Cost-saving Measures Research Articles

Lived realities of legal aid: austerity, the pandemic and beyond

ABSTRACT This paper examines the intersecting impacts of austerity policies and the Covid-19 pandemic on the legal aid sector in England and Wales, emphasising their combined implications for professional practices and identities. Legal aid lawyers play a crucial role in upholding social justice and supporting marginalised communities, yet decades of cost-saving measures, epitomised by the Legal Aid, Sentencing and Punishment of Offenders (LASPO) Act 2012, have severely constrained the sector. LASPO's drastic funding cuts removed large areas of law from scope, creating legal aid deserts and deterring young lawyers from pursuing legal aid. The Covid-19 pandemic compounded these challenges, bringing a surge in demand from new and existing client populations. Simultaneously, the sector underwent a rapid technological transformation, enabling hybrid working but also disrupting traditional professional networks, everyday practice, and client relationships. Drawing on 131 semi-structured interviews with legal aid professionals, this article explores two key issues: the post-pandemic escalation in legal aid demand and complexity, and the erosion of professional identity and cohesion among legal aid lawyers. We argue these overlapping crises have amplified longstanding pressures on the sector and undermined its capacity to address a newly diverse range of legal need.

The Role of Psychological Capital and Job Securities Factors on Shaping Readiness to Change

This study investigates the challenges construction sector companies face due to market disruptions and the lack of innovation, with a specific focus on PT Wijaya Karya (WIKA), a leading Indonesian construction firm. Drawing on Kodak's failure as a cautionary example of the risks of neglecting technological advancements, the research underscores the critical need for companies to remain adaptable and ready to innovate to address evolving customer demands. In response to a significant financial loss of IDR 7.13 trillion in 2023, WIKA implemented cost-saving measures, including workforce restructuring and halting recruitment. Despite these setbacks, the company showcased resilience by initiating innovative projects, such as electric motorcycles and precast concrete technologies, contributing to its recovery. The research emphasizes WIKA's initiatives to cultivate employee readiness for change through programs like Wikasatrian and technology skills development. Utilizing a descriptive quantitative approach, the study surveyed 233 managers and directors from government-owned construction firms (BUMN), employing instruments to measure readiness for change, psychological capital, and job security. Data analysis using Structural Equation Modeling (SEM) confirmed that psychological capital plays a critical mediating role between job security and readiness to change. Findings reveal that job security significantly impacts readiness to change, with psychological capital acting as a strong mediator. The study highlights the importance of investing in psychological resources to foster adaptability, particularly in sectors undergoing technological and organizational transformations. The model demonstrated strong validity, with fit indices including GFI (0.90), CFI (0.98), TLI (0.97), NFI (0.97), and RMSEA (0.09), affirming its robustness and providing valuable insights into the public construction sector, an area often underexplored in previous research.

Variables Affecting 90-Day Overall Reimbursement After Anterior Cruciate Ligament Reconstruction: Analysis of Nearly 250,000 Patients in the United States.

Anterior cruciate ligament reconstruction (ACLR) is a commonly performed orthopaedic procedure. As the number of ACLRs continues to increase in incidence, understanding the variability and drivers of cost to the health care system may help target cost-saving measures. To examine the variability in overall 90-day reimbursements (amount paid for health care services) for ACLR using a national, multi-insurance, administrative database and to assess factors associated with variability. Cross-sectional study. Using the M151 PearlDiver data set (data from 2010 to April 30, 2021), the authors identified the 90-day total reimbursements in patients who underwent ACLR. Patient age, sex, and comorbidity burden; insurance type; inpatient versus outpatient surgery status; and 90-day postoperative adverse events were determined and were correlated with overall reimbursements using multivariable logistic regression. A total of 249,484 patients who underwent ACLR during the study period were identified. The mean patient age was 31.6 ± 13.58 years, 50.3% were female, the mean Elixhauser Comorbidity Index (ECI) was 1.4 ± 1.8, and procedures were performed on an outpatient basis for 245,507 patients (98.4%). Insurance type was commercial for 220,284 patients (88.3%), Medicaid for 17,660 (7.1%), and Medicare for 3500 (1.4%). The mean overall 90-day reimbursement was $4281.91 ± $4982.61 (median [interquartile range], $3032 [$1681-5142]), and the total reimbursement for the patient cohort was $1,049,250,747. On multivariable linear regression, the variables independently associated with the greatest changes in overall reimbursement were (in decreasing order) hospital readmission (+$17,675.23), adverse events (+$1554.14), inpatient procedure (+$1246.51), and emergency department visits (+$784.06). Lesser but significant associations were found with greater ECI (+$252.30) and female sex (+$101.01). Decreased overall reimbursement was associated with older age (-$12.19) and Medicare (-$883.48)/Medicaid (-$493.18) relative to commercial insurance. In the current study, large variability was found in overall ACLR reimbursement/cost within the health care system. Hospital admissions (inpatient surgery and readmission) and adverse events were associated with the greatest increase in costs and emphasize the need to optimize these metrics above and beyond patient experience.

Can the compressed sensing theory be utilized in active source surface wave exploration - A primary result

Abstract Active source surface wave exploration is a crucial technique for delineating shallow underground structures, widely utilized in geological engineering, urban geology, environmental geology, geological hazard assessment, and related fields. Seismic data acquisition plays a pivotal role in active source surface wave exploration techniques, which accounts for the vast majority of costs. Consequently, research into low-cost acquisition methods holds great significance for active source surface wave exploration. Compressed sensing theory, a novel sampling paradigm, has been proven to facilitate cost-saving measures in certain geophysical prospecting techniques. However, its potential has not yet been investigated within the realm of surface wave exploration. This study explores the feasibility of applying compressed sensing theory in shallow seismic surface wave exploration. An edge-preservation piecewise random sampling method is employed as the compressed sensing sampling strategy, and data reconstruction is accomplished through a damped rank reduction technique. The fully sampled and reconstructed data undergo identical surface wave data processing procedures, including dispersion spectrum calculation, and dispersion curve inversion. Simulated and field surface wave data experiments demonstrate that the reconstructed data obtained via compressed sensing theory can achieve comparable results to conventionally sampled data. Based on this theory, it is possible to significantly reduce the requisite number of equipment and field workload, making it a promising way for shallow subsurface structure detection.

The use of artificial intelligence in colonoscopic evaluations.

This review aims to highlight the transformative impact of artificial intelligence in the field of gastrointestinal endoscopy, particularly in the detection and characterization of colorectal polyps. Over the past decade, artificial intelligence has significantly advanced the medical industry, including gastrointestinal endoscopy. Computer aided diagnosis - detection (CADe) systems have shown notable success in increasing ADR. Recent meta-analyses of RCTs have demonstrated that patients undergoing colonoscopy with CADe assistance had a higher ADR compared with conventional methods. Similarly, computer aided diagnosis - characterization (CADx) systems have proven effective in distinguishing between adenomatous and nonadenomatous polyps, enhancing diagnostic confidence and supporting cost-saving measures like the resect-and-discard strategy. Despite the high performance of these systems, the variability in real-world adoption highlights the importance of integrating artificial intelligence as an assistive tool rather than a replacement for human expertise. Artificial intelligence integration in colonoscopy, through CADe and CADx systems, marks a significant advancement in gastroenterology. These systems enhance lesion detection and characterization, leading to improved diagnostic accuracy, training outcomes, and clinical workflow efficiency. While artificial intelligence offers substantial benefits, the optimal approach involves using artificial intelligence to augment the expertise of endoscopists, ensuring that clinical decisions remain under human oversight.

Incidence of symptomatic discoid meniscus in Korea: epidemiologic big data analysis from HIRA database

BackgroundThere is a lack of evidence of the diagnosis and treatment-related epidemiological studies of symptomatic discoid meniscus. This study analyzed the national epidemiological data for discoid meniscus in South Korea.MethodsFrom 2011 to 2019, data related to the diagnosis and procedure codes of discoid meniscus were obtained from the Korean Health Insurance Review and Assessment Service database. All patients encoded as discoid meniscus were included. Data were extracted and further analyzed as follows: (1) the total number and the incidence (cases per 100,000) of discoid meniscus diagnosis per year, (2) sex distribution, (3) age distribution, (4) discoid meniscus ratio (total discoid meniscus coding per total meniscus injury coding), and (5) surgical procedures after discoid meniscus injury.ResultsThe total number of discoid meniscus diagnosed was 4576 in 2011 and increased to 6639 in 2019, representing a 45.1% increase. The incidence was 9.5 in 2011 and increased to 13.0 in 2019. Concerning sex, discoid meniscus was more common in females (55%) than in males (45%) over the study period. Regarding age, the peak age of discoid meniscus in 2011 was “under 19,” whereas in 2019, the peak age was observed in the 50s. The discoid meniscus ratio range was 2.12–2.60% from 2011 to 2019. The total number of meniscectomy increased by 20% from 2000 in 2011 to 2475 in 2014. However, the total number of meniscus repairs was 318 in 2011 and increased to 502 in 2019, indicating an increase of 58%.ConclusionsThe total number and incidence of symptomatic discoid as well as the discoid meniscus ratio and the incidence of total discoid meniscus repair steadily increased from 2011 to 2019. The number of meniscus repair procedures increased more rapidly than that of meniscectomy. The current study helps understand the epidemiology of symptomatic discoid meniscus, its prevention, and cost-saving measures in South Korea.

Optimizing the role of scrub nurses during robotic surgery console time

At our institution, scrub nurses leave the surgical field during the console time for robotic surgeries to attend to other duties. The first assistant then assumes their responsibilities, allowing for efficient use of staff time and resources. This practice improves teamwork and can be presented as a cost-saving measure for hospital administrations.

Delabeling of allergy to beta-lactam antibiotics in hospitalized patients: a prospective study evaluating cost savings.

Patients with a penicillin allergy label are at risk of an associated increase in adverse antibiotic events and hospitalization costs. We aimed to study the economic savings derived from the correct diagnosis and delabeling inpatients with suspected beta-lactam allergy, considering the acquisition cost of antimicrobials prescribed during a patient's hospital stay. We prospectively evaluated patients admitted to the University Hospital of Salamanca who had been labeled as allergic to beta-lactams and performed a delabeling study. Subsequently, cost differences between antibiotics administered before and after the allergy study and those derived from those patients who received alternative antibiotics during admission and those who switched to beta-lactams after the allergy study were calculated. One hundred seventy-seven inpatients labeled as allergic to beta-lactams underwent a delabeling study; 34 (19.2%) were confirmed to have allergy to beta-lactams. Of the total number of patients, 136 (76.8%) received antibiotics during their hospitalization, involving a mean (SD) cost of €203.07 (318.42) and a median (IQR) cost of €88.97 (48.86-233.56). After delabeling in 85 (62.5%) patients, the antibiotic treatment was changed to beta-lactams. In this group of patients, the mean cost (SD) decreased from €188.91 (351.09) before the change to 91.31 (136.07) afterward, and the median cost (IQR) decreased from €72.92 (45.82-211.99) to €19.24 (11.66-168). The reduction was significant compared to the median cost of patients whose treatment was not changed to beta-lactams (p<0.001). Delabeling hospitalized patients represents a cost-saving measure for treating patients labeled as allergic to beta-lactams.

UTILITY OF CONTRAST-ENHANCED T2-FLAIR FOR IMAGING OF BRAIN METASTASESUSING A HALF-DOSE HIGH-RELAXIVITY CONTRAST AGENT IN COMPARISON WITH ROUTINE DOSE CONTRAST-ENHANCED BRAIN IMAGING

Aim &amp; Objectives: This study aims to assess the efficacy of delayed contrast-enhanced T2 fluid-attenuated inversion recovery (CE-T2 FLAIR) by using half dose high relaxivity contrast agent to assess the degree of enhancement among the lesions and to detect additional metastatic brain lesions usually smaller lesions(&lt;5mm), which are significantly missed on routine-dose CE-T1 weighted imaging (CE-T1WI). Material &amp; Methods:The main source of data for this study was radiologically diagnosed lung cancer patients who were clinically suspected to have brain metastasis referred from various departments of Silchar Medical College and Hospital. The studywas carried out for a period of 1 year from March 1, 2023, to February 29, 2024, A total of 40 patients with brain metastases were scanned using a SIEMENS TIM AVANTO 1.5T scanner, routine MR pulse sequences pre- and post-contrast administration were acquired. Results: Out of 40 patients, males were more affected (57.5 %) than females (42.5 %). The highest number of cases were found between the 61-70 years age group with the lung (31 cases) being the most common primary malignancy causing brain metastases. A total of 90 lesions were detected among 40 patients which were grouped into A (25 lesions), B (36 lesions), and C (29 lesions) groups. A total of 6 lesions were missed on Routine dose contrast-enhanced brain imaging of which 2 lesions belong to group B (Rim enhancing lesions &gt;5mm) and 4 lesions belong to group C (Lesions &lt;5mm), however, these lesions were picked up on delayed half dose contrast-enhanced FLAIR images. The contrast ratio (CR) on 3 consecutive half dose CE-T2 FLAIR ranged between 59.09%-76.80%, suggesting that delay in imaging post-contrast administration resulted in a significant increase in the contrast ratio (CR) among metastatic lesions. Conclusions: CE-T1-weighted sequences and CE-T2 FLAIR sequences complement each other effectively in evaluating brain metastases. Bigger and homogenously enhancing lesions are best seen on CE-T1-weighted sequences. Smaller lesions and lesions showing rim enhancement are best visualized on delayed (5 min) CE-T2 fluid-attenuated inversion recovery (FLAIR) sequences with half the dose ofcontrast agent (gadobenatedimeglumine) compared to routine dose CE-T1-weighted sequences. This approach serves as a cost-saving measure for both patients and the healthcare system.

Non-typhoidal Salmonella in Nigeria: do outcomes of ‘multisectoral’ surveillance, treatment and control justify the intervention costs?

ABSTRACT Non-typhoidal salmonellosis (NTS) is significant and an economic burden in Nigeria. To determine whether investment in NTS control is economically justifiable, Outbreak Costing Tool (OCT) was used to estimate the robust funding of public and animal health systems for epidemio-surveillance and control of multisectoral NTS outbreaks in Nigeria. Health, production, and economic data were collected and used to populate the tool for evaluation. The multisectoral NTS burden for the year 2020 in Nigeria was US$ 930,887,379.00. Approximately 4,835 technical officers, and 3,700 non-technical staff (n = 8,535) were needed with an investment of >2.2 million work hours. The investment cost for NTS control was US$ 53,854,660.87. The non-labour-related cost was 89.21% of the total intervention costs. The overall intervention’s investment was 374.15% of the estimated national and subnational systems’ annual budget for diarrhoeal diseases, and the outbreak response period attracted the highest costs (53%) of the total intervention. In conclusion, intervention against NTS was beneficial (benefit – cost ratio: 17.29), hence justifying the need for multisectoral surveillance-response against NTS in Nigeria. Complex sectoral silos must give way to coordinated collaborations to optimize benefits; and over-centralization of health interventions’ associated delays must be removed through decentralized sub-national-focused framework that empowers rapid investigation, response, control, data collection, and analyses. It should assist anticipatory planning, and outbreak investigation and reduce critical response time. Anticipatory planning tools, when applied pre-emptively, can benefit budgeting, identify gaps, and assist in the delivery of cost-saving and effective measures against infectious disease.

Trends in the Utilization of Outsourced Marketing Departments by Landlords of Boarding Rooms in Ho Chi Minh City

In an era marked by escalating competition, the adoption of Outsourced Marketing practices emerges not only as a cost-saving measure but also as a catalyst for the enhancement of operational efficiency, and market competitiveness. The deployment of outsourced marketing strategies proves to be especially germane to the operational business of boarding-room enterprises in Ho Chi Minh City, rooted in features of operational scale, industry domain specificity, and responsiveness to evolving technological paradigms and consumer information acquisition demand. Fundamental advantages of outsourced marketing services to boarding room landlords encompass cost mitigation; revenue augmentation; simultaneously, increased time for specialized pursuits, brand equity amplification, and recognition level for the rental rooms system. This article principally discusses the trends in the utilization of outsourced marketing departments by boarding room landlords in Ho Chi Minh City, according to three focal domains: (1) The scale of outsourcing, (2) Process of managing and performing outsourced marketing, (3) The influence of outsourced marketing on the operational outcomes of boarding rooms enterprises.

Information Systems and Performance of Insurance Firms in Nairobi County, Kenya

Purpose: The goal of the study was to ascertain how information systems influenced the insurance industry's performance in Nairobi County, Kenya. Methodology: This study employed a descriptive research design. The respondents were drawn from all 58 insurance firms in Kenya as listed by Insurance Regulatory Authority (2023). The study sample comprised of five senior management officer from each of the target population of 58 insurance companies in Kenya. Stratified sampling procedure was applied to select the subjects of study based on geographical location in Nairobi County. Data collection was done using structured questionnaires. The questionnaire had both open-ended and closed-ended questions. Descriptive and inferential statistics were employed in the study to analyze the data. The coding and analysis were performed using SPSS version 21, and the results were shown as tables. Findings: The study concludes that technical factors have a positive and significant impact on Nairobi County insurance businesses' performance. The study discovered that the performance of insurance companies in Nairobi County is influenced by information system compatibility, confidentiality, ease of use, and reliability. the study comes to the conclusion that Nairobi County's environmental features significantly and favorably affect the performance of insurance companies. The study found that the performance of insurance companies in Nairobi County is influenced by competition, industry size, and pressure from suppliers and customers. Additionally, the study concludes that organizational factors have a positive and significant impact on Nairobi County insurance companies' performance. The study discovered that supplier and consumer pressure, industry size, and competition all had an impact on Nairobi County's insurance companies' performance. Resources factors encompassing availability of financial, human, and technological resources were established as the most influential component of the information systems with regard to performance of the insurance firms. Unique Contribution to Theory, Practice and Policy: The study was ancored on Technology Acceptance Model (TAM). The study also recommends that management should allocate financial resources strategically, focusing on areas that directly contribute to business growth, such as marketing, technology upgrades, and talent acquisition. In addition, management should ensure efficient use of financial, human and technology resources by closely monitoring expenses, avoiding unnecessary costs, and seeking opportunities for cost-saving measures.

Use of Oncotype vs. Breast Cancer Index (BCI) for extended endocrine therapy decisions: A single center analysis in stage IA hormone receptor positive breast cancer.

e13083 Background: Extended Endocrine Therapy (EET) for hormone receptor positive HER-2 negative early-stage breast cancer reduces late recurrence risks but raises concerns about toxicity. Biomarker tests like the Breast Cancer Index (BCI) are vital for identifying patients who could benefit from continued ET, reassuring others against unnecessary extension. This study evaluates prognostic implications for both Oncotype Dx (Recurrence score, RS) and BCI amidst concerns about added testing costs in patients with early stage, estrogen receptor (ER) positive breast cancer. Methods: This is a single institution retrospective review of Stage IA ER positive HER-2 negative breast cancer patients who underwent both Oncotype Dx and BCI testing from January 2021 to December 2023. Pearson's correlation coefficient (r) was used to assess the linear relationship between the assays (p&lt;0.05 for significance), analysis was performed with SAS software, version 9.4. Results: Fifty-eight patients with Stage IA ER positive HER-2 negative breast cancer who had both Oncotype and BCI results were identified (100% female; mean age 72.2 years [54-87]). After a median followed up of 72 months (63-75), no systemic or locoregional recurrences were reported. A low positive correlation between Oncotype and BCI was observed across the entire cohort (r=0.4058; p=0.0016). However, subgroup analysis showed no significant correlations: Oncotype &lt;11 (n=17; r=0.2415; p=0.3504), Oncotype ≤18 (n=43; r=0.0914; p=0.5600), Oncotype &lt;26 (n=51; r=0.2530; p=0.0733); Oncotype ≥26 (n=7; r=-0.5634; p=0.1878). Correlation was also not found in patients with Grade 1 tumor (n=16; r=0.3138; p=0.2365). Thirty-nine patients (67.24%) had their treatment recommendation changed based on BCI results. Side effects from ET affected 15 patients (25.86%) and included arthralgias (60%, n=9), hot flashes (26.67%, n=4), depression (13.33%, n=2), insomnia (6.67%, n=1), and others (53.3%, n=8). Twenty-two patients (37.93%) developed new osteopenia, and 6 (10.34%) new osteoporosis while on EET. Eight patients (13.79%) had ET interruption during their treatment course. Conclusions: Despite inclination towards cost-saving measures, Oncotype DX may be more useful to give prognosis in the early adjuvant period whereas BCI is more useful to evaluate late recurrence risk. Low or high Oncotype scores and tumor grade may not align with BCI findings. Considering the importance of managing toxicity against the risk of late recurrence, incorporating BCI testing can enhance EET recommendations, even for Stage I, node-negative, ER positive patients.

Experimental validation of data-driven reactive control strategy for wave energy converters: A Gaussian process regression approach

Wave energy is a renewable energy source that can generate electricity without emitting carbon dioxide using wave energy converters (WECs). WECs face several challenges, such as effectively harnessing wave energy, ensuring operational safety, and implementing cost-saving measures. In this study, a data-driven reactive control strategy for WECs using Gaussian process regression is experimentally validated. The control strategy aimed to maximize energy absorption while satisfying physical constraints without a WEC dynamic model. In this study, the Gaussian process regression model represents a WEC dynamic model using an approximation function based on the input/output data. Experimental validation results confirmed that the proposed data-driven reactive control strategy effectively controlled the WEC and improved its performance using the Gaussian model. Moreover, performance was improved under different wave conditions compared to those used during training. The control strategy can be useful in situations where conventional methods cannot realize ideal control parameters, such as when substantial model errors exist or the WEC dynamic model changes over time. The data-driven approach that uses Gaussian process regression reduces learning costs compared to other machine-learning methods. It also has stable control performance because it is independent of the training dataset. The potential of data-driven approaches for optimizing WEC control strategies was highlighted.

The relationship between freight train length and the risk of derailment.

In recent years, longer and heavier trains have become more common, primarily driven by efficiency and cost-saving measures in the railroad industry. Regulation of train length is currently under consideration in the United States at both the federal and state levels, because of concerns that longer trains may have a higher risk of derailment, but the relationship between train length and risk of derailment is not yet well understood. In this study, we use data on freight train accidents during the 2013-2022 period from the Federal Railroad Administration (FRA) Rail Equipment Accident and Highway-Rail Grade Crossing Accident databases to estimate the relationship between freight train length and the risk of derailment. We determine that longer trains do have a greater risk of derailment. Based on our analysis, running 100-car trains is associated with 1.11 (95% confidence interval: 1.10-1.12) times the derailment odds of running 50-car trains (or a 11% increase), even accounting for the fact that only half as many 100-car trains would need to run. For 200-car trains, the odds increase by 24% (odds ratio 1.24, 95% confidence interval: 1.20-1.28), again accounting for the need for fewer trains. Understanding derailment risk is an important component for evaluating the overall safety of the rail system and for the future development and regulation of freight rail transportation. Given the limitations of the current data on freight train length, this study provides an important step toward such an understanding.

Unveiling gas–liquid metal reactions in metal additive manufacturing: High-fidelity modeling validated with experiments

Gases in the atmosphere inevitably react with the melt pool during metal additive manufacturing (AM). Oxygen is particularly reactive, and excessive uncontrolled oxidation is detrimental, so most machines purge the chamber with inert gases, which can minimize but not eliminate such reactions. Alternatively, some users exploit the gas–liquid metal reactivity as an opportunity to introduce beneficial precipitates into the melt pool (“reactive AM”). However, the gas–liquid metal reaction and mechanisms in both scenarios remain unclear. Experimental works hitherto provide different explanations to the same phenomena. Therefore, this work seeks to clarify the mass transfer process of oxygen during metal AM through high-fidelity modeling by considering the competition between diffusion and chemical reaction, suboxide evaporation, and the influence of the vapor plume. The simulation results, validated with experiments, provide consolidated insights into the oxygen evolution behavior during metal AM. Counterintuitively, higher melt pool temperatures do not necessarily lead to greater oxidation rates during processing. The melt pool has regions of high and low oxygen gains due to temperature-dependent reaction regimes, with concurrent oxygen loss from evaporation of metal suboxides. Thus, the net oxygen flux varies for different materials, and the oxygen content cumulatively changes as multiple tracks are scanned. Overall, this work provides useful guidance to the AM community that seeks to ameliorate or exploit the inevitable gas–liquid interaction in metal AM. Cost-saving measures may be possible for determining the purity of shielding gas used in AM, and physics-guided measures can be taken to limit or control gas–liquid metal reactions.

Managing disrupted supply chains in Swedish hospitals during the COVID-19 pandemic

ABSTRACT The COVID-19 pandemic has disrupted global supply chains and caused widespread shortages of healthcare supplies. This mixed-methods study examined the management of supply shortages in Swedish hospitals during the COVID-19 pandemic. The key findings are that the shortage of supplies was initially severe owing to low regional and national contingency inventory levels, a lack of knowledge of supply chain management, and cost-saving measures. The perceived consequences of the shortage of personal protective equipment persisted in emergency and inpatient departments, in the later waves. Although pharmaceutical shortages later decreased, hospital managers were disappointed that they persisted. This study also highlights the effectiveness of consensus-based hourly supply agreements between service organisations and unit managers, which makes the prioritisation of the limited supply more dynamic. Despite these challenges, hospitals were able to adapt to the supply chain disruptions caused by the pandemic; however, the results emphasise the importance of preparedness for future pandemics.

Transitioning to a Hydrogen Economy: Exploring the Viability of Adapting Natural Gas Pipelines for Hydrogen Transport through a Case Study on Compression vs. Looping

The growing importance of hydrogen as an energy carrier in a future decarbonised energy system has led to a surge in its production plans. However, the development of infrastructure for hydrogen delivery, particularly in the hard-to-abate sectors, remains a significant challenge. While constructing new pipelines entails substantial investment, repurposing existing pipelines offers a cost-effective approach to jump-starting hydrogen networks. Many European countries and, more recently, other regions are exploring the possibility of utilising their current pipeline infrastructure for hydrogen transport. Despite the recent efforts to enhance the understanding of pipeline compatibility and integrity for hydrogen transportation, including issues such as embrittlement, blend ratios, safety concerns, compressor optimisation, and corrosion in distribution networks, there has been limited or no focus on pipeline expansion options to address the low-energy density of hydrogen blends and associated costs. This study, therefore, aims to explore expansion options for existing natural gas high-pressure pipelines through additional compression or looping. It seeks to analyse the corresponding cost implications to achieve an affordable and sustainable hydrogen economy by investigating the utilisation of existing natural gas pipeline infrastructure for hydrogen transportation as a cost-saving measure. It explores two expansion strategies, namely pipeline looping (also known as pipeline reinforcement) and compression, for repurposing a segment of a 342 km × 36 inch existing pipeline, from the Escravos–Lagos gas pipeline system (ELPS) in Nigeria, for hydrogen transport. Employing the Promax® process simulator tool, the study assesses compliance with the API RP 14E and ASME B31.12 standards for hydrogen and hydrogen–methane blends. Both expansion strategies demonstrate acceptable velocity and pressure drop characteristics for hydrogen blends of up to 40%. Additionally, the increase in hydrogen content leads to heightened compression power requirements until approximately 80% hydrogen in the blends for compression and a corresponding extension in looping length until around 80% hydrogen in the blend for looping. Moreover, the compression option is more economically viable for all investigated proportions of hydrogen blends for the PS1–PS5 segment of the Escravos–Lagos gas pipeline case study. The percentage price differentials between the two expansion strategies reach as high as 495% for a 20% hydrogen proportion in the blend. This study offers valuable insights into the technical and economic implications of repurposing existing natural gas infrastructure for hydrogen transportation.

Negative impact of a health insurer-mandated de-simplification from a single-tablet regimen to a two-tablet regimen.

Antiretroviral therapy (ART) accounts for a considerable proportion of HIV care expenses. In June 2021, a Dutch healthcare insurer implemented a mandatory policy to de-simplify branded RPV/TDF/FTC (Eviplera) into a two-tablet regimen containing rilpivirine (Edurant) and generic TDF/FTC as part of cost-saving measures. The objectives of this study were to evaluate the acceptance of this policy, the trends in ART dispensation, and cost developments. A retrospective database study. In this study, medication dispensation data were obtained from the Dutch Foundation for Pharmaceutical Statistics (SFK). This database covers 98% of all medication dispensations from Dutch pharmacies including people with HIV who receive ART. We received pseudonymized data exclusively from individuals insured by the insurer for the years 2020-2022. Costs were calculated using Dutch drug prices for each year. In June 2021, 128 people with HIV were on branded RPV/TDF/FTC. Following the policy implementation, 59 (46%) had switched to RPV + generic TDF/FTC, but after 1.5 years, only 17 of 128 individuals (13%) used the proposed two-tablet regimen. The other 111/128 used RPV/TDF/FTC with prescriptions for 'medical necessity' ( n = 29), switched to RPV/TAF/FTC ( n = 51), or other ART ( n = 31). Despite expectations of cost-savings, costs increased from €72 988 in May 2021 to €75 649 in May 2022. A mandatory switch from an STR to a TTR in people with HIV proved unsuccessful, marked by low acceptance, and increased costs after 1 year. This underscores the necessity of incorporating patient and prescriber involvement in changing medication policies.

Research on the Displacement Impact of Artificial Intelligence on the Film Industry

In recent years, the film industry has witnessed a significant transformation with the emergence of Artificial Intelligence (AI) as a formidable creative force. This abstract provides an overview of an essay exploring AI’s multifaceted implications in the film sector. The essay delves into the palpable concerns surrounding AI’s influence on the industry, particularly in scriptwriting. AI’s remarkable script generation capabilities have led companies to explore cost-saving measures, which raises questions about the potential displacement of human creatives. The essay examines how these changes have sparked tensions, exemplified by the Writers Guild of America (WGA) strike. However, amidst these concerns, the coexistence potential of AI and human creativity is highlighted. The role of AI-regulating laws in safeguarding employment and ensuring ethical AI implementation will be discussed. Moreover, the essay underscores the enduring value of human creativity, as very few AI systems have passed the Turing test. Ultimately, the essay argues that the path forward lies in human-AI collaboration, offering insights into how the film industry can strike a harmonious balance between technological innovation and artistic expression.