High Resource Utilization Research Articles

A bibliometric analysis of patient-reported outcome measures in adult spinal deformity, and the future of patient-centric outcome assessments in the era of predictive analytics

Surgical treatment of adult spinal deformity (ASD) is associated with high resource utilization, high costs, and potential complications. In order to generate consensus for treatment paradigms and to demonstrate value, it is crucial to accurately assess clinical outcomes. Historically, objective assessments in ASD were performed by providers, and in recent decades the use of patient-reported outcome measures (PROMs) have become widely incorporated. Here, we report results of a bibliometric analysis of PROMs in ASD, synthesizing a global view of the topic and mapping trends in the field. In the modern era, enabling advancements in predictive modeling and machine learning, along with technology within smartphones and wearables, may supplement traditional patient-centric outcomes assessments and overcome some of their limitations.

A green production process of electrolytic manganese metal based on solvent extraction

A green method for producing electrolytic manganese metal using solvent extraction was developed to address the challenges of impurity magnesium contained in the electrolyte and ammonia nitrogen carried by electrolytic manganese residue, involving leaching, heavy metal removal, solvent extraction, stripping, and electrolysis. The extraction process used neodecanoic acid as an extractant to separate impurity Mg from the electrolyte, which had a Mn/Mg separation coefficient of 105.24. The removal of Mg from the electrolyte was 88.87% and the number of electrolyte cycles was increased by a factor of 9. DFT calculations show that neodecanoic acid has good electron donor capacity and chemical reactivity, it binds better to Mn than to Mg. The loaded organic phase was stripped through the anodic liquid, enabling the anodic liquid containing ammonia nitrogen to be closed-circulated between the stripping and electrolysis processes. The manganese content of the electrolytic manganese metal produced by this process is 99.81%, which meets the requirements of the Chinese national standard for DJMnD grade products. The separated impurity magnesium provides raw material for the preparation of high purity magnesium oxide, and the use of two stages of water circulation makes the electrolytic manganese residue completely free of ammonia nitrogen, which has the advantage of high resource utilization and clean production.

Environmental Gradients and Vegetation Types Alter the Effects of Leaf Traits on the Dominance of Woody Angiosperm Species

Leaf traits can reflect plant photosynthetic capacity, resource utilization strategy and adaptability to the environment. However, whether species’ leaf traits are tightly related to the functioning of their community and how that relationship varies with environmental gradients remain largely unexplored. We measured 6 leaf traits, including petiole fineness (PF), specific leaf area (SLA), leaf area (LA), leaf length–width ratio (LLWR), leaf nitrogen content (LN) and leaf phosphorus content (LP), of 733 populations (415 species) of 19 woody angiosperm communities in the eastern Qinghai–Tibetan Plateau across multiple climatic zones or vegetation types. Through meta-analysis and relative importance analysis, the relationship between leaf traits of species and their community dominance and its change with environments were analyzed. The results showed that species dominance was correlated positively with their LA and LP, suggesting that species with high light interception and resource utilization capacity can easily become dominant species in woody angiosperm communities. Along the altitudinal gradient, the effect of PF and SLA on species dominance increased and changed significantly in their pattern, from positive or nonsignificant in temperate forests to negative in alpine and subalpine shrubs, suggesting that increasing petiole mechanical support and lamina protection cost is a dominant leaf growth strategy in stressful high-altitude environments. Our findings demonstrate that the demand for efficient light acquisition and/or utilization and species adaptability or tolerance to specific environmental stress are key mechanisms by which leaf traits govern community composition and functioning.

Operating Room Recycling: Opportunities to Reduce Carbon Emissions Without Increases in Cost

BackgroundThe healthcare industry is a major contributor to greenhouse gas emissions. Within the hospital, operating rooms are responsible for the largest proportion of emissions due to high resource utilization and waste generation. Our aim was to generate estimates of greenhouse gas emissions avoided and cost implications following implementation of a recycling program across operating rooms at our freestanding children's hospital. MethodsData were collected from three commonly performed pediatric surgical procedures: circumcision, laparoscopic inguinal hernia repair, and laparoscopic gastrostomy tube placement. Five cases of each procedure were observed. Recyclable paper and plastic waste was weighed. Emission equivalencies were determined using the Environmental Protection Agency Greenhouse Gas Equivalencies Calculator. Institutional cost of waste disposal was $66.25 United States Dollars (USD)/ton for recyclable waste and $67.00 USD/ton for solid waste. ResultsThe proportion of recyclable waste ranged from 23.3% for circumcision to 29.5% for laparoscopic gastrostomy tube placement. The amount of waste redirected from landfill to a recycling stream could result in annual avoidance of 58,500 to 91,500 kg carbon dioxide equivalent emissions, or 6583 to 10,296 gallons of gasoline. Establishing a recycling program would not require additional cost and could lead to modest cost savings (range $15 to 24 USD/year). ConclusionsIncorporation of recycling into operating rooms has the potential to reduce greenhouse gas emissions without increased cost. Clinicians and hospital administrators should consider operating room recycling programs as they work towards improved environmental stewardship. Level of EvidenceLevel VI – evidence form a single descriptive or qualitative study.

EdgeDrones: Co-scheduling of drones for multi-location aerial computing missions

Low altitude platform (LAP) unmanned aerial vehicles (UAVs), also called drones, are currently being exploited by Edge computing (EC) systems to execute complex resource-hungry use cases, such as virtual reality, smart cities, autonomous vehicles, etc., by attaching portable edge devices on them. However, a typical drone has limited flight time, coupled with the resource-constrained attached edge device, which can jeopardize aerial computing missions if they are not holistically taking into consideration. Moreover, the fundamental challenge is how to co-schedule multi-drone among multi-location where EC services are needed, such that drones are scheduled to maximize the utility from the activities while meeting computing resource and flight time constraints. Therefore, for a given fleet of drones and tasks across disjointed target locations in a city, we derive a machine learning (ML) linear regression model that estimates these tasks resource requirement and execution time. Leveraging this estimation values, we jointly consider each drone’s flight time availability and its attached edge device resource capacity, and formulate a novel Multi-Location Capacitated Mission Scheduling Problem (MLCMSP) that selects suitable drones and co-schedules their flight routes with the least total distance to visit and execute tasks at the target locations. Then, we show that faster scheduling and execution of complex tasks at each location, while considering the inter-task dependencies is important to achieve effective solution for our MLCMSP. Hence, we further propose EdgeDrones, a variant bin-packing optimization approach through gang-scheduling of inter-dependent tasks that co-schedules and co-locates tasks tightly so as to achieve faster execution time, as well as to fully utilize available resources. Extensive experiments on Alibaba cluster trace with information on task dependencies (about 12,207,703 dependencies) show that EdgeDrones achieves up to 73% higher resource utilization, up to 17.6 times faster executions, and up to 2.87 times faster flight travel time compared to the baseline approaches.

Out‐of‐pocket expenses associated with pediatric heart transplantation

Heart transplantation in children is associated with high resource utilization. However, the financial burden on families and the association with patient and demographic factors remains unclear. This study aims to examine out-of-pocket expenses associated with pediatric heart transplantation. An anonymous REDCap survey was distributed to caregivers of children who have undergone heart transplantation using social media, national organizations, and during clinic encounters from May through August 2022. There were a total of 146 respondents. The median monthly out-of-pocket expense was $250 (IQR $75-$500) and 20 respondents (13.7%) reported monthly expenses of >$1000. Families with commercial insurance reported significantly higher out-of-pocket expenses compared to those with government-sponsored insurance (median $350 vs. $100, p < .001). Families with government-sponsored insurance were most happy with their insurance coverage, followed by commercial insurance and then coverage through the Affordable Care Act (p < .001 for all pairwise comparisons). There was no statistically significant difference in overall transplant-related out-of-pocket expenses based on total household income (p = .222). Monthly out-of-pocket expense was not associated with the number of medications, type of immunosuppressants, or post-transplant complications including rejection, PTLD, or CAV (p = NS for all). Cardiac catheterizations and unplanned admissions were reported as the events that incurred the highest out-of-pocket expense. Families of children who have undergone heart transplantation can incur significant out-of-pocket expenses and strategies to mitigate this financial burden should be investigated.

181 Costs of Surgery in Adult Spinal Deformity: Do Higher Cost Surgeries Lead to Better Outcomes?

INTRODUCTION: With increased focus on delivering cost effective healthcare, interventions associated with high resource utilization, such as adult spinal deformity (ASD) surgery, have received greater scrutiny. METHODS: A retrospective analysis of a single-center ASD database. ASD patients ≥18 years with baseline (BL) and 2-year (2Y) data were included. Surgical costs were calculated based on 2021 average Medicare reimbursement by CPT code. Costs of complications and reoperations were intentionally excluded. Patients were ranked into tertiles by surgical cost. The tertile with the highest surgical costs (HC) and lowest surgical costs (LC) were propensity score matched (PSM’d) to account for differences in baseline age and deformity. Multivariable logistic regressions assessed odds of achieving outcomes of interest in PSM’d groups. RESULTS: 421 patients met inclusion (139 LC; 127 HC). After PSM, 102 patients remained in each cost group with an average reimbursement of LC: $11,279 vs. HC: $29,274. PSM’d groups had similar demographics and baseline deformity (all p &gt;.05). Compared to LC patients, HC had higher odds of meeting SCB in SRS-22-Total (OR: 2.461, [1.321, 4.586], p = .005) and higher odds of meeting SCB in NRS Back (OR:1.961, [1.032, 3.723], p = .040). With respect to deformity, HC patients were more likely to have “0” Schwab modifier at 2Y in SVA (OR: 5.736, [2.798, 11.761], p&lt;.001), PI-LL (OR: 2.239, [1.100, 4.559], p = .026), and PT (OR: 2.456, [1.335, 4.518], p = .004). CONCLUSIONS: While patient presentation impacts surgical planning and costs, we sought to control for such variations to assess association between surgical costs and outcomes. Although higher cost did not guarantee an ideal outcome, high cost patients generally experienced superior patient reported outcomes and realignment at 2-years. Thus, isolating cost reduction as a public health priority may compromise outcomes in ASD patients.

PD13-01 COST-EFFECTIVENESS OF INITIAL MANAGEMENT OF HIGH-GRADE T1 BLADDER CANCER WITH INTRAVESICAL BCG VS IMMEDIATE RADICAL CYSTECTOMY

You have accessJournal of UrologyCME1 Apr 2023PD13-01 COST-EFFECTIVENESS OF INITIAL MANAGEMENT OF HIGH-GRADE T1 BLADDER CANCER WITH INTRAVESICAL BCG VS IMMEDIATE RADICAL CYSTECTOMY Heather Huelster, Neil Mason, Kyle Rose, Andrew Chang, Mahrukh Naqvi, Robert Gore, Youngchul Kim, Scott Gilbert, and Facundo Davaro Heather HuelsterHeather Huelster More articles by this author , Neil MasonNeil Mason More articles by this author , Kyle RoseKyle Rose More articles by this author , Andrew ChangAndrew Chang More articles by this author , Mahrukh NaqviMahrukh Naqvi More articles by this author , Robert GoreRobert Gore More articles by this author , Youngchul KimYoungchul Kim More articles by this author , Scott GilbertScott Gilbert More articles by this author , and Facundo DavaroFacundo Davaro More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003260.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Recurrent, BCG-refractory, or progressive high-grade T1 non-muscle invasive bladder cancer (HGT1) patients are exposed to costly treatments and toxicity from repeated transurethral resections and intravesical treatments. Escalation of therapy culminates in radical cystectomy in up to one-third. High healthcare resource utilization for this group of bladder cancer patients presents a challenging dilemma defined by balancing sufficiently aggressive management with the cost, toxicity, and quality-of-life implications of treatment. METHODS: A Markov model was constructed to compare the cost-effectiveness of HGT1 cancers managed initially with intravesical BCG with delayed radical cystectomy for NMIBC progression or recurrence versus immediate radical cystectomy with ileal conduit urinary diversion. The base case was represented by a 70 year old potent man with a new diagnosis of HG T1 bladder cancer, ECOG 0-1 performance status, and renal function acceptable for cisplatin-based chemotherapy. Five-year oncologic outcomes, adverse event rates, and published utility values were extracted from current literature. Drug and procedural costs were calculated from a US Medicare perspective and converted to 2021 US dollars. A willingness-to-pay threshold of $150,000 per quality adjusted life year (QALY) was considered cost-effective. One-way sensitivity analysis was then performed to identify correlates with overall cost and identify break-even points for recurrence and progression risk. RESULTS: The mean five-year costs for initial management of HGT1 were $43,197 (SD $3847) for intravesical BCG and $39,502 (SD $5434) for immediate radical cystectomy. Immediate cystectomy generated a gain of 1.7 QALYs and dominated intravesical BCG, generating an ICER of -$2238/QALY. Costs associated with cystectomy, TURBT, and BCG toxicity had the greatest impact on ICER. One-way sensitivity analysis demonstrated that intravesical BCG became a cost-effective management strategy if the 5-year recurrence rate of HG T1 was less than 56% or the five-year progression rate to MIBC was less than 4%. CONCLUSIONS: At current costs, treatment of HG T1 bladder cancer with immediate radical cystectomy achieves better oncologic and quality of life outcomes at lower cost over five years, and therefore is a more cost-effective management strategy than initial treatment with intravesical BCG. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e405 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Heather Huelster More articles by this author Neil Mason More articles by this author Kyle Rose More articles by this author Andrew Chang More articles by this author Mahrukh Naqvi More articles by this author Robert Gore More articles by this author Youngchul Kim More articles by this author Scott Gilbert More articles by this author Facundo Davaro More articles by this author Expand All Advertisement PDF downloadLoading ...

5613022 SOCIETAL BURDEN OF SICKLE CELL DISEASE IN THE UK: EMPIRICAL ESTIMATES OF PRODUCTIVITY LOSS AND LOSS OF FUTURE INCOME USING REAL-WORLD EVIDENCE

Background: Sickle cell disease (SCD) is associated with high healthcare resource utilization (HCRU), lowered life expectancy, and unemployment. The combination of routine healthcare appointments, acute crises, and organ damage causes productivity loss (PL). Early death and long-term unemployment also lead to loss of future income (LFI). Both PL and LFI are important aspects of the burden of SCD on society, as lost income due to a genetic disease can have intergenerational impacts. Aims: To empirically quantify the societal cost of SCD using observed PL and estimated LFI. Methods: We identified 9272 patients aged ≥12 years with SCD using the English Clinical Practice Research Datalink (CPRD) linked with Hospital Episode Statistics between January 1, 2007 and March 31, 2019. We obtained mortality data from the Office of National Statistics (ONS) death register. To quantify PL, we assigned time to HCRU events based on Choi et al, 2019.1 We assessed PL due to sickness at home using doctors’ sick notes in the CPRD, assuming 10 days’ PL for each note. Patients could self-certify sickness without a doctor’s note for 7 days. We assumed a 5-day work week, with 1 day of 7.5 h based on the average 37.5 h UK work week. We estimated costs of PL by multiplying the mean hourly adult wage for the year the resource was used by the time lost. For patients aged 12 to 18 years, PL was attributed to a main caregiver using adult wages. We inflated the cost of PL to 2021 pounds sterling using the Consumer Price Index (CPI). Unemployment, medical retirement, and death were LFI events. Once patients were recorded as unemployed or medically retired, we assumed they never returned to work. We also assumed those who did not die lived past state retirement age, which is currently 68 years. Only observed events were used to calculate the discounted present value of LFI based on years from the earliest LFI event to age 68. The discount rate was 3.5%. We used the 2021 age-specific mean income from the ONS to estimate future income at each decade. Results: A total of 62.5% of patients were female; 73.5% were Black; mean (standard deviation) age was 36.3 (15.7) years. Median follow-up was 7.1 years (interquartile range 3.6-10.1). Mean cost of PL was £1821 per patient-year (PPY), equivalent to >3 weeks’ average 2021 UK weekly earnings (£586). Patients lost a mean of 5.5 days PPY in hospital stays, 2.7 days PPY in outpatient clinics, 3.6 days PPY for primary care visits, 1.1 days PPY in emergency care, and 2.2 days PPY for sickness at home. We estimated £510,315 LFI for each patient with an LFI event, equivalent to £30,546 per patient in the cohort. Of the 555 LFI events, 425 (76.6%) were deaths, occurring at a median age of 61 years. Unemployment accounted for 129 (23.2%) events occurring at a median age of 39 years. One person (0.2%) was medically retired at age 61. Summary/Conclusion: To our knowledge, this is the first study presenting empirical estimates of PL and LFI for patients with SCD from a large, nationally representative UK data set.Societal costs of SCD in the UK are substantial; PL due to healthcare appointments or to sickness at home is equivalent to >3 weeks’ lost earnings PPY. Those who cannot work or die of their disease lose over £500,000 in a lifetime. Our results are consistent with Lubeck et al, 2019, who estimated an LFI of $695,000 (£489,800, purchasing power parity inflated to 2021 using the CPI) from a simulated SCD cohort in the US.2

Subcritical hydrothermal oxidation of semi-dry ash from iron ore sintering flue gas desulfurization: Experimental and kinetic studies.

Realization of low temperature and high efficiency oxidation of CaSO3 is the key to solve the issue of ecological hazards caused by semi-dry sintering flue gas desulfurization ash. The subcritical hydrothermal technology was employed for the oxidation of CaSO3, achieving 89.83% of CaSO3 at 180°C, 2MPa for 120min with a solid-to-liquid ratio of 1:20. The macroscopic oxidation kinetics of CaSO3 in the subcritical hydrothermal reaction system was investigated. A mathematical model was established, incorporating the intrinsic reaction, CaSO3 dissolution, oxygen diffusion and CaSO4 precipitation. It was concluded that the macroscopic oxidation of CaSO3 was co-controlled by the oxygen diffusion and CaSO4 precipitation. Subcritical hydrothermal technology promises not only higher efficiency, but more importantly, potentially "one-step" preparation of CaSO4 whiskers, enabling cost-effective and high value-added resource utilization of the semi-dry FGD ash.

Cloud Workload Turning Points Prediction via Cloud Feature-Enhanced Deep Learning

Cloud workload turning point is either a local peak point standing for workload pressure or a local valley point standing for resource waste. Predicting such critical points is important to give warnings to system managers to take precautionary measures aimed at achieving high resource utilization, quality of service (QoS), and profit of the investment. Existing researches mainly focus on point value prediction only, whereas trend-based turning point prediction is not considered. This is partly due to the fact that traditional trend prediction methods have a weak ability to represent the cloud features, which means that they cannot describe the highly-variable cloud workloads time series. This paper introduces a novel cloud workload turning point prediction approach based on cloud feature-enhanced deep learning. Firstly, we establish a turning point prediction model of cloud server workload by taking cloud workload features into consideration. Then, a cloud feature-enhanced deep learning model is designed for workload turning point prediction. Experiments on the most famous Google cluster demonstrate the effectiveness of our model compared with state-of-the-art models. To the best of our knowledge, this paper is the first systematic research on turning point-based trend prediction of cloud workload time series by cloud feature-enhanced deep learning.

Quality improvement sustainability to decrease utilization drift for therapeutic hypothermia in the NICU.

Therapeutic hypothermia (TH) is now standard of care for the neuroprotection of patients with moderate to severe hypoxic-ischemic encephalopathy (HIE). TH misuse results in increased medical complication rates and high health care resource utilization. Quality improvement (QI) methodology can address drift from clinical guidelines. Assessment of sustainability of any intervention over time is an integral part of the QI methodology. Our prior QI intervention improved medical documentation using an electronic medical record-smart phrase (EMR-SP) and demonstrated special cause variation. This study serves as Epoch 3 and investigates the sustainability of our QI methods to decrease TH misuse. A total of 64 patients met the diagnostic criteria for HIE. Over the study period, 50 patients were treated with TH, and 33 cases (66%) used TH appropriately. The number of appropriate TH cases between cases of misuse increased to an average of 9 in Epoch 3 from 1.9 in Epoch 2. Of the 50 cases, 34 (68%) had EMR-SP documentation included. Length of stay and TH complication rates did not vary between cases of TH misuse and appropriate TH use. Our study confirmed a sustained decrease in TH misuse, despite inconsistent use of EMR-SP. We speculate that culture change involving increased awareness of guidelines through education may have contributed more to a lasting change.

Reliability Enhancement of Fast Charging Station under Electric Vehicle Supply Equipment Failures and Repairs

This work focuses on the enhancement of the charging reliability of both scheduled (SEVs) and opportunistic (UEVs) electric vehicle (EV) users in an EV fast charging station (FCS). The proposed charging coordination strategies allow UEVs to exploit unused charging resources to optimally utilize the limited charging resources of FCS. However, the optimum utilization of limited charging resources of an FCS while assuring a reliable charging process for plugged-in EVs under random failures of electric vehicle supply equipment (EVSE) is a real challenge for the FCS controller. When the FCS admits UEVs in addition to SEVs, assuring a satisfactory quality of service to both EV user categories is also dispensable. Therefore, we analyze the performance of reservation of off-board mobile chargers (MOBCs) to enhance the charging reliability of EV users while achieving high charging resource utilization. This work proposes resource allocation and charging coordination strategies for an FCS where MOBCs are used to enhance the charging reliability of both SEVs and UEVs. Moreover, the proposed dynamic charging resource coordination strategies are analyzed with a continuous time Markov-chain (CTMC). The presented results from the CTMC model demonstrate that the proposed strategies outperform the EV charging process of the FCS in terms of high resource utilization and reliability while guaranteeing a satisfactory quality of service to EV users.

Association of Hospital Resource Utilization With Neurodevelopmental Outcomes in Neonates With Hypoxic-Ischemic Encephalopathy

Intercenter variation exists in the management of hypoxic-ischemic encephalopathy (HIE). It is unclear whether increased resource utilization translates into improved neurodevelopmental outcomes. To determine if higher resource utilization during the first 4 days of age, quantified by hospital costs, is associated with survival without neurodevelopmental impairment (NDI) among infants with HIE. Retrospective cohort analysis of neonates with HIE who underwent therapeutic hypothermia (TH) at US children's hospitals participating in the Children's Hospitals Neonatal Database between 2010 and 2016. Data were analyzed from December 2021 to December 2022. Infants who survived to 4 days of age and had neurodevelopmental outcomes assessed at greater than 11 months of age were divided into 2 groups: (1) death or NDI and (2) survived without NDI. Resource utilization was defined as costs of hospitalization including neonatal neurocritical care (NNCC). Data were linked with Pediatric Health Information Systems to quantify standardized costs by terciles. The main outcome was death or NDI. Characteristics, outcomes, hospitalization, and NNCC costs were compared. Among the 381 patients who were included, median (IQR) gestational age was 39 (38-40) weeks; maternal race included 79 (20.7%) Black mothers, 237 (62.2%) White mothers, and 58 (15.2%) mothers with other race; 80 (21%) died, 64 (17%) survived with NDI (combined death or NDI group: 144 patients [38%]), and 237 (62%) survived without NDI. The combined death or NDI group had a higher rate of infants with Apgar score at 10 minutes less than or equal to 5 (65.3% [94 of 144] vs 39.7% [94 of 237]; P < .001) and a lower rate of infants with mild or moderate HIE (36.1% [52 of 144] vs 82.3% [195 of 237]; P < .001) compared with the survived without NDI group. Compared with low-cost centers, there was no association between high- or medium-hospitalization cost centers and death or NDI. High- and medium-EEG cost centers had lower odds of death or NDI compared with low-cost centers (high vs low: OR, 0.30 [95% CI, 0.16-0.57]; medium vs low: OR, 0.29 [95% CI, 0.13-0.62]). High- and medium-laboratory cost centers had higher odds of death or NDI compared with low-cost centers (high vs low: OR, 2.35 [95% CI, 1.19-4.66]; medium vs low: OR, 1.93 [95% CI, 1.07-3.47]). High-antiseizure medication cost centers had higher odds of death or NDI compared with low-cost centers (high vs. low: OR, 3.72 [95% CI, 1.51-9.18]; medium vs low: OR, 1.56 [95% CI, 0.71-3.42]). Hospitalization costs during the first 4 days of age in neonates with HIE treated with TH were not associated with neurodevelopmental outcomes. Higher EEG costs were associated with lower odds of death or NDI yet higher laboratory and antiseizure medication costs were not. These findings serve as first steps toward identifying aspects of NNCC that are associated with outcomes.

Optimization of coal-to-liquid processes; A way forward towards carbon neutrality, high economic returns and effective resource utilization. Evidences from China

As the world's largest consumer of coal, China is committed to developing a carbon–neutral coal industry. For this purpose, upgrading the carbon emission-intensive coal-chemical industries, such as coal-to-liquids (CTL) is imperative. This study develops a technical–economic framework to model and test four promising CTL upgrading processes. First and second processes involve low-temperature Fischer-Tropsch (FT) synthesis practices with larger gasifiers and air-separating units than the current level. Third, the process combines olefin and fuel co-production practices that utilize low- and high-temperature FT synthesis processes. Finally, the process produces both electricity and fuel by sending the tail gas of the synthesis process to an integrated cycle. Aspen Plus® is used to simulate the chemical processes, and the financial cost accounting model of the American Association of Cost Engineers is utilized to estimate the financial costs accurately. The results show that the upgraded processes can achieve an energy efficiency of more than 48 %, which is 6 % higher than the existing coal-to-oil process. Additionally, the break-even point is 2 %–14.45 % lower than the actual process, reducing carbon emissions by 2.78 %–10.34 %. According to these findings, the upgrade can help China reach its carbon neutrality targets and significantly contribute to global climate change and sustainable development goals.

Diagnosis and Management of Pediatric Heart Failure.

Heart failure is a highly morbid syndrome, recognized as a major cause of adult mortality. Heart failure in pediatric patients, whether in the setting of congenital or acquired heart disease, is similarly associated with high mortality and resource utilization. Understanding the clinical presentation, diagnosis, and initial stabilization of pediatric heart failure is paramount for any acute care clinician as it may mimic common childhood ailments like viral respiratory or gastrointestinal illnesses. Pediatric heart failure occurs in patients with palliated or unpalliated congenital heart disease, familial or acquired cardiomyopathy, acquired valve disease, and myocarditis. This review will focus on heart failure in pediatric patients with structurally normal hearts and will summarize what is known about patterns of presentation, etiologies, diagnostic evaluation, and the acute and chronic management of this highly morbid syndrome.

An optimal algorithm for energy harvesting in optical networks

Optical fiber cables, which make up the majority of the world's telecommunications infrastructure, now carry the vast majority of digital data. However, because to the Internet's exponential expansion and a slew of bandwidth-hungry new services like online gaming, 3D or high-definition television, and cloud computing, this infrastructure will soon run out of capacity. The growing need for faster transmission speeds by clients has led to the development of heterogeneous optical networks. High throughput, portability, and future information interconnects may all be accommodated by such a system. Delivering such high-capacity connections to a mobile client should need heterogeneous optical networks. Different multiple access user technologies have been suggested to meet the needs of a group of future heterogeneous optical network users. In order to address the high energy consumption, poor QoS and low resource utilization in cloud radio access network, this paper proposed a novel algorithm. The main idea is to allocate virtual resources with energy-awareness and hybrid energy supply. Then, the energy arrival and consumption models were established based on different network devices. Simulation results show that the proposed algorithm effectively improved the energy consumption performance and QoS as compared with existing methods.

Use of Remote Cardiorespiratory Monitoring is Associated with a Reduction in Hospitalizations for Subjects with COPD.

Chronic obstructive pulmonary disease (COPD) is prevalent and results in high healthcare resource utilization. The largest impact on health status and proportion of healthcare costs in COPD are related to hospitalizations for acute exacerbations. Accordingly, the Centers for Medicare & Medicaid Services have advocated for remote patient monitoring (RPM) to aid in chronic disease management. However, there has been a lack of evidence for the effectiveness of RPM in reducing the need for unplanned hospitalizations for patients with COPD. This pre/post study was a retrospective analysis of unplanned hospitalizations in a cohort of COPD subjects started on RPM at a large, outpatient pulmonary practice. The study included all subjects with at least one unplanned, all-cause hospitalization or emergency room visit in the prior year, who had elected to enroll in an RPM service for assistance with clinical management. Additional inclusion criteria included being on RPM for at least 12 months and a patient of the practice for at least two years (12 months pre- and post-initiation of RPM). The study included 126 subjects. RPM was associated with a significantly lower rate of unplanned hospitalizations per patient per year (1.09 ± 0.07 versus 0.38 ± 0.06, P<0.001). Unplanned, all-cause hospitalization rates were lower in subjects started on RPM for COPD when compared to their prior year. These results support the potential of RPM to improve the long-term management of COPD.

Treatment patterns, healthcare resource utilization and costs of HER2-negative gastric/gastroesophageal junction cancer.

Aim: To describe treatment patterns, healthcare resource utilization and costs in HER2-negative gastric/gastroesophageal (G/GEJ) cancer in theUSA. Methods: Retrospective IQVIA Adjudicated Closed Claims database analysis; patients with HER2-negative G/GEJ cancer initiating systemic therapy between October 2016 and December 2019 were identified. Results: Among 1317 patients, platinum plus taxane regimens (54%) were common in neoadjuvant/adjuvant settings. Platinum-taxane (41%) and platinum-fluoropyrimidine (36%) regimens were common first-line therapies in the metastatic setting. Treatment regimens were heterogeneous in later lines. Hospitalization rates ranged from 39% (first-, second-line metastatic settings) to 61% (neoadjuvant/adjuvant setting). High healthcare resource utilization was driven by high outpatient costs. Mean per-patient per-month outpatient costs combining physician office and hospital visits ranged from US$10,944 to $12,582 (representing 52-70% of total costs). Conclusion: For G/GEJ cancer, systemic regimens varied across lines of therapy with variation increasing with subsequent therapy lines; high healthcare costs persist for systemic treatment, particularly outpatient services.

FLoadNet: Load Balancing in Fog Networks With Cooperative Multiagent Using Actor–Critic Method

The growing demands of the Internet of Things (IoT) require a platform that supports real-time interactions and high availability of services to devices. In this context, the fog computing paradigm has emerged as an attractive solution for processing the data of IoT applications. Owing to the unpredictable traffic demands and resource heterogeneity in the fog environment, a smart workload distribution is essential to achieve high resource utilization and computing efficiency. To this end, this paper considers a joint link and server load balancing problem with multiple cooperative access points, (APs), in a combined edge-fog-cloud environment. The joint optimization problem is formulated as a stochastic game, and an actor-critic reinforcement learning framework, called FLoadNet, is proposed to optimize the joint policy of the multi-agents. FLoadNet consists of a centralized critic network, with parameter sharing and distributed individual actor networks in all the APs. Due to the learning dynamics and partially observable environment, we propose an extended critic network model, where cooperative APs learn to communicate among themselves while evaluating the value function. Unlike previous studies, the proposed critic network is designed to train both value and message functions, which is shown to significantly reduce the computational cost. The main goal of this work is to advance the development of efficient edge learning and the application of distributed learning algorithms specifically to fog network load balancing. The experimental results show that FLoadNet outperforms baseline load balancing methods.