High-cost Utilization Research Articles

Effect of probiotic fermentation on the extraction rate and bioactivity of plant-based polysaccharides: A review

Polysaccharides are biomacromolecules that make up the human body and have good physicochemical properties, bioactivities, and applications; these positive properties can be observed especially in polysaccharides from plants. However, the relatively low extraction rate and bioactivity of plant-based polysaccharides limit their application and popularization. Searching for a better extraction approach is important because of the disadvantages of high cost, environmental pollution, and narrow utilization range of physical, chemical, and enzymatic methods. This work conducted a review and found that probiotic fermentation effectively improved the extraction rate of plant-based polysaccharides in most cases. Meanwhile, probiotic fermentation significantly enhanced the bioactivities (including hypoglycemic, hypolipidemic, antioxidant, immunomodulatory, and probiotic activities) of plant-based polysaccharides. From a long-term perspective, probiotic fermentation might be a green and efficient strategy to improve the extraction rate and bioactivity of plant-based polysaccharides with great development potential, with probiotic-fermented dairy products and beverages being the best examples.

Impact of Home Telehealth Expansion on High-Cost Utilization Among Veterans Health Administration Patients with Diabetes.

Home telehealth (HT) services have rapidly expanded in the Veterans Health Administration (VHA), but little is known about the real-world impact of the expansion of these services on utilization. To evaluate the impact of expanding HT diabetes services in VHA on high-cost utilization. This cohort study used cross-temporal propensity score matching to identify patients with diabetes who would receive HT services (treatment group) with program expansion (treatment group) with a comparison group of patients with diabetes who did not receive HT services (control group) between 2010 and 2018. A difference-in-differences design was used to compare pre-post changes in high-cost utilization between propensity-matched groups. Data used was from the VHA's Corporate Data Warehouse. VHA patients with diabetes, n=7214 in the treatment group who received HT services, and n=1,067,138 in the control group who did not receive HT services. Emergency department (ED) visits, all-cause hospitalization, and hospitalizations for ambulatory care sensitive conditions (ACSCs). In the baseline period, patients in our sample had a mean age of 67 years old (SD=11 years), were 97% male, and 78% had a hemoglobin A1c (HbA1c) < 8%. The increase in HT use was associated with a net increase of ED visits per patient (0.215 95% CI [0.152, 0.279]), all-cause hospitalization (0.053 95% CI [0.032, 0.074]), and ACSC hospitalization (0.032 95% CI [0.019, 0.045]). Expanding HT or remote monitoring services may lead to additional needs being identified for patients, including increased access to in-person care, such as ED or hospital services.

Optimal Configuration of Electricity-Heat Integrated Energy Storage Supplier and Multi-Microgrid System Scheduling Strategy Considering Demand Response

Shared energy storage system provides an attractive solution to the high configuration cost and low utilization rate of multi-microgrid energy storage system. In this paper, an electricity-heat integrated energy storage supplier (EHIESS) containing electricity and heat storage devices is proposed to provide shared energy storage services for multi-microgrid system in order to realize mutual profits for different subjects. To this end, electric boiler (EB) is introduced into EHIESS to realize the electricity-heat coupling of EHIESS and improve the energy utilization rate of electricity and heat storage equipment. Secondly, due to the problem of the uncertainty in user-side operation of multi-microgrid system, a price-based demand response (DR) mechanism is proposed to further optimize the resource allocation of shared electricity and heat energy storage devices. On this basis, a bi-level optimization model considering the capacity configuration of EHIESS and the optimal scheduling of multi-microgrid system is proposed, with the objectives of maximizing the profits of energy storage suppliers in upper-level and minimizing the operation costs of the multi-microgrid system in lower-level, and solved based on the Karush-Kuhn-Tucker (KKT) condition and Big-M method. The simulation results show that in case of demand response, the total operation cost of multi-microgrid system and the total operation profit of EHIESS are 51,687.73 and 11,983.88 CNY, respectively; and the corresponding electricity storage unit capacity is 9730.80 kWh. The proposed model realizes the mutual profits of EHIESS and multi-microgrid system.

Research Progress of Pt-Based Catalysts toward Cathodic Oxygen Reduction Reactions for Proton Exchange Membrane Fuel Cells

Proton exchange membrane fuel cells (PEMFCs) have been considered by many countries and enterprises because of their cleanness and efficiency. However, due to their high cost and low platinum utilization rate, the commercialization process of PEMFC is severely limited. The cathode catalyst layer (CCL) plays an important role in manipulating the performance and lifespan of PEMFCs, which makes them one of the most significant research focuses in this community. In the CCL, the intrinsic activity and stability of the catalysts determine the performance and lifetime of the catalyst layer. In this paper, the composition and working principle of the PEMFC and cathode catalyst layer are briefly introduced, focusing on Pt-based catalysts for oxygen reduction reactions (ORRs). The research progress of Pt-based catalysts in the past five years is particularly reviewed, mainly concentrating on the development status of emerging Pt-based catalysts which are popular in the current research field, including novel concepts like phase regulation (intermetallic alloys and high-entropy alloys), interface engineering (coupled low-Pt/Pt-free catalysts), and single-atom catalysts. Finally, the future research and development directions of Pt-based ORR catalysts are summarized and prospected.

High-efficiency recovery of valuable metals from spent lithium-ion batteries: Optimization of SO2 pressure leaching and selective extraction of trace impurities

The recovery of valuable metals from spent lithium-ion batteries (LIBs) is crucial for environmental protection and resource optimization. In the traditional recovery process of spent LIBs, the leaching of high-valence metals has the problems of high cost and limited reagent utilization, and some valuable metals are lost in the subsequent purification process of the leaching solution. To reduce the cost of reagents, this study proposes the use of low-cost SO2 as a reagent combined with pressure leaching to efficiently recover high-valence metals from delithiated materials of spent LIBs, while selective solvent extraction is used to remove trace impurities in the leaching solution to avoid the loss of valuable metals. Experimental results demonstrated that by optimizing the conditions to 0.25 MPa SO2 partial pressure and 60 min reaction time at 70 °C, the leaching efficiencies for Ni, Co, and Mn reached 99.6%, 99.3%, and 99.6%, respectively. The kinetic study indicated that the leaching process was diffusion-controlled. Furthermore, the delithiated materials were used to completely utilize the residual SO2 in the solution to obtain a high concentration Ni–Co–Mn rich solution. Subsequently, Fe and Al impurities were deeply removed through a synergistic extraction of Di-2-ethylhexyl phosphoric acid (D2EHPA) and tributyl phosphate (TBP) without loss of valuable metals, achieving a high-purity Ni–Co–Mn solution. The process developed based on this work has the characteristics of environmental friendliness, high valuable metal recovery, and high product purity, providing a reference technical method for the synergistic treatment of waste SO2 flue gas with spent LIBs and the deep purification of impurities in spent LIBs.

Effects of Non-Face-to-Face Chronic Care Management on Service Utilization and Outcomes Among US Medicare Beneficiaries with Diabetes.

Type 2 diabetes mellitus (T2DM) results in heavy economic and disease burdens in Louisiana. The Centers for Medicare and Medicaid Services has reimbursed non-face-to-face chronic care management (NFFCCM) for patients with two or more chronic conditions since 2015. To assess the impacts of NFFCCM on healthcare utilization and health outcomes. This retrospective cohort study included Medicare fee-for-service beneficiaries with T2DM and at least one additional chronic disease between 2014 and 2018. At least one record of NFFCCM Current Procedural Terminology codes. The health outcomes in the study included major adverse cardiovascular events (MACE), all-cause mortality, and heart failure. The monthly service utilization and continuity of care index for primary care were also included. The propensity score method was used to balance the baseline differences between the two groups. Weighted multivariate regression models were developed using propensity score weights to assess the impacts of NFFCCM on outcomes. During the 5years of study period, 8415 patients among the 118,643 Medicare beneficiaries received at least one NFFCCM. Patients receiving any NFFCCM had reduced healthcare utilization compared with patients not receiving NFFCCM, including 0.012 (95% CI - 0.014 to - 0.011; p < 0.001) fewer monthly hospital admissions, 0.017 (95% CI - 0.019 to - 0.016; p < 0.001) fewer monthly ED visits, and 0.399 (95% CI 0.375 to 0.423; p < 0.001) more monthly outpatient encounters. Patients receiving NFFCCM services had lower MACE event rates of 7.4% (95% CI 7.1 to 7.8%; p < 0.001), all-cause mortality rate of 7.8% (95% CI 7.4 to 8.1%; p < 0.001), and heart failure rate of 0.3% (95% CI 0.2 to 0.5%; p < 0.001), respectively. These findings suggest that reimbursement for NFFCCM was associated with the shifting high-cost utilization to lower-cost primary health care settings among patients with diabetes in Louisiana.

Metallic Nanoclusters for Electrochemical Water Splitting

AbstractElectrocatalytic water splitting is regarded as one of the most promising strategies for producing clean and sustainable energy sources (H2 and O2) in cathodic hydrogen evolution reaction (HER) and anodic oxygen evolution reaction (OER), respectively. Currently, transition metal nanoparticles (NPs) such as commercial Pt/C, IrO2, and RuO2 are still popular catalysts for industrial‐level HER and OER processes. However, both the high cost and low atomic utilization of NPs can not satisfy the requirements of atomic economy and green chemistry. Compared with NPs, metallic nanoclusters (NCs), which have higher atom utilization and optimized electronic structure than NPs, show unique activities for water splitting. In this review, the recently reported advanced design strategies for preparing various NCs are discussed in detail. The methods to control the particle size, coordinated environment, and morphology of NCs are also summarized. The electrochemical activity and stability of NCs can be influenced by the synergistic effect between NCs and supporting materials, which is also mentioned. Then, the recently reported state‐of‐art‐catalysts for both HER and OER along with the detailed catalytic mechanism are described to show the advanced design principles. Finally, the future perspectives and some remaining challenges are also presented.

Research on distribution network optimal operation with a novel medium voltage photovoltaic power generation device with the soft open point function

Soft open point (SOP) realizes the normal and flexible interconnection between distribution network feeders, leading to the improvement of the flexibility and rapidity of the distribution network control. However, drawbacks such as high cost and low utilization rate limit its application. A novel medium voltage photovoltaic power generation device with the SOP function is proposed in this paper. There are two grid-connected interfaces, and both of them adopt the cascaded H-bridge topology. A common DC-link is used for both H-bridge inverters belonging to the two grid-connected interfaces respectively. The proposed device eliminates the step-up transformers, and can be connected directly to the medium voltage distribution network. Therefore, advantages such as simple structure, low cost, low power loss and fault-tolerant operation capability are able to be obtained. The stability and flexibility of the distribution network operation are improved. The topology and power flow mode of the proposed medium voltage photovoltaic power generation device with the SOP function are analyzed, and the distribution network multi-objective optimal operation model with the proposed device is established. The proposed medium voltage photovoltaic power generation device with the SOP function is connected to the modified IEEE 33-node distribution network, and the network optimal operation with the device in terms of the power flow optimization and voltage improvement is analyzed.

Solar heat collection photoelectric tracking servo drive system based on cloud computing

In order to solve the problem of high cost and low utilization of solar power generation, the author proposed a solar heat collection photoelectric tracking servo drive system based on cloud computing. By establishing the MATLAB/SIMULINK simulation mathematical model of PID and adaptive fuzzy PID control in the core controller PLC, the authors compare and analyze the response characteristics of the tracking control system under different control strategies under the action of unit step signal and disturbance. The experimental results show that the overshoot of the adaptive fuzzy PID control algorithm is very small, almost zero, the response speed is the fastest, the transition time is the shortest, the system reaches stability at about 0.02 second. In conclusion the tracking control system of solar concentrator under adaptive fuzzy PID control not only has good tracking control accuracy, but also has the advantages of strong anti-interference ability and good stability, which greatly improves the comprehensive performance of the tracking control system of solar concentrator.

The Diabetes Health Plan and Healthcare Utilization Among Beneficiaries with Low Incomes

BackgroundThe socioeconomic status (SES) gradient in hospital and emergency room utilization among adults with type 2 diabetes (T2DM) is partially driven by cost-related non-adherence.ObjectiveTo test the impact of the Diabetes Health Plan (DHP), a diabetes-specific health plan incorporating value-based insurance design principles on healthcare utilization among low-income adults with T2DM.DesignTo examine the impact of the DHP on healthcare utilization, we employed a difference-in-differences (DID) study design with a propensity-matched comparison group. We modeled count and dichotomous outcomes using Poisson and logit models, respectively.ParticipantsCohort of adults (18–64) with T2DM, with an annual household income <$ 30,000, and who were continuously enrolled in an employer-sponsored UnitedHealthcare plan for at least 2 years between 2009 and 2014.InterventionsThe DHP reduces or eliminates out-of-pocket costs for disease management visits, diabetes-related medicines, and diabetes self-monitoring supplies. The DHP also provides access to diabetes-specific telephone case management as well as other online resources.Main MeasuresNumber of disease management visits (N = 1732), any emergency room utilization (N = 1758), and any hospitalization (N = 1733), within the year.Key ResultsDID models predicting disease management visits suggested that DHP-exposed beneficiaries had 1.7 fewer in-person disease management visits per year (− 1.70 [95% CI: − 2.19, − 1.20], p < 0.001), on average, than comparison beneficiaries. Models for emergency room (0.00 [95% CI: − 0.06, 0.06], p = 0.966) and hospital utilization (− 0.03 [95% CI: − 0.08, − 0.01], p = 0.164) did not demonstrate statistically significant changes associated with DHP exposure.ConclusionsWhile no relationship between DHP exposure and high-cost utilization was observed in the short term, fewer in-person disease management visits were observed. Future studies are needed to determine the clinical implications of these findings.

Advanced process control for salvianolic acid A conversion reaction based on data-driven and mechanism-driven model

On-line monitoring and process control are the most efficient techniques to ensure high quality, low cost, and effective resource utilization in modern process engineering. The high-temperature and high-pressure operating conditions make the process control challenging during conversion reaction. In this study, the contents of main substances produced during chemical conversion of salvianolic acid A were monitored and controlled by an advanced process control method. At first, a kinetic model was established according to the reaction mechanism. Then, a high-precision partial least squares calibration model was established based on near-infrared spectroscopy. Finally, the conversion reaction was controlled in real-time by combining the data-driven model with the mechanism model. The correlation coefficients obtained by the data-driven model were all > 0.9. The fitting correlation coefficients of reaction rate constants were all > 0.9. The concentration of the reaction product was controlled within the limit by adjusting the reaction temperature based on the concentration-temperature curve. Combining the data-driven model with the mechanism model, the reaction process was controlled in real-time. This study emphasized the advantages of advanced process control for high temperature and high-pressure reaction processes and exemplified it as an important step in implementing intelligent production.

Like Attracts Like: Personalized Federated Learning in Decentralized Edge Computing

The emerging Personalized Federated Learning (PFL) methods aim to produce personalized models for different users, so as to keep track of their individualized requirements in Edge Computing (EC). The centralized PFL methods may suffer from the communication bottleneck and single point of failure. As an alternative solution, the decentralized PFL (DPFL) methods are performed in a Peer-to-Peer (P2P) manner, and collaboratively train personalized models by model aggregation among congenial devices. However, these DPFL methods may incur high communication cost and low resource utilization induced by large-scale models. Herein, we take the communication constraint and heterogeneity into consideration and propose to realize communication-efficient DPFL with adaptive model pruning and neighbor selection. We theoretically analyze the convergence of the proposed DPFL method, and study the impacts of both model pruning and neighbor selection on training performance. Furthermore, we propose an efficient algorithm that combines model pruning and neighbor selection to achieve a trade-off between model quality and communication cost. Extensive simulation and testbed experiments on real-world datasets are conducted. The experimental results demonstrate that the proposed algorithm can improve the test accuracy by at most 13% and save the traffic consumption by 45.4% on average compared with the existing PFL methods.

Erosive Damages of the Gastroduodenal Zone in Servicemen: Clinical and Pharmacoeconomic Aspects

Erosive and ulcerative lesions of the gastroduodenal zone in military personnel occupy one of the key places in the structure of the general pathology of internal organs. They significantly reduce the quality of life, affect the work capacity and personal life. Risk factors for their development is H. pylori infection, stress, severe trauma, certain drugs, and smoking. Delay in diagnosis and treatment can have negative consequences. The objective: to analyze the disease course, determine the clinical and pharmacoeconomic efficacy of the combined bismuth-containing and acid-suppressive treatment regimens for erosive gastroduodenal lesions in military personnel. Materials and methods. The study was designed as analyze of 40 medical charts of military personnel, who underwent treatment of the non-HP-associated erosive lesions of the gastroduodenal zone at the National Military Medical Clinical Center (NMMCC) «Main Military Clinical Hospital». The study used clinical, bibliographic, statistical, pharmacoeconomic analysis together with the assessment of the quality of life by SF-36 questionnaire. Results. It was found that the treatment regimen with use of rabeprazole and colloidal bismuth subcitrate has better clinical effectiveness (85% of patients recovered in 14 days of treatment compared to the group with omeprazole monotherapy, where the same indicator was 60%). Also, this scheme has a higher cost-utility (by 48%) and cost efficiency (by 56%) at a lower cost of treatment (by 17%). Conclusion. The treatment regimen for non-HP-associated erosive lesions of the gastroduodenal zone based on rabeprazole and colloidal bismuth subcitrate is more expedient from the point of view of clinical effectiveness and pharmacoeconomic feasibility compared to the regimen based on omeprazole alone and its use can improve the pharmacoeconomic results and rationality of budget funds use.

Healthcare Resource Utilization and Healthcare Costs of COVID-19 Patients in A Tertiary Care Public Hospital: A Retrospective Cohort Study in Thailand

Objective: Health care costs (HCCs) are a significant concern in developing countries. The authors investigated the healthcare resource utilization (HCRU) and HCCs for patients with COVID-19 based on disease severity and infection site. Materials and Methods: The authors reviewed data from the electronic medical records of COVID-19 patients admitted to the present study hospital between January 2020 and April 2020. The authors used comorbidities and patient characteristics as covariates. Analyses were conducted using simple linear regression and generalized linear regression models with a log-link and gamma distribution. Results: Two hundred two patients had confirmed SARS-CoV-2 infection. Total costs per patient were 6,626 USD (756 to 45,586). Personal protection equipment costs were the most significant cost for COVID-19 patients with a mean of 3,778 USD. The mean treatment cost per patient was 326 USD. Patients with severe symptoms and lower respiratory tract infection (LRI) had a higher cost and resource utilization value before and after adjusting for covariates. Conclusion: COVID-19 patients with severe symptoms and LRI had higher HCRU. Length of stay, severity of symptoms, and LRI were associated with higher cost of treatment. Keywords: SARS-CoV-2; COVID-19; Healthcare resource utilization; Healthcare costs; Thailand

High Cost and Resource Utilization of Frostbite Readmissions in the United States.

Frostbite is a high morbidity, high-cost injury that can lead to digit or limb necrosis requiring amputation. Our primary aim is to describe the rate of readmission following frostbite injury. Our secondary aims are to describe the overall burden of care, cost, and characteristics of repeat hospitalizations of frostbite-injured people. Hospitalizations following frostbite injury (index and readmissions) were identified in the 2016 and 2017 Nationwide Readmission Database. Multivariable logistic regression was clustered by hospital and additionally adjusted for severe frostbite injury, gender, year, payor group, severity, and comorbidity index. Population estimates were calculated and adjusted for by using survey weight, sampling clusters, and stratum. In the 2-year cohort, 1065 index hospitalizations resulted in 1907 total hospitalizations following frostbite injury. Most patients were male (80.3%), lived in metropolitan/urban areas (82.3%), and nearly half were insured with Medicaid (46.4%). Of the 842 readmissions, 53.7% were associated with complications typically associated with frostbite injury. Overall, 29% of frostbite injuries resulted in at least one amputation. The average total cost and total length of stay of readmissions were $236,872 and 34.7 days. Drug or alcohol abuse, homelessness, Medicaid insurance, and discharge against medical advice (AMA) were independent predictors of unplanned readmission. Factors associated with multiple readmissions include discharge AMA and Medicare insurance, but not drug or alcohol abuse or homelessness. The population-based estimated unplanned readmission rate following frostbite injury was 35.4% (95% confidence interval 32.2%-38.6%). This is the first study examining readmissions following frostbite injury on a national level. Drug or alcohol abuse, homelessness, Medicaid insurance, and discharge AMA were independent predictors of unplanned readmission, while only AMA discharge and Medicare insurance were associated with multiple readmissions. Supportive resources (community and hospital-based) may reduce unplanned readmissions of frostbite-injured patients with those additional risk factors.

73 High Cost and Resource Utilization of Frostbite Readmissions

Abstract Introduction Frostbite is a high morbidity, high-cost injury that can lead to digit or limb necrosis requiring amputation. Our primary aim is to describe the rate of readmission following frostbite injury. Our secondary aims are to describe the overall burden of care, cost, and characteristics of repeat hospitalizations of frostbite-injured people. Methods Index hospitalizations and readmissions were identified in the 2016 and 2017 Nationwide Readmission Database. Weighted incidence and characteristics of readmissions associated with frostbite injury were calculated and adjusted for by using survey weight, sampling clusters, and stratum. Multivariable logistic regression was clustered by hospital and additionally adjusted for severe frostbite injury, gender, year, payor group, severity, and comorbidity index. Results The unplanned readmission rate following frostbite injury was 35.4% (95% CI 32.2 – 38.6%). In the two-year cohort, 1,065 index hospitalizations resulted in 1,907 total hospitalizations following frostbite injury. Most patients were male (80.3%), lived in metropolitan/urban areas (82.3%), and nearly half were insured with Medicaid (46.4%). Of the 842 readmissions, 53.7% were associated with complications typically associated with frostbite injury. Overall, 29% of frostbite injuries resulted in at least one amputation. The average total cost and total LOS of readmissions was $236,872 and 34.7 days. Drug or alcohol abuse, homelessness, Medicaid insurance, and discharge AMA were independent predictors of unplanned readmission. Factors associated with multiple readmissions include discharge AMA and Medicare Insurance, but not drug or alcohol abuse or homelessness. Conclusions This is the first study examining readmissions following frostbite injury on a national level. Drug or alcohol abuse, homelessness, Medicaid insurance, and discharge AMA were independent predictors of unplanned readmission, while only AMA discharge and Medicare insurance were associated with multiple readmissions.

Research on the Performance of Solar Aided Power Generation System Based on Annular Fresnel Solar Concentrator

A solar-aided power generation (SAPG) system effectively promotes the high efficiency and low cost utilization of solar energy. In this paper, the SAPG system is represented by conventional coal-fired units and an annular Fresnel solar concentrator (AFSC) system. The annular Fresnel solar concentrator system is adopted to generate solar steam to replace the extraction steam of the turbine. According to the steam–water matrix equation and improved Flugel formula, the variable conditions simulation and analysis of the thermo-economic index were proposed by Matlab. Furthermore, in order to obtain the range of small disturbance, the method of partial replacement is used, that is, the extraction steam of the turbine is replaced from 0 to 100% with a step size of 20%. In this work, a SAPG system is proposed and its thermo-economic index and small disturbance scope are analyzed. The results show that the SAPG system is energy-saving, and the application scope of small disturbance is related to the quantity of the extraction steam and evaluation index.

Pseudo-Random Key Stream Generation Algorithm for Encryption Purposes

For both chaos-based stream ciphers and chaos-based block ciphers, key streams have a crucial influence on their security. A well designed pseudo-chaotic number generator (PCNG) that exhibits both chaotic properties and pseudo-randomness is a good candidate for creating the cryptographic key stream for encryption purposes. PCNGs are based on multiple chaotic maps. Since the majority of the chaotic maps are defined using real numbers, most of the proposed PCNGs use floating-point notations. However, this data type, especially the double-precision notation, has disadvantages of high computation cost and inefficient resource utilization. Also, the quantification errors may undermine the reliability of the produced key stream. To overcome these drawbacks, a key stream generation algorithm using a PCNG scheme is proposed in this paper. The PCNG is based on reformulated skew tent maps over a 32-bit integer field. It not only reduces the resource utilization from the hardware perspective, but also ensures the key stream performance over various operation platforms. Furthermore, the proposed PCNG uses a parameter changeable strategy, which can help to expand the key space, and thus increases the immunity against the brute-force attack. The quality of the key stream produced by the PCNG has been tested in a stream cipher. The analysis and the obtained test results have demonstrated that the proposed PCNG is secure and reliable to generate cryptographic key streams for encryption purposes.

Reducing cost and waste in pediatric laparoscopic procedures

BackgroundIn 2017 the healthcare cost in the United States accounted for 17.9% of the Gross Domestic Product (GDP). Furthermore, healthcare facilities produce more than 4 billion pounds of waste annually. Interhospital and intersurgeon variabilities in surgical procedures are some of the drivers of high healthcare cost and waste. We sought to determine the effect of a monthly surgeon report card detailing the utilization and cost of disposable and reusable surgical supplies on cost and waste reduction for pediatric laparoscopic procedures. MethodsStarting in July 2017, surgeons were provided with an individual report with supply cost per case, high cost, and disposable supply utilization, and clinical outcomes. Cost, utilization, and clinical outcomes six quarters before and after the intervention were compared. ResultsA total of 998 pediatric laparoscopic procedures were analyzed. We reduced the median supply cost per case by 43% after the intervention with total cost savings of $71,035 for the first four quarters. We also reduced the use of disposable trocars by 56% and the use of disposable harmonics and staplers by 33%. ConclusionsUsing a periodic surgeon report card, we significantly reduced supply cost and utilization of disposable items for all pediatric laparoscopic procedures performed at the University of Wisconsin American Family Children's Hospital. Type of studyCost effectiveness study. Level of evidenceLevel III.

Highly efficient near-infrared photothermal antibacterial membrane with incorporated biogenic CuSe nanoparticles

Photothermal antibacterial membranes are attractive separation materials, but the high cost and poor solar utilization are currently two major hurdles to their widespread application. Here, we report the use of biogenic copper selenide nanoparticles (bio-CuSe) to fabricate low-cost photothermal antibacterial membranes. By using Shewanella oneidensis MR-1 cells as the “biofactory”, uniform-sized, near-infrared (NIR)-responsive bio-CuSe, with superior light-to-heat conversion efficiency (30.8%) over most reported copper chalcogenide nanomaterials, were facilely synthesized. The bio-CuSe together with bacterial cells were incorporated into a polyvinylidene fluoride (PVDF) membrane to significantly improve the membrane hydrophilicity, surface smoothness and matrix cavities, which benefited a slightly improved water flux. The resulting bio-CuSe/ PVDF membrane showed 75% less biofilm development and improved antifouling properties towards bovine serum albumin (BSA) than the unmodified membrane in the dark. After NIR irradiation for 30 min, the water temperature at the membrane vicinity increased by 14.6 ℃, allowing for > 95% suppression in bacterial growth. In addition, complete bacteriostasis was achieved by the dry membrane. Given the green-synthesis nature and superior NIR photothermal activity of the bio-CuSe-modified membrane, it holds a great potential for applications in multiple fields such as water and air purification, disinfection, therapy and various antibacterial products manufacturing.