Resource Costs Research Articles

Délais d'attente d'implantation de valve aortique transcutanée (TAVI) et mortalité durant la période d'attente en Algérie

BackgroundTrans Aortic Valve Implantation (TAVI) has become the primary treatment for aortic stenosis in patients over 75 years old. Despite its clinical efficacy, it's adoption in emerging countries remains low due to the high cost of prostheses and limited healthcare funding resources. This leads to prolonged waiting times for the TAVI procedure, which may lead to complications; these data are missing particularly in emerging countries. AimsTo describe waiting time for TAVI and mortality rate in this waiting period. Materials and methodsThis was prospective registry, patients referred for TAVI were prospectively followed; waiting time was calculated from the first visit after referral to TAVI implantation, clinical and, call fellow up was performed every 3 months. We divided patients into two groups: Group 1 (G1) patients still awaiting TAVI (105 patients), and those who underwent TAVI (36 patients). Group 2 (G2) patients who died while awaiting TAVI (16 patients, 10,2 %). ResultsDemographic characteristics were similar, with a tendency for older age in G2 (79.5 ± 5.7 years vs. 82.5 ± 7.4 years, p=0,06). G2 exhibited more left ventricular ejection fraction (LVEF) impairment (8.5% vs. 25%, p=0,03) and a higher rate of severe heart failure with dyspnea stages III or IV (2.8% vs. 12.5%, p<0,001). The mean follow-up in G1 was 242.9 ± 137.4 days; the waiting time for TAVI was 231.7 ± 134.1 days, and the average time between the first consultation and death while awaiting TAVI (G2) was 335.1 ± 167.4 days. Conclusionin our series, waiting time is high due to limited Trans aortic heart valve availability, mortality during this wait exceeds 10%. Adverse prognostic factors include impaired LVEF and severe dyspnea stages III or IV.

Preparation of entangled W states based on cavity QED system

Abstract In this paper, we present a qubit-loss-free(QLF) fusion scheme for generating large-scale atom W states in cavity quantum electrodynamics(QED) system. Compared to the most current fusion schemes which are conditioned on the case where one particle can be extracted from each initial W state to fusion process, our scheme will access one or two particles from each W state. Based on the atom-cavity-field detuned interaction, three |W&gt; n+m+t states can be generated from |W&gt; n , |W&gt; m and |W&gt; t state with the help of two auxiliary atoms, three |W&gt; n+m+t+q states can be generated from |W&gt; n , |W&gt; m , |W&gt; t and a |W&gt; q state with the help of three auxiliary atoms. Comparing the numerical simulations of the resource cost of fusing three small-size W states based on the precious schemes with those based ours, our fusion scheme seems more efficient. This QLF fusion scheme can be generalized to the case of fusing k different or inentical particles W states. Furthermore, with no qubit loss, it greatly reduces the number of fusion steps and prepare W states with larger particle numbers.

Digital transformation at third-party logistics providers: Challenges and best practices

Background: Digital transformation (DT) is key for service providers in the logistics industry to achieve or retain a sustainable competitive advantage. However, for many third-party logistics (3PLs) in South Africa, implementing DT remains a challenge.Objectives: To explore the challenges that hinder the implementation of DT and to present the best practices that are important for achieving success in DT among South African logistics service providers.Method: This study was exploratory and descriptive. Data were collected through semi-structured interviews with a sample of 10 managers employed by South African 3PLs companies. Thematic analysis was used to analyse the data, which involved manually coding the findings, the organisation of these ‘codes’ into related areas to construct ‘descriptive’ themes and the development of ‘analytical’ themes.Results: The challenges and best practices of DT implementation centre around leadership and strategic alignment, technological integration and innovation, data management and cybersecurity, and resource optimisation and cost management.Conclusion: Substantial challenges and best practices associated with DT implementation in the logistics sector were identified.Contribution: The significance of the study lies in examining DT through the lens of 3PLs providers in South Africa, a segment not conventionally associated with innovation. The outcomes contribute to academic research and industry practice. Firstly, the findings bridge a critical gap in the existing literature, providing insight into previously unexplored DT challenges and best practices. Secondly, this study provides valuable insights into key areas, offering practical guidance for industry practitioners.

Cost-effectiveness analysis of a cardio-oncology rehabilitation framework compared to an exercise intervention for cancer survivors with high cardiovascular risk.

A cardio-oncology rehabilitation model among cancer survivors showed superior results comparing to a community-based exercise intervention. However, questions remain about its cost-effectiveness. To assess the cost-effectiveness of a center-based cardiac rehabilitation (CBCR) program when compared to usual care encompassing a community-based exercise training (CBET), among cancer survivors with high cardiovascular risk. The CORE study was a single-center, prospective, randomized controlled trial; 80 adult cancer survivors with previous exposure to cardiotoxic cancer treatment and/or with previous cardiovascular disease were assigned (1:1 ratio) to an 8-week CBCR or CBET, twice/week. Cost-effectiveness was a pre-specified secondary endpoint. Outcomes included healthcare resource use and costs, quality-adjusted life-years (QALYs) and cost-effectiveness; incremental cost-effectiveness ratio (ICER) was computed from a societal perspective. 75 patients completed the study (CBCR N=38; CBET N=37). The CBCR had significantly higher cost per patient (477.76 ± 39.08€) compared to CBET group (339.32 ± 53.88€), with a significant between-group difference 138.44€ (95% CI, 116.82 to 160.05€, p<0.01). A between-group difference by 0.100 points in QALYs was observed, favouring the CBCR (95% CI, -0.163 to -0.037, p=0.002). When CBCR was compared with CBET, the ICER was €1,383.24 per QALY gained; at a willingness-to-pay threshold of €5,000 per QALY, the probability of CBCR being cost-effective was 99.9% (95% CI, 99.4 to 100.0). The CORE trial shows that a CBCR is a cost-effective intervention in the management of cancer survivors with high cardiovascular risk, reinforcing the potential benefits of this multidisciplinary approach in supportive care of this specific subset of cancer patients.

Identifying suitable methods for evaluating the sterilizing effects of pyriproxyfen on adult malaria vectors: a comparison of the oviposition and ovary dissection methods

BackgroundNets containing pyriproxyfen, an insect growth regulator that sterilizes adult mosquitoes, have become available for malaria control. Suitable methods for investigating vector susceptibility to pyriproxyfen and evaluating its efficacy on nets need to be identified. The sterilizing effects of pyriproxyfen on adult malaria vectors can be assessed by measuring oviposition or by dissecting mosquito ovaries to determine damage by pyriproxyfen (ovary dissection).MethodLaboratory bioassays were performed to compare the oviposition and ovary dissection methods for monitoring susceptibility to pyriproxyfen in wild malaria vectors using WHO bottle bioassays and for evaluating its efficacy on nets in cone bioassays. Blood-fed mosquitoes of susceptible and pyrethroid-resistant strains of Anopheles gambiae sensu lato were exposed to pyriproxyfen-treated bottles (100 μg and 200 μg) and to unwashed and washed pieces of a pyriproxyfen long-lasting net in cone bioassays. Survivors were assessed for the sterilizing effects of pyriproxyfen using both methods. The methods were compared in terms of their reliability, sensitivity, specificity, resources (cost and time) required and perceived difficulties by trained laboratory technicians.ResultsThe total number of An. gambiae s.l. mosquitoes assessed for the sterilizing effects of pyriproxyfen were 1745 for the oviposition method and 1698 for the ovary dissection method. Fertility rates of control unexposed mosquitoes were significantly higher with ovary dissection compared to oviposition in both bottle bioassays (99–100% vs. 34–59%, P < 0.05) and cone bioassays (99–100% vs. 18–33%, P < 0.001). Oviposition rates of control unexposed mosquitoes were lower with wild pyrethroid-resistant An. gambiae s.l. Cové, compared to the laboratory-maintained reference susceptible An gambiae sensu stricto Kisumu (18–34% vs. 58–76%, P < 0.05). Sterilization rates of the Kisumu strain in bottle bioassays with the pyriproxyfen diagnostic dose (100 μg) were suboptimal with the oviposition method (90%) but showed full susceptibility with ovary dissection (99%). Wild pyrethroid-resistant Cové mosquitoes were fully susceptible to pyriproxyfen in bottle bioassays using ovary dissection (> 99%), but not with the oviposition method (69%). Both methods showed similar levels of sensitivity (89–98% vs. 89–100%). Specificity was substantially higher with ovary dissection compared to the oviposition method in both bottle bioassays (99–100% vs. 34–48%) and cone tests (100% vs.18–76%). Ovary dissection was also more sensitive for detecting the residual activity of pyriproxyfen in a washed net compared to oviposition. The oviposition method though cheaper, was less reliable and more time-consuming. Laboratory technicians preferred ovary dissection mostly due to its reliability.ConclusionThe ovary dissection method was more accurate, more reliable and more efficient compared to the oviposition method for evaluating the sterilizing effects of pyriproxyfen on adult malaria vectors in susceptibility bioassays and for evaluating the efficacy of pyriproxyfen-treated nets.

#1968 IgA nephropathy and impact of proteinuria and kidney function decline on healthcare resource utilisation among adults in the United Kingdom

Abstract Background and Aims Immunoglobulin A nephropathy (IgAN) is the most common primary glomerulonephritis and can result in kidney failure, especially if left untreated. Proteinuria ≥1.0 g/day is a major risk factor for IgAN progression and rapid kidney function decline. This study describes the characteristics of patients with IgAN in the United Kingdom (UK) and the impact of proteinuria and chronic kidney disease (CKD) stage on healthcare resource utilisation (HRU) and costs. Method In this retrospective, descriptive analysis, eligible patients had at least one code among ICD-9 583.9, ICD-10 N02.8, and ICD-10 N02.9 between 1 October 2015 and 1 October 2022. They were stratified by CKD stage and proteinuria level. CKD stage was defined by ICD-10 N18 code and estimated glomerular filtration rate. Proteinuria level was grouped as low or high by protein excretion rate (&amp;lt;1 g/day vs ≥1 g/day), protein/creatinine ratio (&amp;lt;0.88 g/g vs ≥0.88 g/g), or albumin/creatinine ratio (&amp;lt;100 mg/mmol vs ≥100 mg/mmol). HRU data for 1 year from the index date were obtained from electronic medical records, and costs were obtained from the National Schedule of the National Health Service 2021/22. Weighted average costs were calculated for inpatient, outpatient, and emergency visits. Results We identified 6 940 patients with IgAN. The mean age was 62 years, and most patients (n = 3 980; 57%) were male. For all visit types, HRU (Fig.) and costs (Table) increased with advancing CKD. For all visit types combined, the mean total cost per patient was &amp;gt;23 times higher for CKD stage 5 than stage 1 (£60 259 vs £2 609). Of 2 080 patients with proteinuria data, 560 (27%) had high proteinuria. Annual costs per patient (Table) and the numbers of all visit types (Figure) were higher for patients with a protein excretion rate ≥1 g/day than those with a rate &amp;lt;1 g/day (£12 622 vs £2 822). Conclusion In patients with IgAN in the UK, elevated proteinuria and advanced CKD stage were associated with higher HRU and costs across visit types. Treatments that reduce proteinuria can slow disease progression and prevent rapid decline in kidney function while potentially reducing IgAN-related resource utilisation and costs.

High Cerium content Fe‐Ce‐Nd‐B sintered magnets with high coercivity

Ce substitution of Nd in FeNdB sintered magnets is very interesting for reasons of resource efficiency, sustainability and costs. However, the magnetic properties of high Ce‐content magnets are poor. This is mainly due to the lower values of intrinsic magnetic properties of Fe14Ce2B compared to Fe14Nd2B as well as the Laves phase Fe2Ce, which is formed in the grain boundaries and forms flat aggregates for higher Ce‐content. In this paper, sintered magnets with 75 at% degree of substitution of the composition Fe70.9‐[(Ce1‐xLax)0.75Nd0.25]18.8‐B5.8‐M4.5 (M = Co, Ti, Al, Ga, Cu, 0 ≤ × ≤ 0.3) are produced and analyzed. It is shown that a new rare earth rich grain boundary phase is formed adding La and that the Laves phase fraction can be reduced by up to 85%. With increasing La content, the remanence and Curie temperature increase and the temperature coefficient of Hc improves. A coercivity, remanence and maximum energy density of up to µ0Hc = 0.74 T, Jr = 0.98 T and (BH)max = 139.9 kJ/m3 have been achieved.This article is protected by copyright. All rights reserved.

Chemotherapy-induced febrile neutropenia (FN): healthcare resource utilization (HCRU) and costs in commercially insured patients in the US

PurposeFebrile neutropenia (FN) is a known side effect of chemotherapy, often requiring hospitalization. Economic burden increases with an FN episode and estimates of cost per episode should be updated from real-world data.MethodsA retrospective claims analysis of FN episodes in patients with non-myeloid malignancies from 2014 to 2021 was performed in IQVIA PharMetrics® Plus database. FN episodes were defined as having same-day claims for neutropenia and fever or infection, plus antibiotic in outpatient settings, following a claim for chemotherapy; index date was defined as the first claim for neutropenia/fever/infection. Patients receiving bone marrow/stem cell transplant and CAR-T therapy were excluded, as were select hematologic malignancies or COVID-19. Healthcare utilization and costs were evaluated and described overall, by episode type (w/wo hospitalization), index year, malignancy type, NCI comorbidity score, and age group.Results7,033 FN episodes were identified from 6,825 patients. Most episodes had a hospitalization (91.2%) and 86% of patients had ≥1 risk factor for FN. Overall, FN episodes had a mean (SD) FN-related cost of $25,176 ($39,943). Episodes with hospitalization had higher average FN-related costs versus those without hospitalization ($26,868 vs $7,738), and costs increased with comorbidity score (NCI=0: $23,095; NCI >0-2: $26,084; NCI ≥2: $26,851).ConclusionsFN continues to be associated with significant economic burden, and varied by cancer type, comorbidity burden, and age. In this analysis, most FN episodes were not preceded by GCSF prophylaxis. The results of this study highlight the opportunity to utilize GCSF in appropriate oncology scenarios.

Healthcare Resource Utilization, Costs, Clinical Events, and Treatment Patterns in Extreme High-Risk Patients for Cardiovascular Events Undergoing Lipoprotein Apheresis: A German Claims Data Analysis

Abstract Aim Insights into treatment patterns, clinical and economic burden of patients undergoing Lipoprotein apheresis (LA). 3 cohorts were characterized: newly treated [Cohort A], experienced [B], matched cohort [C, high CV risk without LA]. Method Clinical burden was assessed by cardiovascular-related hospitalizations and procedures. Economic and clinical outcomes were described over a 12-month baseline period up to 3 years after LA initiation. Results Absolute LA cases decreased from 1.7 to 1.1 per 100,000 patients. In Cohort A, rate of major cardiovascular hospitalizations decreased, while annual healthcare expenditure increased. Cohort B had significantly higher costs than C. Conclusion LA may be associated with a reduced frequency of myocardial infarction-related hospitalizations. However, it is expensive. Alternatives are needed to reduce its high economic burden.

The impact of surgery resident training on the duration of tibial plateau leveling osteotomy surgery.

To investigate the impact of surgery resident training on surgery duration in tibial plateau leveling osteotomy (TPLO) and evaluate whether surgery duration differs with each year of residency training. Retrospective medical record review. A total of 256 client-owned dogs underwent TPLO. Records of dogs that underwent TPLO between August 2019 and August 2022 were reviewed. The effects of the surgeon (faculty/resident) and the procedure (arthrotomy/arthroscopy) on TPLO surgery duration were examined with an analysis of variance, and geometric least squares means (GLSM) were compared. A linear mixed effects model (LMM) was fitted to quantify fixed and random effects. Four faculty surgeons performed 74 (29%) TPLOs, while 10 residents performed 182 (71%) TPLOs under the direct supervision of a faculty surgeon. All TPLOs were conducted with arthrotomy (109; 43%) or arthroscopy (147; 57%). Overall, residents (GLSM, 153 min) required 54% more surgery duration than faculty surgeons (GLSM, 99 min). Surgery duration among first-year residents (GLSM, 170 min) was 15% longer than second- (GLSM, 148 min) and third-year (GLSM, 147 min) residents, whereas the duration did not differ statistically between second- and third-year residents. Arthroscopy, meniscal tear treatment, surgery on the right stifle, and increasing patient weight were also associated with longer surgery duration. The duration of TPLO surgery significantly decreased after the first year of residency, but did not decrease afterward. The results will aid with resource allocation, curricula planning, and cost management associated with resident training.

Cost Effectiveness of Adding Fenfluramine to Standard of Care for Patients with Dravet Syndrome in Sweden.

This study evaluated, in a Swedish setting, the cost effectiveness of fenfluramine (FFA) as an add-on to standard of care (SoC) for reducing seizure frequency in Dravet syndrome, a severe developmental epileptic encephalopathy. Cost effectiveness of FFA+SoC compared with SoC only was evaluated using a patient-level simulation model with a lifetime horizon. Patient characteristics and treatment effects, including convulsive seizures, seizure-free days and mortality, were derived from FFA clinical trials. Resource use and costs included cost of drug acquisition, routine care and monitoring, as well as ongoing and emergency resources. Quality of life (QoL) estimates for patients and their caregivers were derived from clinical trial data. Robustness was evaluated by one-way sensitivity analysis, probabilistic sensitivity analysis and scenario analyses. Lifetime cost of FFA+SoC was ~3 million SEK per patient compared with ~1.5 million SEK for SoC only. FFA+SoC generated 15% more QALYs than SoC only (21.2 vs 18.5 over a lifetime), resulting in an incremental cost-effectiveness ratio (ICER) of ~540,000SEK. Moreover, FFA+SoC had a higher probability of being cost effective than SoC only from a willingness-to-pay threshold of 710,000SEK. Results remained generally consistent across scenario analyses, with only few exceptions (exclusions of carer utility or FFA effect on sudden unexpected death in epilepsy). Due to better seizure control, FFA is a clinically meaningful add-on therapy and was estimated to be a cost-effective addition to current SoC for patients with this rare disease in Sweden at a willingness-to-pay threshold of 1,000,000 SEK.

The heterogeneous impact of China–Europe railway express on the efficiency of logistics industry in node cities

PurposeThe spatiotemporal compression effect of China–Europe Railway Express (CR-Express) can reduce the flow costs of resources between China’s node cities. Additionally, it can break through the limitations of low-added-value marine products, significantly impacting the logistics industry efficiency. However, there are few literature verifying and analyzing its heterogeneity. This study explores the impact of CR-Express on the efficiency of logistics industry in node cities and analyzes the heterogeneity.Design/methodology/approachFirst, this study uses panel data to measure the efficiency of node city logistics industry. Secondly, this study discusses the impact of the opening of CR-Express on the efficiency of logistics industry in node cities based on the multi-period differential model. Finally, according to the node city difference, the sample city experimental group is grouped for heterogeneity analysis.FindingsThe results show that CR-Express can promote the urban logistics industry efficiency, with an average effect of 4.55%. According to the urban characteristics classification, the heterogeneity analysis shows that the efficiency improvement effect of logistics industry in inland cities is more obvious. The improvement effect of node cities and central cities in central and western China is stronger, especially in the sample of megacities and type I big cities. Compared with non-value chain industrial products, the CR-Express has significant promotion effects on the logistics efficiency of the cities where main goods are value chain products.Originality/valueUnder the background of double cycle development, this paper can provide a scientific basis for the investment benefit evaluation of CR-Express construction and the follow-up route planning.

Treatment Patterns, Acute Healthcare Resource Use, and Costs of Patients with Treatment-Resistant Depression Completing Induction Phase of Esketamine in the United States.

This study aimed to understand treatment patterns, acute healthcare use, and cost patterns among adults with treatment-resistant depression (TRD) who completed induction treatment with esketamine nasal spray in the United States (US). Per label, induction is defined as administration twice a week for 4 weeks, after which maintenance is started on a weekly basis for 4 weeks, and thereafter, patients are treated weekly or bimonthly. Adults with one or more esketamine claim (index date) on or after March 5, 2019 were selected from Optum's de-identified Clinformatics® Data Mart Database (January 2016-June 2022). Before the index date, patients had evidence of TRD and ≥12 months of continuous insurance eligibility (baseline period). Patients with eight or more esketamine treatment sessions were included in the main cohort. A subgroup included patients with one or more baseline mental health (MH)-related inpatient (IP) admission or emergency department (ED) visit (i.e., prior acute healthcare users). Treatment patterns were described during the follow-up period (index date until earliest of end of insurance eligibility or data); acute healthcare (i.e., IP and ED) resource use and costs (2021 US dollars) were reported during the baseline and follow-up periods. Of the 322 patients in the main cohort, 111 comprised the subgroup of prior acute healthcare users. During the follow-up period, mean time from index date to eighth esketamine session was 73.2days in the main cohort and 78.8days in the subgroup (per label, 28days). Further, 75.2% of the main cohort and 73.9% of the subgroup completed four or more esketamine maintenance sessions following induction. In the main cohort, mean all-cause acute healthcare costs per patient per month (PPPM) decreased from baseline ($837) to follow-up ($770). Similar reductions were observed for mean MH-related acute healthcare costs PPPM (baseline $648, follow-up $577). In the subgroup, mean all-cause acute healthcare costs PPPM also decreased (baseline $2323, follow-up $1423), driven by mean MH-related acute healthcare costs PPPM (baseline $1880, follow-up $1139). Mean all-cause acute healthcare use per ten patients per month remained largely stable from baseline to follow-up in the main cohort (IP days: baseline 2.24, follow-up 2.13; ED visits: baseline 1.33, follow-up 1.45) and decreased in the subgroup (IP days: baseline 6.38, follow-up 4.56; ED visits: baseline 2.58, follow-up 2.41). Trends in mean MH-related acute healthcare use were similar. Patients generally required more time than label recommendation to complete esketamine induction treatment, and most went on to have 12 or more esketamine sessions. Completion of induction treatment correlated with reductions in mean all-cause and MH-related acute healthcare costs. Larger reductions were seen in the subgroup of prior acute healthcare users.

Intelligent detection method of microparticle virus in silkworm based on YOLOv8 improved algorithm

AbstractThe presence of microparticle viruses significantly impacts the quality of silkworm seeds for domestic sericulture, making their exclusion from detection in silkworm seed production crucial. Traditional methods for detecting microparticle viruses in silkworms, such as manual microscopic observation, molecular biology, and immunological approaches, are cumbersome and unable to achieve intelligent, batch real-time detection. To address this challenge, we employ the YOLOv8 algorithm in this paper. Firstly, NAM attention is introduced in the original algorithm’s Backbone component, allowing the model to extract more generic feature information. Secondly, ODConv replaces Conv in the Head component of the original algorithm, enhancing the model’s ability to identify microparticle viruses. Finally, NWD-LOSS modifies the CIoU loss of the original algorithm to obtain a more accurate prediction box. Experimental results demonstrate that the NN-YOLOv8 model outperforms mainstream detection algorithms in detecting silkworm microparticle diseases. With an average detection time of 22.6 milliseconds per image, the model shows promising prospects for future applications. This model improvement enhances detection efficiency and reduces human resource costs, effectively realizing detection intelligence.

The Effect of Amortizing the Value of Human Resource Cost on the Financial Performance of Nigeria Banks

This study looked into how Nigerian banks' financial performance was affected by depreciating their human resource costs. The research design used in this study is the survey research design. Reliability and validity of the data sources were established by the questionnaire. The data were analyzed using the descriptive and Regression statistical technique. It was discovered that human resources had a major influence (Adj R2 = 0. 858, F (9.064)). The findings showed that financial performance benefited from the expense of human resource training. FP was significantly impacted by HRTC (β = 0.3.86, t = - 1.586, p&lt; 0.05), and FP was significantly impacted by HRAC (β = 0.911, t = 4.143, p&lt;0.05). According to the study, using acquisition costs for human resources has a favorable effect on an organization's financial performance. The management boards of the banks under examination are advised by the study to work toward implementing the policy of classifying human resource costs as assets. To guarantee that their employees have the technical know-how and understanding to perform their tasks more efficiently, banks must plan regular training sessions for their HR department. Since the organization's most significant asset is its human resources, the Central Bank of Nigeria ought to ensure that the funds allocated to them are appropriately declared and acknowledged as assets in bank annual reports. By doing this, the genuine financial performance of the institutions will be more accurately depicted.

Physical activity with person-centered guidance supported by a digital platform or with telephone follow-up for persons with chronic widespread pain: Health economic considerations along a randomized controlled trial.

The aim was to investigate the resource use and costs associated with the co-creation of a physical activity plan for persons with chronic widespread pain (CWP) followed by support through a digital platform, compared to telephone follow-up. In this 12-month cost comparison study following up results after a randomized controlled trial, individuals with CWP, aged 20-65 years, were recruited at primary healthcare units in Western Sweden. All participants developed a person-centered health-enhancing physical activity plan together with a physiotherapist. Participants were then randomized to either an intervention group (n = 69) who had a follow-up visit after 2 weeks and was thereafter supported through a digital platform, or an active control group (n = 70) that was followed up through one phone call after a month. Costs to the health system were salary costs for the time recorded by physiotherapists when delivering the interventions. The reported time per person (2.8 h during the 12 months) corresponded to costs of SEK 958 (range: 746-1,517) for the initial visits and follow-up (both study groups), and an additional 2.5 h (corresponding to a mean SEK 833; range: 636-1,257) for the time spent in the digital platform to support the intervention group. After co-creation of a physical activity plan, it was more costly to support persons through a digital platform, compared to telephone follow-up.

Blockchain-Based Lean Supply Chain: A Simulation Approach

This paper aims to propose a model based on blockchain and cloud computing technologies to support lean production techniques for industrial supply chain management, evaluating how the combination of these technologies provides improvement in the chain performance. The literature review contextualizes the state of the art in studies related to the application of blockchain technology to lean manufacturing processes, as well as identifies research gaps in this field. Besides, this study models and simulates an architecture based on both the Hyperledger Fabric network and a virtual machine in the cloud environment, assessing its applicability and performance in the industrial supply chain. The analysis addresses lean aspects identified as research gaps, including integration of stakeholders in the collaborative production of customized products, conditions of flexibility and adaptability to demand variations, coordinated relationship of networks involving small and medium-sized enterprises, and behavior of various players acting simultaneously and consensually. The proposed model reveals a decentralized and nonlinear information sharing concept that demonstrates a logic of simultaneous participation of all players involved in the supply chain. The low costs and processing times identified in the simulation indicate the robustness of the system even in transactions involving a large number of companies and a large amount of data. This architecture offers an integration solution between stakeholders to support operational processes, providing insights for researchers and specialists in the adoption of innovative, reliable and inclusive information technologies for companies of different sizes or levels of development, with a focus on lean manufacturing, reduction in resource consumption and cost reduction. The developed model, which combines blockchain and cloud computing technologies applied to stages of lean production systems, presents a differentiated solution on the planning of integrated production systems, indicating the differential in this work.

Improvement in the Accuracy and Efficiency of Smoothed Particle Hydrodynamics: Point Generation and Adaptive Particle Refinement/Coarsening Algorithms

Improvement in the Accuracy and Efficiency of Smoothed Particle Hydrodynamics: Point Generation and Adaptive Particle Refinement/Coarsening Algorithms

Technical Systems Effectiveness Management Technique

Currently, the task of performing a target function by a technical system with minimal resource costs is urgent. Obtaining the beneficial effect of a vehicle depends on many factors, which can become the basis for the formation of a control effect on the functional part of the system. At the same time, it is necessary to take into account the importance of a useful (target) effect in order to manage the technical systems effectiveness. The purpose of this article is to describe an instrument that allows adaptively redistributing the resource spent on the implementation of a purposeful process in the vehicle, based on the requirements of the consumer function and the target effect. As a result of the conducted research, the article proposes a technique for redistributing the resource of a technical system in the interests of its effectiveness management. The features of the presented technique are the visibility of its results presentation, as well as the possibility of application in evaluating the effectiveness and it`s management in relation to various types of technical systems, which will allow to substantiate the practical significance of obtained results.

Association Between Sleep Apnea Treatment and Health Care Resource Use in Patients With Atrial Fibrillation.

Obstructive sleep apnea (OSA) contributes to the generation, recurrence, and perpetuation of atrial fibrillation, and it is associated with worse outcomes. Little is known about the economic impact of OSA therapy in atrial fibrillation. This retrospective cohort study assessed the impact of positive airway pressure (PAP) therapy adherence on health care resource use and costs in patients with OSA and atrial fibrillation. Insurance claims data for ≥1 year before sleep testing and 2 years after device setup were linked with objective PAP therapy use data. PAP adherence was defined from an extension of the US Medicare 90-day definition. Inverse probability of treatment weighting was used to create covariate-balanced PAP adherence groups to mitigate confounding. Of 5867 patients (32% women; mean age, 62.7 years), 41% were adherent, 38% were intermediate, and 21% were nonadherent. Mean±SD number of all-cause emergency department visits (0.61±1.21 versus 0.77±1.55 [P=0.023] versus 0.95±1.90 [P<0.001]), all-cause hospitalizations (0.19±0.69 versus 0.24±0.72 [P=0.002] versus 0.34±1.16 [P<0.001]), and cardiac-related hospitalizations (0.06±0.26 versus 0.09±0.41 [P=0.023] versus 0.10±0.44 [P=0.004]) were significantly lower in adherent versus intermediate and nonadherent patients, as were all-cause inpatient costs ($2200±$8054 versus $3274±$12 065 [P=0.002] versus $4483±$16 499 [P<0.001]). All-cause emergency department costs were significantly lower in adherent and intermediate versus nonadherent patients ($499±$1229 and $563±$1292 versus $691±$1652 [P<0.001 and P=0.002], respectively). These data suggest clinical and economic benefits of PAP therapy in patients with concomitant OSA and atrial fibrillation. This supports the value of diagnosing and managing OSA and highlights the need for strategies to enhance PAP adherence in this population.