Major Cost Research Articles

The Financial Burden of Aspirin versus Oral Factor Xa Inhibitors for Thromboprophylaxis Following Total Knee Arthroplasty

BackgroundAspirin and oral factor Xa inhibitor thromboprophylaxis regimens are associated with similarly low rates of venous thromboembolism following total knee arthroplasty (TKA). However, the rate of prosthetic joint infection (PJI) is lower with aspirin use. This study aimed to compare the cost differential between aspirin and factor Xa inhibitor thromboprophylaxis with respect to PJI management. MethodsWe used previously published rates of PJI following aspirin and factor Xa inhibitor thromboprophylaxis in primary TKA patients at a single, large institution. Prices for individual drugs were obtained from our hospital’s pharmacy service. The cost of PJI included that of 2-stage septic revision, with or without the cost of 1-year follow-up. National data were obtained to determine annual projected TKA volume. ResultsThe per-patient costs associated with a 28-day course of aspirin versus factor Xa inhibitor thromboprophylaxis were $17.36 and $3,784.20, respectively. Including cost of follow-up, per-patient costs for a 28-day course of aspirin versus factor Xa inhibitors increased to $73,358.76 and $77,125.60, respectively. The weighted average per-patient costs for a 28-day course were $237.38 and $4,370.93, respectively. The annual cost difference could amount to over $14.1 billion in the United States by 2040. ConclusionsThe per-patient cost associated with factor Xa inhibitor thromboprophylaxis is as much as 1,980.6% higher than that of an aspirin regimen due to increased costs of primary treatment, differential PJI rates, and high costs of management. In an era of value-based care, the use of aspirin is associated with major cost advantages.

Cost of illness due to pertussis in adults ≥50 years of age in the United Kingdom

BackgroundPertussis is an endemic respiratory tract infection caused by Bordetella pertussis that may affect all individuals from infants to older adults. Pertussis incidence in adults is often underreported and in various countries, including the United Kingdom (UK), there are evidence gaps on pertussis-associated economic burden in the older adult population. We aimed to quantify the economic burden of pertussis in adults aged ≥50 years in the UK. MethodsA cost-of-illness study was conducted to estimate the cost of pertussis from a societal perspective. We utilized a sum diagnosis cost approach in which costs related to infection with pertussis were included. Medical, patient, and indirect costs were calculated individually and combined to calculate total costs. A framework was developed to assess costs for consecutive age groups from 50–54 years of age to ≥85 years of age. Sensitivity and scenario analyses were used to assess analysis uncertainty. ResultsThe base-case analysis estimated the total annual economic burden of pertussis to be approximately £238 million (M). This comprised approximately £159 M in indirect costs, £66 M in medical costs, and £13 M in patient costs. Costs for the age group 55–59 years had the highest impact on the economic burden, with approximately £79 M in total annual costs. Visits to general practitioners and nurses were the largest contributors to medical costs (∼£37 M) followed by inpatient visits (∼£21 M). Transportation costs (∼£10 M) were the major patient costs. Productivity loss (∼£71 M) and leisure time loss (∼£72 M) had comparable contributions to annual indirect costs. Sensitivity and scenario analyses suggested that incidence rates, indirect costs, and underreporting estimates had the highest impact on outcomes. ConclusionTotal cost of pertussis in the UK among adults ≥50 years of age is substantial and highest for adults 55–59 years of age. Indirect costs were the main contributors to the economic burden.

Innovative parallel synthesis of 5-nonanone and furfural from lignocellulosic biomass accompanied by deep economic analysis

An integrated strategy is developed to utilize all three primary components (cellulose, hemicellulose, and lignin) of lignocellulosic biomass for the coproduction of hydrocarbon fuel (5-nonanone) and bio-chemicals (furfural and high purity lignin). After biomass fractionation, (1) 5-nonanone is produced with high yield of 89% using cellulose-derived γ-valerolactone (GVL), which can potentially serve as a platform molecule for the production of liquid hydrocarbon fuels for the transportation sector; (2) furfural, a valuable platform chemical, is produced using hemicellulose; and (3) production of high-purity lignin, which can be used to produce carbon foams or battery anodes. Separation subsystems are designed to effectively recover the solvents for reuse in the conversion processes, which ultimately improves the economic feasibility of the integrated process, resulting in achieving lower minimum selling price (MSP) of $5.47 GGE-1 for 5-nonanone compared to market price. Heat pump is introduced to perform heat integration, which reduces utility requirements more than 85%. Finally, a wide range of techno-economic analysis is performed to highlight the major cost and technological drivers of the integrated process.

Broad-Spectrum Foraging, Trade, and Lithic Technology: A First Approach to the Slab Stone Tools from Prehispanic Sierras of Córdoba, Argentina

ABSTRACT The article presents the study of the slab stone tools collected at the San Roque locality (Sierras of Córdoba, Argentina), a poorly known tool type that merits more detailed studies. . The assemblage was also analyzed from a technological-functional point of view, but the source of raw materials was also investigated to infer the range of past mobility and/or the size of trade networks. The major cost of tools was represented by the systematic acquisition of the raw material from the quarries located 25–200 km rather than by manufacturing. Technological attributes and use-wear on active edges suggest that they were broad-functional tools linked to the need for a broad-spectrum adaptative strategy that required diverse tools for processing a wide variety of foodstuff and their by-products. The landfall of crop plant cultivation ca. 1200 years BP, probably increased the need for this tool type, reinforcing pre-existent trade networks for raw material acquisition. .

Economic burden of atherosclerotic cardiovascular disease: a matched case–control study in more than 450,000 Swedish individuals

AimTo examine direct and indirect costs, early retirement, cardiovascular events and mortality over 5 years in people with atherosclerotic cardiovascular disease (ASCVD) and matched controls in Sweden.MethodsIndividuals aged ≥ 16 years living in Sweden on 01 January 2012 were identified in an existing database. Individuals with ASCVD were propensity score matched to controls without ASCVD by age, sex and educational status. We compared direct healthcare costs (inpatient, outpatient and drug costs), indirect costs (resulting from work absence) and the risk of stroke, myocardial infarction (MI) and early retirement.ResultsAfter matching, there were 231,417 individuals in each cohort. Total mean per-person annual costs were over 2.5 times higher in the ASCVD group versus the controls (€6923 vs €2699). Indirect costs contributed to 60% and 67% of annual costs in the ASCVD and control groups, respectively. Inpatient costs accounted for ≥ 70% of direct healthcare costs. Cumulative total costs over the 5-year period were €32,011 in the ASCVD group and €12,931 in the controls. People with ASCVD were 3 times more likely to enter early retirement than controls (hazard ratio [HR] 3.02 [95% CI 2.76–3.31]) and approximately 2 times more likely to experience stroke (HR 1.83 [1.77–1.89]) or MI (HR 2.27 [2.20–2.34]).ConclusionASCVD is associated with both economic and clinical impacts. People with ASCVD incurred considerably higher costs than matched controls, with indirect costs resulting from work absence and inpatient admissions being major cost drivers, and were also more likely to experience additional ASCVD events.

Results from the BETTER WISE trial: a pragmatic cluster two arm parallel randomized controlled trial for primary prevention and screening in primary care during the COVID-19 pandemic

BackgroundCancer and chronic diseases are a major cost to the healthcare system and multidisciplinary models with access to prevention and screening resources have demonstrated improvements in chronic disease management and prevention. Research demonstrated that a trained Prevention Practitioner (PP) in multidisciplinary team settings can improve achievement of patient level prevention and screening actions seven months after the intervention.MethodsWe tested the effectiveness of the PP intervention in a pragmatic two-arm cluster randomized controlled trial. Patients aged 40–65 were randomized at the physician level to an intervention group or to a wait-list control group. The intervention consisted of a patient visit with a PP. The PP received training in prevention and screening and use of the BETTER WISE tool kit. The effectiveness of the intervention was assessed using a composite outcome of the proportion of the eligible prevention and screening actions achieved between intervention and control groups at 12-months. ResultsFifty-nine physicians were recruited in Alberta, Ontario, and Newfoundland and Labrador. Of the 1,005 patients enrolled, 733 (72.9%) completed the 12-month analysis. The COVID-19 pandemic occurred during the study time frame at which time nonessential prevention and screening services were not available and in-person visits with the PP were not allowed. Many patients and sites did not receive the intervention as planned.The mean composite score was not significantly higher in patients receiving the PP intervention as compared to the control group. To understand the impact of COVID on the project, we also considered a subset of patients who had received the intervention and who attended the 12-month follow-up visit before COVID-19. This assessment demonstrated the effectiveness of the BETTER visits, similar to the findings in previous BETTER studies. ConclusionsWe did not observe an improvement in cancer and chronic disease prevention and screening (CCDPS) outcomes at 12 months after a BETTER WISE prevention visit: due to the COVID-19 pandemic, the study was not implemented as planned. Though benefits were described in those who received the intervention before COVID-19, the sample size was too small to make conclusions. This study may be a harbinger of a substantial decrease and delay in CCDPS activities under COVID restrictions. Trial registrationISRCTN21333761. Registered on 19/12/2016. http://www.isrctn.com/ISRCTN21333761.

Extended duration of treatment using reduced-frequency dosing of anti-PD-1 therapy in patients with advanced melanoma and Merkel cell carcinoma.

Optimal duration of treatment (DoT) with immune checkpoint inhibitors (ICI) in metastatic cancers remains unclear. Many patients, especially those without radiologic complete remission, develop progressive disease after ICI discontinuation. Extending DoT with ICI may potentially improve efficacy outcomes but presents major logistical and cost challenges with standard frequency dosing (SFD). Receptor occupancy data supports reduced frequency dosing (RFD) of anti-PD-1 antibodies, which may represent a more practical and economically viable option to extend DoT. We conducted a retrospective study of patients with metastatic melanoma and Merkel cell carcinoma (MCC), who received ICI at RFD administered every 3months, after initial disease control at SFD. We evaluated efficacy, safety, and cost-savings of the RFD approach in this cohort. Between 2014 and 2021, 23 patients with advanced melanoma (N = 18) or MCC (N = 5) received anti-PD-1 therapy at RFD. Median DoT was 1.1years at SFD and 1.2years at RFD. The 3year PFS after start of RFD was 73% in melanoma and 100% in MCC patients, which compare favorably to historical control rates. In the subset of 15 patients who received at least 2years of therapy, total savings amounted to $1.1 million in drug costs and 384h saved despite the extended DoT (median 3.4years), as compared to the calculated cost of 2years at SFD. ICI administration at RFD can allow extension of treatment duration, while preserving efficacy and reducing logistical and financial burden. RFD approach deserves further exploration in prospective clinical trials.

Physics-Based Swab and Surge Simulations and the Machine Learning Modeling of Field Telemetry Swab Datasets

Drilling operations are the major cost factor for the oil industry. Appropriately designed operations are essential for successful drilling. Optimized drilling operations also enhance drilling performance and reduce drilling costs. This is achieved by increasing the bit life (minimizing premature bit wear), drilling more quickly, which reduces drilling time, and also reducing tripping operations. This paper is presented in two parts. The first part compares the parametric physics-based swab and surge simulation results obtained from the Bingham plastic, power law, and Robertson–Stiff models. The aim is to show how the model’s predictions deviate from each other. Two 80:20 oil/water ratio (OWR) oil-based drilling fluids and two 90:10 OWR oil-based drilling fluids, 1.96 sg and 2.0 sg, were considered in vertical and deviated wells. Analysis of the simulation results revealed that the deviations depend on the drilling fluid’s physical and rheological parameters as well as the well trajectory. Moreover, the model’s predictions were inconsistent. Data-driven machine learning (ML) modeling is the focus of the second section. Data-driven modeling was performed using both software-generated datasets and field datasets. The results show that the random forest regressor (RF), artificial neural network (ANN), long short-term memory (LSTM), LightGBM, XGBoost, and multivariate regression models predicted the training and test datasets with higher R-squared and minimum mean square error values. Deploying the ML model in real-time applications and the planning phase would lead to potential applications of artificial intelligence for well planning and optimization processes.

Specific coenzyme preference switching for an aldo-keto reductase that synthesizes the chiral intermediate of duloxetine

The synthesis of chiral intermediates for the traditional antidepressant duloxetine has gained significant attention as the number of depressed patients continues to grow. S-N, N-Dimethyl-3-hydroxy-3-(2-thienyl)-1-propanamide (S-DHTP) is a critical intermediate in the synthesis of duloxetine, and the chemical synthesis process is complex and environmentally unfriendly. Reduced nicotinamide adenine dinucleotide phosphate (NADPH) is a major cost driver in the biocatalytic production of S-DHTP from N, N-Dimethyl-3-keto-3-(2-thienyl)-1-propanamide (DKTP). Here, we successfully modified the coenzyme preference of an aldo-keto reductase (AKR7-2-1) to use the cheaper reduced nicotinamide adenine dinucleotide (NADH) through a coenzyme preference modification approach. We utilized protein engineering to create a superior mutant, Y53F, which increased the coenzyme specificity of AKR7-2-1 by 875-fold and improved its thermal stability, enhancing its potential for industrial applications. Molecular dynamics simulations were performed to demonstrate the effect of mutations at key sites on the protein, revealing the altered coenzyme preference and increased thermal stability from structural and energetic changes. This study validates the viability of the coenzyme preference modification strategy for aldo-keto reductase, offering valuable insights for fellow researchers and guiding future investigations.

A multigrid assisted reanalysis method for accelerated heat transfer topology optimization

Heat sinks are widely applied in industry, and heat transfer topology optimization can improve their performance while saving materials. However, the prohibitive computational cost hinders its development. Therefore, the Multigrid Assisted Reanalysis (MGAR) method is proposed to address the issue. The Combined Approximate Reduced Order Model (CAROM) is employed to reduce the dimensionality of governing equations, and computational efficiency is significantly improved. In addition, CAROM should be dynamically updated to ensure the accuracy of solutions, thus constructing the CAROM also take up a major computational cost. For this purpose, the V-cycle multigrid is employed to construct basis vectors of CAROM instead of direct solvers. Since the MGAR involves almost no matrix decomposition, except for solving the reduced linear systems, the MGAR is equipped to handle large-scale problems due to the advantage of high computational efficiency and low memory requirements. The competence of the MGAR is verified by several cases including thermal compliance minimization and maximum temperature minimization.

Costs to Implement a Pediatric Weight Management Program Across 3 Distinct Contexts.

The Connect for Health program is an evidence-based program that aligns with national recommendations for pediatric weight management and includes clinical decision support, educational handouts, and community resources. As implementation costs are a major driver of program adoption and maintenance decisions, we assessed the costs to implement the Connect for Health program across 3 health systems that primarily serve low-income communities with a high prevalence of childhood obesity. We used time-driven activity-based costing methods. Each health system (site) developed a process map and a detailed report of all implementation actions taken, aligned with major implementation requirements (eg, electronic health record integration) or strategies (eg, providing clinician training). For each action, sites identified the personnel involved and estimated the time they spent, allowing us to estimate the total costs of implementation and breakdown costs by major implementation activities. Process maps indicated that the program integrated easily into well-child visits. Overall implementation costs ranged from $77,103 (Prisma Health) to $84,954 (Denver Health) to $142,721 (Massachusetts General Hospital). Across implementation activities, setting up the technological aspects of the program was a major driver of costs. Other cost drivers included training, engaging stakeholders, and audit and feedback activities, though there was variability across systems based on organizational context and implementation choices. Our work highlights the major cost drivers of implementing the Connect for Health program. Accounting for context-specific considerations when assessing the costs of implementation is crucial, especially to facilitate accurate projections of implementation costs in future settings.

Comparison of costs associated with transcatheter mitral valve repair: PASCAL vs MitraClip in a real-world setting

AimsWe aimed to conduct a clinical process cost analysis to evaluate all upcoming costs of mitral valve transcatheter edge-to-edge repair (M-TEER) treatment using the MitraClip and the PASCAL repair system.MethodsFirst, we prospectively enrolled 107 M-TEER patients treated with either the PASCAL or MitraClip system and compared all upcoming costs during the M-TEER procedure and the associated in-hospital stay. Second, we retrospectively analysed 716 M-TEER procedures with regard to the occurrence of complications and their associated costs. All materials used in the catheterization laboratory for the procedures were evaluated. The cost analysis considered various expenses, such as general in-hospital costs, device costs, catheter laboratory and material costs.ResultsIn the prospective study, 51 patients were treated using the PASCAL system, and 56 were treated using the MitraClip system. The two groups had comparable baseline characteristics and comorbidities. The total in-hospital costs were 25 414 (Interquartile range (IQR) 24 631, 27 697) € in the PASCAL group and 25 633 (IQR 24 752, 28 256) € in the MitraClip group (p = 0.515). The major cost driver was initial material expenditure, mostly triggered by device costs, which were similar to the PASCAL and MitraClip systems. Overall intensive care unit and general ward costs did not differ between the PASCAL and MitraClip groups. In the retrospective analysis, M-TEER-related complications were rare but were associated with higher costs, mainly due to prolonged hospitalisation.ConclusionThe major cost driver of M-TEER was the material expenditure, which was mostly triggered by high device costs. The costs of treating patients were similar for the PASCAL and MitraClip systems. M-TEER-related complications are associated with higher costs, mainly due to prolonged hospitalisation. This analysis provides valuable insights into reducing expenses by modifying the process of M-TEER.

A propensity score matching analysis using statistical methods for estimating the impact of intervention: The cost of malaria and its impact on the health system

Colombia contributes 17% of all malaria cases in Latin America and the Caribbean and continues to have major health and economic costs. A propensity score-matched cost-of-illness study was conducted using an incidence-based approach focused on direct healthcare costs in 2019. The statistical analysis was designed to determine the economic burden attributed to malaria on the Colombian health system, a middle-income country with universal coverage. Propensity score analysis effectively adjusted for confounding, thus facilitating comparability between groups with and without malaria. Direct costs attributable to malaria were estimated using a bottom-up strategy using fractions attributable to the population. We used administrative databases containing patient-level information on the consumption of healthcare services and reports on healthcare spending published by the Colombian Ministry of Health. All expenses were reported in Colombian pesos and converted to US dollars. We show malaria imposes a significant economic burden on the Colombian health system. The most affected population is part of the subsidized regime, which assumes the greatest financial burden. The cost of complicated malaria far exceeds that incurred for uncomplicated malaria. Propensity score matching adjusted for significant differences in comorbidities between groups, allowing for the closest estimate of malaria-attributed costs in the country.

(Invited) Advanced Redox Flow Batteries: Process and Design Innovation Opportunities

Large-scale electric-energy-storage (EES) systems have the potential to transform the electric grid, especially long-duration energy storage (LDES) solutions [1]. However, the economic requirements for LDES systems are more challenging than those for EES applications with shorter discharge durations, since the value proposition for most LDES applications tends to be significantly lower on a normalized basis (i.e., $/kWh of EES capacity). EES systems with independent power and energy components, e.g., pumped-storage hydro (PSH), redox flow batteries (RFBs), and reversible fuel cells (RFCs) have a major inherent cost advantage, since one can readily increase the energy/power ratio by selectively adding more energy capacity, without the added cost of excessive power components. RFBs also have other unique attributes that make this battery architecture ideally suited for grid-scale LDES, namely: long cycle life even with deep cycles, inherently superior safety [2], good round-trip energy efficiency (i.e., compared to RFCs), and simplified recyclability due to the separated components. A rigorous techno-economic analysis (TEA) model has shown that RFBs can enable LDES systems with lower capital cost than other types of batteries at comparable production volumes [3]. However, production volumes of RFBs are currently substantially lower than some other types of batteries, especially lithium-ion batteries. This same TEA model also projects that the capital cost of all-vanadium RFBs (VRFBs) at low production volumes is > $500/kWh. Therefore, what is needed to accelerate the commercialization of VRFBs are innovations that can potentially improve capital costs at low production volumes [4]. This invited talk will focus on some potentially near-term possibilities; namely, those that do not necessarily require new materials. This includes: 1) high performance RFB cells [5], 2) a variety of advanced RFB manufacturing processes, including innovative electrolyte-purification [6] and electrolyte-shipping processes [7], 3) alternative state-of-charge (SOC) measurement methods [8], 4) simple RFB performance diagnostics [9], 5) novel RFB system architectures (e.g., [10]), and 6) business-model innovations [11]. References P. Denholm, et.al., “Storage Futures Study, The Four Phases of Storage Deployment” National Renewable Energy Laboratory, NREL/TP-6A20-77480 (2021).R. Wittman, M. L. Perry, et.al, “Perspective: On the Need for Reliability and Safety of Grid-Scale Aqueous Batteries,” JES, 167 (2020). DOI: 10.1149/1945-7111/ab9406R. M. Darling, et.al., “Pathways to Low-Cost Electrochemical Energy Storage,” Energy & Environ. Science (2014). DOI: 10.1039/c4ee02158dM. L. Perry, “The Pathway to Widespread Commercialization of Redox Flow Batteries,” A03-0475 (Invited), 241st ECS Meeting (2022).M. L. Perry, et.al., “High Power Density Redox Flow Battery Cells,” ECS Transactions, 53 (2013). DOI: 10.1149/05307.0007ecstC. Tai-Chieh Wan, K. E. Rodby, M. L. Perry, Y.-M. Chiang, F. R. Brushett, “Hydrogen evolution mitigation in iron-chromium redox flow batteries via electrochemical purification of the electrolyte,” J. of Power Sources, 554 (2023). DOI: 10.1016/j.jpowsour.2022.232248T. V. Nguyen, Y. Li, and M. L. Perry, “Densification, Precipitation, and Dissolution of Vanadium Electrolyte for Vanadium Redox Flow Battery Systems,” Submitted for 2023 ECS Meeting, Symposia A03.E. J. Alexandrescu and M. L. Perry, “Measuring Electrochemical Potentials for Health Monitoring of RFBs,” Submitted for 2023 ECS Meeting, Symposia A03.M. L. Perry, “Development of a Simple and Rapid Diagnostic for Redox Flow-Battery Cells,” Symposium I02, 242nd ECS Meeting, (2022).M. L. Perry, “Flow battery with two-phase storage,” U.S. Patent 9,350,039 (2016).Largo Physical Vanadium, Investor Presentation, lpvanadium.com (2022).

Reprocessing and reuse of dialyzers: A technological solution for balancing cost and quality in lower and middle-income countries.

Hemodialysis is the commonest kidney replacement therapy (KRT) globally and rapidly growing in developing countries, while in developed countries it is reaching a plateau. The penetration of hemodialysis (HD) varies widely among countries and is largely influenced by socioeconomics, healthcare financing, particularly by government, local infrastructure, healthcare workforce, health system characteristics, and affordability of the population. Biomedical equipment, consumables, disposables, and labor are major cost drivers of KRT. Implementing strategies to balance cost and quality of care is an arduous task for health care planning, delivery, and patient care in low- and middle-income countries. In this context, the cost of dialyzers which form a significant component of the recurring cost of HD can be reduced by reuse after appropriate reprocessing. But this practice is largely abandoned in developed countries because of concerns of safety. However, the evidence against the reuse of modern dialyzers is not robust and certainly not based on well-designed randomized trials. The industrialization of dialysis delivery, the interests of equipment manufacturers and the nature of dialysis delivery have propelled single use of dialyzers. In this context, developing countries needing to expand HD services access at low cost are caught at crossroads. Process improvements are needed to standardize reprocessing that prioritizes safety while maintaining effectiveness. Recent advances in mobile and internet technologies could make this an achievable reality. We propose such an approach that would ensure treatment effectiveness, patient and healthcare provider safety, efficient resource utilization, and cost control.

Solid Oxide Stack Development at Elcogen

Elcogen is one of the leading European manufacturers of solid oxide cell (SOC) and stack technologies. Elcogen stacks are a unique combination of best-in-class performance and low-cost product structure. The stack products are designed for low temperature operation enabling major cost reductions on the system level. This article summarizes the recent activities and development trends of Elcogen.Elcogen solid oxide technology can be used both in electrolysis and fuel cell mode. In electrolysis mode, steam is converted with electricity into green hydrogen. The electrolysis technology can also be used to produce syngases for e-fuel production by combining steam and carbon dioxide. Elcogen technology can be operated at high conversion efficiency level with a variety of fuels in the fuel cell mode.Elcogen is currently focused on ramping up its unit cell and stack production with increased customer demand. The goal is to set-up of a manufacturing plant for stacks with annual capacity close to 200 MW in electrolysis mode.

Development of Electrolyte Additives to Enable High-Voltage LiNi0.5Mn1.5O4 Lithium Ion Batteries

Electrochemical energy storage (EES) is still key to realize wide spread use of renewable energies. For large-scale EES production, the development of high energy density, non-toxic, cost-effective materials is necessary. In this study, a cobalt free active material, Lithium Nickel Manganese Oxide, LiNi0.5Mn1.5O4 (LNMO), was employed in the production of cathodes for high voltage lithium ion battery (LIB) applications. LNMO is an attractive cathode active material due to its high operating potential (~4.7 vs. Li/Li+ [1]), non-toxicity and low cost. The practical application of LNMO cathodes in LIBs has been relatively limited, especially for large scale application, due challenges associated with the material (i.e. electrolyte decomposition at high voltage, self-discharge and dissolution of the transition metals [2]).Electrolyte additives are an effective way to address these challenges, without major cost increase or changes to the production approach. In this study the role of different electrolyte additives in high-voltage full-cell LIBs with both graphite and silicon-graphite anodes is investigated. Additives known for their solid electrolyte interphase (SEI) forming ability (i.e. vinylene carbonate (VC) and fluoroethylene carbonate (FEC)), as well as additives that play additional roles such as cathode electrolyte interface formation or HF scavenging (i.e. tris(trimethylsilyl) phosphite (TMSP) and succinate anhydride (SA)), are used [3]. Galvanostatic cycling measurements were performed in 3-electrode cells in order to investigate the rate capability and long term cycling stability of LMNO/Gr and LMNO/Gr-Si full-cells with different electrolyte additives. The electrochemical characterization was verified with post mortem analysis to confirm the SEI composition, chemical and mechanical stability of the electrodes and lack of lithium plating. Post mortem investigations were done with Raman spectroscopy, scanning electron microscopy-energy dispersive X-ray analysis (SEM-EDX) and optical microscopy. Improved rate performance and better long term cycling stability of both full-cell chemistries was achieved for electrolytes containing the TMSP additive.

Cost analysis of the WHO-HEARTS program for hypertension control and CVD prevention in primary health facilities in Ethiopia

BackgroundIn 2020, Ethiopia launched the Ethiopia Hypertension Control Initiative (EHCI) program to improve hypertension care using the approach described in the WHO HEARTS technical package. ObjectiveTo estimate the costs of implementing the HEARTS program for hypertension control and cardiovascular disease (CVD) prevention in the primary care setting in Ethiopia for adult primary care users in the catchment area of five examined facilities. Study designThis study entails a program cost analysis using cross-sectional primary and secondary data. MethodsMicro-costing facility surveys were used to assess activity costs related to training, counselling, screening, lab diagnosis, medications, monitoring, and start-up costs at five selected health facilities. Cost data were obtained from primary and secondary sources, and expert opinion. Annual costs from the health system perspective were estimated using the Excel-based HEARTS costing tool under two intervention scenarios – hypertension-only control and a CVD risk management program, which addresses diabetes and hypercholesterolemia in addition to hypertension. ResultsThe estimated cost per adult primary care user was USD 5.3 for hypertension control and USD 19.3 for integrated CVD risk management. The estimated medication cost per person treated for hypertension was USD 9.0, whereas treating diabetes and high cholesterol would cost USD 15.4 and USD 15.3 per person treated, respectively. Medications were the major cost driver, accounting for 37% of the total cost in the hypertension control program. In the CVD risk management scenario, the proportions of medication and lab diagnostics of total costs were 18% and 64%, respectively. ConclusionsThe results from this study can inform planning and budgeting for HEARTS scale-up to prevent CVD across Ethiopia.

Comparative outcomes associated with rivaroxaban versus warfarin use in elderly patients with atrial fibrillation or acute venous thromboembolism managed in the United States: a systematic review of observational studies

Background Advancing age is a risk factor for developing non-valvular atrial fibrillation (NVAF) or acute venous thromboembolism (VTE). We assessed the comparative effectiveness, safety, costs, and healthcare utilization associated with rivaroxaban versus warfarin in patients of advanced age managed in the United States (US). Methods We conducted a systematic review of Medline and Embase through April 2023 to identify real-world evidence (RWE) studies of older adults (at least 65+ years of age) with either NVAF or VTE who received either rivaroxaban or warfarin in the US and reported an outcome of stroke or systemic embolism (SSE), ischemic stroke (IS), recurrent VTE, major bleeding, intracranial hemorrhage, costs, or healthcare resource utilization. We classified each outcome of interest per study as “positive” (lower risk), “negative” (higher risk), or “neutral” based upon the summary effect size of rivaroxaban versus warfarin. Results Twenty-nine RWE studies met inclusion criteria, mostly (83%) in NVAF populations. For SSE with rivaroxaban versus warfarin, 68.8% of studies showed positive effects and 31.2% showed neutral outcome. For major bleeding, 57.7% showed neutral effects, 38.5% showed negative effects, and 3.8% of studies showed positive effects with rivaroxaban versus warfarin. Of the two studies reporting cost data, both were positive, showing lower costs for SSE for rivaroxaban versus warfarin and neutral cost for major bleeding costs. Conclusions This systematic review supports findings from subgroup analyses of randomized controlled trials that, compared with warfarin, rivaroxaban is associated with generally neutral or positive effects on thrombosis and a mixed picture on bleeding outcomes in older adults with either NVAF or VTE treated in the United States.

Graphite rapidly forms via annihilation of screw dislocations

Graphite is the thermodynamically stable form of carbon and yet is remarkably difficult to synthesize. We show the annihilation of screw dislocations is critical for graphitization. These dislocations wind through the layers like a spiral staircase, inhibiting lateral growth of the graphenic crystallites (La) and preventing AB stacking of Bernal graphite. High-resolution transmission electron microscopy identifies screws as interdigitated fringes with narrow focal depth in graphitizing polyvinyl chloride. Molecular dynamics simulations of parallel graphenic fragments confirm that screws spontaneously form during heating, with higher annealing temperature driving screw annihilation and crystallite growth. The time evolution and kinetics of graphitization is tracked via X-ray diffraction, showing the growth of La and reduction of the interlayer spacing, consistent with screw annihilation. We find that graphite forms orders of magnitude faster than previously assumed, taking less than ten seconds at 3000 °C and just minutes at 2500 °C. This rapid transformation suggests major cost savings in synthetic graphite production, important for lithium-ion batteries and smelting electrodes. By reducing the time spent at ultra-high temperatures, energy costs and component degradation can be significantly lower.