Extra Cost Research Articles

Financial Toxicity and Its Associated Factors in Cancer Patients: A Cross-sectional Study in Indonesia

Background: Financial toxicity has been shown to negatively affect cancer patients’ quality of life, depression, anxiety, and even mortality rates. However, there is only limited data on financial toxicity and its associated factors, which are needed to address this problem in Indonesia. Purpose: This study aimed to identify factors associated with financial toxicity in cancer patients in Indonesia.Methods: This study was a cross-sectional study that recruited respondents at a cancer health center in Indonesia using a convenience sampling method. A total of 110 adult cancer patients undergoing treatment took part in the study. The questionnaires comprised sociodemographic data, clinical characteristics, and the Comprehensive Score for Financial Toxicity (COST). Logistic regression was performed to achieve the study's aim.Results: The median value of the financial toxicity index was 3.01 (min-max=1-5), indicating a medium level of financial toxicity. Occupational status was the only factor found to be associated with financial toxicity in this study. The participants who were unemployed were 2.389 more likely to have a higher financial toxicity level compared to those who were employed (OR=2.389; p=0.048).Conclusion: Unemployment was identified to be associated with financial toxicity among cancer patients. Nurses should assess and assist patients in utilizing financial resources and develop strategies to manage extra costs that burden them financially. Future nationwide studies are essential to provide more robust evidence on multifaceted factors influencing financial toxicity and inform policy-making aimed at effectively addressing financial toxicity.

A modified approach for efficient cogging torque suppression in a flux switching permanent magnet generator used in micro‐scale wind turbines

AbstractIn recent years, Flux Switching Permanent Magnet (FSPM) machines have attracted notable attention in direct drive, low speed, and high torque density applications such as wind turbines. However, their relatively high cogging torque has been identified as a significant challenge for such applications primarily because of its effects on both starting and running performance of the wind turbines. The authors, therefore, aim to present a modified approach that can improve the cogging torque issue and eliminate the weaknesses of the previously introduced designs. To reach this goal, first, an operating point is chosen for the studied machine regarding the available small‐scale turbines in the market. Then, the potential benefits of combining different cogging torque reduction schemes are investigated thorough the proposed method. This is intended to be done on the rotor teeth without imposing any complications or extra costs. The results show that a simultaneous improvement in the cogging torque and the energy conversion capability of the machine could be achieved through this cost‐effective approach. To end with, the sensitivity of the best cases to the expected manufacturing tolerances is investigated. All analyses are performed via two‐dimensional finite‐element (2D‐FE) models, the accuracy of which has been pre‐certified through experimental measurement.

Enhancing employment conditions for migrant seasonal workers—Assessing consumer preferences for ‘fair-labour’ apples

Abstract Criticisms over labour practices in agricultural production often target the living and working conditions of migrant seasonal workers. This article assesses consumer preferences for apples produced under social conditions exceeding current legal standards. The analysis is based on a discrete choice experiment (DCE) with a sample of 204 German consumers, who were asked to choose among domestic ‘fair-labour’ apples and standard apples. The former differed in six attributes describing the social conditions facing migrant seasonal workers on German farms. A mixed logit and latent class model were used to analyse the data. The predicted probability of choosing a ‘fair-labour’ apple was 85 per cent. Consumers valued higher minimum wages, the inclusion of migrant workers in Germany's social security system, and bonus payments for work on Sundays and public holidays. Improved accommodation and limits on the maximum permissible weekly working hours were considered less important. The low-price elasticity suggests that farmers could recoup a large share of the extra costs involved in providing enhanced living and working conditions for their workers.

COMMUNICATION PREFERENCES FOR DEPRESCRIBING BISPHOSPHONATES IN NURSING HOME RESIDENTS WITH DEMENTIA

Abstract Bisphosphonates are potential targets for deprescribing in nursing home residents with dementia as goals of care change from preventive to palliative. Yet, prescribers lack communication guidance to address deprescribing. We sought to characterize and compare communication preferences of prescribers and family/informal caregivers regarding bisphosphonate deprescribing. We conducted 23 semi-structured interviews with prescribers (12) and caregivers (11). Prescribers and caregivers were asked to provide their impressions of 7 conversation starters for discussing deprescribing bisphosphonates. A qualitative framework analysis was used to identify themes throughout the interviews across the following domains: content of communication, relationship between communicators, and preferred communication styles. Among prescribers, there were 10 physicians and 2 nurse practitioners; most (9) were female and White. Among caregivers, 8 were female, 7 were White, and 5 were Latino/a; most (9) had a post-secondary degree. The most preferred deprescribing conversation starter for prescribers focused on increased risk of adverse effects, while caregivers most preferred a discussion weighing risks versus benefits. The least preferred conversation starter for deprescribing across both groups focused on the extra effort and cost of continuing bisphosphonates. Similarities and differences between prescribers and caregivers regarding important topics for deprescribing conversations were identified, including quality of life, risk versus benefit, and shared decision-making. While caregivers and prescribers agreed on some communication preferences, this study highlights nuanced differences in preferred communication about deprescribing bisphosphonates. The results of this study may contribute to clinical guidance for prescribers and education materials for caregivers to facilitate more effective conversations about deprescribing bisphosphonates.

Is telemedicine worth the effort? A study on the impact of effort cost on healthcare platform with heterogeneous preferences

Telemedicine involves remote delivery of healthcare and virtual meetings between patients and doctors. However, its implementation in a traditional hospital can incur extra costs stemming from additional staffing, training, and IT infrastructure requirements. The effort needed by a doctor to treat a patient can be different depending on the mode of treatment. A principal-agent model is developed to find the optimal policy for both the agent (service provider, such as doctors) and the principal (platform, such as a hospital). We assume there are two types of service options, and the doctor prefers the service type with the lower effort cost. If the doctor’s policy is to accept both types of service options, her revenue may increase or decrease with an increase in the arrival rate of the less preferred service option. Offering only the service option with the higher average revenue is preferred if the service model is under the full control of the hospital. More importantly, the doctor and the hospital may not choose the same optimal strategies for certain values of effort costs. We show that this incentive misalignment issue can be solved by offering extra compensation for the less preferred service type of the doctor, which in turn affects the doctor’s strategy as well as the hospital’s rewards. Our study contributes to the literature on service queues with heterogeneous demands, as well as research on implementing telemedicine applications in healthcare systems.

Multi-modal cell-free DNA genomic and fragmentomic patterns enhance cancer survival and recurrence analysis

The structure of cell-free DNA (cfDNA) is altered in the blood of patients with cancer. From whole-genome sequencing, we retrieve the cfDNA fragment-end composition using a new software (FrEIA [fragment end integrated analysis]), as well as the cfDNA size and tumor fraction in three independent cohorts (n= 925 cancer from >10 types and 321 control samples). At 95% specificity, we detect 72% cancer samples using at least one cfDNA measure, including 64% early-stage cancer (n= 220). cfDNA detection correlates with a shorter overall (p= 0.0086) and recurrence-free (p= 0.017) survival in patients with resectable esophageal adenocarcinoma. Integrating cfDNA measures with machine learning in an independent test set (n= 396 cancer, 90 controls) achieve a detection accuracy of 82% and area under the receiver operating characteristic curve of 0.96. In conclusion, harnessing the biological features of cfDNA can improve, at no extra cost, the diagnostic performance of liquid biopsies.

Automated preparation of nanoscopic structures: Graph-based sequence analysis, mismatch detection, and pH-consistent protonation with uncertainty estimates.

Structure and function in nanoscale atomistic assemblies are tightly coupled, and every atom with its specific position and even every electron will have a decisive effect on the electronic structure, and hence, on the molecular properties. Molecular simulations of nanoscopic atomistic structures therefore require accurately resolved three-dimensional input structures. If extracted from experiment, these structures often suffer from severe uncertainties, of which the lack of information on hydrogen atoms is a prominent example. Hence, experimental structures require careful review and curation, which is a time-consuming and error-prone process. Here, we present a fast and robust protocol for the automated structure analysis and pH-consistent protonation, in short, ASAP. For biomolecules as a target, the ASAP protocol integrates sequence analysis and error assessment of a given input structure. ASAP allows for p prediction from reference data through Gaussian process regression including uncertainty estimation and connects to system-focused atomistic modeling described in Brunken and Reiher (J. Chem. Theory Comput. 16, 2020, 1646). Although focused on biomolecules, ASAP can be extended to other nanoscopic objects, because most of its design elements rely on a general graph-based foundation guaranteeing transferability. The modular character of the underlying pipeline supports different degrees of automation, which allows for (i) efficient feedback loops for human-machine interaction with a low entrance barrier and for (ii) integration into autonomous procedures such as automated force field parametrizations. This facilitates fast switching of the pH-state through on-the-fly system-focused reparametrization during a molecular simulation at virtually no extra computational cost.

Costs of breast cancer recurrence after initial treatment for HR+, HER2−, high-risk early breast cancer: estimates from SEER-Medicare linked data

Objective To assess the costs of treated recurrence and survival in elderly patients with early breast cancer (EBC) at high risk of recurrence using Surveillance Epidemiology and End Results (SEER) registry-Medicare linked claims data. Methods This retrospective study included patients aged ≥65 years with hormone receptor-positive (HR+), human epidermal growth factor receptor 2 negative (HER2−), node-positive EBC at high risk of recurrence. Treated recurrences were defined based on treatment events/procedure codes from claims. Primary outcomes were monthly total extra costs and cumulative extra costs of treated recurrence relative to patients with non/untreated recurrence. Costs were calculated using a Kaplan-Meier sampling average estimator method and inflated to 2021 US$. Secondary outcomes included analysis by recurrence type and overall survival (OS) after recurrence. Subgroup analysis evaluated costs in patients with Medicare Part D coverage. Results Among 3,081 eligible patients [mean (SD) age at diagnosis was 74.5 (7.1) years], the majority were females (97.4%) and white (87.8%). Treated recurrence was observed in 964 patients (31.3%). The monthly extra cost of treated recurrence was highest at the beginning of the first treated recurrence episode, with 6-year cumulative cost of $117,926. Six-year cumulative extra costs were higher for patients with distant recurrences ($168,656) than for patients with locoregional recurrences ($96,465). Median OS was 4.34 years for all treated recurrences, 1.92 years for distant recurrence, and 6.78 years for locoregional recurrence. Similar cumulative extra cost trends were observed in the subgroup with Part D coverage as in the overall population. Limitations This study utilizes claims data to identify treated recurrence. Due to age constraints of the dataset, results may not extrapolate to a younger population where EBC is commonly diagnosed. Conclusion EBC recurrence in this elderly population has substantial costs, particularly in patients with distant recurrences. Therapies that delay or prevent recurrence may reduce long-term costs significantly.

Application of Solvent-Assisted Dual-Network Hydrogel in Water-Based Drilling Fluid for Lost Circulation Treatment in Fractured Formation.

During oil and gas well construction, lost circulation caused substantial nonoperation time and extra costs, and hydrogel, resilient and environmentally friendly, was one of the major types of material for lost circulation treatment. To migrate the weak bonding and hydrothermal degradation of conventional single network hydrogels, dual network (DN) hydrogel was prepared and immersed in solvents of polyethylene glycol (PEG), ethylene glycol, and glycerol. The swelling of DN gels at different temperatures was studied with water content and swelling rate tests, and the gel structural and morphology was characterized with attenuated total reflectance infrared spectroscopy (ATR-IR) and scanning electron microscopy test. Then, the compression test and fracture plugging performance test were conducted to study the strength of the gel. The results show that compared to those in ethylene glycol and glycerin, DN gel after immersion in PEG (DN-PEG) exhibits greater compression strength and better plugging performance even at high temperatures. The compression strength of DN-PEG was twice that of DN hydrogel before immersion, and its fracture plug breaking pressure can reach over 10.0 MPa. After undergoing hydrothermal treatment at 90 °C, the compression strength of the DN-PEG was nearly 20 times that of the DN hydrogel, and the fracture plug breaking pressure was still 2.81 MPa. According to ATR-IR spectroscopy, as the molecular weight of the solvent increases, more hydroxyl groups in the PEG have better ability to bind with hydrogen bonds, which greatly inhibits the swelling and polymer chain breakage, thereby reducing hydrothermal degradation in the strength of the dual-network hydrogel. Our work proposed an effective method to reduce the degradation of hydrogel in water at high temperature, and the prepared DN-PEG hydrogel was a promising material for lost circulation treatments in fractured formation.

Developing a new flexibility-oriented model for generation expansion planning studies of renewable-based energy systems

This paper presents a flexibility-oriented generation expansion planning (GEP) model with the goal of increasing renewable energy penetration. The model incorporates GEP and unit commitment while considering improved reserve requirements. Utilizing GEP and unit commitment results in considering short-term operational constraints. Furthermore, given the increase in renewable portfolio standards (RPS) and the need for accurate reserve requirements determination, it is essential to consider improved reserve requirements in the proposed model. Moreover, this model utilizes a metric that measures power system flexibility deficiency and leads to flexible power system expansion by integrating it into the objective function. The flexibility-oriented GEP model is developed using mixed-integer linear programming and applied to a scaled-sized case study representing the national power system of Iran with a twenty-year planning horizon. The results show that neglecting improved reserve requirements leads to plans short on flexibility, and considering these requirements substantially declines the upward flexibility violation costs by 68% under the base scenario and 87% under increasing non-hydro RPS scenario. Furthermore, using the flexibility metric coupled with improved reserve requirements changes the optimal path for power system expansion and reduces the risk of flexibility deficiency. Also, increasing RPS by 35% would strongly depend on developing fast-response dispatchable generation units in the years before renewable energy resources expansion; however it doesn’t impose a significant extra cost of planning and the total cost will increase just by 9.43%.

Enhancement of biodiesel production using magnetic nanocatalyst CrFe2O4 from mixed waste cooking oil by an empirical model

Biodiesel has achieved widespread recognition as an unconventional energy source, despite its extra manufacturing cost and sustainable resources. Mixed waste cooking oil is one of the best feedstock for sustainable biodiesel production. This study looked at the prospect of using the easily separable magnetic nanocatalyst CrFe2O4 to reduce the manufacturing cost and being used in both esterification and transesterification simultaneously with less percentage of 0.5, produced the highest oil conversion. Before being used in conversion process, the magnetic nanocatalyst underwent Fourier transform infrared, XRD, scanning electron microscope, TGA, AFM, and BET analysis to evaluate its characteristics. Response surface methodology was employed in the conversion process and achieved 97% yield with the utilization of 0.4 (v/v) methanol/oil ratio, 0.5 wt. % catalyst concentration, 600 rpm stirring speed, and the duration of 80 min. The effect of methanol consumption and time was considerably more significant than the effect of stirring speed and catalyst usage, according to the analysis of variance. The generated biodiesel met all physicochemical characteristics with high potential, according to ASTM and EN standards. Right combinations of saturated and unsaturated fatty acids confirm the promising feasibility of the application of waste biomass feedstocks as an alternate option for the sustainable, cost effective and energy efficient synthesis of biodiesel production.

Parametric analysis of chiller plant energy consumption in a tropical climate

The approach that could reduce the energy consumption of water-cooled chillers in office buildings was investigated through experimental and simulation methods. The chiller was modelled in TRNSYS and validated using physical measurements from an operational water-cooled water chiller and fan coil system. The validated model was used to analyse the energy consumption of the water chiller-fan coil system under a high chilled water temperature setpoint (CWTS) in a representative commercial office building. Subsequently, indoor thermal comfort was evaluated using the PMV-PPD model. Finally, the design of experiment (DOE) was employed using a statistical two-level non-randomized factorial design in Minitab to study the effects of high CWTS, number of rows, and tube diameter on the heat and mass transfer performance of the fan coil unit. The results showed that the CWTS can be increased by various degrees from 10 up to 18 °C for energy efficiency for a commercial office building in the tropics. This increase in CWTS would result in a daily energy saving potential of about 5% of the chiller as compared to the existing operational settings without any extra cost. Conversely, the daily energy consumption by the fan coil would increase by about 5.5% by this increment in the CWTS. It was determined that the chiller system can provide comfort even when the CWTS is increased to 14 °C. The DOE analysis showed that under the condition of high CWTS (14 °C), energy consumption that is less than the current energy consumption may be expected from the fan coil system when the number of rows increased from 3 to 6 and the tube diameter increased from 7 to 9 mm.

Preconditioned geometric iterative methods for B-spline interpolation

The geometric iterative method (GIM) is widely used in data interpolation/fitting, but its slow convergence affects the computational efficiency. Recently, much work has been done to guarantee the acceleration of GIM in the literature. This work aims to accelerate the convergence rate by introducing a preconditioning technique. After constructing the preconditioner, we preprocess the progressive iterative approximation (PIA) and its variants, called the preconditioned GIMs. We show that the proposed preconditioned GIMs converge, and the extra computation cost of the preconditioning technique is negligible. Several numerical experiments are given to demonstrate that our preconditioner can accelerate the convergence rate of PIA and its variants.

Applying traffic camera and deep learning-based image analysis to predict PM2.5 concentrations

BackgroundAir pollution has caused a significant burden in terms of mortality and mobility worldwide. However, the current coverage of air quality monitoring networks is still limited. ObjectiveThis study aims to apply a novel approach to convert the existing traffic cameras into sensors measuring particulate matter with a diameter of 2.5 μm or less (PM2.5) so that the coverage of PM2.5 monitoring could be expanded without extra cost. MethodsIn our study, the traffic camera images were collected at a rate of 4 images/h and the corresponding hourly PM2.5 concentration was collected from the reference grade PM2.5 station 3 km away. A customized neural network model was trained to obtain the PM2.5 concentration from images followed by a random forest model to predict the hourly PM2.5 concentration. The saliency maps and the feature importance were utilized to interpret the neural network. ResultsProposed novel approach has a high prediction performance to predict hourly PM2.5 from traffic camera images, with a root mean square error (RMSE) of 0.76 μg/m3 and a coefficient of determination (R2) of 0.98. The saliency map shows neural network focuses on unobstructed far-end road surfaces while the random forest feature importance highlights the first quarter image's significance. The model performance is robust whether weather conditions are controlled or not. ConclusionOur study provided a practical approach to converting the existing traffic cameras into PM2.5 sensors. The deep learning method based on the Resnet architecture in our study can broaden the coverage of PM2.5 monitoring with no additional infrastructure needed.

Risk management practice for foreign banks in the Chinese financial sector: a case study of HSBC China

This dissertation uses a single case study approach with a mix of qualitative and quantitative analysis of secondary data for research process. It aims to answer the research questions of how does risk management framework of foreign banks work in China’s regulatory and economic environment. Through an in-depth analysis of the risk management practice of HSBC Bank (China) in 5 years period, the author finds risk management policies and assessment procedures are always align with organization’s risk appetite and strategy. In addition, based about HSBC, the portfolio with higher capital requirement has lower return due to the extra cost. And there is no clear evidence that stricter supervisions will impact the efficiency of risk management.

Towards a low energy, stirless photobioreactor using photosynthetic motile microalgae

Microalgae have a high potential for application in different industries including renewable energy production from light and atmospheric CO2. Biotechnologies should provide high production rates while using the mass and energy resources in a restrained manner. Often, mixing and gas provision are combined to minimize the energetic requirements of photobioreactors. Recent studies suggest that bioconvective patterns naturally developed in suspensions of motile microorganisms may provide biomixing. In this paper we report a study of the phototactic response of Chlamydomonas reinhardtii to induce biomixing in a small bioreactor at macro-scale. By exploiting the phototactic mechanism, we stimulated the microalgae to swim in opposite directions repeatedly in cycles of 40 min (20′ left, 20′ right) in the photobioreactor. The resulting Phototactic Oscillatory Motion (POM) lasted 7 days and maintained an amplitude close to the width of the bioreactor. Phototaxis allowed algae to remain in suspension without the use of any mechanical stirring system. We have demonstrated that light can be controlled to effectively provide mixing and ensure access to nutrients in form of an oscillatory motion at no extra energetic costs. This strategy can replace mechanical agitation in the manner of a ‘phototactic stirring’ under certain circumstances in pursuit of energetic sobriety.

A Review of Disputes in Claims for Loss and Expense Related to the PWD Form of Contract Based on Malaysian Legal Cases

Construction disputes arising from claims have become common in this unique and complex industry. Resolving disputes leads to extra costs and is time-consuming. Most of the disputed claims in construction occur due to project delays. A claim for loss and expense is one of the claims incurred due to certain events that usually arise from the delay. Therefore, this paper aimed to identify disputes in claims for loss and expense related to the PWD form of contract based on Malaysian legal cases. Understanding why disputes occur in construction contracts can reduce the chances of their occurrence, and parties can establish a quick, cost-effective resolution process that will not jeopardise their potential in future business relationships when disputes arise. The research adopted a review related to construction law cases from 'Malayan Law Journal Report/Unreported'. Findings indicate that disputes in claims for loss and expenses related to the Public Works Department (PWD) form of contract can be categorised into contractual, documentation, and procedure. Understanding the contract provisions is a must for every construction party to obtain successful claims. This paper suggests identifying disputes related to PAM forms of contracts in the Malaysian construction industry, so that the contracting parties can understand the impact of the disputes.

Optimal design of a sector-coupled renewable methanol production amid political goals and expected conflicts: Costs vs. land use

Methanol is an important bulk chemical which can be produced from renewable resources with the currently available technologies and doing so has a high potential for greenhouse gas (GHG) emission reductions for the chemical sector. Reaching the targets for climate change mitigation and biodiversity protection will require designing not only renewable, but also land-efficient chemical production systems. However, under the current economic imperative of cost minimization, the efficient use of land is often not considered during production system design and compromise solutions are left undiscovered, the potential of land-use intensifying technologies stays unknown and the impact of their exclusion, e.g. due to political reasons, is not quantified. This study addresses these issues for renewable production of methanol through the biogas- and power-to-methanol production pathways, which are considered concurrently with processes allowing intensified land use (agrivoltaics, wheat straw anaerobic digestion, heat pumps, wind turbines, etc.) in a previously unexplored technological scope. The designs, as well as the effect of coupling with other production systems (residential heat, electricity, and food) as a strategy to reduce the total annualized costs (TAC) and direct land use, are investigated using the FluxMax approach, an optimization-based design methodology. It simultaneously accounts for the, often neglected, dynamics of renewable energy harvesting, waste-heat utilization and biomass production under the fluctuating renewable resource and product-demand conditions of an example location in Saxony-Anhalt, Germany. Reductions of the TAC of 19 %, direct land use of 9 % and GHG emissions of 12 % for the production system by coupling all four of these products were determined. Furthermore, Pareto fronts were constructed to quantify the trade-off between the conflicting objectives of minimizing TAC and direct land use, demonstrating that land use can be reduced by up to 10 % with minimal extra costs among the available technologies. Political conflicts and goals, which may influence the deployment of the considered technologies, are discussed from a political science perspective and highlight the need for further interdisciplinary collaboration.

Hand Hygiene Knowledge and Perception Survey for Healthcare Workers in Government Hospitals (GHs) in Bahrain.

Introduction and aim Healthcare-associated infections (HAIs) are a serious concern in all healthcare facilities as they may lead to many serious consequences, like prolonged hospitalization, increased mortality and morbidity, and extra costs. Effective hand hygiene (HH) is the primary proven measure known to be effective in reducing the risk of HAIs in all healthcare settings. This study aimed to measure the healthcare workers' (HCWs) knowledge and perception of HH at government hospitals (GHs) in Bahrain. Subjects and methods This cross-sectional study was conducted among HCWs working in GHs in the Kingdom of Bahrain. A self-administered questionnaire was distributed among the targeted population using a Google survey (Google LLC, California, USA). The questionnaire includes socio-demographic data (e.g., age, gender, nationality, etc.) and a validated WHO questionnaire measuring perceptions and knowledge toward HH. Results Of the 285 HCWs, 75.4% were females, and 48.1% were aged between 31 and 40 years old. The overall mean perception was 35.9 (SD 6.93) out of 42 points, with nearly 80% of HCWs considered to have good perception levels. The overall mean knowledge score was 11.4 (SD 1.37) out of 14 points. Accordingly, 75.4% were considered to have good knowledge levels. Factors associated with increased perception include increasing age, female gender, non-Bahraini, being a nurse with increasing years of working experience, and receiving formal training in HH. Being a nurse was the sole significant predictor of increased knowledge. Conclusion The knowledge and perception of HH among HCWs were sufficient. Being a nurse was a significant predictor of both knowledge and perception. Further, a significant positive correlation was noted between the knowledge and perception scores. Maintaining the level of knowledge and perception of HH could lead to improved HH compliance among HCWs.

Selection of tramcars for sustainable urban transportation by using the modified WASPAS approach based on Heronian operators

The wrong design of rail system vehicle fleets is one of the most critical problems in terms of urban transportation. Light rail system fleets in many large cities, including Istanbul, consist of various types and feature vehicles. It creates significant problems in integrating each rail system vehicle into the system. In addition, while it is necessary to keep an inventory of spare parts for each different type of vehicle, it requires different qualifications for professionals involved in processes such as maintenance and repair, leading to extra costs. In this context, the study's primary purpose is to determine the most suitable light rail vehicles for urban transportation systems and create vehicle fleets accordingly. In that regard, the study aims to provide a reliable and practical decision-making model that can be used as a roadmap for decision-makers when choosing tramcars to solve these problems. The present work proposes a hybrid procedure integrating the Best and Worst Method (BWM) and Power-Heronian Weighted Aggregated Sum Product Assessment (WASPAS'PH) approaches. The most critical implication of the work indicated that the acquisition cost per tramcar set (0.148) is still the most influential factor. The economic lifespan of tramcars (0.037), the number of seats in a vehicle set (0.041), and energy consumption (0.072) have followed the most significant criterion, respectively. Besides, it highlighted that the A14 Brand CR (0.7819) is the most appropriate option for well-structuring the urban light rail system fleet. An extensive validation test to check the suggested model's robustness confirmed the procedure's stability and consistency.