Long-term Costs Research Articles

Cost-Effectiveness and Clinical Outcomes of Secondary Hyperparathyroidism Treatments in Patients with Chronic Kidney Disease.

The study addresses the challenge of treating secondary hyperparathyroidism (SHPT) in chronic kidney disease (CKD) patients, focusing on the cost-effectiveness of surgical versus pharmacological interventions. Conducting a retrospective analysis on 152 CKD patients with SHPT at the Third People's Hospital of Chengdu, the study matched 80 patients into two groups: 40 undergoing parathyroidectomy with autotransplantation (PTX + AT) and 40 treated with calcimimetics. PTX + AT was more effective in alleviating symptoms, particularly bodily pain, and demonstrated greater cost-effectiveness over a long-term period compared to calcimimetics. This was especially significant in patients with PTH levels > 1800 pg/mL and hyperphosphatemia. Despite similar initial costs, PTX + AT led to a substantial decrease in expenses during the 2-5 years post-treatment period, PTX + AT results in an ICER of -RMB 26.71/QALY for the first post-treatment year and -RMB-111.9k/QALY for the 2-5 year period, indicating cost-effectiveness with reduced long-term costs. The study also found an increased economic burden in managing patients with hyperphosphatemia. Surgical intervention (PTX + AT) is advocated as the primary treatment strategy for severe SHPT in CKD patients, owing to its long-term economic and clinical advantages. The results underscore the need for a severity-based approach in treating SHPT.

A cost and demand sensitive adjustment algorithm for service function chain in data center network

The introduction of Network Function Virtualization (NFV) and Software-Defined Network (SDN) architectures has significantly reduced the Operational Expenditure (OPEX) and Capital Expenditure (CAPEX) of network system. However, NFV orchestration management also brings about challenges. After the initial deployment of VNFs, due to the volatility of network requests, the original deployment may not be able to meet user resource demands. The key issue is how to readjust resources dynamically to accommodate more network requests without violating Quality of Service (QoS) for users. Several existing techniques can be used to achieve this goal, such as horizontal scaling, vertical scaling, and virtual network function (VNF) migration. However, these techniques inevitably incur some overhead, such as the cost of instantiating VNF and link rerouting. Additionally, resource adjustment may also result in unbalanced distribution of network resources. In this paper, an Intelligent Service Function Chain Dynamic Adjustment Algorithm (ISFCDAA) is proposed to address the above challenges. Firstly, an Integer Linear Programming (ILP) model is established with the objective of minimizing the long-term adjustment cost and reducing the imbalance of resource distribution. Then we transform the optimization process into a Markov Decision Process (MDP). Secondly, to solve the problems that the state and action space is too large and the state transition probability is uncertain in MDP, a SFC dynamic adjustment algorithm based on deep reinforcement learning is proposed. This algorithm can obtain an approximate optimal adjustment strategy for ILP model. The simulation results show that ISFCDAA can reduce the adjustment overhead and maintain a balanced distribution of network resources while ensuring the QoS. Compared with the existing algorithms, the average standard deviation of resource distribution of ISFCDAA is reduced by up to 9.90%, the average acceptance rate of ISFCDAA is improved by up to 39.57%, and the average long-term profit is improved by up to 42.92%. The incorporation of cost and demand-sensitive considerations into ISFCDAA enhances its responsiveness to fluctuating network demands, solidifying its effectiveness in dynamic resource management scenarios.

Healthcare utilization and costs associated with autologous haematopoietic stem cell transplantation in Norwegian patients with relapsing remitting multiple sclerosis

Multiple sclerosis (MS) patients experience long-term deterioration of neurological function, reduced quality of life, long-lasting treatment cycles, and an increased risk of early workability loss imposing an economic burden to society. Autologous haematopoietic stem cell transplantation (AHSCT) has shown promising treatment effects for relapsing remitting MS (RRMS). This study employs a micro-costing approach to estimate healthcare utilization and costs associated with AHSCT in Norwegian RRMS patients. Patient-level data were extracted from medical journals of 30 RRMS patients receiving AHSCT treatment at Haukeland University Hospital in the period from January 2015 to January 2018. The time horizon for the analysis was from the pretransplant screening until one year after AHSCT. A correlation was found between patient body weight and total healthcare cost. The average total healthcare cost of AHSCT for RRMS patients was estimated to EUR 66 304 (95% CI: EUR 63 598 – EUR 69 010) including costs associated with the pre-AHSCT period, AHSCT treatment phases and one-year follow-up. The majority of the costs, EUR 64 329, occurred during the treatment phase and within the first 100 days after AHSCT. The results indicate that long-term healthcare cost savings may be achieved using AHSCT in selected patients with aggressive RRMS. This is due to the high costs of most used disease modifying treatments. Further research including long-term clinical data is needed to determine the cost-effectiveness of this treatment.

Transient Data Caching Based on Maximum Entropy Actor–Critic in Internet-of-Things Networks

AbstractWith the rapid development of the Internet-of-Things (IoT), a massive amount of transient data is transmitted in edge networks. Transient data are highly time-sensitive, such as monitoring data generated by industrial devices. Due to their inefficiency, traditional caching strategies in edge networks are inadequate for handling transient data. Thus, to improve the efficiency of transient data caching, we construct a freshness model of transient data and propose a maximum entropy Actor–Critic-based caching strategy, TD-MEAC-which can improve the freshness of cached data and reduce the long-term caching cost. Simulation results show that the proposed TD-MEAC achieves a higher cache hit rate and maintains a higher average freshness of cached transient data compared with the existing DRL and baseline caching strategies.

Protocol for a pilot cluster randomised controlled trial of a multicomponent sustainable return to work IGLOo intervention.

Long-term sickness costs businesses in the United Kingdom (UK) approximately £7 billion per annum. Most long-term sickness absences are attributed to common mental health conditions, which are also highly prevalent in people with acute or musculoskeletal health conditions. This study will pilot the IGLOo (Individual, Group, Leaders, Organisation, overarching context) intervention which aims to support workers in returning to and remaining in work following long-term sickness absence. The potential impact of the intervention is a timely return to work (main trial primary outcome) and prevention of a further episode of long-term sick leave. The intervention will be piloted in a randomised controlled trial (RCT) to examine the feasibility of the intervention (pilot trial primary outcome) and to inform a fully powered definitive trial to evaluate sustainable return to work (RTW) in people with primary or secondary mental ill-health who go on long-term sick leave. A two-arm feasibility randomised controlled trial (with a 30-month study period including 12-month follow-up) of the IGLOo intervention will be conducted in large organisations (≥ 600 workers) from the Yorkshire and Humberside regions, in the UK. Eight consenting organisations will be recruited and randomised to the intervention or control arms of the study (1:1 ratio), with a minimum recruitment target of 13 workers eligible to participate from each. Organisations assigned to the control group will continue with their usual practice. Feasibility data will include data collected on recruitment, retention and attrition of participants; completion of research outcome measures; and intervention compliance. Measurements of mental health, RTW, work outcomes, quality-of-life, workplace support and communication and other demographic data will be taken at baseline, 3, 6, 9 and 12 months in all participants. Qualitative interviews and survey data with all participants will explore the experiences of participants, acceptability of the intervention components and evaluation measures. Exploratory economic evaluation will be conducted to further inform a definitive trial. The findings from this pilot study will help to inform the development of a definitive cluster RCT designed to examine the efficacy of this intervention on health and work-related outcomes in UK workers on long-term sick leave. ISRCTN11788559 (prospectively registered, date registered 6 October 2022).

Cost-Effectiveness of CT, CTA, MRI, and Specialized MRI for Evaluation of Patients Presenting to the Emergency Department With Dizziness.

BACKGROUND. Underlying stroke is often misdiagnosed in patients presenting with dizziness. Although such patients are usually ineligible for acute stroke treatment, accurate diagnosis may still improve outcomes through selection of patients for secondary prevention measures. OBJECTIVE. The purpose of our study was to investigate the cost-effectiveness of differing neuroimaging approaches in the evaluation of patients presenting to the emergency department (ED) with dizziness who are not candidates for acute intervention. METHODS. A Markov decision-analytic model was constructed from a health care system perspective for the evaluation of a patient presenting to the ED with dizziness. Four diagnostic strategies were compared: noncontrast head CT, head and neck CTA, conventional brain MRI, and specialized brain MRI (including multiplanar high-resolution DWI). Differing long-term costs and outcomes related to stroke detection and secondary prevention measures were compared. Cost-effectiveness was calculated in terms of lifetime expenditures in 2022 U.S. dollars for each quality-adjusted life year (QALY); deterministic and probabilistic sensitivity analyses were performed. RESULTS. Specialized MRI resulted in the highest QALYs and was the most cost-effective strategy with US$13,477 greater cost and 0.48 greater QALYs compared with noncontrast head CT. Conventional MRI had the next-highest health benefit, although was dominated by extension with incremental cost of US$6757 and 0.25 QALY; CTA was also dominated by extension, with incremental cost of US$3952 for 0.13 QALY. Non-contrast CT alone had the lowest utility among the four imaging choices. In the deterministic sensitivity analyses, specialized MRI remained the most cost-effective strategy. Conventional MRI was more cost-effective than CTA across a wide range of model parameters, with incremental cost-effectiveness remaining less than US$30,000/QALY. Probabilistic sensitivity analysis yielded similar results as found in the base-case analysis, with specialized MRI being more cost-effective than conventional MRI, which in turn was more cost-effective than CTA. CONCLUSION. The use of MRI in patients presenting to the ED with dizziness improves stroke detection and selection for subsequent preventive measures. MRI-based evaluation leads to lower long-term costs and higher cumulative QALYs. CLINICAL IMPACT. MRI, incorporating specialized protocols when available, is the preferred approach for evaluation of patients presenting to the ED with dizziness, to establish a stroke diagnosis and to select patients for secondary prevention measures.

Abstract 4: Unveiling the Economic Burden of Stroke in the European Union: Comparisons With the USA

Introduction: Stroke places a significant economic impact on health and social care systems, as well as indirect costs through premature retirement, and absenteeism, reducing productivity and economic output, and necessitating care for patients from friends and family. This study aims to provide novel and up- to-date evidence on the economic burden of stroke across 27 EU countries allowing to draw comparisons with the USA. Methods: Stroke-related costs were estimated for 27 EU countries in 2021. Country-specific resource use was estimated using aggregate data on morbidity, mortality, health, social and informal care, apportioned to stroke using patient-level data based on responses from 140,000 participants. Resource use was valued using country-specific unit costs. To allow for meaningful comparisons with the 2018 American Heart Association (AHA) estimates of stroke costs in the USA, costs are reported in US $ adjusted for price differentials and inflation. Results: In 2021, excluding long-term care costs as not included in AHA estimates, stroke cost the EU health care systems $39 billion (2% of health expenditure). Within this total, there was wide variation in per-capita healthcare costs (ranging from $30 in Malta to $177 in Austria), with that for the EU being $87. In the USA, comparable stroke-related healthcare costs accounted for 2% ($35 billion) of US health expenditure, and $108 per capita (comparable to Belgium - $103). In the EU-27, productivity losses due to early mortality were estimated at $8 billion ($19 per capita), compared to $21 billion in the USA ($65 per capita). Long-term nursing home care costs were є21 billion in the EU-27, driving the proportion of total healthcare expenditure due to stroke to 3%. Unpaid care for stroke patients accounted for $38 billion in the EU-27, with absence from work costing the EU economy an additional $4 billion. The total costs of stroke for the EU-27 were $110 billion. Conclusions: This study provides contemporary estimates of the wide-ranging impact of stroke on all aspects of 27 European countries’ economies, allowing for meaningful comparisons with the USA. The data help inform evidence based polices to reduce the impact of stroke, promoting care access and better health outcomes and economic sustainability.

Long-term cost planning of data-driven wind-storage hybrid systems

—To address the long-term cost planning problem accurately, typically a significant number of formulas are required. However, this increases computational complexity and limits the generalizability of the approach to practical problems. To overcome these challenges, this study adopts a data-driven approach that considers uncertainties to evaluate the long-term cost planning problem accurately for wind power generation with hybrid energy storage. A method for predicting wind power output is proposed using temporal convolutional networks to handle long-term uncertainties. Additionally, an instantaneous phase-synchronous wind power output feature extraction method based on Hilbert transform theory is introduced to capture time-series fluctuation characteristics and address short-term uncertainties. Furthermore, the long-term operational costs and planning of high-percentage new energy wind farms with hybrid energy storage are discussed by combining the wind power output characteristics with the operating characteristics and lifespan of hybrid energy storage devices. The experimental results demonstrate the significant advantages of the deep learning probabilistic prediction model combined with wind power feature extraction. The algorithm validates the effectiveness of considering multiple uncertainties in the planning of microgrids with hybrid energy storage, particularly in considering the uncertainty of the decreasing trend in the investment cost of battery energy storage.

Validation of preparedness and willingness on early detection of autism spectrum disorder among healthcare providers in Jordan

In recent years, there have been significant advancements in the field of early detection and intervention for children with developmental and behavioural disorders, with significant in the context of Autism Spectrum Disorder (ASD). It highlights the advantages of early detection, such as reduced long-term costs and positive effects on a child's development. However, it also acknowledges the prevalent barriers to early ASD diagnosis and intervention. This study aims to develop and validate questionnaires on Preparedness and Willingness in early ASD detection among Al-Mafraq City, Jordan, healthcare providers. The research in the Al-Mafraq region of Jordan employed a cross-sectional research design. The study first involved the development of a questionnaire, which underwent rigorous content validation by a panel of experts well-versed in ASD. Face validity was assessed utilizing the Face Validity Index (FVI). A random sample of 130 healthcare providers from one hospital answered the draft questionnaires online for the EFA analysis recommended. It resulted in satisfactory items' factor loadings (r>0.60) and internal reliability (Cronbach's alpha >0.8). Followed by CFA from a random sample of another 202 healthcare providers from another hospital and healthcare centres in Al-Mafraq showed that the instrument effectively met the validation criteria, demonstrating its reliability and validity in assessing healthcare providers' Preparedness and Willingness for early ASD detection. Notably, the participants in the study exhibit differing degrees of Preparedness and Willingness. In conclusion, the study underscores the critical standing of developing a comprehensive instrument to evaluate the limitations associated with early ASD detection among healthcare providers.

Renewable Energies in Vocational Training

This paper tries to show how the relationship between energy production, obtained from renewable sources based on low-power generators, and passive house’s design, can be a clue to get low consumption energy buildings. As it is briefly described in this paper, we have applied a Live Cycle Assessment procedure in a vocational training school, and we have detected the main points of energy consumption that can be modified to obtain long-term cost savings. What we have also found is that, after applying the mentioned methodology to this kind of public building, where it is developed an educational activity, the value added of the service given and the image of the educational institution among the community can be improved, according to the three constituent parts that usually define the sustainable development. The main aim of this paper is to offer a simple action protocol to improve the cost of the power invoice, mainly by reducing the environmental impact. Although the initial cost may intimidate the understandings and application of these measures, such an approach will promote the rising awareness in the students and teaching staff, setting environmental friendly practices as everyday routines.

Key considerations for modelling the long-term costs and benefits of treatments for ANCA-associated vasculitis.

Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a group of severe and chronic autoimmune diseases. Patients undergo two treatment phases: inducing remission and maintaining remission to prevent organ damage. Immunosuppressants, including glucocorticoids (GCs) are used as first-line treatment, but long-term GC use is associated with toxic effects. Novel treatments reduce or replace the need for long-term GC, and therefore can reduce GC-related toxicity. The evolving treatment landscape has presented new challenges for health technology assessment (HTA) of new treatments in AAV and long-term modelling of costs and outcomes in this disease. Using the appraisal of avacopan in England (NICE) as a case study, this paper aims to identify the key challenges involved in the economic evaluation of new treatments for AAV, with a particular focus on the long-term modelling of the treatment costs and benefits for the purpose of HTA. The outcome of this study is a set of recommendations for modelling the cost-effectiveness of new treatments for AAV from the HTA perspective. The discussion focuses on the appropriate model structure, approach to modelling end-stage renal disease (ESRD) as a key determinant of costeffectiveness, capturing the impact of GC-related adverse events, and estimation of short and long-term costs of AAV. Economic evaluation of new treatments for AAV needs to capture all relevant downstream effects. ESRD is a key driver of cost-effectiveness but is associated with major uncertainty. Future observational studies need to offer sufficient detail to allow for differentiation in event rates across treatment options.

The economic impact of cannabis use disorder and dementia diagnosis in veterans diagnosed with traumatic brain injury.

Studies have demonstrated that individuals diagnosed with traumatic brain injury (TBI) frequently use medical and recreational cannabis to treat persistent symptoms of TBI, such as chronic pain and sleep disturbances, which can lead to cannabis use disorder (CUD). We aimed to determine the Veterans Health Administration (VHA) healthcare utilization and costs associated with CUD and dementia diagnosis in veterans with TBI. This observational study used administrative datasets from the population of post-9/11 veterans from the Long-term Impact of Military-Relevant Brain Injury Consortium-Chronic Effects of Neurotrauma Consortium and the VA Data Warehouse. We compared the differential VHA costs among the following cohorts of veterans: (1) No dementia diagnosis and No CUD group, (2) Dementia diagnosis only (Dementia only), (3) CUD only, and (4) comorbid dementia diagnosis and CUD (Dementia and CUD). Generalized estimating equations and negative binomial regression models were used to estimate total annual costs (inflation-adjusted) and the incidence rate of healthcare utilization, respectively, by dementia diagnosis and CUD status. Data from 387,770 veterans with TBI (88.4% men; median [interquartile range (IQR)] age at the time of TBI: 30 [14] years; 63.5% white) were followed from 2000 to 2020. Overall, we observed a trend of gradually increasing healthcare costs 5 years after TBI onset. Interestingly, in this cohort of veterans within 5 years of TBI, we observed substantial healthcare costs in the Dementia only group (peak = $46,808) that were not observed in the CUD and dementia group. Relative to those without either condition, the annual total VHA costs were $3,368 higher in the CUD only group, while no significant differences were observed in the Dementia only and Dementia and CUD groups. The findings suggest that those in the Dementia only group might be getting their healthcare needs met more quickly and within 5 years of TBI diagnosis, whereas veterans in the Dementia and CUD group are not receiving early care, resulting in higher long-term healthcare costs. Further investigations should examine what impact the timing of dementia and CUD diagnoses have on specific categories of inpatient and outpatient care in VA and community care facilities.

The costs of chronic pain-Long-term estimates.

Chronic pain is a condition with severe impact on many aspects of life, including work, functional ability and quality of life, thereby reducing physical, mental and social well-being. Despite the high prevalence and burden of chronic pain, it has received disproportionally little attention in research and public policy and the societal costs of chronic pain remain largely unknown. This study aimed to describe the long-term healthcare and work absence costs of individuals with and without self-identified chronic pain. The study population were participants in two Norwegian population health studies (HUNT3 and Tromsø6). Participants were defined as having chronic pain based on a self-reported answer to a question on chronic pain in the health studies in 2008. Individuals in the study population were linked to four national register databases on healthcare resource use and work absence. In our study, 36% (n = 63,782) self-reported to have chronic pain and the average years of age was 56.6. The accumulated difference in costs between those with and without chronic pain from 2010 to 2016 was €55,003 (CI: 54,414-55,592) per individual. Extrapolating this to the entire population suggests that chronic pain imposes a yearly burden of 4% of GDP. Eighty per cent of the costs were estimated to be productivity loss. Insights from this study can provide a greater understanding of the extent of healthcare use and productivity loss by those with chronic pain and serve as an important basis for improvements in rehabilitation and quality of care, and the education of the public on the burden of chronic pain. This was the first study to estimate the economic burden associated with chronic pain in the general population using linked individual-level administrative data and self-reported survey answers. We provide calculations showing that annual costs of chronic pain may be as high as €12 billion or 4% of GDP. Findings from this study highlight the need for a greater understanding of the substantial healthcare use and productivity losses among individuals with chronic pain.

Lifetime prediction and maintenance assessment of Lithium-ion batteries based on combined information of discharge voltage curves and capacity fade

Current two-stage Lithium-ion battery degradation models commonly treat the change point (CP) in two ways. First, it is a random variable, which increases model complexity and the computational cost for predicting the remaining useful life (RUL). Second, it is a deterministic value, which will simplify the degradation models. The value of CP needs to be well identified for an accurate description of the degradation process. However, the capacity data is generally non-monotonic due to energy regeneration, which makes it hard to use in determining the CP. In addition, our laboratory data on the discharge voltage profile shows a potential for CP detection. Thus, we developed a hybrid method that combines dynamic time warping and nonnegative matrix factorization to detect the CPs of battery cells by using voltage discharge profiles. Then, we proposed a two-stage Wiener process incorporating CP detection method to describe the battery capacity degradation pattern. The proposed model is applied to our lab data and NASA data to predict RUL. Finally, maintenance strategies are analyzed to enhance the management of Lithium-ion batteries by minimizing the long-term cost rate under different replacement policies.

Plant Cryopreservation: Principles, Applications, and Challenges of Banking Plant Diversity at Ultralow Temperatures.

Progressive loss of plant diversity requires the protection of wild and agri-/horticultural species. For species whose seeds are extremely short-lived, or rarely or never produce seeds, or whose genetic makeup must be preserved, cryopreservation offers the only possibility for long-term conservation. At temperatures below freezing, most vegetative plant tissues suffer severe damage from ice crystal formation and require protection. In this review, we describe how increasing the concentration of cellular solutes by air drying or adding cryoprotectants, together with rapid cooling, results in a vitrified, highly viscous state in which cells can remain viable and be stored. On this basis, a range of dormant bud-freezing, slow-cooling, and (droplet-)vitrification protocols have been developed, but few are used to cryobank important agricultural/horticultural/timber and threatened species. To improve cryopreservation efficiency, the effects of cryoprotectants and molecular processes need to be understood and the costs for cryobanking reduced. However, overall, the long-term costs of cryopreservation are low, while the benefits are huge.

Commercial provider staff experiences of the NHS low calorie diet programme pilot: a qualitative exploration of key barriers and facilitators

BackgroundThe National Health Service Type 2 Diabetes Path to Remission programme in England (known as the NHS Low Calorie Diet programme when piloted) was established to support people living with excess weight and Type 2 Diabetes to lose weight and improve their glycaemic control. A mixed method evaluation was commissioned to provide an enhanced understanding of the long-term cost effectiveness of the pilot programme, its implementation, equity and transferability across broad and diverse populations. This study provided key insights on implementation and equity from the service providers’ perspective.MethodsThirteen focus groups were conducted with commercial providers of the programme, during the initial pilot rollout. Participants were purposively sampled across all provider organisations and staff roles involved in implementing and delivering the programme. Normalisation Process Theory (NPT) was used to design the topic schedule, with the addition of topics on equity and person-centredness. Data were thematically analysed using NPT constructs with additional inductively created codes. Codes were summarised, and analytical themes generated.ResultsThe programme was found to fulfil the requirements for normalisation from the providers’ perspective. However, barriers were identified in engaging GP practices and receiving sufficient referrals, as well as supporting service users through challenges to remain compliant. There was variation in communication and training between provider sites. Areas for learning and improvement included adapting systems and processes and closing the gap where needs of service users are not fully met.ConclusionsThe evaluation of the pilot programme demonstrated that it was workable when supported by effective primary care engagement, comprehensive training, and effective internal and external communication. However, limitations were identified in relation to programme specifications e.g. eligibility criteria, service specification and local commissioning decisions e.g. pattern of roll out, incentivisation of general practice. A person-centred approach to care is fundamental and should include cultural adaptation(s), and the assessment and signposting to additional support and services where required.

Periodontists and stem cell-based therapy for alveolar bone regeneration: A national survey.

Stem cell-based therapy for bone regeneration has received attention in medical settings but has not yet been used in clinical practice for treating alveolar bone defects. The objectives of this study were to explore whether periodontists had heard about this approach, and if so how, how interested they were to learn about it, which attitudes and behavioral intentions they had related to using stem cell-based grafting, and what they would like to know before using this approach. Anonymous survey data were collected from 481 members of the American Academy of Periodontology (response rate: 19.41%). Responses showed 35.3% had heard about stem cell-based therapy, mostly from publications (9.6%) and meetings (8.3%); 76.1% wanted to learn about it through in-person continuing education (CE) courses, 68.6% in online CE courses, and 57.1% from manuals; 73% considered this approach promising; and 54.9% preferred it to traditional approaches. It was important to them that it would result in more bone volume (93%), better bone quality (90.4%), and accelerated healing (83.2%). Also, 60.1% considered it likely/very likely that they would adopt this approach, 54% that patients would prefer it, and 62.1% that it would benefit their practice. When asked what they would like to know about this approach, information about short- and long-term outcomes, cost, and logistical considerations were most frequently named. These findings provide the basis to develop educational interventions for periodontists about this novel approach and inform future research activities aimed to translate this approach to clinical practice.

Real-time energy management strategy for flexible traction power supply system

Energy management strategies (EMS) for the flexible traction power supply system (FTPSS) typically depend on the accurate predictive model or probabilistic estimation of traction load and renewable energy generation. However, it can be challenging due to the ultra-short-term dramatic fluctuation in traction load profile. To address the issue, a model-free EMS is proposed to achieve the power dispatch in real time based on the current state. Firstly, a sequential stochastic optimization model is built to optimize the long-term operating cost and load fluctuation. Through the relaxation of time-coupling constraints and incorporation of the Lyapunov optimization technique, the problem is decomposed into individual optimization problems at each time slot. Considering the complementary characteristic of hybrid energy storage system, a bi-level optimization framework is constructed to separately control powers of the supercapacitor and battery with the hierarchical sequence method. More importantly, a fully informative control strategy with the known future load profile and renewable energy generation is adopted as the evaluation benchmark. The gap between the proposed method and the benchmark can be demonstrated to fall within a certain range of below 10% by mathematical derivation and extensive cases.

Complex Metal Oxides as Emerging Inorganic Hole-Transporting Materials for Perovskite Solar Cells.

Perovskite solar cells (PSCs) have achieved revolutionary progress during the past decades with a rapidly boosting rate in power conversion efficiencies from 3.8% to 26.1%. However, high-efficiency PSCs with organic hole-transporting materials (HTMs) suffer from inferior long-term stability and high costs. The replacement of organic HTMs with inorganic counterparts such as metal oxides can solve the above-mentioned problems to realize highly robust and cost-effective PSCs. Nevertheless, the widely used simple metal oxide-based HTMs are limited by the low conductivity and poor light transmittance due to the fixed atomic environment. As an emerging family of inorganic HTMs, complex metal oxides with superior structural/compositional flexibility have attracted rapidly increasing interest recently, showing superior carrier conductivity/mobility and superb light transmittance. Herein, the recent advancements in the design and development of complex metal oxide-based HTMs for high-performance PSCs are summarized by emphasizing the superiority of complex metal oxides as HTMs over simple metal oxide-based counterparts. Consequently, several distinct strategies for the design of complex metal oxide-based HTMs are proposed. Last, the future directions and remaining challenges of inorganic complex metal oxide-based HTMs for PSCs are also presented. This review aims to provide valuable guidelines for the further advancements of robust, high-efficiency, and low-cost PSCs.

Cost Effectiveness of Zanubrutinib Versus Ibrutinib in Relapsed or Refractory Chronic Lymphocytic Leukemia.

While the efficacy and safety of zanubrutinib have been established in relapsed or refractory chronic lymphocytic leukemia, the evidence on cost effectiveness is still lacking. We aimed to evaluate the cost effectiveness of zanubrutinib versus ibrutinib in relapsed or refractory chronic lymphocytic leukemia from the commercial payer perspective in the USA. A partitioned survival model was developed based on survival curves from the phase III ALPINE trial. We reconstructed patient-level data for each curve and conducted a parametric estimation to incorporate long-term clinical outcomes and treatment costs into the model. Medical costs and utilities were obtained from public data and previous cost-effectiveness studies. A discount rate of 3.0% per annum was applied and costs were adjusted to 2023 US dollars. The incremental cost-effectiveness ratio was calculated by dividing the incremental costs of zanubrutinib over ibrutinib by the incremental life-years or quality-adjusted life-years. Deterministic and probabilistic sensitivity analyses were performed to examine the robustness of the results. Over a 10-year analysis period, the incremental cost-effectiveness ratio of zanubrutinib versus ibrutinib was $91,260perlife-year gainedand $120,634perquality-adjusted life-yeargained, making it cost effective within a threshold of $150,000perquality-adjusted life-yeargained. The incremental cost-effectiveness ratio was most sensitive to drug acquisition costs and progression-free survival distributions, and the probability of zanubrutinib being cost effective was approximately 52.8%, with a 30.0% likelihood of dominance. Zanubrutinib is likely to be cost effective versus ibrutinib in relapsed or refractory chronic lymphocytic leukemia in the USA, but the high threshold should be noted. Our findings may provide a basis for pricing strategy and reimbursement decisions for zanubrutinib.