Laboratory Costs Research Articles

BN SO44 - Is routine histological analysis of excised gallbladders necessary?

Abstract Background Gallbladder cancer is rare representing <1% of annual cancer diagnoses in the UK. It is more common in females (2.4/100,000 vs 1/100,000) with a peak age incidence of 85–89-years. Our trust routinely histologically analyses all resected gallbladders, over 1000 per year, regardless of indication. Our pathologists estimate that each specimen costs £75 to analyse, reflecting an annual cost of over £80,000. A 2021 systematic review suggested selective histological analysis is safe, reduces laboratory burden and costs. We aimed to assess our centre’s cholecystectomy specimens to ascertain the incidental gallbladder cancer diagnoses and explore the possibility of selective analysis. Method A retrospective search of our pathology database was carried out for the terms “cancer” and “gallbladder” from 2015 to 2018 inclusive. After exclusion of non-gallbladder primary cancers, all selected cases electronic notes were retrospectively reviewed. The primary outcome was the incidental findings of gallbladder cancer. Secondary outcomes were the indications for surgery, intraoperative findings, histological macroscopic description, final diagnosis and further management where applicable. Results We identified 4421 gallbladder specimens of which 12 (0.27%) identified cancer. The ratio of female to male diagnoses was 5:1 and the median age was 73.5 years. Of the 12 cancers, 7 (0.16%) of these were incidental findings, with 5 having surgery for symptomatic gallstones and 2 for gallbladder polyps. The 5 symptomatic gallstones patients all had grossly abnormal macroscopic appearances of the serosa, dense adhesions or exudate; all were confirmed as gallbladder adenocarcinoma. Three patients were fit enough for limited liver resection. Conclusion Our results demonstrate that across four years the rate of incidental gallbladder adenocarcinoma diagnosed by cholecystectomy was 0.16%. In all non-polypoidal cases (0.11%), the gallbladder was macroscopically abnormal. This suggests that with careful criteria, selective gallbladder histological analysis may reduce laboratory burden and therefore costs associated with elective gallbladder surgery. With increasing emphasis to improve efficiency and rationalise healthcare spending, our results suggest that selective histological analysis may be safe and effective. However, given the consequences of missing a cancer diagnosis it would require a larger scale multi centre study to support a move in this direction.

Improving the Laboratory Investigation Price Revising Process at Sri Jayawardhanapura General Hospital

Sri Jayawardhanapura General Hospital (SJGH) is a non-profit public enterprise that offers reasonable services. The hospital relies on government grants and revenue generated by patient care services for funding. One of its crucial departments is a laboratory, which serves as a vital support service and the main profit center. However, the frequent rise of consumable prices during economic crises significantly impacts the variable costs of laboratory tests, resulting in financial losses.Calculating the cost incurred by laboratory investigations is essential for implementing a price revision strategy to address this issue. Given the absence of a recognized method for calculating investigation costs, adopting the World Health Organization's Laboratory Test Costing Tool (LTCT), a user-friendly Microsoft Excel-based tool, is recommended. This tool is specifically designed to assist in calculating laboratory test costs, ensuring a more accurate understanding of expenses incurred.Additionally, establishing key indicators to signal the need for price revision and assigning responsibility to initiate the price revision process when these indicators are triggered will streamline the process and improve its responsiveness to financial challenges. By employing such a system, SJGJ can better manage its laboratory costs, maintain service quality, and ensure sustainable operations even during economic hardships.

Analisis Minimalisasi Biaya Terapi Antibiotik Ceftriaxone dan Cefotaxime Pada Pasien Pneumonia di Instalasi Rawat Inap RSUD Kabupaten Kediri

Pneumonia is an infection caused by pathogenic microorganisms such as microbes, bacteria, fungi and viruses that cause inflammation of the lung tissue. The prevalence of pneumonia has increased every year. The first-line therapy used at the Kediri District Hospital is the use of ceftriaxone and cefotaxime antibiotics. Decision making on antibiotic use has an influence on the amount of medical costs incurred by patients. This study aims to determine which antibiotics are more cost-minimal and whether there is a significant difference between the use of ceftriaxone and cefotaxime antibiotic therapy at Kediri District Hospital. The design of this study was cross sectional, data collection was done retrospectively. The analysis method used independent t-test statistical test. The perspective in this study was seen through the provider, namely the hospital, a total of 215 pneumonia patients and the sample for this study was 63 patients. With 32 patients receiving ceftriaxone antibiotic therapy and 31 patients receiving cefotaxime antibiotic therapy. Total direct medical costs were categorized into four types of costs, namely treatment costs, antibiotic costs, other drug costs, laboratory and radiology costs. The average total direct medical costs of patients who received ceftriaxone antibiotic therapy were more cost minimal than patients who received cefotaxime antibiotics, namely Rp.2,296,449 and Rp.2,464,470. The results of the difference test using independent t-test statistics show a p-value of 0.219 so that it can be interpreted that there is no significant difference.

Comparing costs associated with management of antibiotic-recalcitrant recurrent urinary tract infections for one year pre- and post-electrofulguration.

To quantify and compare recurrent urinary tract infection costs between 1 year before and 1 year after electrofulguration. Following IRB approval, a well-characterized cohort of non-neurogenic women with >3 symptomatic urinary tract infections(UTIs)/year, a negative upper and lower urinary tract evaluation, and inflammatory bladder lesions (cystitis) on office cystoscopy who underwent fulguration of these lesions was analyzed. Cost of visits, imaging, labs, and medications were summed for 1-year pre- and post-fulguration using the Medicare Physician Fee Schedule, local pharmacy pricing, and institutional expenses. Before fulguration, all patients underwent clinic visit, noninvasive flow study, and flexible cystoscopy, and post-fulguration, 6-week follow-up visit and 6-month cystoscopy. Ninety-threewomen met study criteria (mean age 64), with 100% 1-year follow-up. Before fulguration, 73% of patients used daily antibiotic suppression, 6% self-start antibiotics, and 5% postcoital prophylaxis. Some also used vaginal estrogens (17%), urinary analgesics (13%), and cranberry or d-mannose supplements (7%). At 1 year post-fulguration, 82% had 0-1 infections and no cystoscopy evidence of cystitis, while 14% required additional fulguration for new cystitis sites and recurrent infections. Patients had on average 0.7 infections in the 1-year post-fulguration, which was significantly lower than pre-fulguration (p < 0.05). Mean 1-year pre-fulguration cost was $1328 (median $1071, range $291-$5564). Mean 1-year post-fulguration cost was $617 (median $467, range $275-$4580). On average, post-fulguration costs were $710 lower than pre-EF (p < 0.05). For women with antibiotic-refractory recurrent urinary tract infections and cystoscopy evidence of cystitis, fulguration was associated with a significant reduction in UTI-related costs in the 1-year post-fulguration.

Revealing the catalytic behavior of different types ZVI (powder Fe0, sponge Fe1, foam Fe2) in US/Fex/PDS and its effect on the dewaterability of waste activated sludge

The ultrasound (US) irradiation-coupled zero-valent iron (ZVI) activated persulfate system could improve dewatering performance, reduce WAS volume, decrease transport and final disposal costs. However, there are huge differences between various types of ZVI on activation efficiency, reaction mechanism, and application potential in WAS conditioning process. In this study, three ZVI (Fex) catalysts (Fe0 powder iron, Fe1 sponge iron and Fe2 foam iron) were used in the US/PDS system, whose catalytic performance and the fundamentals of the WAS conditioning were explored and compared. The results showed that the capillary suction time (CST) reduction rates were 89 %, 85 %, and 87 % in US/Fe0/PDS, US/Fe1/PDS, and US/Fe2/PDS, respectively, which indicated that the US/Fex/PDS system had an outstanding conditioning performance. The WAS reduction rate was US/Fe1/PDS > US/Fe2/PDS > US/Fe0/PDS attributed to Fe1 surface activate sites. Similarly, the organic matters characterization showed soluble protein content (PN), polysaccharide content (PS), and microbial by-products were significantly reduced in the US/Fe1/PDS system. Further examination of the thermodynamic parameters revealed that the WAS cohesive interfacial energy (ΔGslscoh) was minimally reduced to promote release of bound water in the system due to the effective regulation of intermolecular forces. In addition, examination of the trivalent iron/divalent iron ratio (Fe3+/Fe2+) to assess the efficacy of ferric ion recycling showed a significant advantage for US/Fe1/PDS system. On the basis of improving catalyst utilization, PDS produced SO4·- that dominated free radicals to condition WAS, improve dewaterability and achieve WAS reduction. Finally, evaluating laboratory WAS conditioning results and costs, US/Fe1/PDS system has potential applications value.

Disparities in healthcare-seeking behaviors and associated costs between Venezuelan migrants and Colombians residing in Colombia

BackgroundColombia, which hosts over 3 million of the Venezuelan diaspora, is lauded for its progressive approach to social integration, including providing migrants access to its universal health coverage system. However, barriers to healthcare persist for both migrant and host populations, with poorly understood disparities in healthcare-seeking behaviors and associated costs. This is the first study to link healthcare-seeking behaviors with costs for Venezuelan migrants in Colombia, encompassing costs of missing work or usual activities due to healthcare events.MethodsWe use self-reported survey data from Venezuelan migrants and Colombians living in Colombia (September-November 2020) to compare healthcare-seeking behaviors and cost variables by nationality using two-sampled t-tests or Chi-square tests (X2). The International Classification of Diseases was used to compare reported household illnesses for both populations. Average health service direct costs were estimated using the Colombian Government’s Suficiencia database and self-reported out-of-pocket (OOP) payments for laboratory and pharmacy services. Indirect costs were calculated by multiplying self-reported days of missed work or usual activities with estimated income levels, derived by matching characteristics using the Gran Enquesta Integrada de Hogares database. We calculate economic burdens for both populations, combining self-reported healthcare-seeking behaviors and estimated healthcare service unit costs across six healthcare-seeking behavior categories.ResultsDespite similar disease profiles, Venezuelan migrants are 21.3% more likely to forego formal care than Colombians, with 746.3% more Venezuelans reporting lack of health insurance as their primary reason. Venezuelan women and uninsured report the greatest difficulties in accessing health services, with accessing medications becoming more difficult for Venezuelan women during the COVID-19 pandemic. Colombians cost the health system more per treated illness event (US$40) than Venezuelans (US$26) in our sample, over a thirty-day period. Venezuelans incur higher costs for emergency department visits (123.5% more) and laboratory/ pharmacy OOP payments (24.7% more).ConclusionsWhile Colombians and Venezuelans share similar disease burdens, significant differences exist in access, cost, and health-seeking behaviors. Increasing Venezuelan health insurance enrollment and tackling accessibility barriers are crucial for ensuring healthcare equity and effectively integrating the migrant population. Findings suggest that improving migrant access to primary healthcare would produce savings in Colombian healthcare expenditures.

Cholecystectomy in children: indications, clinical, laboratory and histopathological findings and cost analysis.

The most common indication for cholecystectomy in children is cholelithiasis, and routine histopathological examination is performed on all gallbladder specimens. Currently, selective histopathological examination is suggested instead of routine examination due to the low frequency of gallbladder cancer in adults. The purpose of this study was to evaluate the indications, clinical, laboratory and histopathological findings of the cholecystectomy in children. We also questioned the contribution and cost-effectiveness of routine histopathological evaluation in diagnosis and treatment. A total of 114 children underwent cholecystectomy between the years 2008 and 2022. The clinical findings, laboratory, and imaging results of the patients and histopathological findings of the gallbladder specimens were evaluated retrospectively. Cholelithiasis were diagnosed in 71%, choledochal malformation in 15.8%, hydrops of gallbladder and/or biliary sludge in 12.3%, and hypoplasia of gallbladder in 0.9% of the patients. Histopathologically significant findings were observed in only 3 patients (2.6%); adenomyomatosis in 2 and angiodysplasia and pyloric metaplasia in 1. While the cost of a cholecystectomy and histopathologic examination combined amounted to 27.77% of the minimum wage in Türkiye in 2024, the histopathologic examination alone constitutes just 0.67% of the minimum wage and 2.4% of the operation fee. In children undergoing cholecystectomy, histopathological examination does not provide any significant contribution to the patient's diagnosis and follow-up management. In children, selective gallbladder histopathological examination might reduce health costs and save time for pathologists.

6502 Comparing TBII vs TSI Assays at University Hospital; A Quality Improvement Project

Abstract Disclosure: L.E. Chozet: None. G. Le: None. M.A. Escobar Vasco: None. Radionuclide uptake and scan in the setting of thyrotoxicosis is considered the gold standard test to diagnose Graves' disease (GD). However, TSH-receptor antibodies (TRAB) tests are now being used as optional first-line tests given their widespread availability and cost-effectiveness. Thyrotropin-binding inhibitory immunoglobulin (TBII) and thyroid-stimulating immunoglobulin (TSI) assays are commonly obtained in patients admitted with thyrotoxicosis. Both assays are readily available at our institution. Our project aimed to further review and compare these two assays. To determine turnaround times of these assays at our institution, as well as cost-effectiveness of ordering both TBII and TSI assays vs only ordering one assay. We did a retrospective evaluation of 27 patients with lab evidence of thyrotoxicosis at University Hospital between April 2022, and May 2023 who were tested with both TBII, TSI assays simultaneously during their hospital stay to compare their concordance. We then compared turnaround times in days for laboratory results to be available. TBII, TSI assays are not done in-house. They are instead sent to an outside laboratory. Our hospital pathology services provided us with information regarding lab costs. We investigated which assay is more cost-effective. Based on our data, TBII and TSI were concordant in almost all patients evaluated (26 out of 27). Ordering TBII as the first initial test for GD is more cost-effective than ordering both TSI, TBII simultaneously. Our findings are consistent with previous studies, which suggest that ordering both assays (TBII and TSI) could be reserved for patients where the diagnosis of GD is not clear. Presentation: 6/3/2024

A-248 Assessment of Nanopore Sequencing for HIV Genotyping: A Comparative Study with Sanger Sequencing

Abstract Background The HIV drug resistance test, conducted through genotyping of the Human Immunodeficiency Virus (HIV), is a critical tool for assessing drug resistance in virus-infected patients and is commonly performed using Sanger Sequencing methodology (first-generation sequencing). Nanopore sequencing (third-generation sequencing) is a new technology that started to be commercialized a few years ago and has recently undergone significant updates with the new Q20+ chemistry. Therefore, this study aims to evaluate the potential use of nanopore sequencing (MinION) for HIV genotyping. Methods The genomic region encoding HIV protease and transcriptase was amplified by nested PCR using primer pairs modified with unique barcodes in the second round of amplification. Three libraries were assembled, including samples from 22 HIV-positive patients, one negative control (negative control patient), and one no-template control (NTC) per library, totaling 66 HIV-positive samples. The libraries were constructed using the SQK-LSK114 kit and sequenced on a MinION platform using the new Q20+ chemistry in flowcells or flongle R10.4.1. The sequences were assembled and analyzed using HIVdb-NGS (Stanford). Validation tests, such as accuracy and precision, were conducted following WHO recommendations for HIV genotyping. The same samples were also sequenced using the Sanger method for comparison. Results 62 HIV sequences were generated by the MinION and analyzed in the described pipeline. The average sequence coverage per sample was 25,866 x. 41 sequences were classified as type B (63.08%), 12 as type C (18.46%), 8 as type F (12.31%), three as CRF02_AG (4.62%), and 1 as a recombinant B+C (1.54%). All identified subtypes were consistent with those found by the Sanger method. The average similarity between the sequences of each sample (MinION vs Sanger) was 98.68% (minimum 94.96%, maximum 99.95%). Basecalling similarity at relevant positions (associated with resistance) was above 98% in 59 out of 62 samples (95.16%), meeting the acceptance criteria recommended by the WHO. Conclusions Our results suggest that nanopore sequencing (utilizing Q20+ chemistry) can replace Sanger sequencing for HIV genotyping, which is used to monitor the effectiveness of anti-HIV drugs. This transition will allow for a reduction in test costs in laboratories with high demand for HIV drug resistance testing. Additionally, the use of modified primers proposed here eliminates the need for commercial barcodes, resulting in reduced processing time and improved throughput.

B-085 Optimizing Thyroglobulin Antibody Interference Thresholds to Minimize Turn-around Time

Abstract Background Serum thyroglobulin (Tg) is a key biomarker used to detect disease recurrence in patients with differentiated thyroid cancers who have undergone complete thyroidectomy. Thyroglobulin antibodies (TgAb) can interfere with accurate measurement of serum Tg levels, producing falsely low results in automated immunoassays. Thus before measurement of Tg, TgAb levels are measured to determine if in-house immunoassays can be used or if the patient’s sample will need to be sent out for radioimmunoassay (RIA) or mass spectrometry methodologies, which are less sensitive to TgAb interference. We recently transitioned to new instrumentation and noted a sharp increase in Tg samples with TgAb interference that needed to be sent out when we used the limit of detection (LOD) of the Roche TgAb assay. This increases turnaround times for patients and increases laboratory costs. We hypothesized that the LOD of the Roche TgAb assay is below the level of interference in Tg immunoassays. To test this we compared the performance of TgAb immunoassays (IA) and Tg measurements by IA and RIA with the intention of proposing a more appropriate threshold for TgAb interference for the Roche TgAb assay. Methods We collected 121 serum specimens, which were above the LOD of the Roche TgAb (R-TgAb) assay, which is 10 IU/mL. These specimens were sent as part of standard care to USC for measurement of TgAb by Kronus (K-TgAb) and Tg by RIA. On these split samples we also measured Tg by Beckman Access (B-Tg). We compared the detection of TgAb by USC to varying thresholds of Roche TgAb measurements (10 IU/mL [LOD], 20 IU/mL, and 115 IU/mL [reference interval for autoimmunity]), and assessed the agreement between Tg measurements by Beckman IA and USC RIA for different Roche TgAb thresholds. Analyses were performed in Prism Graphpad using linear regression. Results Qualitatively, the concordance for R-TgAb to RIA (reference) at 10 IU/mL was 31%, at 20 IU/mL was 90%, and at 115 IU/mL was 80%. Quantitative agreement between the B-Tg immunoassay and RIA for the TgAb thresholds of: TgAb &amp;gt;10 IU/mL gave an R2=0.97 for Tg comparison, &amp;gt;20 IU/mL gave an R2=0.99, and &amp;gt;115 IU/mL R2=0.99. Conclusions Prior studies have shown that TgAb immunoassays can produce significant qualitative and quantitative differences. In our study, we attempt to validate the use of the Roche immunoassay with a cutoff of 20 IU/mL to minimize interference between Tg and TgAb in order to accurately detect recurrence of thyroid cancer. We found that a TgAb cutoff of 20 IU/mL we maintained acceptable agreement between Tg methods indicating no significant interference up to 20 IU/mL. With the TgAb cutoff of 20 IU/mL, we would be able to reduce sendouts for this cohort from 121 to 42, reducing sendouts by 65% and allowing a faster turnaround time for a significant proportion of our patients.

Comparing Financial Efficiency and Quality of Care in Telemedicine, and Clinical Visits for Chronic Patients Registered in Primary Healthcare Centers of Makkah, Saudi Arabia

Primary healthcare plays a fundamental role in advancing public health, and the evaluation of its effectiveness is crucial part for ongoing enhancement and evolution. The escalating prevalence of non-communicable diseases is placing significant burden on the healthcare resources of both developed and developing countries. The aim of this study is to evaluate the financial efficiency and quality of care provided through telemedicine in virtual clinics compared to traditional clinical visits for chronic patients attending Primary Healthcare Centers (PHCs) in Makkah, Saudi Arabia. This research is using an analytical cross-sectional study design, and it included all adults registered in the HIS for 2023 with DM or HTN. The researcher compared in-person and virtual visit costs and some of the health outcomes. The study included 106,828 participants, with 392,441 visits to Primary Health Centers. The distribution was 52.12% male and 47.88% female, with 53.89% having DM and 46.11% HTN. Education level significantly influences visit preferences (p = 0.003), with higher educated participans evenly splitting between in-person and virtual visits, while those with no literacy favored in-person visits. Significant cost differences were observed between in-person and virtual visits (p &lt; .001), with in-person visits incurring higher lab test counts and costs. In conclusion, our findings show that virtual visits and telehealth services have lower costs compared to the in-person consultations, with almost identical health outcomes for both groups. Which indicates that the virtual and in-person consultations have comparable quality.

Better Care, Same Cost - Reducing Unplanned Care for Multi-visit Patients: A Payer-Provider Model.

Many interventions implemented for multi-visit patients (MVP) have been developed to address patient-centric needs of these individuals and reduce unplanned care for ambulatory-sensitive conditions. More rigorous research is needed to better understand the impact of these interventions on changes in care utilization including unplanned care. To evaluate the impact of the Enhanced Care Program (ECP), a payer-provider collaborative model, on unplanned care use and cost of care. Using propensity methods, a comparison group was constructed using insurer membership files. Comparisons were performed using a difference-in-differences analysis. Patients enrolled in ECP through December 2019 were considered eligible for the study (n = 357). All patients had five or more ED visits in the past year or two or more inpatient hospitalizations in the past year prior to enrollment. ECP is a high-intensity outpatient intervention intended to reduce avoidable unplanned care such as ED visits and inpatient hospital stays through home visits, chronic/acute disease management, and intensive care coordination. The primary outcomes of interest were events per 100 members per year of ED use with return to home, unplanned inpatient and observational status admissions, and unplanned behavioral health inpatient admission, and cost of care per member per month. Overall total unplanned care encounters were significantly reduced with a difference-in-difference of 320 unplanned care encounters per 100 members per year in the intervention group (p < 0.05). The ECP group showed statistically significant decreases in costs of unplanned ED, unplanned observation admission, and unplanned inpatient behavioral medicine costs, but statistically significant increases in overall pharmacy costs and lab costs. Changes in total costs of care for the ECP group were not statistically different than the control group (p = 0.55). ECP showed significant reduction of unplanned care for MVP patients.

Value for money of medicine sampling and quality testing: evidence from Indonesia

BackgroundSubstandard and falsified medicines (SFMs) are a public health concern of global importance. Postmarket surveillance in the form of medicine sampling and quality testing can prevent and detect SFM, however,...

COST OF ILLNESS ANALYSIS OF EPILEPSY OUTPATIENTS USING VALPROIC ACID, PHENYTOIN AND CARBAMAZEPINE THERAPY IN HOSPITAL IN INDONESIA

Epilepsy is a condition of the onset of attacks in the form of abnormal, irregular brain nerve cell movements, occurring repeatedly and causing temporary motor, sensory or mental function disorders. The treatment of epilepsy has costs that must be known, including direct medical costs, indirect medical costs, and indirect costs; this study aims to determine the cost of illness of epilepsy in one hospital in banyuasin regency with retrospective costing in outpatients. The research method used in this study is a cross-sectional study using patient medical record data and cost data taken from BPJS claims data and hospital rate patterns. This study uses the BPJS perspective and societal perspective, the cost data taken from the BPJS perspective is the result of BPJS claims according to the INACBGs. Package tariff and for the socital perspective the data taken is doctor consultation data, administrative costs, laboratory costs, drug costs and transportation costs and lost productivity costs carried out by interview method for 12 months. The results of this study indicate that the cost of epilepsy outpatients from a societal perspective is Rp.3,141,414 and for BPJS perspective is Rp.2,338,567.

Optimizing Gaussian process regression (GPR) hyperparameters with three metaheuristic algorithms for viscosity prediction of suspensions containing microencapsulated PCMs

Suspensions containing microencapsulated phase change materials (MPCMs) play a crucial role in thermal energy storage (TES) systems and have applications in building materials, textiles, and cooling systems. This study focuses on accurately predicting the dynamic viscosity, a critical thermophysical property, of suspensions containing MPCMs and MXene particles using Gaussian process regression (GPR). Twelve hyperparameters (HPs) of GPR are analyzed separately and classified into three groups based on their importance. Three metaheuristic algorithms, namely genetic algorithm (GA), particle swarm optimization (PSO), and marine predators algorithm (MPA), are employed to optimize HPs. Optimizing the four most significant hyperparameters (covariance function, basis function, standardization, and sigma) within the first group using any of the three metaheuristic algorithms resulted in excellent outcomes. All algorithms achieved a reasonable R-value (0.9983), demonstrating their effectiveness in this context. The second group explored the impact of including additional, moderate-significant HPs, such as the fit method, predict method and optimizer. While the resulting models showed some improvement over the first group, the PSO-based model within this group exhibited the most noteworthy enhancement, achieving a higher R-value (0.99834). Finally, the third group was analyzed to examine the potential interactions between all twelve HPs. This comprehensive approach, employing the GA, yielded an optimized GPR model with the highest level of target compliance, reflected by an impressive R-value of 0.999224. The developed models are a cost-effective and efficient solution to reduce laboratory costs for various systems, from TES to thermal management.

BCLH2Pro: A novel computational tools approach for hydrogen production prediction via machine learning in biomass chemical looping processes

This study optimizes biomass chemical looping processes (BCLpro), a technique for converting biomass to energy, through machine learning (ML) for sustainable energy production. The study proposes an integrated Fe2O3-based ฺBCLpro combining steam gasification for H2 production. Aspen Plus is used as the primary tool to generate extensive datasets covering 24 biomass types with 18 feature inputs in a supervised model. A methodology involving K-Nearest Neighbors (KNN), Extreme Gradient Boosting (XGB), Light Gradient Boosting Machine (LGBM), Support Vector Machine (SVM), Random Forest (RF), and CatBoost (CB) algorithms was employed to predict H2 yields in the BCLpro, utilizing 10-fold cross-validation for robust model evaluation. Findings highlight the CB algorithm's superior performance, achieving up to 98% predictive accuracy, with carbon content, reducer temperature, and Fe2O3/Al2O3 mass ratio identified as crucial features. The algorithm has been developed into a user-friendly tool, BCLH2Pro, accessible via a web server. This tool is designed to assist in reducing costs, optimizing biomass selection, and planning operational conditions to maximize H2 yield in BCLpro systems. Access to the tool can be obtained through the following link: http://bclh2pro.pythonanywhere.com/.

Approaches to determining the cost of laboratory tests

Background. Determining the cost of laboratory tests is a significant factor in the context of economic analysis and management of clinical diagnostic laboratories. Information about costs allows medical organizations to plan operational activities more efficiently, optimize resource utilization, and exercise control over expenditures. These measures are aimed at improving the financial position and enhancing the operational efficiency of the laboratories.Objective: to review various methods for calculating the cost of laboratory tests.Material and methods. The study included the collection and analysis of publications on calculating cost of laboratory tests, determining their prime cost in PubMed/MEDLINE and Google Scholar databases, as well as in Google and Yandex search engines for similar “cost laboratory test” query. The regulatory documents of the Russian Federation in this area were considered.Results. For calculating the prime cost of laboratory tests such methods as direct costing, regulatory prime costing, total prime costing, activity-based costing (ABC), standard costing, costing for base service, department costing, cost-volume analysis are used. The ABC and standard cost methods provide the most accurate assessment of the impact of various factors.Conclusion. The approaches established by regulatory documents do not contradict each other and represent the implementation of total costing method. At the same time, a medical organization may use other methods for calculating the cost of laboratory tests, depending on the objectives of the analysis, the specifics of the laboratory and the cost accounting method adopted in accounting policy, the management accounting system.

Survey of screw-retained versus cement-retained implant restorations used in both education and private dental practices.

In the literature, it is still unclear if the decisions for selecting the type of implant crown-retaining system are based on scientific-based research or if the Universities' choices, Implant marketing trends, or finances could have a major influence on the private dentists' decisions. Therefore, this study aimed to evaluate the crown-retaining system (cement- or screw-retained) used in dental schools and private dental practices. A 13-item questionnaire was sent to Canadian dental schools (n=10) and dental offices in London (n=298), Canada. The questionnaire included demographic questions and questions to reveal the dentists' perspectives on prosthetic implant treatment between the two-retaining systems. Results were analyzed using descriptive statistics and multinomial logistic regression (p=0.05). Twenty-four private dentists and five dental schools responded to the survey - 62.5% of private practitioners and 60% of universities reported using both systems. A trend was observed in using screw-retained systems by dentists who graduated 5-10 years ago. Straumann, Astra, and Nobel Biocare were the private practices and dental schools' preferred implant systems. The use of platform switching for all cases was selected by 54.2% of the private practitioners and 40% of the dental schools. Resin cement was the private practice's preferred cementation method; the dental schools used glass ionomer and zinc phosphate cement. The multinomial logistic regressions showed no statistical difference between the crown-retaining system chosen and the decision factors. The laboratory technician's recommendations and cost influenced the decision-making process for private dentists. For the universities, perio-restorative outcome, implant position, survival rates, institute preferences, and evidence-based research influenced the crown-retaining system's decision-making process. CONCLUSION: The Canadian dental schools and private practice reported using both screw- and cement-retaining systems. However, there was a difference in the selection criteria as the universities showed a tendency towards a more research-based approach in their decision, while for the private practices, the technicians' recommendations and cost played a major role in the decision process. It was noted that the implant systems preconized by the Universities were observed to be used in private practices.

A Comparative Study to assess the Treatment Cost of Ayurvedic Medicine (Ginger and Castor Oil) and Modern Medicine (DMARDs) in Amavata (Rheumatoid Arthritis)

Ama and Vata are the initial elements in the pathophysiology of Tridosha, whereas Amavata is a result of their vitiation. The expense of treatment is a major factor in the economic burden of RA for both the patient and the health and social care systems. Objective: a. To assess the socio-demographic conditions of the patients of Amavata. b. To compare the cost of a one-month treatment of ginger and castor oil with DMARD in the management of Amavata. Methodology: Total 72 patients of RA Fulfilling the inclusion criteria and having symptoms of RA were enrolled for this Interventional study. Patients were treated in two different groups- Group A- 36 clinically diagnosed and registered patients of Amavata were treated by DMARD Group B- 36 clinically diagnosed and registered patients of Amavata were treated with ginger and castor oil. After the completion of the study, total 62 patients came after one month of treatment, so we included 62 patients in this study. 32 patients in group A and 30 patients in group B Results: The average direct cost of treatment of RA patients in 2024 was estimated as Rs. 2669.17 ($31.96)/month in group A (DMARD Group) and Rs. 1386.69 ($16.62) in group B (Ginger and Castor oil). Major part of total direct costs was covered by medicines (Rs. 1583) in group A and Laboratory cost (Rs. 600) in group B. The ratio of one-month cost of DMARD and Ayurvedic medicine (ginger and castor oil) was 12:1. Discussion: The cost of Ayurvedic medicine was very low in comparison to DMARD. Ayurvedic Medicine ginger and castor oil were easily available, safe, effective and cheap.

Comparative Cost Analysis of Hypercholesterolemia Treatment: Allopathic Medicine and Ayurveda Medicine

The cost of treatment is very high for CVD and the prevalence of hypercholesterolemia is also very high in developing countries. Many Indian people do not have basic amenities and medical facilities are also not accessible. So alternative medicine can play an important role in the treatment of high cholesterol. Arjuna and Kutki are effective medicines in treating high cholesterol. Methodology: Comparative cross sectional study was planned to determine the socio-economic, and demographic status and comparison of treatment costs of high cholesterol patients in SS Hospital, IMS, BHU, Varanasi. Result: The overall expenditure for Group B is significantly high (3670.06) compared to Group A (1341.10). Medicine costs form the largest portion of expenses in Group B (1:4.8), while laboratory costs are the largest in Group A. Discussion: The economic burden poses a significant challenge in the treatment of any illness. Elevated cholesterol levels pose a significant problem in the current state of affairs in India. Developing countries face significant challenges in managing their financial issues.