• Innovative sensor monitors Fe³⁺-EDDS for AOPs processes at neutral pH • Real-time monitoring of Fe 3+ -EDDS in real WWTP effluents • Enables AOP scaling, ensuring environmental compliance and optimized plant design. • Electrochemical sensors offer 78.3% cost savings per sample compared to UHPLC/DAD • Key advancement for automation and control of photo-Fenton at demonstrative scale This study presents the first electrochemical sensor specifically designed to detect the Fe³⁺-EDDS complex, a widely used chelating agent in homogeneous photocatalysis for wastewater treatment at near-neutral pH. Measurements were performed off-line using a glassy carbon electrode (GCE) modified with multi-walled carbon nanotubes (MWCNTs), thereby enhancing sensitivity and electron-transfer capability. Experimental parameters, including MWCNT concentration (0.5–2.0 mg/mL), accumulation time (0–4 min), and Fe³⁺-EDDS concentration (0.01–0.10 mM), were optimized to maximize performance. The sensor exhibited a strong linear response (R² = 0.992) with a sensitivity of 29.4 µA/mM and a detection limit of 0.006 mM. In real wastewater effluents, signal attenuation led to a narrower effective linear range, with reduced proportionality above ∼0.06 mM Fe³⁺–EDDS, highlighting both matrix effects and the need for matrix-specific calibration. Its long-term stability was confirmed for over 100 days using stored MWCNT dispersions. A robust correlation with UHPLC/DAD measurements (Pearson r > 0.91, R 2 > 0.95) validated the sensor's accuracy. The sensor was also tested in a pilot-scale UVA-LED photoreactor to monitor Fe 3+ -EDDS degradation under different Fe 3+ and EDDS dosages. Results demonstrated the sensor's suitability for real-time monitoring of catalyst availability during advanced oxidation processes (AOPs). Additionally, a techno-economic analysis indicated a 78.3% reduction in per-sample cost relative to UHPLC/DAD, underscoring its potential for routine, cost-effective monitoring in wastewater treatment. This novel platform enables cost-effective, off-line monitoring of iron chelate availability in advanced oxidation processes and provides a basis for future development toward real-time sensing in complex water matrices.

G-536 Impact of Reduced Peritoneal Dialysis Solution Bag Use on Clinical Outcomes and Cost Savings Following a National Supply Shortage

Reliance on high peak district heating (DH) power demand constrains the cost-effective operation of community-level hybrid heating systems. The study evaluates tank thermal energy storage (TTES) as a peak-shaving solution for a Finnish energy community heated by a dual source heat pump and DH produced from hydrogen production waste heat. A novel simulation-based parametric analysis framework was developed and utilized to determine the cost-optimal TTES dimensioning for the analyzed community. It jointly assessed peak-shaving effectiveness and economic feasibility by varying threshold power of tank discharging, tank charging power, and tank size (500–1500 m 3 ). Results indicated that effective peak shaving required a balanced combination of threshold power of tank discharging and tank charging power. Lowering the threshold alone was ineffective with a 700 m 3 tank, and performance became less sensitive to control settings at 1500 m 3 . Cost savings were mainly from reduced DH power fees rather than energy costs, with diminishing returns beyond 700 m 3 once the shaved peak approached the threshold power of tank discharging. The cost-optimal dimensioning (1416 kW threshold power of tank discharging, 730 kW tank charging power, and 600 m 3 tank size) reduced the maximum three-hour average DH power demand by 40% from 2452 kW in the baseline without TTES. Correspondingly, the total operating cost was lowered by 17%. It decreased the LCC over a 25-year period by 13% and achieved a discounted payback period of 10.3 years. These findings provide actionable guidance for TTES dimensioning and control in hybrid-heated energy communities under hourly tariff structures. • Community hybrid heating combines dual source heat pump and renewable DH. • Renewable DH is produced utilizing waste heat from hydrogen production. • TTES integration shaves peak DH power demand for lower operating costs. • Cost-optimal TTES is identified through simulation-based parametric analysis. • TTES design and operation are evaluated under hourly renewable DH prices.

This study presents a multi-objective optimization framework for sustainable aviation fuel (SAF) production, integrating artificial neural networks (ANNs) within a mixed-integer quadratically constrained programming (MIQCP) formulation. By embedding data-driven surrogate models into the mathematical optimization structure, the proposed methodology addresses key limitations of conventional superstructure-based approaches, enabling simultaneous optimization of discrete process choices and continuous operating parameters. The framework captures variable input and output stream compositions, facilitating the joint optimization of target product composition and system design. Application to Fischer–Tropsch (FT) kerosene production demonstrates that cost-minimizing configurations under unconstrained CO 2 emissions are dominated by the fossil-based autothermal reforming (ATR) route. Imposing carbon emission constraints necessitates the integration of biomass gasification and direct air capture coupled with carbon sequestration (DAC-CS), resulting in substantially reduced net emissions but higher production costs. At the zero-emission limit, hybrid configurations combining ATR and biomass gasification achieve the lowest costs ( ∼ 2.38 $/kg kerosene ), followed closely by biomass gasification-only ( ∼ 2.43 $/kg), both of which outperform the ATR-only pathway with DAC-CS ( ∼ 2.65 $/kg). In contrast, DAC-only systems relying exclusively on atmospheric CO 2 and water electrolysis are prohibitively expensive ( ∼ 10.8 $/kg). The results highlight the critical role of the embedded ANNs: optimal process conditions, such as FT reactor pressure and gasification temperature, adapt to changing circumstances, consistently outperforming fixed setups and achieving up to 20 % cost savings. • Mixed-integer quadratic formulation optimizing mass fractions of process streams. • Neural networks represent operating conditions & nonlinear behavior of subprocesses. • Comparing fossil-, bio-, and CO 2 -based routes for sustainable aviation fuel synthesis. • With 2.43 $/kg kerosene , biomass routes offer a trade-off of cost vs. emissions. • Surrogate models allow subprocesses to adapt and thereby reduce cost up to 20%.

BACKGROUND: While ambulatory surgery centers (ASCs) are increasingly utilized for outpatient surgery for cost savings and resource efficiency, data comparing outcomes and costs of same-day mastectomy (SDM) with reconstruction at ASCs versus hospital outpatient departments (HOPDs) remain limited. We aimed to identify predictors of overnight admission following SDM with immediate implant/tissue expander reconstruction, and evaluate its safety, feasibility, and cost-efficacy at ASCs versus HOPDs. We performed a retrospective review of women undergoing mastectomy with immediate implant/tissue expander reconstruction from January 2023 to June 2024 at two HOPDs and two ASCs. Patient characteristics, operative metrics, postoperative complications, and predictors of overnight admission were analyzed. Cost analyses utilized Medicare outpatient procedure facility fees for comparison. A total of 492 of 559 patients (88.0%) underwent same-day discharge, including all patients at ASCs. Significant predictors of any overnight admission included age > 65 (OR = 2.482, p = 0.027), living > 30 miles from the hospital (OR = 2.162, p = 0.005), bilateral surgery (OR = 2.435, p = 0.016), and afternoon PACU arrival (OR = 2.005, p = 0.028). Predictors of unplanned overnight admission were increased distance from the hospital (OR = 2.316 (1.110-4.921)), bilateral surgery (OR = 3.020 (1.110-10.613)), and afternoon PACU arrival (OR = 2.698 (1.144-7.449)). ASC patients experienced shorter postoperative stays and equivalent postoperative complications. Cost analysis demonstrated that performing identical procedures at ASCs significantly reduced facility fees (p < 0.001), yielding estimated savings of $1,785,496 (61.2%) per 99 patients compared with HOPDs. For appropriately selected patients, SDM with reconstruction at ASCs is safe, feasible, and associated with substantial cost savings. These findings support expanded use of ASCs to optimize resource utilization without compromising patient outcomes.

To comprehensively assess the cost-utility of icodec, the first once-weekly basal insulin, at 700 and 1050 U formulations compared with once-daily basal insulin analogues in Chinese adults with type 2 diabetes within reimbursement context. A long-term cost-utility analysis was performed using ONWARDS 5 data from the perspective of the Chinese healthcare system. Icodec (700 and 1050 U) was compared with once-daily insulin glargine U100, glargine U300, and degludec over a 40-year time horizon, applying a 5% annual discount rate. Outcomes included diabetes-related complications, costs, and quality-adjusted life-years (QALYs). Sensitivity and scenario analyses were conducted to evaluate robustness and individual comparator results. Compared with once-daily basal insulin analogues, icodec was associated with reduced cardiovascular mortality (RR = 0.97) and lower cumulative incidence of microvascular and macrovascular complications. Icodec yielded an additional 0.261 QALYs and increased life expectancy by 0.031 years, while reducing total costs by $2544.93 (700 U) and $2,916.92 (1050 U). Cost savings were primarily driven by fewer hypoglycemia events. Probabilistic sensitivity analysis showed 100% cost-effectiveness at below 0.4 times China's GDP per capita. Across all scenario analyses, icodec was projected to be cost-saving or cost-effective over a lifetime horizon compared with once-daily basal insulin comparators. Once-weekly icodec represents a cost-effective and clinically beneficial alternative to once-daily basal insulin analogues for Chinese adults with type 2 diabetes within the current reimbursement framework.

Performance and feasibility of integrated microgrid and microalgae hybrid systems for net-zero energy solutions

Increasing Colorectal Cancer Screening: A Systematic Economic Review of Patient Navigation Services.

The decrease in colorectal cancer (CRC) mortality over the past 2 decades is largely attributed to increased screening. This progress has not been evenly distributed across populations. Individuals who seek care at federally qualified health centers (FQHCs) have low CRC screening prevalence. This study aims to assess the effectiveness and cost of interventions to increase CRC screening at FQHCs, by using fecal immunochemical tests (FIT). The authors evaluated changes in FIT screening uptake in eight FQHCs that participated in the Colorectal Cancer Control Program (CRCCP) before and after the multicomponent evidence-based interventions were implemented. Examples of interventions included patient reminders, provider assessment and feedback, and patient navigation. They collected the labor and nonlabor cost of implementing the interventions. Furthermore, they used a validated microsimulation model to assess the long-term cost-effectiveness of the interventions. All eight FQHCs showed increases in CRC screening following the implementation of the multicomponent interventions, with an average increase of 14.4 percentage points (range, 4.9-26.7) and an average intervention cost of $14.40 per person (range, $5.76-$34.70). In five of the eight FQHCs, the interventions resulted in cost savings when public payer costs were considered. In the remaining three FQHCs, the cost per life years saved ranged from $14,898 to $54,111. Multicomponent interventions to increase the use of FIT kits represent an effective and efficient strategy for increasing CRC screening uptake in FQHCs.

Operating room turnover time is a major source of perioperative inefficiency affecting patient care, staff satisfaction, and institutional revenue. A multidisciplinary, collaborative approach to turnover time reduction is required to improve perioperative quality. Surgeons, anesthesiologists, nurses, and perioperative leadership collaborated to develop 2 efficiency interventions. The "Showtime" initiative established a service-specific set-time for a surgical and anesthesia representative to meet in preoperative holding for the operating room's next patient. The "Intentional Rounding" initiative included the charge nurse performing room-to-room morning rounds to proactively identify and mitigate turnover time efficiency issues for the day. These interventions were initiated across the neurosurgery, orthopedics, otolaryngology, and transplant/hepatobiliary service lines within an academic medical center. Implementation of the Showtime and Intentional Rounding initiatives resulted in an average reduction in turnover time of 10.5 minutes (20%) across all service lines. Improvement was noted across each service line, with improvement times ranging from 7 to 22 minutes (17% to 32% improvement, respectively), as well as the ability to sustain higher monthly case volumes. An expected 440 hours of turnover time was recovered during the study period, associated with an estimated savings of $361,419 in direct "empty operating room" costs recovered over the 20-month study period (around $18,000/mo). Two multidisciplinary perioperative interventions focused on improving operating room turnover time efficiency resulted in a systemwide 20% reduction in average turnover time at an academic medical center, with estimated cost savings of more than $18,000 per month. These interventions are sustainable, low resource-intensive, and reproducible across multiple service lines.

FOLFOX has emerged as a new treatment paradigm for locally advanced rectal cancer (LARC). However, whether FOLFOX, which replaces radiotherapy with chemotherapy, offers comprehensive clinical and economic advantages over conventional long-course chemoradiotherapy (LCCRT), especially in high-risk patients, remains unclear. We conducted both within-trial and Markov model-based lifetime analyses to evaluate the short- and long-term economic and health outcomes of FOLFOX compared with LCCRT. Data were derived from the 3 and 10year follow-up of the FOWARC trial (NCT01211210) in China and published data from the PROSPECT trial (NCT01515787) in the USA. Main outcomes included health utility, patient-reported outcomes of adverse events, costs, and quality-adjusted life years (QALYs). Costs were evaluated from the healthcare perspective in 2023 US dollars. Subgroup, scenario, and sensitivity analyses were performed. Within-trial analysis showed that the FOLFOX group had an increasing utility trend, while LCCRT decreased. FOWARC found that LCCRT patients experienced more severe depression and social life impact compared with PROSPECT. Over 45.2 months, FOLFOX cost $3503 less and gained 0.18 more QALYs than LCCRT. Lifetime analysis estimated that FOLFOX gained 0.81 and 0.56 more QALYs, with cost savings of $12,018 and $87,643 compared with LCCRT in China and the USA, respectively. FOLFOX remained cost-effective in high-risk patients requiring supplementary radiotherapy, with LCCRT becoming preferable only when the proportion of these patients reached 64%. Selective radiotherapy avoidance with FOLFOX may be recommended for neoadjuvant treatment of LARC, even in high-risk patients. This substitution could save significant healthcare resources while improving QALYs globally. Trial Registration ClinicalTrials.gov NCT01211210, NCT01515787.

Previous studies have shown poison centers (PCs) reduce healthcare costs, often by preventing unnecessary emergency care visits. An updated cost-savings estimate has not been recently conducted. This was a retrospective study analyzing caller survey data for a three-state American PC, gathered from 2021 to 2024. The PC's annual budget is $3.3 million (M). Eligible cases included public callers whose poisoning question was managed on-site and later completed a post-call telephone survey, including the question, "What would you have done if the poison center was not available to you?" Emergency care costs were estimated using three variables to reflect costs rather than charges. Ambulance transport costs and physician professional fee reimbursements for emergency department (ED) evaluation and management (E&M) codes were calculated from the U.S. Centers for Medicare and Medicaid Services published data. Facility fees from the associated E&M codes were calculated based on a general reimbursement rate of 33% of charges from our PC's affiliated safety-net hospital. E&M codes 99284 and 99285 (levels of service [LOS] 4 and 5, respectively) were used to calculate a cost-savings range. Among 1670 respondents to the survey (overall completion rate, 24%), 1346 (81%) would have immediately sought care; n=916 [55%] of which would immediately call a healthcare professional while n=430 [26%] would call 911 or go to the ED. Extrapolating survey results to our entire caller population, the estimated annual cost-savings from avoided emergency care visits for each state were as follows: Minnesota, $29.4 to 48.0M; North Dakota, $5.0 to 5.7M; South Dakota, $5.1M to 7.5M, for a benefit-to-cost ratio of $12.07 to $18.55:1. When factoring in our annual budget, this results in an annual net savings of $36.5 to 58.0M for our three-state region. Sensitivity analysis, assuming all ED visits reimbursed at LOS 4 and that ambulance transports occurred less frequently and were less costly per transport, still demonstrated robust cost-savings, with a benefit-to-cost ratio of $6.22-6.88:1. Using standard reimbursement data, we demonstrated our poison center likely saves our three-state region more than six times its annual budget solely from preventing unnecessary emergency care visits.

Economic Impact of Self-Injected Biologics for Rheumatoid Arthritis in Japan: A Propensity Score-Matched Analysis From a Public Healthcare Payer Perspective.

Integration of space based solar power into a scaling lunar ISRU based infrastructure and economy

The construction industry is increasingly adopting Building Information Modeling (BIM) technologies to improve project efficiency, reduce errors, and enhance collaboration. Autodesk Navisworks plays a crucial role in integrating multidisciplinary models and enabling efficient clash detection and project visualization. This project focuses on the application of Navisworks for identifying and resolving conflicts between architectural, structural, and MEP (Mechanical, Electrical, Plumbing) systems before construction begins. The study highlights the methodology of model integration, clash detection using the Clash Detective tool, and 4D simulation for project scheduling. The expected outcome includes reduction in construction errors, cost savings, and improved project coordination. The use of Navisworks enhances decision-making and ensures smoother project execution, making it an essential tool in modern civil engineering practices

Cloud-native enterprise architecture has emerged as the defining paradigm for large-scale digital transformation, enabling organisations to replace legacy monolithic systems with containerised, distributed microservices platforms. Amazon Web Services (Amazon Elastic Kubernetes Service) serves as the central orchestration layer for these transformations, providing managed infrastructure that accelerates deployment velocity, enhances system resilience, and significantly reduces total cost of ownership. Enterprises that adopt structured migration strategies — specifically the Replatform and Refactor patterns — achieve measurable improvements in operational efficiency, scalability, and infrastructure footprint reduction. The shift from traditional on-premises data centres to cloud-native environments eliminates the rigidity of monolithic codebases while introducing independent service deployment, fault isolation, and elastic scaling. Zero-downtime cutover frameworks, including blue-green deployment patterns implemented through Kubernetes service selectors and Istio service meshes, protect mission-critical transactions during transition periods. Principal Application Architects who lead these programs draw on deep expertise across containerization tooling, continuous integration and delivery pipelines, multi-terabyte data migration, and cross-functional team orchestration. The cloud computing market, valued at over $675 billion in 2024 and growing at accelerating rates, reflects the urgency organizations place on this transformation. Industries processing high-volume financial transactions — including aviation, logistics, and global carrier operations — directly depend on the reliability, scalability, and cost efficiency that cloud-native platforms deliver. The practical outcomes of well-executed transformation programs include significant reductions in data center footprint, double-digit operational cost savings, and improved capacity to support hundreds of airport and passenger service touchpoints at global scale.

Pharmaceutical marketers have introduced novel ways to deliver point-of-care advertising to clinicians through their electronic health record systems (EHRs) workflow. However, there is a lack of research exploring clinicians' perspectives on prescription drug promotion within EHR systems. To understand clinicians' awareness of, experience with, and opinions about EHR drug promotion. This qualitative study conducted semi-structured individual interviews with 36 clinicians, including physicians, physician assistants, and hospital-based pharmacists. The interviews were conducted between March 19, 2024, and April 9, 2024, using an online videoconference platform. Participants were asked about their knowledge of EHRs that display drug promotions. Participants were shown sample EHR drug promotions in different formats, including banner ads, pop-ups, and sponsored content. For each drug promotion viewed, participants were asked questions about their overall thoughts, likes, recognition, intentions, and if they had any concerns. Participants expressed a lack of awareness regarding the existence of prescription drug promotions that could be displayed within and around EHR systems. Overall, participants preferred promotions that offered cost savings to the patients or that they considered informative. However, many raised concerns about the ethical implications and potential distractions associated with EHR drug promotion. The findings from this qualitative study contribute to the sparse literature on the clinicians' perceptions of EHR drug promotion. The findings highlight the need for further investigation into the influence of prescription drug promotions within EHRs.

Research shows that incorporating Open Educational Resources (OER) into nursing programs can enhance student engagement, reduce financial burdens, and promote inclusivity. However, its utility for teaching public health to student nurses has not been studied. This study evaluated the effectiveness and acceptability of OER in an in-person undergraduate public health nursing course. A retrospective, quantitative analysis was conducted on six course offerings (August 2021-May 2024). Data from two groups-textbook-only (n = 125) and OER-only (n = 247)-were compared using final grades (n = 372) and student evaluations (n = 193). Cost savings were estimated based on bookstore prices ($120 per textbook). Grades were analyzed as categorical variables with z-scores; Chi-square tests examined associations between OER use, costs, and perceptions. Textbooks for the semester-long public health nursing course cost students collectively $8400 per semester; OER was free. No significant differences in overall grades were observed, except for a higher rate of A- grades in the textbook group (p<0.05). Student satisfaction with cost was higher in the OER group (88%vs. 55%, p<0.0001). Perceptions of material necessity for classroom success were similar between textbook and OER groups (p = 0.434). Using OER substantially lowers costs without harming academic performance, supporting its use as a cost-effective, equitable strategy in public health nursing education.

Abstract: Energy efficiency in HVAC systems is a major concern due to increasing energy demand and operational costs. Chiller plants are among the largest energy consumers in commercial and industrial facilities. This study presents a detailed energy audit of a chiller plant to evaluate its performance and identify opportunities for energy savings. Key parameters such as chilled water temperature, condenser water temperature, flow rates, and power consumption were measured and analysed. The performance of the system was assessed using indicators such as Coefficient of Performance (COP) and kW/TR. The audit revealed inefficiencies due to improper load management, heat exchanger fouling, and suboptimal operating conditions. Based on the analysis, several energy conservation measures (ECMs) were proposed, including optimization of cooling tower operation, implementation of variable frequency drives (VFDs), and improved maintenance practices. The implementation of these measures resulted in a significant improvement in system efficiency and enhanced operational performance. The study demonstrates that systematic energy auditing and optimization can lead to substantial cost savings and sustainable operation of chiller plants. Keywords: Energy Audit, Energy Efficiency, Coefficient of Performance (COP), kW/TR, Performance Analysis

Public universities in Malaysia have increasingly adopted solar photovoltaic systems as part of their sustainability and cost-saving strategies. At Universiti Teknologi MARA Kampus Jengka, the rooftop solar installation contributes to lower electricity bills but operates without any form of energy storage. This limits its ability to manage fluctuations in energy supply and demand, especially during periods when solar generation is low. Without storage, excess electricity is exported to the grid while the campus still relies on grid electricity at night or during cloudy days. This raises an important question: can the addition of energy storage improve the economic performance of the system? This study conducts an economic feasibility assessment using actual electricity consumption data, solar production patterns, energy storage cost trends, and tariff structures. Economic indicators such as return on investment, internal rate of return, and payback period are calculated to evaluate the impact of energy storage. The results show that integrating a properly sized energy storage system leads to higher cost savings compared to operating the solar system alone. The findings suggest that energy storage is a viable strategy for improving energy self-sufficiency and reducing long-term operational costs for the university.