High Cost Research Articles

Rancang Bangun Computer Based Test (CBT) Berbasis Web

Examinations are an evaluation method in the teaching and learning process in schools. Generally, exams in schools are still carried out conventionally using paper and stationery, and exam assessments are carried out directly by the teacher. However. The process of creating exam questions, duplicating questions, evaluating and filling in answers is still manual using paper and stationery, causing various obstacles such as high costs and long correction times. To solve the problem above, the researcher used the Agile system development method with the Extreme Programming model which involves four stages: planning, designing, coding and testing. The research results show the success of the CBT application that was built. The application was tested using the black box testing method. Test results show that the correction process is faster by 0.9 seconds and more accurate. Apart from that, in terms of costs, using this application is also cheaper. This shows that the CBT application has a positive impact in increasing the efficiency, accuracy and effectiveness of testing and reducing the costs of administering the exam.

Pengembangan Modul Stock Fulfillment Online Transaction pada Aplikasi Distribution Center System menggunakan Framework Flask di PT.XYZ

The rapid advancement of information technology necessitates that every business adapts to keep pace with technological developments. PT. XYZ, a retail and distribution company, faced challenges with their outdated technology, specifically Oracle Forms. Oracle Forms incurred high maintenance costs and was limited to running on legacy systems. Consequently, PT.XYZ decided to create a Stock Fulfillment Online Transaction module using the Flask frameworks and Python. The development process followed the Agile Scrum methodology, including stages such as requirement analysis, sprint planning, iterative development, continuous testing, and final evaluation. The outcome of this application development demonstrates that using Flask frameworks and Python allows for an application that can operate across various platforms while reducing maintenance costs.

Study of the factors influencing the life cycle cost of green buildings using SEM-SD method

ABSTRACT The recent surge in carbon emissions from the building sector has raised significant environmental concerns. While green building practices have proven effective, their widespread adoption has been hindered by high costs. This study aims to explore the factors impacting the life cycle costs of green buildings, with the aim of achieving “double carbon” reduction. Through an analysis of 42 articles, 24 factors were distilled based on expert opinion. After collecting 322 data through questionnaires, a model of the factors influencing the life cycle cost of green buildings was constructed using structural equation modeling, and a cost simulation study was carried out through the system dynamics method in the practical case to examine how the cost changed. The findings highlight the pivotal role of planning and design, implementation, and operation and maintenance phases. Notably, green building design programs, green construction programs, and the property management level stand out as critical factors emerged as critical factors. These insights can inform strategies to reduce the cost of green buildings, thereby fostering energy conservation and emission reduction in the construction industry.

Implementation of the International Consortium of Health Outcomes Measurement CHD standard set in patients undergoing pulmonary valve replacement.

Despite the burden of CHD, a high cost and utilization condition, an implementation of long-term outcome measures is lacking. The objective of this study is to pilot the implementation of the International Consortium of Health Outcomes Measurement CHD standard set in patients undergoing pulmonary valve replacement, a procedure performed in mostly well patients with diverse CHD. Patients ≥ 8 years old undergoing catheterization-based pulmonary valve replacement were approached via various approaches for patient-reported outcomes, with a follow-up assessment at 3 months post-procedure. Implementation strategy analysis was performed via a hybrid type 2 design. Of the 74 patients undergoing pulmonary valve replacement, 32 completed initial patient-reported outcomes with variable response rates by strategy (email and in-person explanation 100%, email only 54%, and email followed by text/call 64%). Ages ranged 8-67 years (mean 30). Pre-procedurally, 34% had symptomatic arrhythmias, which improved post-procedure. For those in school, 43% missed ≥ 6 days per year, and over half had work absenteeism. Financial concerns were reported in 34%. Patients reported high satisfaction with life (50% [n = 16]) and health-related quality of life (90% [n = 26]). Depression symptoms were reported in 84% (n = 27) and anxiety in 62.5% (n = 18), with tendency towards improvement post-procedurally. Pilot implementation of the International Consortium of Health Outcomes Measurement CHD standard set in pulmonary valve replacement patients reveals a significant burden of disease not previously reported. Barriers to the implementation include a sustainable, automated system for patient-reported outcome collection and infrastructure to assess in real time. This provides an example of implementing cardiac outcomes set in clinical practice.

Quick and easy assessment of sarcopenia in cirrhosis: Can ultrasound be the solution?

Cirrhosis is frequently associated with sarcopenia, with reported rates of over 80% in patients with decompensated alcohol-related liver disease. Sarcopenia negatively impacts the prognosis of cirrhotic patients and affects the response to treatment of patients with hepatocellular carcinoma (HCC). For these reasons, identifying an easy-to-perform method to assess sarcopenia in is a key element in the optimization of care in this patient population. Assessment of muscle mass by computed tomography is considered the standard of care for the diagnosis of sarcopenia, but exposure to radiation and high costs limit its application in this setting, especially for repeated assessments. We believe that ultrasound, a cheap and harmless technique also used for HCC screening in cirrhotic patients, could have an expanding role in the diagnosis and follow-up of sarcopenia in these patients.

Synergistic Effects of TiO2 and Carbon Black for Water Evaporation-Induced Electricity Generation.

Water evaporation-induced electricity generators (WEGs) have drawn widespread attention in the field of hydrovoltaic technology, which can convert atmospheric thermal energy into sustainable electric power. However, it is restricted in the wide application of WEGs due to the low power output, complex fabrication process, and high cost. Herein, we present a simple and effective approach to fabricate TiO2-carbon black film-based WEGs (TC-WEGs). A single TC-WEG device can sustainably output an open-circuit voltage of 1.9 V and a maximum power density of 40.9 μW/cm2. Moreover, it has been shown that TC-WEGs exhibit stable electrical energy output when operating in seawater, which can yield a short-circuit current of 1.2 μA. The superior electricity generation performance can be attributed to the intrinsic characteristics of the TC-WEGs, including hydrophilicity, porous structure, and electrical conductivity. This work provides an important reference for the constant harvesting of clean energy.

Synthesis of Novel Polymers with Biodegradability by Main-Chain Editing of Chiral Polyketones.

Although the use of biodegradable plastics is suitable for unrecoverable, single-use plastic, their high production cost and much lower variety compared to commodity plastics limit their application. In this study, we developed a new polymer with potential biodegradability, poly(ketone/ester), synthesized from propylene and carbon monoxide. Propylene and carbon monoxide are easily available at low costs from fossil resources, and they can also be derived from biomass. Using an atom insertion reaction to the main chain of the polymer, the main-chain editing of the polymer molecule proceeded with up to 89% selectivity for atom insertion over main-chain cleavage.

The Existential Crisis in Naipaul’s Novel a Bend in the River

The novel A Bend in the River presents the transitional period from colonial to postcolonial in an unnamed African country through the life experiences and challenges that the main character, Salim, goes through. Naipaul presents everything through Salim’s perspective by making him the representative of all the migrants that have to undergo a double tragedy: losing their native country, its culture, and customs and tradition by adopting into the new country.  The second tragedy occurs when they no longer are seen as part of this new country, where they have already tried to make themselves fit to the new culture, traditions, and mentally they consider themselves as an integral part of it. Thus, Salim and all the migrants go through this transitional process but with a very high cost: losing themselves, their identity, and the feeling of rootlessness. This paper focuses on the crisis of identity and their existential quest in this never-ending process of transformation toward political democracy and prosperity.      Received: 9 February 2024 / Accepted: 19 April 2024 / Published: 5 May 2024

Self-Powered Autonomous Electrostatic Dust Removal for Solar Panels by an Electret Generator.

Solar panels often suffer from dust accumulation, significantly reducing their output, especially in desert regions where many of the world's largest solar plants are located. Here, an autonomous dust removal system for solar panels, powered by a wind-driven rotary electret generator is proposed. The generator applies a high voltage between one solar panel's output electrode and an upper mesh electrode to generate a strong electrostatic field. It is discovered that dust particles on the insulative glass cover of the panel can be charged under the high electrical field, assisted by adsorbed water, even in low-humidity environments. The charged particles are subsequently repelled from the solar panel with the significant Coulomb force. Two panels covered with sand dust are cleaned in only 6.6min by a 15cm diameter rotary electret generator at 1.6ms-1 wind speed. Experimental results manifest that the system can work effectively in a wide range of environmental conditions, and doesn't impact the panel performance for long-term operation. This autonomous system, with its high dust removal efficiency, simplicity, and low cost, holds great potential in practical applications.

Record-High Thermoelectric Performance in Al-Doped ZnO via Anderson Localization of Band Edge States.

Oxides are of interest for thermoelectrics due to their high thermal stability, chemical inertness, low cost, and eco-friendly constituting elements. Here, adopting a unique synthesis route via chemical co-precipitation at strongly alkaline conditions, one of the highest thermoelectric performances for ZnO ceramics ( 21.5µW cm-1 K-2 and 0.5 at 1100K in ) is achieved. These results are linked to a distinct modification of the electronic structure: charge carriers become trapped at the edge of the conduction band due to Anderson localization, evidenced by an anomalously low carrier mobility, and characteristic temperature and doping dependencies of charge transport. The bi-dimensional optimization of doping and carrier localization enable a simultaneous improvement of the Seebeck coefficient and electrical conductivity, opening a novel pathway to advance ZnOthermoelectrics.

Technological innovations and optimized work methods in subsea maintenance and production

Subsea maintenance and production represent critical aspects of offshore operations, vital for sustaining energy production and ensuring operational efficiency. However, these endeavors face numerous challenges, including the complexities of deepwater environments, harsh weather conditions, and the high costs associated with traditional maintenance methods. To address these challenges, this paper explores the integration of technological innovations and optimized work methods in subsea operations. Technological innovations play a pivotal role in revolutionizing subsea maintenance and production. Remote monitoring and control systems enable real-time data collection and decision-making, enhancing operational visibility and efficiency. Autonomous underwater vehicles (AUVs) offer the capability to conduct inspections and repairs in remote and hazardous environments, reducing human intervention and associated risks. Robotics and automation further streamline maintenance tasks, improving accuracy and reducing downtime. Advanced materials and coatings enhance equipment durability and corrosion resistance, prolonging asset lifecycles and reducing maintenance requirements. In parallel, optimized work methods offer strategic approaches to enhance subsea operations' effectiveness. Predictive maintenance strategies leverage data analytics and machine learning to anticipate equipment failures, enabling proactive interventions and minimizing downtime. Condition-based monitoring facilitates real-time assessment of asset health, enabling timely maintenance interventions and cost savings. Integrated asset management systems provide holistic insights into asset performance and facilitate informed decision-making. Lean operations and continuous improvement methodologies further optimize workflows, driving operational excellence and cost efficiency. Through case studies and industry examples, this paper highlights the successful implementation of technological innovations and optimized work methods in subsea maintenance and production. Furthermore, it explores future trends, regulatory considerations, and the importance of industry collaborations in shaping the future of subsea operations. Ultimately, the integration of these approaches offers a pathway towards enhanced operational efficiency, reduced costs, and sustainable subsea operations. Keywords: Technological Innovations, Optimized Work Methods, Subsea Maintenance and Production.

Biosimilars and access to biologic therapy in immune-mediated diseases

ABSTRACT Background The rise of biologic agents has been a major breakthrough in treating immune-mediated inflammatory diseases (IMIDs). However, their high cost underscores the need for strategies to optimize treatment efficiency. Biosimilars offer cost-effective alternatives to biologics. This study aimed to assess biosimilar drug availability’s impact on biologic therapy access for IMIDs. Research design and methods A retrospective observational study in 15 Spanish hospitals analyzed IMID patients (arthropathies, inflammatory bowel disease and psoriasis) initiating biologic therapy with originator or biosimilar drugs (infliximab, etanercept, adalimumab). Time to availability and initiation of biologic therapy were assessed. Results 267 patients were included, with 58.4% starting on biosimilars. The mean time to availability of the biologic drugs in the hospitals was 15.9 ± 6.7 months, (20.0 ± 12.4 for originator and 11.8 ± 5.2 for biosimilars). Mean time to biologic treatment was 7.7 ± 9.0 years (8.6 ± 8.9 for originators and 7.0 ± 9.0 for biosimilars). Showing statistically significant differences among conditions. Conclusion The emergence of biosimilar drugs has enhanced market competition and accelerated their adoption into hospitals’ therapeutic regimens over original reference drugs. This has significantly improved access to biologic therapy for patients with IMIDs, evidenced by a notable 1.6-year reduction in access time for biosimilar drugs.

Antimicrobial and anti-biofilm properties of oleuropein against Escherichia coli and fluconazole-resistant isolates of Candida albicans and Candida glabrata

BackgroundSide effects associated with antimicrobial drugs, as well as their high cost, have prompted a search for low-cost herbal medicinal substances with fewer side effects. These substances can be used as supplements to medicine or to strengthen their effects. The current study investigated the effect of oleuropein on the inhibition of fungal and bacterial biofilm in-vitro and at the molecular level.Materials and methodsIn this experimental study, antimicrobial properties were evaluated using microbroth dilution method. The effect of oleuropein on the formation and eradication of biofilm was assessed on 96-well flat bottom microtiter plates and their effects were observed through scanning electron microscopy (SEM). Its effect on key genes (Hwp1, Als3, Epa1, Epa6, LuxS, Pfs) involved in biofilm formation was investigated using the quantitative reverse transcriptase-polymerase chain reaction (RT-qPCR) method.ResultsThe minimum inhibitory concentration (MIC) and minimum fungicidal/bactericidal concentration (MFC/MBC) for oleuropein were found to be 65 mg/ml and 130 mg/ml, respectively. Oleuropein significantly inhibited biofilm formation at MIC/2 (32.5 mg/ml), MIC/4 (16.25 mg/ml), MIC/8 (8.125 mg/ml) and MIC/16 (4.062 mg/ml) (p < 0.0001). The anti-biofilm effect of oleuropein was confirmed by SEM. RT-qPCR indicated significant down regulation of expression genes involved in biofilm formation in Candida albicans (Hwp1, Als3) and Candida glabrata (Epa1, Epa6) as well as Escherichia coli (LuxS, Pfs) genes after culture with a MIC/2 of oleuropein (p < 0.0001).ConclusionsThe results indicate that oleuropein has antifungal and antibacterial properties that enable it to inhibit or destroy the formation of fungal and bacterial biofilm.

Open vs. robot-assisted preperitoneal inguinal hernia repair. Are they truly clinically different?

Inguinal hernia repair lacks a standard repair technique, with laparo-endoscopic and open preperitoneal methods showing similar outcomes. Despite higher costs, the popularity of robotic surgery is on the rise, driven by technological advantages. Controversies persist in comparing open repair techniques with the robotic approach, given contradictory results. The objective of this study was to compare postoperative outcomes, including complications, chronic pain, and recurrence, between open and robotic-assisted preperitoneal inguinal hernia repair. This single-center retrospective study encompassed patients undergoing elective inguinal hernia repair in a specialized unit, employing both open preperitoneal and robotic-assisted laparoscopic approaches from September 2018 to May 2023. Comparative analysis of short- and long-term outcomes between these techniques was conducted. Additionally, multivariate logistic regression was employed to explore predictors of postoperative complications. A total of 308 patients met the inclusion criteria. 198 (64%) patients underwent surgery using an open preperitoneal approach and 110 (36%) using robot-assisted laparoscopy. Patients in the robot-assisted group were younger (P = 0.006) and had fewer comorbidities (P < 0.001). There were no differences between the groups in terms of postoperative complications (P = 0.133), chronic pain (P = 0.463) or recurrence (P = 0.192). Multivariate analysis identified ASA ≥ III (OR, 1.763; 95%CI, 1.068-3.994; P = 0.027) and inguinoscrotal hernias (OR, 2.371, 95%CI, 1.407-3.944; P = 0.001) as risk factors of postoperative complications. Both open preperitoneal and robotic-assisted laparoscopic approaches show similar outcomes for complications, chronic pain, and recurrence when performed by experienced surgeons. The open preperitoneal approach, with its quicker operative time, may be advantageous for high-comorbidity cases. Treatment choice should consider patient factors, surgeon experience, and healthcare resources.

111 Current and future usage of soybean meal in swine diets in China

Abstract The objective of this presentation was to introduce the utilization tendency and research progress of soybean meal (SBM) in swine diets in China. As for the utilization tendency of SBM in China, it not only brings great pressure to the food security of China, but also directly pushes the high production cost of animal products. In 2022, 117 million tons of protein feed was consumed by the animal husbandry in China, accounting for nearly 1/3 of the total protein feed consumption in the world. Thus, the application of low-protein diet has been promoted with the strong support of the Ministry of Agriculture and Rural Affairs in China since 2018. With the related techniques, including popularizing low protein diet, developing new protein feed resources, promoting precise nutrition, and feeding technology, even though the compound feed output has increased by more than 84 million tons in 2022 in China, the SBM consumption in feed has reduced 6%. Recently, the geopolitical challenges, regional unrest and climate change tendency have increased the great uncertainty of protein feed supply, which requires us to deeply understand the significance of SBM reduction and substitution in animal feed. As for the research progress, the available energy contents of SBM were determined on growing pigs. Barrows [n = 24; initial body weight (BW) = 36 ± 1.4 kg] were randomly allotted to 4 diets containing SBM with either corn basal or corn-soybean meal basal, and total feces and urine collection method and indirect calorimetry method were used to determine the available energy of SBM. The results showed that the average digestible energy (DE), metabolizable energy (ME), net energy (NE), and retained energy (RE) values in SBM [17.36, 16.52, 10.62, and 5.06 MJ/kg dry matter (DM), respectively] determined using the corn-SBM-basal diet were not different from the those determined using the corn-basal diet. Moreover, the best fitted prediction equations developed based on 22 SBM samples produced from soybeans from China (n = 6), USA (n = 6), Brazil (n = 7) or Argentina (n = 3) were: DE = 38.44 - 0.43 CF - 0.98 GE + 0.11 ADF (R2 = 0.67, P &amp;lt; 0.01) and ME = 2.74 + 0.97 DE - 0.06 CP (R2 = 0.79, P &amp;lt; 0.01). The in vitro digestion kinetics of SBM from different sources showed that the release of amino acids in the 0-10 min time interval was significantly negatively correlated with the NE of SBM (R2 = -0.34).

Reconstructing Solvation Structure by Steric Hindrance‐Coordination Push‐Pull of Dipolymer‐H2O‐Zn2+ toward Long‐life Aqueous Zinc‐Metal Batteries

Aqueous zinc‐metal batteries are prospective energy storge devices due to their intrinsically high safety and cost effectiveness. Yet, uneven deposition of zinc ions in electrochemical reduction and side reactions at the anode interface significantly hinder their development and application. Here, we propose a solvation‐interface attenuation strategy enabled by a frustrated tertiary amine amphiphilic dipolymer electrolyte additive. The configuration of superhydrophilic segments with covalently bonded lipophilic spacers enables coupled steric hindrance/coordination, which establishes a balanced push‐pull dynamic of dipolymer‐H2O‐Zn2+. Such interplay reconstructs the solvation structure of Zn2+ and allows the formation of a stable dipolymer‐inorganic hybrid solid electrolyte interface (SEI) layer. This SEI layer effectively shields the zinc‐metal anode from water and anions, significantly reducing side reactions. In addition, the dipolymer adsorbed at the zinc‐metal anode interface regulates the interfacial electrochemical reduction kinetics and ensures uniform zinc deposition. As a result, the Zn‐Zn symmetric cells with dipolymer‐containing electrolyte exhibit remarkable cycling stability exceeding 5800 h (242 days). The Zn‐NVO batteries and Zn‐AC hybrid ion supercapacitors also deliver stable cycling for up to 1440 h (60 days) with high‐capacity retention over 80%. This research demonstrates the potential to facilitate the development and commercialization of zinc‐based energy storage devices.

OPTIMAL CENTRAL BANK DIGITAL CURRENCY DESIGN FOR EMERGING ECONOMIES

The growth of digitalisation presents the possibility for Central Bank Digital Currency (CBDC) to emerge as a secure and efficient payment method. However, despite the benefits, CBDC implementation needs to be adapted to the capabilities and needs of each country. This study uses meta-strength, weakness, opportunity, and threat (meta-SWOT) analysis to assess the internal strengths and weaknesses, as well as the external opportunities and threats, to determine the most optimal CBDC design for emerging economies. In analysing internal aspects, CBDC allows for an efficient payment system, followed by a more effective monetary policy. Furthermore, the technology creates the possibility to boost financial inclusion and trace many illicit activities. However, to achieve that, high investment costs and privacy issues must be accommodated, followed by technological risks such as the digital divide and electrical outages. Turning to external aspects, growing technology, the network effect, enthusiasm for CBDC, and the impracticality of cash usage have become catalysts for CBDC development. Despite these opportunities, central banks should be wary of the threat of cyberattacks, quickening bank disintermediation, legal issues within their respective countries, and competition with private crypto companies. Altogether, the most optimal CBDC design in emerging economies is retail and wholesale coverage, interest-bearing (wholesale) and noninterest-bearing (retail) remuneration, account-based and token-based paymentsystems, a traceable degree of anonymity, hybrid architecture, a Decentralised Ledger Technology (DLT) ledger system, and domestic and cross-border scope. These results are supported by rigorous examination of global CBDC research and development.

Reconstructing Solvation Structure by Steric Hindrance-Coordination Push-Pull of Dipolymer-H2O-Zn2+ toward Long-life Aqueous Zinc-Metal Batteries.

Aqueous zinc-metal batteries are prospective energy storge devices due to their intrinsically high safety and cost effectiveness. Yet, uneven deposition of zinc ions in electrochemical reduction and side reactions at the anode interface significantly hinder their development and application. Here, we propose a solvation-interface attenuation strategy enabled by a frustrated tertiary amine amphiphilic dipolymer electrolyte additive. The configuration of superhydrophilic segments with covalently bonded lipophilic spacers enables coupled steric hindrance/coordination, which establishes a balanced push-pull dynamic of dipolymer-H2O-Zn2+. Such interplay reconstructs the solvation structure of Zn2+ and allows the formation of a stable dipolymer-inorganic hybrid solid electrolyte interface (SEI) layer. This SEI layer effectively shields the zinc-metal anode from water and anions, significantly reducing side reactions. In addition, the dipolymer adsorbed at the zinc-metal anode interface regulates the interfacial electrochemical reduction kinetics and ensures uniform zinc deposition. As a result, the Zn-Zn symmetric cells with dipolymer-containing electrolyte exhibit remarkable cycling stability exceeding 5800 h (242 days). The Zn-NVO batteries and Zn-AC hybrid ion supercapacitors also deliver stable cycling for up to 1440 h (60 days) with high-capacity retention over 80%. This research demonstrates the potential to facilitate the development and commercialization of zinc-based energy storage devices.

THE ASSESSMENT OF THE FACTORS OF RESILIENCE TO CLIMATE CHANGE AMONG ARABLE CROP FARMERS IN DELTA STATE. NIGERIA.

Climate change is real and overwhelmingly affecting farming activities in Delta State. Objectives of the study are to identify arable crops that the farmers in Delta State cultivate, identify agricultural practices that are resilient to climate change and constraints affecting the choice of agricultural practices in Delta State. Arable crop farmers in Delta State formed the population from which sample was drawn. A multi-stage sampling technique was used to sample the farmers to get the sample size of 225. Data were analyzed with frequency, percentage, mean and standard deviation. Majority of arable crop farmers (55.4%) were female. Maize, cassava, vegetables, beans, cowpea and yam are major arable crops engaged. The results indicated that mixed cropping (=3.18); planting of trees (=3.13); increase use of organic fertilizers (=2.57); mulching of crop (=2.93); planting pest and disease resistant crops (=2.92) were considered serious resilience factors. Factors such as high cost of improved planting varieties (=3.35); poor funding of agricultural rural development program (=3.32); lack of information (=3.34); low capacity of extension agents to boost and build farmers resilience (=3.02) were agreed constraints affecting the choice of agricultural practices. The study revealed that arable crop farmers in Delta State engaged many practices as resilience factors to climate change but many factors affecting their choice of agricultural practices

Longitudinal Analysis of Overlapping Psychosocial Factors Predicting Incident Hospitalization Among Mixed HIV Serostatus Men who have Sex with Men in the Multicenter AIDS Cohort Study.

Men who have sex with men (MSM) are at increased risk for certain types of chronic diseases and mental health problems. Despite having extended survival in the highly active antiretroviral therapy (HAART) era, MSM living with HIV contend with aging-related diseases and complications with treatment. Consequent hospitalizations incur high costs, fear, low quality of life, and frailty. Unlike heterosexual men, MSM experience more structural violence and "syndemics" of psychosocial factors that not only accelerate HIV acquisition and transmission risk but also may increase morbidity, leading to greater rates of hospitalization. We aim to examine the impact of "syndemic" psychosocial factors on the incidence of hospitalization among geographically diverse MSM in the US. Participants were 1760 MSM from the Multicenter AIDS Cohort Study (MACS) between 2004 and 2019. We examined the relationship between six psychosocial factors (depression, stimulant use, smoking, heroin use, childhood sexual abuse, and intimate partner violence) and incident hospitalization (admission to a hospital for treatment). We found a positive dose-response relationship between the number of syndemic factors and hospitalization. MSM reporting five or more syndemic factors had over twice the risk of hospitalization compared to MSM without syndemic factors [aRR = 2.14 (95% CI = 1.56, 2.94)]. Psychosocial factors synergistically increased hospitalizations over time. The positive dose-response relationship between the number of syndemic factors and hospitalization and the synergistic effects of these factors underscore the need for interventions that disentangle the syndemics to reduce hospitalization and related costs and improve the quality of life among MSM.