Extra Cost Research Articles

The potential of phenomic selection for the joint Ethiopian malt barley breeding program

AbstractPhenomic selection is an alternative approach to genomic selection that uses near‐infrared spectra information to predict the performance of genotypes. This research assessed the effectiveness of phenomic selection in barley (Hordeum vulgare L.) using data from 21 trials carried out at Bekoji, Kofele, Holetta, Debre Markos, and Debre Berhane in Ethiopia from 2018 to 2021. Fivefold cross‐validation analysis showed robust predictability for traits, ranging from 0.5 to 0.8 for days to heading, days to maturity, plant height, 1000‐kernel weight, and grain yield. Days to heading and days to maturity showed similar correlation patterns across the ranges of the wavelengths. Days to heading and 1000‐kernel weight were positively and negatively correlated along the range of the wavelength above 1800 nm, respectively. Forward validation using an independent set of genotypes provided predictability above 0.3 for all traits. This result underscores the effectiveness of phenomic selection and its potential application in low‐budget, small‐scale breeding programs. The study affirmed the Ethiopian barley breeding program could implement phenomic selection as a routine selection tool without extra cost.

Environmental policies and stagnation in a two-country economy

Global warming poses a serious and acute threat to our planet. However, negotiations over the allocation of permissible carbon emissions often lead to conflicts of interest between developed and developing countries. Developing countries claim that global warming results from long-term pollution emissions by developed countries, while developed countries demand that developing countries should make adequate efforts to reduce carbon emissions. Both developed and developing countries generally agree that stricter emission limits will strain their economies due to the associated extra abatement costs. Using a two-country model with wealth preferences, we find that the impacts of a country’s emission limit on real consumption and pollution emissions in both countries vary depending on the combination of their business situations. If both countries achieve full employment, one country’s stricter emission limit decreases real consumption in both, as expected. However, if one country faces aggregate demand stagnation while the other achieves full employment, a stricter emission limit imposed by the stagnant country increases real consumption in both countries.

Enhanced biomass densification pretreatment using binary chemicals for efficient lignocellulosic valorization

Many effective pretreatment methods (such as dilute acid, dilute alkali, ionic liquids, etc.) have been developed for lignocellulose upgrading, but several defaults of low working mass, high sugar loss and extra cost of solid-liquid separation and water washing hinder their large-scale application in industry. Besides, the valorization of lignin-rich residue from pretreated biomass after hydrolysis or fermentation greatly contributes to the economy and sustainability of lignocellulosic biorefinery, which is usually underestimated. This study developed a densification pretreatment with binary chemicals (densifying lignocellulosic biomass with sulfuric acid (SA) and metal salt (MS) followed by autoclave treatment ((DLCA(SA-MS)), which was conducted under mild condition (121 °C) with a biomass working mass as high as 400 kg/m3. The DLCA(SA-MS) biomass achieved over 95% sugar retention, 90% enzymatic sugar conversion and a high concentration of fermentable sugar (212.3 g/L) with superior fermentability. Furthermore, bio-adsorbent derived from DLCA(SA-MS) biomass residue was highly adsorptive and suitable for dyeing wastewater treatment, providing a feasible and eco-friendly method for lignin-rich residue valorization. These findings indicated that DLCA(SA-MS) pretreatment enables the full-component utilization of biomass and boosts the economic viability of lignocellulosic biorefinery.

Meet and Greet Sessions: A Unique Virtual Opt-Out Approach to Support Trainee Well-Being.

Background Interventions to support graduate medical education (GME) trainee well-being at the institutional level continue to be an area for continuous improvement. Objective To assess participation, feasibility, and acceptability of a virtual, individual, brief, nonevaluative opt-out approach to accessing mental health support for residents and fellows. Methods From 2021 to 2023, all GME programs at one large institution were invited to participate. During orientation, incoming trainees from programs that had communicated interest were prescheduled for optional 20-minute, virtual "meet and greet" sessions with a counselor from the hospital's Employee Assistance Program. Nonformal feedback was gathered using an anonymous 6-question survey. Results Three hundred thirty-four residents and fellows from 12 of 74 (16%) participating GME programs were prescheduled for opt-out sessions over 3 academic years. Of the 334, 182 (54%) attended the sessions, 116 (35%) subsequently reached out to start counseling, and 108 (32%) responded to the survey. Each year, approximately 7 counselor hours were needed for the opt-out sessions per week over an 8-week period, which was feasible and added no extra cost. In the follow-up survey shared with all participants, 59 of 81 (73%) respondents reported that the sessions helped to reduce barriers to seeking mental health care. Conclusions During orientation, one-half of invited GME trainees participated in a virtual, individual, brief, nonevaluative meet and greet session with a counselor using an opt-out approach, and one-third subsequently requested counseling. Survey feedback was encouraging, and this approach can serve to help normalize culture surrounding accessing mental health services.

Resolving subgrid-scale structures for multiphase flows using a filament moment-of-fluid method

Multiphase flows are present in many industrial and engineering applications as well as in some physical phenomena. Capturing the interface between the phases for complex flows is challenging and requires an accurate method, especially to resolve fine-scale structures. The moment-of-fluid (MOF) method improves drastically the accuracy of interface reconstruction compared to previous geometrical methods. Instead of refining the mesh to capture increased levels of detail, the MOF method, which uses zeroth and first moments as well as a conglomeration algorithm, enables subgrid structures such as filaments to be captured at a small extra cost. Coupled to a finite volume Navier–Stokes solver, the MOF method has been tested on a fixed grid and validated using well-known benchmark problems such as the dam break flows, the Rayleigh–Taylor and Kelvin–Helmholtz instability problems, and a rising bubble. The ability of the novel filament MOF method to capture the filamentary structures that eventually form for the Rayleigh–Taylor instability and rising bubble problems is assessed. Good agreement has been found with other numerical results and experimental measurements available in the literature.

Fine-grained detoxification framework via instance-level prefixes for large language models

Large Language Models (LLMs) have demonstrated remarkable performance across various natural language processing (NLP) tasks. However, their practical usability is often compromised by a propensity to generate toxic content, such as insults, threats, and profanity, particularly in response to adversarial prompts. Several fine-tuning and decoding approaches have been employed to address this challenge to mitigate toxicity. Nevertheless, these methods typically necessitate additional resources, such as high-quality training data or auxiliary models, thereby incurring extra costs. In this paper, we propose a novel detoxification framework, Fine-Grained Detoxification via Instance-Level Prefixes (FGDILP), which effectively mitigates the generation of toxic text without incurring additional training costs. Specifically, FGDILP leverages contextualized representations in attention space by contrasting a positive prefix-prepended prompt against multiple negative prefix-prepended prompts at the instance level. This methodology facilitates the construction of fine-grained subtoxicity vectors, which are subsequently fused to adjust the original generation pathway when responding to raw prompts. Our results demonstrate that FGDILP enables controlled text generation concerning detoxification at both the utterance and context levels. While our method slightly impacts generation fluency and diversity, it significantly outperforms prompt-based baselines regarding detoxification effectiveness. Our code is available at https://github.com/xinykou/FGDILP.

Swachh Bharat Mission Gramin: Uptake and challenges in rural Coimbatore

ABSTRACT Introduction: Water, sanitation, and hygiene (WASH)-related infectious diseases contribute to approximately 5% of the global disease burden. Despite sanitation being a human right, 673 million people worldwide had limited access to toilets. To tackle the same, Swachh Bharat Mission-Gramin (SBM-G) was launched in 2014 to facilitate the construction of over 100 million individual household latrines (IHHLs) across India. However, literature evidence on acceptance of SBM-G in Tamil Nadu, particularly in Coimbatore, is scarce. Objectives: The primary objective was to investigate the utilisation of the SBM-G scheme and its associated factors in rural Coimbatore. Materials and Methods: In 2022, a mixed-methods study incorporating quantitative (using a purpose-designed questionnaire) and qualitative (using in-depth interviews and focus group discussions) components was conducted among 60 SBM-G beneficiaries in Kovai Medical Center and Hospital Institute of Health Sciences and Research (KMCH IHSR)’s rural field practice area. Quantitative data were analysed using Statistical Package for the Social Sciences (SPSS) v23 and qualitative data using manual thematic content analysis. Results: Before IHHL construction, 93.7% of respondents practiced open-air defecation (OAD). The issues perceived with OAD were distance (28.8%) and privacy concerns (12.5%). After SBM-G implementation, 78.3% reported using the IHHL ‘all the time’, reflecting a substantial shift in behaviour. Most respondents received financial aid within about six months (INR 8,000), often in a single instalment. The majority had constructed their IHHLs before 2015. The expenditures incurred varied significantly, with 58.3% spending extra costs ranging between INR 10,000 and 30,000. Water supply to households significantly influenced IHHL usage. Conclusion: While rural villagers appreciate the SBM-G financial assistance for IHHLs, concerns about the inadequacy of the sanctioned amount for proper piped water supply and septic tanks persist. Nonetheless, there is a clear demonstration of positive behavioural change, marked by reduced OAD and increased IHHL usage.

Comparative Analysis of Congestion Management Methods with Integrated Renewable Energy Generation

Inclusion of renewable energy in power grid at micro and macro level has imposed numerous challenges in the recent years. Occurrence and managing congestion in the power transmission line due to unpredictable and stochastic nature of Renewable Energy Source (RES) integration has become a challenging task to the grid operators. Transmission lines operate at bottlenecks during a congestion episode adding to the extra congestion cost and risk in grid stability which becomes burden to the generation as well as end users. Different methodologies are applied to detect and manage the congestion to eliminate the congestion cost factor and maintain grid stability. The presented analysis compares conventional methodology Linear Sensitivity Factors (LSF) and Heuristic methodology Particle Swarm Optimization (PSO) and Artificial Neural Network (ANN) methods for congestion management in power transmission lines with integrated RES (wind and solar) system. For comparative analysis, a modified standard IEEE 30 Bus system is chosen which is integrated with real time RES generation. Optimal locations of RES generation with minimized congestion cost and percentage of RES curtailment are chosen as objective function for comparison of the methodologies.

From ideal to realistic compact hybrid PV-CSP systems: A technoeconomic evaluation

Compact PV/CSP hybrid systems, based on the integration of both PV and CSP technologies within a single power plant, have been attracting interest in recent years, because of their potential to lower the cost of solar electricity and minimize the land footprint required. However, the objective evaluation of these technologies is complicated by the fact that they involve two separate converters, each delivering a different form of energy (dispatchable for CSP, non-dispatchable for PV). We propose here an original evaluation and optimization approach based on 3 techno-economic indicators quantifying (1) the overall conversion efficiency of these systems compared to their standalone CSP counterparts, (2) the energy production balance between PV and CSP, and (3) the extra manufacturing cost compared to standalone CSP systems. These different indicators are evaluated for two families of hybrid systems (PV Topping and PV Mirror) and for 3 geometries of concentrating optics (Linear Fresnel Lenses, Parabolic Troughs and Solar Towers). One originality of our approach lies in its ability to determine the optoelectronic properties of PV cells likely to lead to the best hybrid performance, taking into account whether or not they are able to reach their own theoretical limits. Another original feature is that the hybrid systems considered in our analysis are compared with CSP equivalents which have been independently optimized. It is shown that the integration of realistic solar cell technologies whose performances deviate significantly from their theoretical limits notably restricts the range of operating conditions for which hybrid systems could outperform their standalone CSP counterparts. We conclude this work by discussing a number of key challenges that need to be overcome in order to develop more competitive and efficient hybrid systems.

A dynamic evolutionary game to discourage enterprise “greenwashing”

To meet the increasing consumer demand for green products and services, governments have increased their regulation of enterprise production behaviors so that enterprises may choose “greenwashing” to obtain the premium of green products at the lowest cost under government regulation. The increase of greenwashing hinders green innovation by enterprises. To quantify this problem and seek solutions to promote enterprises cleaner production and sustainable development, we established a tripartite evolutionary game model for enterprises, consumers, and governments. Using the model, we analyzed the stability of their strategy combinations through simulations and explored the impact of some parameters on the strategy selection. We found that (1) the combination of enterprises adopting true green, consumers buying green products, and weak government regulation was the most environmentally friendly and low-cost strategy solution in the tripartite game system. (2) An increase in government penalties or subsidies to enterprises, as well as a reduction of the extra cost of producing green products, can improve the probability that enterprises will adopt cleaner production. Based on the results, the government should define reasonable subsidies and penalties, guide enterprises to assume their social responsibility, and stimulate consumer green demand. Enterprises should improve their moral qualities, actively engage in green innovation, and increase investment in green product research to guide the game system towards the ideal state.

Sustainability Assessment of Harvesting Rainwater and Air-Conditioning Condensate Water in Multi-Family Residential Buildings under Various Conditions in Israel—A Simulation Study

The environmental impacts and water savings of different configurations of non-potable domestic water use (toilet flushing and laundry), sourced from rainwater harvesting (RWH) and air-conditioning condensate water (ACWH), in multi-family buildings in Israel are examined. Two building types differing in specific roof areas, and three climatic sub-regions were modeled. RWH satisfied 23 and 46% of the water demand for toilet flushing and laundry in high-rise and low-rise buildings, respectively. Air conditioning is used almost daily during Israel’s hot and dry summers. Hence, the combined RWH-ACWH system saved 42 and 64% in high- and low-rise buildings, respectively. Displacing desalinated seawater, a significant water source in Israel, with alternative water sources lowered the environmental impacts with an increase in storage, up to a certain volume, beyond which impacts started rising. The same infrastructure is used during winter for RWH and for ACWH during summer; thus, combining the two exhibits significant water savings, with marginal extra costs while lowering the environmental impacts.

Tularemia in Pediatric Patients: A Case Series and Review of the Literature.

Unfamiliar to pediatricians, tularemia can lead to delays in diagnosis and hinder appropriate treatment, as its clinical presentation often shares similarities with other more prevalent causes of lymphadenopathy diseases in children. We conducted a comprehensive literature review to offer contemporary insights into the clinical manifestations and treatment strategies for tularemia infection in children. Three cases of glandular tularemia were diagnosed in the Pediatric Robert Debré Hospital (Paris) between October 2020 and February 2022. In addition, we conducted a literature search using PubMed in December 2023 of cases of tularemia in children published in English. The 94 cases of the literature review highlight the large age range (from 6 weeks to 17 years) and multiple sources of infection, including diverse zoonotic transmission (86.7%) and contact with contaminated water (13.3%). Fever was a consistent symptom. Ulceroglandular (46.7%), glandular (17%) and oropharyngeal forms (18.1%) predominated. The most frequently used diagnostic method was serology (60.6%). The median time to diagnosis for tularemia was 23.5 days. Hospitalization was required in 63.2% of cases, with a median duration of 4 days. Targeted treatment was based on aminoglycosides (37.6%), fluoroquinolones (30.6%) or tetracyclines (12.9%), in accordance with WHO recommendations, with a mainly favorable outcome, although several cases of meningitis were observed. Pediatricians should be aware of the etiology of this febrile lymphadenopathy, notably when experiencing beta-lactam treatment failure, even in young infants, which could help reduce the extra costs associated with inappropriate antibiotic use and hospitalization.

Channel Choice in Live Streaming Commerce

Live streaming has significantly transformed the landscape of both offline and online retail operations. This article explores the optimal timing and circumstances under which a firm with a specific product should launch a live streaming channel, and if so, whether it should use third-party streaming, self-run streaming, or a combination of both. We demonstrate that no single channel structure is universally superior to the others: the firm's optimal channel strategy depends on the third-party streamer's popularity and bargaining power, the investment and broadcasting effort cost for the live streaming channel, consumer's channel preference and extra cost for watching live streaming, cross-channel spillover, as well as the price sensitivity of a product. In general, live streaming is most beneficial for firms selling products that aren't highly price sensitive, where traditional pricing tool is less important for attracting consumers. Start-ups should collaborate with either highly popular streamers or those with a small but dedicated following, avoiding those with intermediate popularity. In contrast, established firms should partner with streamers who have a moderate level of popularity. An established firm considering leveraging two or more channels concurrently should additionally take into consideration the cross-channel spillover, channel encroachment cost, and channel competition. Our research reveals that, contrary to expectation, price in live streaming channels may not always be lower than those in traditional channels. Furthermore, highly popular streamers do not always demand higher revenue-sharing ratios and slotting fees. This research sheds light on the key decisions for firms considering live streaming commerce: whether to adopt it, when to integrate it into their strategy, and how to effectively implement it.

ThP5.10 - Post ERCP Pancreatitis at a Tertiary Center - A Retrospective Incidence and Causal Analysis

Abstract Background Incidence of Post Endoscopic Retrograde Cholangio-Pancreatography (ERCP) Pancreatitis (PEP) varies between 3.5% and 9.7% as per the 2014 meta-analyses. Our aim was to evaluate the incidence, perform a causal analysis and gauge the financial implications of PEP in our hospital for general surgical patients to help optimise the utilisation of resources. Methods All General Surgical patients who had ERCP between 01/10/2022 and 31/03/2023 were included in the analysis. A successful ERCP was defined as cannulation of the biliary tree. The digital patient records were analysed and collected onto a master datasheet. They were divided into PEP and non-PEP groups. Results A total of 131/155 attempted ERCPs were successful. Of these 131, 13 (9.92%) developed PEP. Females were predominantly affected. Three out of six patients (50%) undergoing ERCP for malignant biliary obstructions developed PEP. Elective ERCPs (15% vs 6.5%) and higher mean bilirubin levels >= 134.92 µmol/L posed a greater risk of developing PEP (p-value=0.021). The mean hospital stay was 3.5 days longer (2-49 days) in the PEP group. The total extra cost to the NHS ranged from £20,475 - £35,763 over 6 months. Conclusion Patients with gallstone disease should receive prompt cholecystectomy in adherence to NICE guidelines to reduce the risk of gallstone-related problems and ERCP need. This in turn would lead to a reduction in PEP and positively affect the financial implications on the NHS. We also recommend a randomised control trial for patients with grossly deranged liver function tests to compare ERCP with laparoscopic cholecystectomy and common bile duct explorations combined.

Sustainable Paddy Farming in Edirne: Evaluating the Impacts of Excessive Fertilizer and Pesticide Use

This study examines the environmental and economic impacts of chemical fertilizer and pesticide use in paddy fields in Edirne Province, Türkiye. Chemical fertilizers, especially nitrogen and phosphorus, are crucial for boosting paddy yield and ensuring food security. However, recent trends indicate significant potassium deficiency and excessive pesticide use, leading to environmental degradation and higher production costs. Incorrect fertilization techniques and pesticide usage can lower product quality and yield, adversely affecting farmers’ incomes and the national economy. Surveying 139 paddy farmers, the research found that farmers apply the herbicidal active ingredients Tefuryltrione, Clomazone, Tembotrione, and Quinclorac at rates of 129.35%, 34.27%, 18.06%, and 155.29% above the recommended levels, respectively. The excessive use of pesticides costs each farmer an additional USD 925.67, totaling USD 5.32 million for Edirne. The majority of farmers (69.2%) do not conduct soil analysis, indicating a potential gap in adopting the best practices for soil management and fertilization. Farmers use 84% less potassium than recommended while applying nitrogen and phosphorus 13% and 14% above the recommended levels, respectively. The extra cost of fertilizer use in Edirne is calculated as USD 833,135.49. This situation harms the economy and may have adverse effects on the environment and potential health effects on consumers.

Human–computer interaction using artificial intelligence-based expert prioritization and neuro quantum fuzzy picture rough sets for identity management choices of non-fungible tokens in the Metaverse

Necessary improvements should be made to increase the effectiveness of non-fungible tokens on the Metaverse platform without having extra costs. For the purpose of handing this process more efficiently, there is a need to determine the most important factors for a more successful integration of non-fungible tokens into this platform. Accordingly, this study aims to determine the appropriate the identity management choices of non-fungible tokens in the Metaverse. There are three different stages in the proposed novel fuzzy decision-making model. The first stage includes prioritizing the expert choices with artificial intelligence-based decision-making methodology. Secondly, the criteria sets for managing non-fungible tokens are weighted by using Quantum picture fuzzy rough sets-based M-SWARA methodology. Finally, the identity management choices regarding non-fungible tokens in the Metaverse are ranked with Quantum picture fuzzy rough sets oriented VIKOR. The main contribution of this study is that artificial intelligence methodology is integrated to the fuzzy decision-making modelling to differentiate the experts. With the help of this situation, it can be possible to create clusters for the experts. Hence, the opinions of experts outside this group may be excluded from the scope. It has been determined that security must be ensured first to increase the use of non-fungible tokens on the Metaverse platform. Similarly, technological infrastructure must also be sufficient to achieve this objective. Moreover, biometrics for unique identification has the best ranking performance among the alternatives. Privacy with authentication plays also critical role for the effectiveness of this process.

Cost-effectiveness analysis of first-line sintilimab plus chemotherapy vs. chemotherapy alone for unresectable advanced or metastatic gastric or gastroesophageal junction cancer in China.

The Chinese Society of Clinical Oncology (CSCO) has recommended sintilimab plus chemotherapy (SINT + Chemo) as a standard first-line therapy for advanced gastric cancer or gastroesophageal junction cancer (GC/GEJC), based on the proven effectiveness and safety in the ORINT-16 trail. Its cost-effectiveness, however, remains to be evaluated. We established a partitioned survival approach (PartSA) model with a 10-year time horizon to determine whether SINT + Chemo (vs. chemotherapy) was more cost-effective as a first-line treatment for unresectable advanced or metastatic GC/GEJC. Survival data was generated from the ORIENT-16 trail. Cost calculation was limited to direct medical costs. Database of Hunan Public Resources Trading Service Platform was used as the source for obtaining drug prices. Other cost and utility values were gathered from established literature. Incremental cost-effectiveness ratio (ICER) was the primary output. Additionally, we conducted sensitivity analysis, subgroup analysis, and scenario analysis. In the base-case analysis, group SINT + Chemo showed an increase in utility value by 0.32 quality-adjusted life-years (QALYs) at an extra cost of $7988.43, resulting in an ICER of $25239.29/QALY, below the Chinese cost-effective willingness-to-pay (WTP) threshold of $38223.34. Upon further subgroup analysis according to patients' programmed death 1 ligand (PD-L1) combined positive score (CPS), the ICERs were $26341.01/QALY for patients highly expressing PD-L1 (CPS ≥5) and $17658.26/QALY for patients lowly expressing PD-L1 (CPS <5). Based on the sensitivity analysis, we found the PFS utility was the parameter that had the most significant impact on the model's outcomes. Moreover, in scenario analysis, the results remained consistent despite variations in the model's time frame. In China, SINT + Chemo is a more cost-effective option (vs. chemotherapy) as a first-line therapy for unresectable advanced or metastatic GC/GEJC, irrespective of PD-L1 expression levels.

Cost of non-quality in the flexible infrastructure sector

Poor quality means that specified requirements are not met, be they safety, performance, regulatory standards, among others, resulting in additional costs for the company. The aim of this article is to study the costs related to extra freight in Logistics, delve into existing data in search of the main causes and apply these Quality management tools in A3 format, with a view to reducing extra freight costs. For the analysis, the Pareto model was chosen, using the 80/20 rule, where 80% of the results are generated by 20% of the causes, to identify the main types of causes that generated the extra freight and with the 2022 Extra Freight database controlled by Logistics, a first Pareto was built with the faults identified. The implementation of the A1 report with pareto data analysis at the first and second levels proved to be effective in directing the efforts of the areas involved to solve the causes with the greatest impact in a structured and effective manner, since the A1 tool aims to remedy the root cause, measuring the results by operational indicators, OPIS, with a view to improving the performance of the key indicators, KPIS.

The Use of Bio-control Agents in Mulberry Pest Management: Successful Techniques and Important Issues

Since bio-control agents target specific pests without affecting the usefulness insects or/and damaging the soil and water resources, it plays a role in conservation of ecological balance in the environment. A variety of insect and non-insect pests, as well as hosts of parasites (fungi, insect, and mite parasites), occur in silkworm sericulture. This method does not in any way influence the sustainability of environment through pest control as required by sustainable agriculture. Since bio-control agents are known to be harmless to human beings and other organisms that may be of equal importance in the ecosystem such as pollinators, wildlife etc., they also have safety advantages. This is a big step forward to eradicating pests as compared to the chemical pesticides which have been known to affect the human lives and other wildlife. In the meantime, the bio-control agents may be cost effective in the long run. Because bio-control agents could offer continuous control of pests with minimal extra cost, it is possible, even when the outlay of obtaining and developing such organisms is more expensive than straightforward chemical applications. Further, the use of bio-control agents may reduce the reliance on traditional chemical pesticides and hence cost outlay and pest control costs and also reduce the probabilities of pesticide resistance. In the farming of mulberry, bio control agents are one the most important components of integrated pest management and have proved be an effective substitute to chemical control. Bio-control agents offer long-term pest suppression in comparison to chemical control methods, whose impacts tend to weaken after several generations of treatment. The continuous use of chemicals may result in pest resistance to the pesticides used. Spraying synthetic pesticides leads to the formation of pesticide residues on mulberry foliage, which affects food products and environmental health.

Incisional negative pressure wound therapy for the prevention of surgical site complications in Paediatric patients with non-idiopathic scoliosis: A randomized clinical trial.

Surgical wound complications are adverse events with important repercussions for the health of patients and health system. Surgical site infections and wound dehiscences are among the most important surgical wound complications, with a high incidence in paediatric patients undergoing surgery for non-idiopathic scoliosis. Incisional negative pressure wound therapy for surgical incisions is used as a preventive measure against surgical wound complications in adults; however, there has been scant evidence for using it in children. The purpose of this study is to evaluate the cost-effectiveness of incisional negative pressure wound therapy in preventing surgical wound complications in paediatric patients undergoing surgery to treat non-idiopathic scoliosis. Randomized clinical trial. Children younger than 18 years of age undergoing surgery for non-idiopathic scoliosis were randomly assigned into two groups to receive one of two different types of dressings for the first 7 days after surgery. One group were treated with a postoperative hydrofibre and hydrocolloid dressing with silver for wounds (control group), and the other group received a single-use incisional negative pressure wound therapy system (intervention group). The wounds were assessed after removal of the dressings at 7 days after surgery and again at 30, 90, and 180 days after surgery. Surgical wound complications, sociodemographic variables, variables related to the procedure and postoperative period, economic costs of treatment of surgical wound complications, and time to healing of the surgical wound were recorded. Per protocol and per intention to treat analysis was made. The per protocol incidence of surgical wound complications was 7.7% in the intervention group versus 38.5% in the control group (p = 0.009; Fisher exact test. RR = 0.20 IC95%: 0.05-0.83). Surgical wound dehiscence, surgical site infections, seroma, and fibrin were the most common surgical wound complications. The type of surgery, duration of surgery, and patients' age were associated with a higher risk for surgical wound complications. Postoperative hydrofibre and hydrocolloid dressing with silver for wounds were found to be associated with a longer time to healing. Initial costs for dressings in the group receiving incisional negative pressure wound therapy were higher, but the total postoperative costs were higher for those receiving postoperative hydrofibre and hydrocolloid dressing with silver for wounds. It was found that for each US$1.00 of extra costs for using incisional negative pressure wound therapy, there was a benefit of US$12.93 in relation to the cost of complications prevented. Incisional negative pressure wound therapy is cost-effective in the prevention of surgical wound complications in children undergoing surgery for non-idiopathic scoliosis.