Cost Reduction Research Articles

Systematic review: effectiveness and safety of switching between originator infliximab and biosimilar infliximab in patients with inflammatory bowel disease.

Infliximab (IFX) biosimilars are available to treat inflammatory bowel disease (IBD), offering cost reductions versus originator IFX in some jurisdictions. However, concerns remain regarding the efficacy and safety of originator-to-biosimilar switching. This systematic literature review evaluated safety and effectiveness of switching between IFX products in patients with IBD, including multiple switchers. Embase, PubMed, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials were searched to capture studies (2012-2022) including patients with IBD who switched between approved IFX products. Effectiveness outcomes: disease activity; disease severity; response to treatment; patient-reported outcomes (PROs). Safety outcomes: incidence and rate of adverse events (AEs); discontinuations due to AEs, failure rate; hospitalizations; surgeries. Immunogenicity outcomes (n, %): anti-drug antibodies; patients receiving concomitant immunomodulatory medication. Data from 85 publications (81 observational, two randomized controlled trials) was included. Clinical effectiveness outcomes were consistent with the known profile of originator IFX with no difference after switching. There were no unexpected/serious AEs after switching, and rates of AEs were generally consistent with the known profile of IFX. Most studies reported that clinical, PROs, and safety outcomes for originator-to-biosimilar switching were clinically equivalent to originator responses. Limited data are available regarding multiple switches. www.crd.york.ac.uk/prospero identifier is CRD42021289144.

Health Resource Utilization and Cost Impact of Integrative Medicine Services for Newly Diagnosed Chronic Pain Patients.

Background: Integrative medicine (IM) is the healing-oriented practice of medicine that emphasizes the relationship between practitioner and patient. It considers the whole person, their environment, lifestyle, and social and cultural factors. It is evidence based and makes use of all appropriate therapies, conventional and complimentary. Objective: To evaluate the impact of IM services on health outcomes and care costs of chronic pain management patients compared with standard care. Methods: This article uses University of New Mexico hospital billing data from 10/2016 to 09/2019 to identify patients with nervous system or musculoskeletal pain. A total of 1,304 patients were matched using propensity scores into IM services (treatment: 652) and standard care (control: 652) cohorts for difference-in-differences analysis. The patients were matched based on age, sex, race, zip code, insurance type, ICD-10s, prescriptions, health care events, and medical claim costs. Results: Patients who used IM services had better health outcomes and lower costs at 3-month, 6-month, and 12-month follow-up. At the 12-month follow-up, the IM group showed a 19% decrease in utilization of inpatient care, a 37% decrease in Emergency Department utilization, and an 11.3% reduction in claim costs compared with the control group. Conclusion: Patients who utilize IM services as part of chronic pain management have overall lower health care costs and better health outcomes. Unfortunately, in the health system studied, less than 3% of patients utilize these services. Promotion of and education about IM services should be aimed at both patients and their providers.

Telescopic forklift selection through a novel interval-valued Fermatean fuzzy PIPRECIA–WISP approach

Telescopic forklifts stand apart from other forklift types, boasting numerous benefits. They offer notable advantages, such as enhanced manoeuvrability, accessibility to elevated areas, versatility, and the capacity to operate at high speeds. Choosing appropriate telescopic forklifts can substantially enhance operational efficiency and efficacy within the industry. Concurrently, it can bolster business competitiveness by expediting logistical processes, yielding notable cost reductions. Nonetheless, the intricacy and specificity inherent in these machines complicate the decision-making process for stakeholders. Furthermore, conflicting criteria, the continuous evolution of manufacturers’ models, and the industry’s intricate nature compound the selection challenges. Hence, there is a pressing need for a resilient, dependable, and practical decision-making framework capable of adeptly navigating uncertainties to yield reliable and coherent outcomes. This study aimed to develop an integrated decision-making model based on interval-valued Fermatean fuzzy (IVFF) sets to respond to these requirements and address this critical decision-making problem in the relevant industry, which is also significantly affected by complex uncertainties. This work, therefore, introduces an integrated methodology for decision-making, IVFF–PIPRECIA and IVFF–WISP techniques. IVFF–PIPRECIA determines criteria importance weights, whereas IVFF–WISP identifies optimal alternatives. A case study in the textile industry validates the framework’s practicality. Purchase price emerges as the primary criterion, exceeding 500 thousand euros for telescopic forklifts, followed closely by load-carrying capacity. The second alternative proves to be the best option. Comparative and sensitivity analyses confirm the model’s credibility. The approach effectively handles decision-making uncertainties, yielding competitive outcomes. It can be applied to diverse engineering problems. Insights from this study assist users in selecting optimal equipment and may inform forklift manufacturers in improving machinery. Future research could focus on establishing real-time operational data collection frameworks for these vehicles.

AUTOMATED COMPLEX FOR MEASURING THE WINDING TEMPERATURE OF TRACTION ELECTRIC MACHINES DURING THEIR HEATING TEST

Purpose. The development and implementation of automated complexes for testing traction electric machines of rolling stock at the current stage is an extremely important task. Automated test complexes provide an opportunity to significantly increase the quality and efficiency of tests on traction electric machines. Thanks to the use of advanced technologies, these complexes ensure accurate data collection and analysis during tests. One of the main advantages of automated complexes is the reduction of cost and labor costs for conducting tests. Instead of manual intervention by operators, automation systems can perform many tasks automatically, saving time and reducing labor costs. Methodology. The methodological basis of the research is analytical research methods based on the compilation of a calculation system of differential equations based on the accepted test scheme, as well as the development of an algorithm for conducting tests on a designed stand. Findings. The proposed test complex allows to conduct tests of collector traction electric machines, to determine the excess temperature of the windings of electric machines without the need to stop them. The functional scheme of the measuring complex allows you to automatically record the parameters of the tested electric machines, and if necessary, it is possible to output the test results to a computer with the subsequent formation of the test protocol in electronic form. The accuracy of the determination of the measured parameters is ensured by the accuracy of the measuring devices and the algorithm of the measuring complex. Originality. The proposed automated measuring complex is a big step in the direction of improving the efficiency and reliability of heating tests of traction electric machines. One of its key advantages is the ability to perform tests without stopping the machine, which significantly reduces the time and costs of conducting tests. Automatic registration of measured parameters allows to record several controlled indicators at the same time, which provides a more complete and objective assessment of the state of the electric machine during testing. This complex not only facilitates the testing process and reduces the cost of time and resources, but also increases the reliability of the obtained results, which is important for manufacturers and operators of transport systems. In general, the automated measuring complex opens up new opportunities for increasing the efficiency and reliability of testing electric traction machines, contributing to the further development of transport technologies. Practical value. The implementation of the obtained results by enterprises for the repair of traction electric machines of rolling stock will allow to reduce the material costs of carrying out repairs while simultaneously improving the quality of the conducted tests.

Productive and Ruminal Microbiological Behavior of Sheep Fed with Two Levels of Dehydrated Orange Residue

Objective: To evaluate the productive and ruminal microbiological behavior of sheep fed with two levels of dehydrated orange residue (DOR). Design/methodology/approach: Thirty Dorper x Katahdin crossbred male sheep with an average live weight of 22 ± 1.0 kg were distributed in a completely randomized design, with three treatments and ten repetitions. The distribution of treatments was as follows: T1 = diet with 0% DOR (control), T2 = diet with 15% DOR, and T3 = diet with 30% DOR. The variables evaluated were daily weight gain, dry matter intake, feed conversion, ruminal pH, and microbiological analysis. Results: There were no significant differences (p>0.05) in the productive variables due to the inclusion of DOR in the diet. Similarly, the concentration of ruminal microorganisms did not present significant differences between treatments. Study limitations/implications: The study did not include an economic analysis that would demonstrate a reduction in production costs by decreasing the inclusion of maize in the diet. Conclusions: Maize grain is one of the most commonly used cereals as an energy source in sheep feeding; however, it can be replaced by DOR up to 30% without affecting the productive and ruminal microbiological variables in fattening sheep.

Abbreviated Breast MRI Protocols in the Screening of High-Risk Females

Abstract Background Standard MRI breast more often than not, have lengthy protocols that make them much more expensive and time-consuming. And in spite its great potential for early detection of breast cancer in high-risk females, its wide application remains difficult, therefore the use of abbreviated MRI protocols in breast cancer screening is introduced. Results This study was done on high-risk women with a lifetime risk of over 20%. The majority of the examinations were performed on women with previous history of breast cancer (63.3%), while 36.7% had moderate to high family history. An abbreviated protocol was created form the sequences obtained from the full diagnostic protocol, which consisted of a pre-contrast T1, post-contrast T1, subtraction and MIP images. On MRI examination using the conventional protocol, 36% of the women in our study were diagnosed with breast mass lesions, of which 20% were malignant masses. Benign findings, whether mass or non-mass lesions constitutes of a total of 50.1%, and about 26.7% were normal. All the malignant lesions were identified on the abbreviated protocol by the designated reader after review of the clinical history. So, the cancer detection rate in our study using the abbreviated MRI protocols revealed a Kappa agreement test of 1.000, i.e., perfect agreement with the conventional protocols for the participant females. Conclusion The use of abbreviated MRI breast is feasible without compromising the cancer detection rate compared to a full protocol. It also achieved a significant reduction in scanning time, interpretation time, and total cost of the study, proving its efficacy and making it a more accessible first line of screening high-risk females.

Impact of a family support intervention on hospitalization costs and hospital readmissions among ICU patients at high risk of death or severe functional impairment

BackgroundPatients with advanced critical illness often receive more intensive treatment than they would choose for themselves, which contributes to high health care costs near the end of life. The purpose of this study was to determine whether a family support intervention delivered by the interprofessional ICU team decreases hospitalization costs and hospital readmissions among critically ill patients at high risk of death or severe functional impairment.ResultsWe examined index hospitalization costs as well as post-discharge utilization of acute care hospitals, rehabilitation and skilled nursing facilities, and hospice services for the PARTNER trial, a multicenter, stepped-wedge, cluster randomized trial of an interprofessional ICU family support intervention. We determined patients’ total controllable and direct variable costs using a computerized accounting system. We determined post-discharge resource utilization (as defined above) by structured telephone interview at 6-month follow-up. We used multiple variable regression modelling to compare outcomes between groups. Compared to usual care, the PARTNER intervention resulted in significantly lower total controllable costs (geometric mean: $26,529 vs $32,105; log-linear coefficient: − 0.30; 95% CI − 0.49, − 0.11) and direct variable costs ($3912 vs $6034; − 0.33; 95% CI − 0.56, − 0.10). A larger cost reduction occurred for decedents ($20,304 vs. $26,610; − 0.66; 95% CI − 1.01, − 0.31) compared to survivors ($31,353 vs. $35,015; − 0.15; 95% CI − 0.35,0.05). A lower proportion in the intervention arm were re-admitted to an acute care hospital (34.9% vs 45.1%; 0.66; 95% CI 0.56, 0.77) or skilled nursing facility (25.3% vs 31.6%; 0.63; 95% CI 0.47, 0.84).ConclusionsA family support intervention delivered by the interprofessional ICU team significantly decreased index hospitalization costs and readmission rates over 6-month follow-up.Trial registration Trial registration number: NCT01844492

USE OF ANIMAL FIBER-REINFORCEMENT IN CONSTRUCTION MATERIALS: A REVIEW

Although natural fibers (NFs), among which animal fibers (AFs) are found, have been used for millennia as reinforcement scheme of some construction materials (CMs), it is not until recent decades when scientific studies have been carried out to quantitively evaluate the impact of adding NFs into CMs, but with a special focus on vegetal fibers (VFs) over AFs. Nevertheless, there have been several studies addressing the use of AFs in different CMs and, therefore, the need of a systematic review study is evident. To contribute to this research gap, this paper presents a comprehensive review study addressing available scientific information of different types of AFs (e.g., sheep wool fibers (SWFs), chicken feathers fibers (CFFs), human hair fibers (HHFs), pig hair fibers (PHFs), silk fibers (SFs), and dog hair fibers (DHFs)) and also their use in four specific different CMs matrices (i.e., cementitious, gypsum, soil and polymer matrices). This comprehensive search was conducted in Web of Science and Science Direct, two of the largest and more prestigious scientific databases, using specific keyword and Boolean operators and the selection of the papers was based on the provision of enough quantitative information of the mixtures (e.g., specific characteristic and dosages of AFs and matrix used) as well as experimental findings. As a result of this study, organized, summarized and sufficient information is provided to support the positive use AF as reinforcement scheme to improve some physical/thermal/mechanical/damage/durability properties of CMs by taking advantage of the abundance of these resources worldwide. Moreover, the use of AFs provides environmental benefits care and cost reductions, which are global objectives within the construction sector. Finally, this review study found that there are still several research gaps in the use of particular AFs (e.g., DHFs) as well as combinations between the AFs CMs addressed in this study (e.g., effects of pig hair fibers in polymer matrices) and these gaps are recommended as future studies.

Paper-based Microfluidic Devices for the Analysis of Various Pathogens from Diverse Samples

Abstract: In today’s era, detection of disease is utmost important for the management of disease. Early detection leads to early management of disease. Paper-based microfluidic devices are promising technologies that are cost-effective, portable and easy to use over conventional methods. In addition, paper-based microfluidics offers low reagent/sample volume, less response time and can be used in resource-limited settings. Researchers are highly fascinated by this technology as it has a lot of potential to convert into commercial monitoring devices. The present article covers the uses of paper-based microfluidic technology for the swift and sensitive detection of pathogens from diverse samples, viz. food, water and blood. In this comprehensive review, paper-based microfluidic devices are introduced, including the basic concepts, current status and applications, along with the discussion of the limitations of microfluidics for the detection of pathogens. Although paper-based microfluidic devices are being developed, their commercialization requires simplification of manufacturing processes, reduction in production costs as well as an increase in production efficiency. Nonetheless, the integration of artificial intelligence (AI) and the Internet of Things (IoT) like smartphones, digital cameras, webcam etc. with paper-associated diagnosis has transformed the point-of-care (POC) diagnostics.

Partial-Cost Analysis and Economic Impact of Ambulatory Coronary Angioplasty in a Private Hospital in the Caribbean: Análisis Parcial de Costos e Impacto Económico de la Angioplastia Coronaria Ambulatoria en un Hospital Privado del Caribe

ObjectivesThis study aimed to assess direct costs of percutaneous coronary intervention (PCI) without hospital admission versus PCI with hospital admission longer than 24 hours in a private hospital-institutional perspective in the Dominican Republic in 2022. MethodsThis study has a comparative approach based on a prospective cross-sectional partial-cost analysis. We evaluated the direct costs of 10 patients from PCI without hospital admission approach and 10 patients from a hospital admission longer than 24 hours as a control group. We used a “first-come-first-served” approach from December 2021 to March 2022. The analysis used the electronic invoice generated for each patient. ResultsPCI without hospital admission approach represents $472.56 in patient savings, equivalent to a cost reduction of 12.5%. The subcosts analysis showed the pharmacy section as the main driver of the overall cost difference. ConclusionsPCI without hospital admission was economically cost-saving compared with the control approach in direct costs in the Dominican perspective. The economic benefit is substantial and compliments the ease of use. This analysis may lead to improvements in institutional management of resources and can potentially be adapted to other health systems in the region.

Improving the Functionality of the Electronic Health Record System through the Development of the Anesthesia Module

Background: With the advancement of healthcare technology, the use of Electronic Health Records (EHR) has become more effective, providing benefits such as cost reduction, improved healthcare quality, and enhanced data recording and mobility. To remain effective, EHRs must meet requirements such as data completeness, failure resilience, high availability, and security. Pekanbaru army hospital has adopted EHR since 2022 for several main services, except for the anesthesia service. The anesthesia service still uses paper records, which are inefficient and lag behind other services. The anesthesia process, involving extensive information and coordination, greatly requires an EHR system. The development of an anesthesia module is expected to facilitate anesthesiologists and nurse anesthetists in managing patient medical information and assist in the execution of surgical procedures. Objective: This study aims to improve the functionality of the electronic health record system (EHRS) in managing medical records in the anesthesia installation service by developing an anesthesia module at the Pekanbaru Army Hospital. Method: The software development methodology used in this research is Agile Methodology where the process of analyzing user needs, collecting data, implementing the system, and evaluating and validating the system. Result: The Anesthesia Module that has been built has various features including: anesthesia patient registration, pre-anesthesia patient data recording, anesthesia induction, post-anesthesia, anesthesia reports, and integration with laboratory and radiology systems. Through testing carried out with the black box test technique, 98% of the system functionality runs well and with the user acceptance test technique, 94% of the system functionality can be accepted by users.

Scenarios for the introduction of hydrogen in the global fuel and energy complex, taking into account the analysis of the economic prerequisites for the inclusion of hydrogen in the global energy balance

Subject. This article discusses possible scenarios for the development of the global hydrogen market in the context of changes in the global energy balance. Objectives. The article aims to determine the prospects for the inclusion of hydrogen in the world energy balance in the process of its transformation, and analyze the economic prerequisites for the use of hydrogen. Methods. For the study, I used a content analysis, comparative analysis, and statistical data. Results. The article presents the author-developed methodology for analyzing the economic prerequisites for the inclusion of hydrogen in the global energy balance, which includes an assessment of the full cost of the hydrogen chain, inertia factors, regulatory and subsidy costs, possible benefits from the use of hydrogen instead of traditional fuels, cost reduction, as well as the calculation of investment indicators. The article assesses forecasts and strategies for the development of hydrogen energy in the world. Conclusions and Relevance. Creating safe, low-cost and reliable ways to transport and store hydrogen will provide an opportunity to replace fossil fuels in the transportation market. The results of the study can be used in decision-making by states and energy companies regarding the development of hydrogen energy and investment in technologies for the production, transportation and storage of hydrogen.

Evaluating the offshore wind business case and green hydrogen production: A case study of a future North Sea Offshore Grid

The European Union aims to increase its climate ambition and achieve climate neutrality by 2050. This necessitates expanding offshore wind energy and green hydrogen production, especially for hard-to-abate industrial sectors. A study examines the impact of green hydrogen on offshore wind projects, specifically focusing on a potential future North Sea offshore grid. The study utilizes data from the TYNDP 2020 Global Ambition scenario 2040, considering several European countries. It aims to assess new transmission and generation capacity utilization and understand the influencing factors. The findings show that incorporating green hydrogen production increases offshore wind utilization and capture prices. The study estimates that by 2040, the levelized cost of hydrogen could potentially decrease to €1.2-1.6/kg H2, assuming low-cost electricity supply and declining capital costs of electrolysers. These results demonstrate the potential benefits and cost reductions of integrating green hydrogen production into North Sea offshore wind projects.

Titanium:sapphire-on-insulator integrated lasers and amplifiers.

Titanium:sapphire (Ti:sapphire) lasers have been essential for advancing fundamental research and technological applications, including the development of the optical frequency comb1, two-photon microscopy2 and experimental quantum optics3,4. Ti:sapphire lasers are unmatched in bandwidth and tuning range, yet their use is restricted because of their large size, cost and need for high optical pump powers5. Here we demonstrate a monocrystalline titanium:sapphire-on-insulator (Ti:SaOI) photonics platform that enables dramatic miniaturization, cost reduction and scalability of Ti:sapphire technology. First, through the fabrication of low-loss whispering-gallery-mode resonators, we realize a Ti:sapphire laser operating with an ultralow, sub-milliwatt lasing threshold. Then, through orders-of-magnitude improvement in mode confinement in Ti:SaOI waveguides, we realize an integrated solid-state (that is, non-semiconductor) optical amplifier operating below 1 μm. We demonstrate unprecedented distortion-free amplification of picosecond pulses to peak powers reaching 1.0 kW. Finally, we demonstrate a tunable integrated Ti:sapphire laser, which can be pumped with low-cost, miniature, off-the-shelf green laser diodes. This opens the doors to new modalities of Ti:sapphire lasers, such as massively scalable Ti:sapphire laser-array systems for several applications. As a proof-of-concept demonstration, we use a Ti:SaOI laser array as the sole optical control for a cavity quantum electrodynamics experiment with artificial atoms in silicon carbide6. This work is a key step towards the democratization of Ti:sapphire technology through a three-orders-of-magnitude reduction in cost and footprint and introduces solid-state broadband amplification of sub-micron wavelength light.

Assessment of the relationship between sales efficiency and e-commerce in private dental offices in an emerging Latin-American city

Background Worldwide, e-commerce, as a business modality that uses information and communication technologies to make transactions of products and services, has become an indispensable part of the global retail market, especially since the COVID-19 pandemic. E-commerce has experienced accelerated growth in recent years, driven by factors such as increased internet penetration, the expansion of mobile devices, user confidence and innovation of digital platforms. Dental offices have found e-commerce an opportunity to improve their competitiveness. The aim of the research was to establish the relationship between the indicators of efficiency maximization in sales and the type of modality of commerce used most by private dental offices within an emerging economy context in Latin-American city. Methods The study was classified as applied research with a non-experimental, correlational and exploratory design. The sample consisted of 34 private dental offices. A simple random probabilistic sampling was chosen. An instrument containing thirteen items including questions about payment, appointments or consultations, and advertising and indicators of efficiency maximization in sales, was used. Results The assessment of the relationship between the efficiency maximization indicators in sales and the commerce employed shows that, beyond cost reduction (PR=8, 95% CI [1.37; 46.81], p=0.021), the type does not have a statistically significant impact on the increase in clients, sales, revenues, and profit increase. (PR=3, 95% CI [0.28; 32.21], p=0.364). Conclusions E-commerce is significantly correlated with a reduction in operational costs.

Joint Concern over Battery Health and Thermal Degradation in the Cruise Control of Intelligently Connected Electric Vehicles Using a Model-Assisted DRL Approach

Eco-driving aims to enhance vehicle efficiency by optimizing speed profiles and driving patterns. However, ensuring safe following distances during eco-driving can lead to excessive use of lithium-ion batteries (LIBs), causing accelerated battery wear and potential safety concerns. This study addresses this issue by proposing a novel, multi-physics-constrained cruise control strategy for intelligently connected electric vehicles (EVs) using deep reinforcement learning (DRL). Integrating a DRL framework with an electrothermal model to estimate unmeasurable states, this strategy simultaneously manages battery degradation and thermal safety while maintaining safe following distances. Results from hardware-in-the-loop simulation testing demonstrated that this approach reduced overall driving costs by 18.72%, decreased battery temperatures by 4 °C to 8 °C in high-temperature environments, and reduced state-of-health (SOH) degradation by up to 46.43%. These findings highlight the strategy’s superiority in convergence efficiency, battery thermal safety, and cost reduction compared to existing methods. This research contributes to the advancement of eco-driving practices, ensuring both vehicle efficiency and battery longevity.

Green Hydrogen Energy Systems: A Review on Their Contribution to a Renewable Energy System

Accelerating the transition to a cleaner global energy system is essential for tackling the climate crisis, and green hydrogen energy systems hold significant promise for integrating renewable energy sources. This paper offers a thorough evaluation of green hydrogen’s potential as a groundbreaking alternative to achieve near-zero greenhouse gas (GHG) emissions within a renewable energy framework. The paper explores current technological options and assesses the industry’s present status alongside future challenges. It also includes an economic analysis to gauge the feasibility of integrating green hydrogen, providing a critical review of the current and future expectations for the levelized cost of hydrogen (LCOH). Depending on the geographic location and the technology employed, the LCOH for green hydrogen can range from as low as EUR 1.12/kg to as high as EUR 16.06/kg. Nonetheless, the findings suggest that green hydrogen could play a crucial role in reducing GHG emissions, particularly in hard-to-decarbonize sectors. A target LCOH of approximately EUR 1/kg by 2050 seems attainable, in some geographies. However, there are still significant hurdles to overcome before green hydrogen can become a cost-competitive alternative. Key challenges include the need for further technological advancements and the establishment of hydrogen policies to achieve cost reductions in electrolyzers, which are vital for green hydrogen production.

Economies of Scale, Efficiency and Optimal Size of the Hospital

Hospitals are being expanded all over the world. Hospitals are becoming larger (i.e., increasing patient admissions each year) and more complex (i.e., offering a wider range of services to patients with more diverse medical care needs). In the hospital sector and other branches of the economy, economies of scale are important, according to which the volume of medical services can be increased by reducing average costs and increasing quality. However, measuring this relationship between the volume of medical services and costs is difficult because hospitals differ substantially in terms of specialization, patient composition, and other parameters that affect the volume of costs. The paper discusses the features of economies of scale in the healthcare sector and the dependence of the volume of medical services on costs and quality. Studies confirm that the influence of various factors on the costs and quality of medical services depends on the environment and the system of incentives in which hospitals operate. Relationships between patients and healthcare providers based solely on price negotiations do not ensure adequate healthcare quality. Due to informational asymmetry with respect to the real cost of hospital services and quality of treatment, medical service buyers cannot influence cost reductions and increase the quality of treatment, which increases hospital power. Thus, when evaluating the impact of hospital competition on costs and quality of care, we must remember that market mechanisms in health care do not always increase public welfare.

Cluster approach to regional oil and fat subcomplex development

The article studies regional oil and fat subcomplex development in terms of the cluster approach application based on coordinating economic interests of sunflower seed producers, processing and marketing organizations under the condition of appropriate government support, as well as methodological, organizational, and information support by the relevant structures. On the basis of the production and economic indicators analysis it has been revealed that in the Saratov region sunflower production is quite effective, but the lack of interconnection between the oil and fat subcomplex subjects leads to uneven production volumes and highly varying profitability in the context of municipal districts of the region and lost profits formation at all stages of product movement. The author has developed a scheme of the regional oil and fat cluster subjects territorial location, represented by the areas of the cluster production core (with sunflower production volumes above the average regional level), production linking areas (with sunflower production volumes below the average regional level), as well as areas with developed infrastructure (with the presence of processing and storage facilities, and transportation hubs), allowing to establish an effective logistics system with mutually beneficial cooperation between regions. On the example of sunflower seed producers in the Saratov region clustering efficiency has been shown, which consists in production costs reduction as a result of transaction costs reduction and sales revenue growth due to the increase in the sunflower purchase price. The study results can be used in programs and proposals development to strengthen integration ties between the agro-industrial complex subjects.

Innovative stimuli-responsive membrane MSF brine rejection dilution by tertiary treated sewage effluent

In this study, treated wastewater and Multi-Stage Flash (MSF) brine were integrated into the Forward Osmosis (FO) system using pressure stimuli-responsive Nanofiltration (PSRNF) membranes to dilute magnesium, calcium, and sulfate MSF plant brine reject. The deposition of magnesium sulfate and calcium sulfate in the heat exchanger is one of the main issues affecting the performance and efficiency of MSF thermal desalination plants. Reducing the concentration of the divalent ions can minimize scale formation and deposition to a level that allows the MSF plant to operate at high top brine temperature (TBT) and without scale problems. The PSRNF membranes were chosen in the FO process because of their high water permeability, rejection of divalent and monovalent ions, small structure parameter (S), and inexpensiveness compared to commercial FO membranes. Three PSRNF membranes were tested in the FO process with the feed solution facing the active membrane layer to avoid active layer delamination. Although the PSRNF membrane exhibited negligible water flux at 0 bar, it increased when a 2–4 bar was applied to the feed solution. The wastewater temperature was set at 25 °C while 40 °C was the brine operational temperature to mimic the field situation. A maximum average water flux of 39.5 L/m2h was recorded at 4 bar feed pressure when the PSRNF membrane was used for the brine dilution, achieving up to 42% divalent ions dilution at 0.02 kWh/m3 specific power consumption. The average water flux in the PRSNF membrane was 35% higher than that in the commercial TFC FO membrane. Notably, the PSRNF membrane is ten times cheaper than commercial FO membranes. Notably, the PSRNF membrane is ten times cheaper than commercial FO membranes, achieving substantial cost reductions and pioneering advancements in FO purification technology.