patients treated with liso-cel in the TRANSCEND FL study. Methods: In this retrospective analysis, patient-level HCRU data from the TRANSCEND FL study database, including hospitalizations and length of hospital stay (LOS) for the entire hospitalization period postinfusion (standard inpatient [IP] and ICU days), diagnostics (eg, laboratory work and imaging), procedures (eg, dialysis and intubation), and medications (eg, oncology supportive care, prophylactics, and other AE management), were analyzed from the day of liso-cel infusion through 6 months of follow-up. Postinfusion costs (not including the cost of liso-cel) were estimated using a microcosting methodology in which HCRU in the 6-month period was identified and unit costs sourced from public databases or literature (adjusted to 2023 US dollars [USD] using the Consumer Price Index) were applied to each HCRU. Facility costs were sourced from the Healthcare Cost and Utilization Project National Inpatient Sample (2020) databases (Dasta JF, et al. Crit Care Med 2005), and the US Centers for Medicare and Medicaid Services (CMS) Hospital Outpatient Prospective Payment System (OPPS; 2023). Diagnostic and procedure costs were obtained from the CMS OPPS (2023), clinical laboratory fee schedule (2023), physician fee schedule (2023), durable medical fee schedule (2023), and Dasta 2005. Medication cost data were obtained from IBM ® Micromedex ® RED BOOK ® (2023) using wholesale acquisition cost and were uniformly applied across sites of care. Average total cost by month after liso-cel infusion was calculated among patients with ongoing status in that month. Patients censored due to data cutoff were excluded. Results: A total of 130 patients were treated with liso-cel in the TRANSCEND FL study, primarily in the fourth-line setting (45.4%). These patients had a median (range) age of 60 (23‒80) years and were predominantly male (83/130 [63.8%]) and White (69/130 [53.1%]); 45 (34.6%) had unknown race. Among patients who received liso-cel infusions, the estimated mean 6-month postinfusion total cost of care was $89,516 (Figure 1). Most 6-month costs ($77,088 [86.1%]) were incurred in Month 1 after infusion and were primarily driven by facility costs ($66,683 [74.5%]), namely standard IP hospitalization and ICU stays. HCRU and LOS (including standard IP hospitalization and ICU days) are shown in Table 1. Almost all patients were hospitalized in the standard IP setting (128/130 [98.5%]). Few patients were admitted to the ICU (4/130 [3.1%]), and 3/130 (2.3%) had an emergency department visit. Median (range) hospitalization time was 14 (3‒45) days for standard IP and 5 (3‒7) days for ICU stays. Some patients received corticosteroids (30/130 [23.1%]) or tocilizumab (31/130 [23.8%]), and few required intravenous immunoglobulin (11/130 [8.5%]), vasopressors (4/130 [3.1%]), lumbar puncture (2/130 [1.5%]), or mechanical ventilation (1/130 [0.8%]). No patients received dialysis. Conclusions: The majority of costs in the 6-month period after liso-cel infusion among patients with R/R FL in the TRANSCEND FL study were incurred in Month 1 and were facility related (IP and ICU hospitalizations and LOS). These findings, consistent with those previously reported for patients with LBCL treated with liso-cel, support that a single infusion of liso-cel is associated with significantly less HCRU and costs after the initial treatment period in the first month.

Facility-Related Healthcare Resource Utilization (HCRU) for Patients Treated with Idecabtagene Vicleucel (Ide-Cel, bb2121) in a Real-World (RW) Setting: A Single-Center Experience

Introduction: Ide-cel is a B-cell maturation antigen (BCMA)-directed chimeric antigen receptor (CAR) T cell therapy associated with deep and durable responses and improved quality of life among triple-class exposed (TCE) patients with relapsed/refractory multiple myeloma (RRMM) (Munshi NC, et al. N Engl J Med 2021;384:705-716; Delforge M, et al. Blood Adv 2022;6:1309-1318). An analysis of 2-year post-infusion facility-related HCRU (fHCRU) associated with ide-cel treatment in the phase 2 KarMMa clinical trial (NCT03361748) found that most facility costs were incurred within the first month following infusion where the median hospital length of stay (LOS) was 19.5 days which included the clinical trial requirement of hospitalization for monitoring and 20% of the patients had intensive care unit (ICU) stays (McGarvey N, et al. Blood 2022;140(suppl 1):10947-10948). In this study, we estimated fHCRU and associated costs for patients with TCE RRMM receiving ide-cel in RW clinical practice. Methods: This was a retrospective chart review of adults (≥ 18 years of age) with TCE RRMM who received an ide-cel infusion in RW clinical practice at H. Lee Moffitt Cancer Center, Tampa, FL, USA from May 25, 2021 to December 27, 2022. Costs were estimated using a two-step micro-costing methodology. Unit costs were sourced from public databases or literature, adjusted to 2022 US dollars and then applied to fHCRU. Patient characteristics and fHCRU were characterized using descriptive statistics, and the distribution of fHCRU was examined by key characteristics using Wilcoxon rank sum or chi-square tests. fHCRU and total facility costs included LOS and ICU stays obtained from the National Inpatient Sample and peer-reviewed literature, inflated to 2022 US dollars (USD); LOS days included readmissions. Unit costs (2022) were applied to post-index hospitalizations at the rate of USD 3001.80 per inpatient day and USD 9351.52 per ICU day. Results: A total of 109 patients were included. Median age was 65 years, 61% were male, 67% were non-Hispanic White, 14% had extramedullary disease, and 28% had high-risk cytogenetics. Patients had a median (range) of 6.0 (4.0-13.0) prior lines of MM therapy; 75% and 30% of patients were triple- and penta-class refractory, respectively. Median (range) follow-up was 9.2 months (0.2-24.4). Any grade cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS) occurred in 82% and 17% of patients, respectively. Moderate or worse CRS and ICANS (grade ≥ 2) occurred in 19% and 10% of patients, respectively. A total of 71% of patients received tocilizumab, 34% received steroids, and 2% received anakinra for toxicity management. Only 26% of patients would have been eligible for the KarMMa trial. In the overall cohort, median LOS was 8.0 days (interquartile range [IQR], 7.0-10.0) and total median hospital costs were USD 24,014 (IQR, USD 21,013-30,018). Five (5%) patients had an ICU stay (median 8.0 days; IQR, 8.0-12.0) with total median costs of USD 76,252 (IQR, USD 76,252-114,378). fHCRU was comparable when analyzed by extramedullary disease, high-risk cytogenetics, penta-class refractory status, age at infusion (< 65 vs ≥ 65 years), and KarMMa clinical trial eligibility criteria ( P > 0.05). LOS and total costs were significantly lower among those with grade < 2 versus grade ≥ 2 CRS (both P < 0.05) or ICANS (both P < 0.01). Patients with more severe toxicity (grade ≥ 2) had a longer median LOS (CRS: 9 vs 8 days, P = 0.017; ICANS: 14 vs 8 days, P = 0.0026, respectively), were more likely to have an ICU stay (CRS: 24% vs 0%, P < 0.001; ICANS: 36% vs 1%, P < 0.001, respectively), and had higher median hospital costs (CRS: USD 27,016 vs USD 24,014, P = 0.0069; ICANS: USD 51,031 vs USD 24,014, P = 0.002, respectively) than patients with less severe toxicity (grade < 2) (Figure). Conclusion: This is the first study to characterize fHCRU and associated costs for patients with TCE RRMM who received ide-cel in a RW single-center practice. Median LOS was only 8 days and few patients (5%) had an ICU stay. fHCRU and associated costs were higher among patients who experienced moderate or worse CRS and neurologic toxicity. A limitation of this study is that fHCRU does not consider drug costs, including that of ide-cel. Additional studies with larger sample sizes and detailed cost analyses are needed to further quantify RW HCRU and pre-infusion and post-infusion costs in this patient population.

Healthcare Resource Utilization and Economic Burden of Cytokine Release Syndrome and Neurotoxicity in Patients with Relapsed and Refractory Multiple Myeloma (RRMM) Receiving Idecabtagene Vicleucel in Earlier-Line Settings in the KarMMa-3 Clinical Trial

Introduction: Adverse events (AE), such as cytokine release syndrome (CRS) and neurological toxicity (NT), have been associated with chimeric antigen receptor (CAR) T cell therapies. Idecabtagene vicleucel (ide-cel, bb2121), a B-cell maturation antigen-directed CAR T cell therapy, demonstrated deep and durable responses in triple-class exposed (TCE) patients (pts) with RRMM in the pivotal, single-arm, open-label phase 2 KarMMa (3 prior lines of therapy [LOTs]; NCT03361748) (Munshi NC, et al. NEJM 2021;384:705-716) and superior progression-free survival with ide-cel vs standard regimens in the phase 3 KarMMa-3 trial (2-4 prior LOTS; NCT03651128) (Rodríguez-Otero P, et al. NEJM 2023;388:1002-1014). Healthcare resource utilization (HCRU) and costs associated with CRS/NT management were estimated previously for pts receiving ide-cel in the KarMMa trial (McGarvey N, et al. Value Health 2023;26:S89) and suggested low rates of severe (grade ≥ 3) CRS/NT following ide-cel infusion and higher HCRU and costs with increasing AE severity. To further assess resource and economic burden associated with care of treatment-emergent AEs, this analysis evaluated HCRU and estimated cost of CRS/NT management among pts treated with ide-cel in earlier-line settings in the KarMMa-3 study. Methods: In this retrospective study, case report forms from the KarMMa-3 clinical trial database among pts experiencing a CRS and/or NT event that initiated within 90 days post ide-cel infusion were assessed. Pt-level HCRU data, including hospitalizations and length of hospital stay (LOS) (standard inpatient [IP], intensive care unit [ICU] days), diagnostics (eg, lab work, imaging), procedures (eg, dialysis, intubation), and medications (eg, oncology supportive care, prophylactics, other AE management) were identified from CRS/NT onset through resolution. AE management costs were estimated using a micro-costing methodology in which unit costs sourced from public databases or literature (eg, United States Centers for Medicare and Medicaid Services, Healthcare Cost and Utilization Project, IBM ® Micromedex ® RED BOOK ®) were adjusted to 2022 US dollars (USD) using the Consumer Price Index and applied to each HCRU identified. Results: Of 225 pts treated with ide-cel in the KarMMa-3 trial, 203 (90.2%) experienced any grade CRS and/or NT event. Pts experiencing a CRS/NT event had a mean (standard deviation [SD]) age of 61.9 (8.9) years and most were male (123/203 [60.6%]), White (138/203 [68.0%]), and non-Hispanic or Latino (138/203 [68.0%]). The majority (187/203 [92.1%]) of pts experienced less severe CRS/NT events (grade ≤ 2), which resolved quicker and relatively few pts (16/203 [7.9%]) had a more severe (grade ≥ 3) event, which took longer to resolve. Among pts who received ide-cel, the estimated median cost of AE management ranged from USD 17,124 (CRS only grade 1) to USD 181,552 (nonconcurrent CRS or NT grade ≥ 3) (Figure 1). Additional median costs for a pt with a grade ≥ 3 CRS/NT event was USD 31,045 higher than a grade ≤ 2 CRS/NT event. Across AE categories, the main contributors to CRS/NT management were facility costs, namely standard IP hospitalizations and ICU stays. Almost all pts (202/203 [99.5%]) had a standard IP hospitalization; 3.9% (8/203) had an ICU stay (Table 1). The trial protocol required a stay of ≥ 15 days post infusion unless admitted to the ICU; some hospitalization days recorded during the AE overlapped with the protocol-required stay. ICU admissions were more common among pts with CRS/NT grade ≥ 3 (7/16 [43.8%]) than those with grade ≤ 2 (1/187 [0.5%]). Median (range) total LOS was 10 days longer among pts with grade ≥ 3 (14.5 [2-84] days) than those with grade ≤ 2 (4 [1-34] days) CRS/NT. Pts with grade ≥ 3 CRS/NT had higher rates of HCRU than those with grade ≤ 2 for several interventions, such as medications (eg, tocilizumab + corticosteroids: 13/16 [81.3%] vs 63/187 [33.7%]), diagnostics (eg, imaging: 14/16 [87.5%] vs 48/187 [25.7%]), and procedures (eg, dialysis:3/16 [18.8%] vs 0/187 [0%]). Conclusions: Most pts with RRMM treated with ide-cel in the KarMMa-3 trial experienced a CRS and/or NT event, however, few were of high severity (grade ≥ 3). HCRU and costs for CRS/NT increased with AE severity and management. CAR T cell therapies associated with lower-severity AEs and planned interventions to prevent higher-grade AEs may provide an opportunity to better manage HCRU and costs.

Methods for Predicting the Costs of Maintaining Nuclear Heritage Facilities in а Safe State

The relevance of the conducted research is determined by the need to control and forecast the costs of enterprises to maintain shutdown nuclear energy facilities in a save condition in order to solve budget planning problems. In the near future, an increase in operating expenses is expected due to an increase in the number of such facilities. To solve the problem econometric forecasting methods are used.Purpose of the research. This study is aimed to develop a methodology for estimating the costs of maintaining nuclear and radiation hazardous facilities in a safe condition and the safe storage of radioactive waste, considering the specifics of accounting at nuclear industry enterprises and forecasting such costs, taking into account plans for shutting down and decommissioning of facilities and removing accumulated radioactive waste from storage facilities in the future.Materials and methods. In the research there was developed the methodology of isolation from the overall structure costs, associated with maintaining shutdown facilities and storage facilities for radioactive waste of nuclear industry enterprises. A cumulative estimation of such costs has been carried out for facilities whose operation for the intended purpose has currently been discontinued. Based on obtained retrospective data, a correlation-regression model with structural changes was developed to predict the costs of maintaining nuclear energy facilities in a safe condition which are expected to be shut down in the future. The developed model allows considering the specifics of facilities, their level of radiation hazard and overall characteristics, the average level of wages at enterprises and the cost of resources.Results. Based on the plans for the shutdown and decommissioning of nuclear energy facilities and the disposal of radioactive waste from storage facilities, the costs of maintaining such facilities in a safe condition with a planning horizon up to 2050 have been forecasted. The results of calculations show that the costs for nuclear energy facilities (except for nuclear power plant units) will increase to 10 billion rubles per year by 2035 (in 2022 prices) and will significantly decrease after 2035 - up to 7.5 billion rubles per year. The reduction will be due to the transfer to a nuclear and radiation safe state of large facilities of radiochemical plants, as well as the conservation of sites for the placement of industrial uranium-graphite reactors. The costs of maintaining the storage facilities of accumulated radioactive waste in a safe condition will be reduced annually (almost linearly) as they are transferred to the disposal of the removed radioactive waste and the conservation of special radioactive waste facilities. By 2035, costs will be reduced from the current level of 5 billion rubles to 4.3 billion rubles per year.Conclusion. The results of the study confirm the high importance of the implementation of the Federal Target Program “Ensuring Nuclear and Radiation Safety for 2016-2020 and for the period up to 2035”, under which it is planned to decommission about 75 stopped nuclear and radiation hazardous facilities and transfer about 155 thousand cubic meters of radioactive waste to disposal.

Postinfusion Monitoring Health Care Resource Utilization and Costs By Site of Care Among Inpatients and Outpatients with Relapsed or Refractory Large B-Cell Lymphoma Who Received Second-Line Treatment with Lisocabtagene Maraleucel in the TRANSFORM and PILOT Clinical Trials

Background:CAR T cell therapy administration is often in an inpatient (IP) setting due to the possibility of severe AEs after infusion. Lisocabtagene maraleucel (liso-cel) is an autologous, CD19-directed, 4-1BB CAR T cell product administered at equal target doses of CD8 + andCD4 + CAR + T cells. Outpatient (OP) administration of liso-cel is feasible given trial-demonstrated low rates of grade ≥ 3 AEs that require hospitalization, including cytokine release syndrome and neurological events (Bachier CR, et al. J Clin Oncol 2020). Follow-up care in the OP setting may differ from that in an IP setting and may offer an opportunity to reduce AE management-related health care resource utilization (HCRU) and costs; limited data is published on this topic. Thus, this study assessed postinfusion monitoring HCRU and costs by site of care (ie, IP/OP) among patients with R/R large B-cell lymphoma (LBCL) treated with liso-cel as second-line (2L) therapy in TRANSFORM (NCT03575351) and PILOT (NCT03483103) clinical trials. Methods: A microcosting methodology was used to assess postinfusion monitoring-related HCRU identified from pooled TRANSFORM and PILOT case report forms and to estimate associated costs (excluding liso-cel acquisition costs) by site of care using a 6-month time frame, beginning on the liso-cel infusion date. HCRU data were analyzed in the 6 months after infusion, including facility (eg, number of standard IP and ICU hospitalizations and length of stay [LOS]), procedures (eg, dialysis or intubation/mechanical ventilation), diagnostics (eg, imaging or laboratory tests), and medication use (eg, tocilizumab or corticosteroids). Unit costs were then applied to each HCRU. Unit costs were assessed from the health care system perspective, derived from publicly available databases (eg, United States [US] Centers for Medicare & Medicaid Services, Healthcare Cost and Utilization Project, and IBM ® Micromedex ® RED BOOK ®) or peer-reviewed literature, and adjusted to 2021 US dollars using the medical component of the Consumer Price Index. Patients were considered OP if discharged on the day of infusion or at the end of the observation period. Results: Among 150 patients treated with liso-cel, 111 (74%) were infused as IPs and 39 (26%) as OPs. Estimated median 6-month total postinfusion monitoring costs were $55,253 in the IP setting and $17,505 in the OP setting, reflecting a reduction of $37,748 for OP site of care (Figure). Among patients cared for in the OP setting who required subsequent hospitalization (19/39 [49%]), the median total LOS was 7 days shorter than patients cared for in the IP setting who required hospitalization (105/111 [95%]) (OP: 7 days [range, 1-33] vs IP: 14 days [range, 1-164]). Facility costs, especially hospitalizations, were the largest contributor to overall median 6-month costs in both the IP setting ($40,501; 73%) and the OP setting ($5697; 33%). The majority of total costs occurred in Month 1 postinfusion for patients in both settings. For patients receiving care in the IP setting, 78% ($42,864) of median costs were incurred within the first month after infusion; for OPs, 36% ($6295) of median costs were incurred within Month 1. Patients in the IP setting had higher rates of key HCRU than in the OP setting, respectively, for the following: standard IP hospitalizations (105/111 [95%] vs 19/39 [49%]), ICU admissions (10/111 [9%] vs 0/39 [0%]), any tocilizumab use (32/111 [29%] vs 5/39 [13%]), and any corticosteroid use (54/111 [49%] vs 17/39 [44%]). Patients in the OP setting had higher rates compared with the IP setting, respectively, for office visits (37/39 [95%] vs 87/111 [78%]) and intubation (2/39 [5%] vs 0/111 [0%]). Conclusions: Among patients with R/R LBCL treated with liso-cel in the 2L TRANSFORM and PILOT trials, estimated median 6-month postinfusion costs were 68% lower for patients cared for in the OP versus IP setting. These results are consistent with a previous analysis of patients treated with liso-cel in the third-line setting (Palomba ML, et al. Leuk Lymphoma 2021); and thus, further support that OP postinfusion monitoring and care may allow health care systems to optimize HCRU and costs for patients with LBCL who receive CAR T cell therapy.

A random arrival rule for airport problems with fuzzy costs

Airport games model situations in which a group of agents use a common facility and they are ordered according to the cost associated with the use that each one of them make of that facility. In this paper we assumed that the cost of the common project is precise but the individual costs are modeled using fuzzy numbers. Our goal will be to obtain a precise allocation of the cost of the common facility among the agents.

Unit costs for allopathic and AYUSH outpatient care in public facilities in Urban Delhi, India.

The National Health Policy, 2017, suggests pluralism in health care with the integrated delivery of AYUSH and allopathic care at public facilities. Information on unit cost of outpatient visits for both types of care at public facilities is useful to guide the policies on health-care delivery. The costs in 2019-20 were estimated for each type of care at allopathic urban primary health center (UPHC) and AYUSH facilities using top-down methodology and adding out-of-pocket expenditures (OOPE) incurred to reflect true costs. Data from national health survey, annual government budgets, and reports were used. The average cost of an outpatient visit for allopathic care was ₹325 at a UPHC and ₹189 in a homeopathic dispensary and ₹692 in an Ayurvedic dispensary. While OOPE per visit at UPHC was ₹177, no OOPE was incurred at AYUSH facilities. The government expenditure per visit for allopathic care at UPHC at ₹148 was the lowest compared to any type of AYUSH care. The cost per facility for allopathic UPHC was higher than both Ayurvedic and homeopathic dispensaries. Unani dispensaries were least cost-effective, both in terms of cost per visit and cost per facility. Costs per visit at a facility are impacted by footfalls. For Ayurveda, despite lower facility costs as compared to UPHC, per visit costs were higher due to low utilization. Improving evidence-based utilization of AYUSH care is critical for the success of the government policy of mainstreaming AYUSH care at low cost.

High-Resolution Powder Diffractometer Facility (HRPDF) for Low and Medium Power Research Reactor

Abstract: The present paper suggests a design of a high-resolution powder diffractometer facility that fits the low and medium power research reactors. The design choice guarantees the acceptable cost of a high-standard facility. Some components can be created in-house, while the design also includes detailed information about the commercially available components. It is highly recommended to carry out Monte Carlo simulations of realistic expected luminosity and resolution parameters of the finally designed and approved instrument in advance. Monte Carlo simulations can eventually show which components should be modified in order to achieve the expected resolution and luminosity parameters of the facility. Keywords: High-resolution powder diffractometer, Design, Construction, Low and medium research reactors.

Social Infrastructure of Soviet Enterprises in the 1950s-1980s: Sources and Mechanisms of Financing (Example of Chelyabinsk Tractor Plant)

The Sources and Mechanisms of Financing the Social Infrastructure of the Chelyabinsk Tractor Plant in the 1950s-1980s. This study examines the sources and mechanisms of financing the social infrastructure of the Chelyabinsk Tractor Plant, a large Soviet industrial enterprise, during the period of 1950s-1980s. The research is based on archival documents from the plant and its trade union organization, which are stored in the United State Archive of the Chelyabinsk Region. It was found that the plant had a significant amount of assets, including housing and a network of social, cultural, and sports facilities. Financing the social infra-structure of Soviet enterprises was a complex system that involved multiple independent sources. The plant made direct payments from its economic stimulation funds, covered the maintenance costs of various facilities transferred to the trade union organization, and covered losses from the housing and communal services system. In addition, funding for these facilities also came from the state budget, social insurance budget, trade union organization budget, targeted subsidies from the All-Russian Central Council of Trade Unions, revenues from self-supporting cultural and sports institutions, and others. The Chelyabinsk Tractor Plant was required to allocate up to 10 % of its profits towards maintaining its social infra-structure, while other sources of funding con-tributed comparable amounts.

Hierarchical joint optimization of modular product family and supply chain architectures considering sustainability

Since sustainability is a growing concern, businesses aim to integrate sustainability principles and practices into product and supply chain architecture (SCA) design. Modular product architecture (MPA) is essential for meeting sustainability demands, as it defines shareable and detachable modules to facilitate assembly/disassembly and recovery. However, Traditional architectural modularity overlooks interface complexity and fails to balance commonality, complexity, and cost for effective facility sharing and ensuring ease of disassembly and upgradeability. Therefore, it is inefficient for economic design, modular recycling, and assembly/disassembly operations. Furthermore, the existing modular clustering methods cannot characterize components that may generate complex modular structures and decrease compatibility for remanufacturing and upgrading. Therefore, such methods cannot offer guidance on modular granularity to reduce premature product discarding through economic upgrading. This paper outlines a modular PFA and SCA by bi-level programming prioritizing sustainability. It emphasizes reducing product discarding and waste generation by focusing on lower remanufacturing costs and higher upgradeability in modular products and SCA. Here, the similarity of operation, ease of disassembly, and upgradability have been used for SCA with architectural and interface modularity. A fuzzy inference system (FIS) differentiates each product component and provides a basis for remanufacturing and upgrading compatibility. The developed leader-follower decision structure allows the selection of suitable and sustainable module candidates to share among product families, considering product architecture, processing activities, and upgrading opportunities. The designed case study on refrigerator PFA shows that the proposed approach saves 23.93 %, 7.21 %, and 17.2 % of SCA costs compared to non-modular, random clustering, and sequential approaches. Further numerical analysis evaluates the proposed model's economic, social, and environmental implications. Accordingly, the model is suitable for guiding modularization for financial gains while promoting environmental and social sustainability.

Analysis of treatment cost differences in patients undergoing femoral versus radial access in outpatient diagnostic cerebral arteriograms.

Outpatient diagnostic cerebral arteriograms are the most common procedure in neuroendovascular surgery, and the use of transradial access for these studies is growing. Although transradial access has been associated with lower hospital costs for elective diagnostic and interventional neuroendovascular procedures, no study has compared transfemoral access and transradial access costs for a homogenous population of patients undergoing outpatient diagnostic cerebral arteriogram. In this single-center retrospective study, the Value Driven Outcomes database was used to evaluate treatment costs for patients who underwent outpatient diagnostic cerebral arteriogram from January 2019 to December 2022. Propensity-score matching was performed to reduce confounders. Costs from each encounter were subcategorized into imaging, supplies, pharmacy, procedures, labs, and facility costs. After matching, 337 patients each for transradial access and transfemoral access were available for analysis. A total of 118,992 cost data points were associated with all encounters. Overall, per-visit costs were 15.2% cheaper for patients who underwent transradial access versus transfemoral access (p < 0.001). Most of the cost difference was due to supplies (35.2% cost difference, p < 0.001) and procedure costs (9.3% cost difference, p < 0.001). No statistical differences were observed between the two approaches in imaging, pharmacy, labs, and facility costs (all p > 0.05). Costs for outpatient diagnostic cerebral arteriogram were lower in patients who underwent transradial access versus transfemoral access because of supply and procedure costs. Understanding reasons for cost differences in common procedures is important for creating strategies to reduce overall healthcare costs. Additionally, addressing the cost differences of newer techniques may increase the likelihood that they are more readily implemented by hospitals and providers.

Toward Online Mobile Facility Location on General Metrics

We introduce an online variant of mobile facility location (MFL) (introduced by Demaine et al. (SODA 258–267 2007)). We call this new problem online mobile facility location (OMFL). In the OMFL problem, initially, we are given a set of k mobile facilities with their starting locations. One by one, requests are added. After each request arrives, one can make some changes to the facility locations before the subsequent request arrives. Each request is always assigned to the nearest facility. The cost of this assignment is the distance from the request to the facility. The objective is to minimize the total cost, which consists of the relocation cost of facilities and the distance cost of requests to their nearest facilities. We provide a lower bound for the OMFL problem that even holds on uniform metrics. A natural approach to solve the OMFL problem for general metric spaces is to utilize hierarchically well-separated trees (HSTs) and directly solve the OMFL problem on HSTs. In this paper, we provide the first step in this direction by solving a generalized variant of the OMFL problem on uniform metrics that we call G-OMFL. We devise a simple deterministic online algorithm and provide a tight analysis for the algorithm. The second step remains an open question. Inspired by the k-server problem, we introduce a new variant of the OMFL problem that focuses solely on minimizing movement cost. We refer to this variant as M-OMFL. Additionally, we provide a lower bound for M-OMFL that is applicable even on uniform metrics.

STM32 BASED WATER QUALITY MONITORING SYSTEM

Water is a precious and essential resource for all life on Earth. Ensuring the quality of water is vital for human health, environmental sustainability, and various industrial applications. This project introduces a novel STM32-based Water Quality Monitoring System designed to address the need for continuous and real-time monitoring of water parameters in various settings like pH and electrical conductivity sensors. The STM32-based Water Quality Monitoring System offers several advantages, including early detection of water pollution, enabling prompt action to mitigate environmental damage and health risks. It provides historical data for trend analysis, aiding in the identification of long-term water quality patterns and trends. Additionally, it reduces the need for manual sampling and laboratory testing, thus lowering operational costs for water treatment facilities. Furthermore, the system is highly adaptable and can be integrated into a variety of water management scenarios, including municipal water supplies, industrial processes, aquaculture, and environmental monitoring. It promotes sustainable water resource management by ensuring that water quality remains within safe and regulated standards In summary, this project presents an innovative STM32-Based Water Quality Monitoring System that leverages advanced microcontroller technology to address the critical issue of water quality monitoring. Key Words: water quality, stm32, pH sensor, conductivity sensor, aquaculture