Significant Cost Savings Research Articles

Extended network applications of coherent pluggable transceivers [Invited

Over the past 15 years, coherent optical transceiver evolution has been driving the increase of capacity in optical networks, enabling the cost-effective transport of higher traffic volumes across submarine, long-haul, regional, and (a fraction of) metro networks. Until recently, these devices have been proprietary and embedded in dedicated line cards, which are deployed and managed within the transport network domain. With the emergence of both implementation and multi-source agreements for coherent optical transceivers in pluggable form factors, significant savings in cost, power consumption, and footprint are now achievable, e.g., in high-speed data center interconnect (DCI) and metro applications. Furthermore, by installing these transceivers directly in routers/switches, the long-envisioned IP over-DWDM architecture can be materialized. Importantly, recent progress in coherent pluggable transceivers’ performance and feature sets is expanding the number of network segments where their benefits can be leveraged. This paper overviews the range of applications of coherent pluggable optical transceivers and investigates in detail how they can (i) meet the stringent requirements of regional/long-haul networks and (ii) further simplify and reduce the capital expenditures of metro-aggregation networks. Particularly, it reports a comparison of the deployment in a reference regional network of coherent pluggable transceivers that retain full interoperability (at the expense of limited performance) and coherent pluggable transceivers designed for best-in-class performance. The network simulation analysis focuses on the key design metrics in this network segment—usable capacity and number of required transceivers—and highlights the importance of adopting high-performance devices. Moreover, it describes how a low-cost filterless architecture can be combined with coherent pluggable transceivers featuring point-to-multipoint (P2MP) capabilities via digital subcarrier multiplexing (DSCM) to reduce capital expenditures in metro-aggregation networks. It is shown that, by exploiting a transmitter-based launch power control, the number of optical amplifiers can be minimized while guaranteeing that the power unbalance associated with the different paths traversed by upstream subcarriers (SCs) can be kept below a target threshold.

A Parametric Study on the Behavior of Arch Composite Beams Prestressed with External Tendons

Arch beams are widely used in bridge construction due to their ability to withstand much greater loads than horizontal beams. The utilization of composite construction has also increased due to its tendency to optimize the utilization of construction materials, leading to significant savings in steel costs. In this research, a detailed experiment work on a simply supported arch composite beam under a positive moment was presented; then, a numerical model was created using ABAQUS to simulate its nonlinear behavior. The beams were formed from a concrete slab attached to steel beams by means of perfobond shear connectors (PSCs). A good agreement between the model and experiment was obtained. A parametric study was developed to identify the influence of the initial prestressing, rise to span ratio, and beam length on the behavior of the arch composite beam. It was found that the presence of tendons enhances the serviceability behavior, increases the ultimate load by 40% compared to the control beam, and equilibrates the horizontal thrust of the arch, even in the absence of initial prestressing. In addition, the beam exhibits a clear tied arch behavior due to the large eccentricity as the rise-to-depth ratio increases. Furthermore, the prestress force was found to be more effective in the longer span and the incremental stress in tendons more remarkable.

Budget Impact Analysis of Integrative Medicine Practices for Pediatric Patients with Chronic Pain.

Chronic pain is a leading cause of morbidity in children and adolescents globally but can be managed with a combination of traditional Western medicine and integrative medicine (IM) practices. This combination has improved various critical health outcomes, such as quality-of-life, sleep, pain, anxiety, and healthcare utilization. These IM practices include acupuncture, yoga, biofeedback, massage, mindfulness, or any combination of these modalities. The current manuscript developed a budget impact model to estimate the institutional costs of implementing these practices among adolescents. A decision tree was used to estimate the reduction in hospitalizations and emergency department (ED) use based on a previously published retrospective analysis of children receiving IM practices comparing utilization rates 1-year pre-and post-implementation of IM services (Figure 1). Costs associated with the implementation of each modality were based on hourly compensation rates for licensed professionals administering each service and equipment associated with delivery (e.g. acupuncture needles, biofeedback equipment, and sensors). The cost of each hospitalization and ED visit was derived from the literature. In addition, cost-savings were estimated based on government- and commercial-contracted reimbursement rates for each service. Cost-savings were approximated to range from $1344 to $3439 per patient, with even greater cost-savings of up to $6,000 and $4,132 when accounting for governmental and commercial payer reimbursement, respectively. IM leads to improved pain relief when combined with traditional medicine and yields significant cost-savings, thus supporting the routine implementation of IM alongside traditional medicine in healthcare settings.

Modeling and energy management of hangar thermo-electrical microgrid for electric plane charging considering multiple zones and resources

Achieving net zero goals by 2050 is driving an energy transition towards clean electrical energy. Consequently, many initiatives have been proposed aiming to reduce carbon emissions in the building and transportation sectors, focusing, for instance, on the implementation of efficient heating and cooling systems based on heat pumps and the use of electric planes. Microgrids can effectively integrate thermal and electrical energy resources and loads to satisfy customer demands while providing technical, economic, and environmental benefits. Thus, this paper proposes the implementation of a model of a hangar microgrid and its Energy Management System to optimize the dispatch of resources of such thermo-electrical airport grid, using a Model Predictive Control approach to address uncertainties, and including a detailed building thermal model, heat pump modeling for the heating and cooling systems, and battery degradation. The proposed mathematical model of the Energy Management System is applied to a model of a microgrid being developed for a hangar at the Waterloo Wellington Flight Centre in Ontario, Canada, taking into account the specific characteristics of the microgrid’s components, the expected energy consumption of the equipment and the electric plane used for pilot training based on field measurements, and multi-room temperature control requirements, seeking to ensure a reliable and cost-effective operation, while considering the occupants’ comfort in different spaces. The results indicate that the proposed Energy Management System model, featuring multi-room temperature control through multiple thermal resources, can achieve significant savings in operational costs and CO2 emissions compared to a scenario where the microgrid is not deployed and another where a single-room building thermal model with a single heat pump is included.

Restoration and evaluation for severed streams in high-density urban areas based on a multi-objective framework: A case study of Heping Stream in Nanjing

Numerous severed streams that emerge during rapid urbanization has been negatively impacting regional water systems and urban environments. Traditional restoration efforts are prone to focus on water quality, overlooking the complex of urban severed stream as natural-social ecosystems. However, current literature indicates a lack of systematic restoration methods and post-implementation evaluations tailored to severed streams, which adversely affects water resource management and sustainable urban development. This study bases on research of the severed streams in Nanjing’s Hexi New District to develop methods for the restoration and evaluation of severed streams in high-density urban areas. Taking the Heping Stream as a case study, it took three years to complete a full-process study encompassing the design, implementation, and post-occupancy evaluation of the restoration of the severed stream. We developed a multi-objective framework, including five measures for the restoration of severed streams, along with performance evaluation indicators from environmental, social, and economic perspectives to compare the state of the severed-stream before and after the restoration. So as to assess the effectiveness of the restoration methods and to put forward suggestions for the improvement of the restoration measures. The results showed that the method had a positive effect on the quality of the water environment, public evaluation, capital investment and energy consumption. Some of the environmental performance indicators were significantly improved after the restoration, especially the dissolved oxygen content, water flow. Most of the social performance indicators were better after the restoration than before. In terms of economic performance indicators, the use of photovoltaic energy resulted in significant savings in electricity and pumping costs. Performance evaluation confirmed comprehensive benefits of the method, with Run off Control, Waterfalls Construction and Riverbank Ecological Restoration being most effective. To improve the benefits of restoration, diverse strategies should be combined together, including runoff control, artificial wetlands, vegetated buffers, and riverbank restoration. This research can support the optimization of future restoration measures and scientific decision-making in urban severed-stream restoration.

A cost effectiveness analysis of a quality improvement intervention to increase preferential balanced fluid prescribing

BackgroundThe higher cost of balanced fluids has historically contributed to preferential normal saline (NS) use. Recent clinical trials demonstrated that balanced fluids reduced the incidence of major adverse kidney events among hospitalized patients and also reduced mortality among critically ill patients. This study sought to conduct an economic evaluation of a recently published quality improvement (QI) intervention to increase preferential balanced fluid prescribing, which significantly increased the relative proportion of balanced fluid orders.MethodsUsing clinical trial data and real-world data from our prior QI intervention in conjunction with local and regional cost data, we constructed a decision tree to examine the economic cost and clinical consequences of using NS, lactated ringers (LR), and plasma-lyte for 30,000 hypothetical adult patients and 1,290 hypothetical critically ill adult patients with sepsis admitted to our institution over one year. Clinical outcomes (hospitalization to day 30) included development of acute kidney injury (AKI), new requirement for renal replacement therapy (RRT), and in-hospital mortality. The primary economic outcome was the difference in cost between the pre- and post-QI intervention periods. Sensitivity analyses and breakeven analyses were performed. Evaluation was conducted from South Carolina hospitals’ perspective.ResultsFor the overall cohort, simulation predicted that 53 AKIs, 2 instances of RRT, and 62 deaths were avoided in the post-intervention year with a net cost savings of $704,507. For the critically ill patients with sepsis, simulation predicted that 32 AKIs, 4 instances of RRT, and 12 deaths were avoided with a net cost savings of $474,676. Sensitivity analyses using outcome data from additional clinical trials also estimated annual cost savings ($77,677-$414,872).ConclusionsThe QI intervention was predicted to improve patient outcomes while yielding significant cost-savings. The marginally increased cost of balanced fluids should not discourage implementation of interventions aimed at increasing evidence-supported balanced fluid prescribing.

Policy predictive model for better management of chronic obstructive pulmonary disease: economic-organisational implications in the Italian healthcare system

Background: Chronic obstructive pulmonary disease (COPD) represents a significant public health problem in Italy, with a high prevalence and a substantial economic burden on the National Health Service (NHS). Effective management of the disease is crucial for reducing exacerbations and improving patients’ quality of life. Methods: This study employs a dynamic predictive model to assess the economic impact of implementing three specific health policies aimed at improving COPD management over a five-year horizon. The analysis is conducted from the perspective of the NHS, focusing on the direct costs associated with disease management. Results: The implementation of the proposed policies demonstrated potential significant savings in direct healthcare costs. The first policy, focused on increasing therapeutic adherence, generated an estimated savings of 202 million €. The second, concerning the wider use of triple therapies, led to savings of about 142 million €. Finally, the third policy, aimed at reducing the delay in prescribing appropriate therapies, contributed to an additional saving of over 175 million € in the time horizon considered in the analysis. Overall, these results suggest a substantial improvement opportunity in COPD management, with significant economic benefits for the Italian NHS. Conclusion: The study confirms the importance of targeted policies in the management of COPD, highlighting how strategic interventions can lead to significant resource savings while simultaneously improving patient care. These results provide a solid foundation for further research and serve as a useful guide for decision-makers in planning effective intervention strategies, aimed at optimizing resources and enhancing disease management in the Italian healthcare context.

Amine-based deep eutectic solvents for CO2 capture: Experiments and molecular thermodynamics

Deep eutectic solvents (DESs) have shown great potential in capturing carbon dioxide (CO2) and are expected to help alleviate the pressing issue of global warming. This study utilizes experimental approaches and molecular dynamics(MD) simulation to research the process of CO2 capture with amine-based DESs. The DESs, composed of methyltriphenylphosphonium bromide (MTPPB) and methyldiethanolamine (MDEA) as the hydrogen bond acceptor (HBA) and donor (HBD), respectively, were evaluated for their physical properties and CO2 absorption capacity. Additionally, the impact of different water contents and temperatures on CO2 absorption was investigated. Results demonstrated that HBD quantity negatively correlates with viscosity while positively correlating with CO2 solubility. The water content of the DESs ranged from 10 wt% to 50 wt%, leading to a progressive reduction in viscosity, while the CO2 absorption capacity initially decreased and then increased. The DES with a molar ratio of 1:16 had the lowest viscosity of 10.5 mPa.s and the greatest CO2 absorption of 0.1004 g CO2/g DES at 50 wt% water content and 303.15 K, causing significant savings in solvent costs. MD simulations were utilized to explore the microscopic interactions among HBA, HBD, CO2, and water, revealing that the addition of 50 wt% water does not affect the structure of the DES. The experimental and computational studies presented in this study illustrate that the introduction of a specific quantity of water to DESs and selecting suitable temperatures can enhance CO2 capture efficiency, providing theoretical support for industrial application of CO2 capture.

Empirical study of facade retrofits for optimizing energy efficiency and cooling in school buildings in Saudi Arabia

Educational buildings in Saudi Arabia are characterized by high energy consumption, primarily due to cooling and lighting demands. This study aims to evaluate and optimize facade retrofitting strategies to improve energy efficiency and evaluate economic performance of many scenarios in Saudi school buildings, aligning with the sustainability objectives of Saudi Vision 2030. The research employs a simulation-based optimization methodology utilizing Design Builder software to explore key facade design variables, including Window-to-Wall Ratio, glazing type, local shading devices, and external wall insulation. The methodology is structured in sequential stages: it begins with the collection of base-case data, followed by a data-driven optimization process targeting specific design variables. This is then complemented by an economic and environmental assessment of the optimal retrofit scenarios, ultimately leading to the identification of the most effective energy-saving solution presented at the conclusion of the study. Through an optimization process, the research identifies retrofitting strategies that reduce cooling loads by up to 17 %, lighting energy consumption by 49 % and annual energy costs by 18 %. The study also includes an economic analysis of the retrofits, revealing significant savings in annual electricity costs and a reduction in the building's carbon footprint. This research contributes valuable insights into sustainable building practices, offering practical solutions for improving energy efficiency in the educational sector. The novelty of this study lies in its comprehensive analysis of facade retrofits within the context of extreme climatic conditions, which provides a replicable model for retrofitting educational buildings across the region. The findings have significant implications for policymakers, architects, and sustainability advocates seeking to meet Saudi Arabia's energy conservation goals.

Development and Test of Low-Cost Multi-Channel Multi-Frequency Lock-In Amplifier for Health and Environment Sensing.

Optical-based sensing techniques and instruments, such as fluorometric systems, absorbance-based sensors, and photoacoustic spectrometers, are important tools for detecting food fraud, adulteration, and contamination for health and environmental purposes. All the aforementioned optical equipments generally require one or more low-frequency Lock-In Amplifiers (LIAs) to extract the signal of interest from background noise. In the cited applications, the required LIA frequency is quite low (up to 1 kHz), and this leads to a simplification of the hardware with consequent good results in portability, reduced size, weight, and low-cost characteristics. The present system, called ENEA DSP Box Due, is based on a very inexpensive microcontroller proto-board and can replace four commercial LIAs, resulting in significant savings in both cost and space. Furthermore, it incorporates a dual-channel oscilloscope and a sinusoidal function generator. This article outlines the architecture of the ENEA DSP Box Due, its electrical characterization, and its applications within a project concerning laser techniques for food and water safety.

A novel dual-wheel air-conditioning system operating strategy in different seasons

The application of solid desiccant air-conditioning systems can significantly reduce building energy consumption. Previous studies have focused on innovating the integration of solid desiccant air-conditioning systems (DACS) to improve dehumidification performance in summer. In this paper, a novel DACS is proposed, which can humidify the supply air in winter based on satisfying the dehumidification demands in summer. It can satisfy the year-round humidity requirements of domestic housing with significant savings in humidification costs. Furthermore, the operating strategy of the novel DACS is proposed, particularly for winter humidification conditions. It is adaptable as well as cost-effective compared to traditional operating strategies. The dehumidification/humidification capacity of the core component, polymer desiccant wheel, and the variation of temperature rise/temperature drop are investigated under different variations of parameters, including air temperature, air humidity, air volume flow rate, and wheel speed. The results show that with the increase of supply air mass flow from 0.6 kg/s to 1.9 kg/s, the power consumption of the system only increases by 9.5 kW. In winter, when the supply air temperature decreases from 8 °C to 1 °C, the power consumption increases by 7.2 kW, but in summer, when the temperature of the supply air increases by 7 °C, the power consumption of the system decreases by 7.0 kW. The power consumption of the system varies greatly when the humidity of the supply air is less than 17 g/kg, conversely, the power consumption of the system showed a negative trend. The analysis demonstrates the effective performance of the proposed system under varying climatic conditions.

(254) THE PRICE OF ED: ANNUAL OUT OF POCKET COST DISPARITIES OF ERECTILE DYSFUNCTION MEDICATIONS

Abstract Introduction The prevalence of erectile dysfunction (ED) in the United States is estimated to be as high as 52% with older men more likely to experience ED. The initial treatment involves the use of phosphodiesterase 5 inhibitors (PDE5-I) to help sustain erections. However, there is wide variability of insurance coverage for PDE5-I, often making the medication inaccessible due to cost barriers. Thus, many discount programs have been created to provide more affordable options. Our goal was to understand the variability in cost through traditional Medicare Part D drug coverage programs and other popular discount programs. Objective To compare the costs of common ED medications between online discount platforms and Medicare Plan D. Methods We collected data on annual out-of-pocket (OOP) costs for ED medications from four different sources: Medicare Plan D, GoodRx, Mark Cuban Cost Plus Drug Company (MCCPDC), and Amazon Pharmacy. We compared the cost of lowest and highest routinely prescribed dosage of medications based on 30 tablets-per-month usage for three medications (Sildenafil 20 mg/100 mg, Tadalafil 2.5 mg/20 mg, Vardenafil 10 mg/20 mg). We compared the cost of PDE5-I under Medicare part D at 1) hospital retail pharmacies (identified using twelve different zip codes encompassing areas with comprehensive urologic oncology centers) and 2) commercial retail pharmacies (CVS, Walgreens, and Walmart – known to be large commercially available pharmacies in the United States). We compared these to GoodRx (at CVS, Walgreens, and Walmart), MCCPDC, and Amazon Pharmacy using R (V4.1.1). Results For Sildenafil 20 mg, the Plan D groups were comparable ranging from $1024-$1098 (Table 1). The cost of online platforms was cheaper, ranging from $82-$275. For Sildenafil 100 mg, the hospital-based pharmacies had a median price of $1446, whereas retail pharmacies under Plan D ranged from $22528-$22542. Online platforms for this drug were preferred at a cost of $89-$324. For Tadalafil 2.5 mg, the Plan D groups ranged from $4721-$4759. The cost of this drug via online platform was much lower, ranging from $82-$312. For Tadalafil 20 mg, the cost via Plan D ranged from $25210-$25235. The online platforms were reported to have much lower costs ranging from $103-$496. Vardenafil (both 10 and 20 mg) ranged from $19015-$19039 from Plan D groups and $86-418 from online pharmacies. For both sildenafil dosages and tadalafil dosages, Costplus was the most affordable option. For Vardenafil, GoodRx CVS was the cheapest option. We then compared the Plan D groups, GoodRx pharmacies, Costplus and Amazon and found that the costs of drugs via the discounted pharmacies were much cheaper compared to Plan D Medicare (Fig. 1). Conclusions Our results demonstrate that online discount pharmacies and GoodRx offer significant cost-savings for patients when compared to Medicare Part D plans. The high price variability at pharmacies due to minimal coverage of these drugs with Plan D may confuse and complicate drug purchases for patients. This analysis highlights the considerable cost disparity between traditional retail drugstores and discount platforms like GoodRx, MCCPDC, and Amazon Pharmacy. When counseling patients, healthcare providers can educate patients on these alternative platforms to increase access to essential medication and alleviate financial burdens. Disclosure No.

Penggunaan Energi Terbarukan PLTS untuk Efisiensi Biaya dan Keberlanjutan Usaha Bubur Bayi Shashi di Bukittinggi

Shashi Baby Porridge business in Bukittinggi faces significant operational cost challenges due to high electricity consumption, particularly from production equipment. To address this issue, a community service team from the Department of Electrical Engineering at Padang State Polytechnic implemented a Solar Power System (SPS) as an alternative solution. The service process included energy needs analysis, SPS system design, installation, and performance monitoring and evaluation. The implementation of the SPS successfully reduced electricity costs and dependence on conventional electricity while supporting environmental conservation efforts. The installed SPS, with a total capacity of 200 Wp, provides energy for lighting, resulting in significant savings in operational costs. Socialization with the owners and workers was also carried out to ensure optimal system maintenance and operation. The outcomes of this project are expected to inspire other small businesses to adopt renewable energy technologies to enhance efficiency and sustainability.

Development and application of artificial hydraulic lime for Chinese architectural heritage restorations

Lime is commonly employed in the restoration of historic buildings due to its strength properties, which align well with the demands of architectural heritage conservation. However, recent shortages in high-quality limestone raw materials and the commercial inclusion of finely ground limestone powder in hydrated lime powder have led to significant challenges. These include low initial strength, pronounced shrinkage and cracking, and poor resistance to frost. Although natural hydraulic lime (NHL) offers moderate strength, its high cost presents an obstacle to widespread use in architectural heritage restoration. Three types of artificial hydraulic lime (AHL) — AHL1, AHL2, and AHL3 — were prepared with the objective of low cost and easy scalability. These were formulated by incorporating white cement (WC), blast furnace slag powder (BFSP), heavy calcium carbonate powder (HCCP), and industrial-grade white sugar (WS) into industrial-grade hydrated lime powder (IHLP). To align the setting time of the AHLs with the requirements of traditional builders, WS was incorporated as a retarding agent. The addition of WC, BFSP, and HCCP to IHLP resulted in enhancements over IHLP in several key aspects: compressive strength, pore structure post-hardening, dry shrinkage rate, and frost resistance. This approach will enhance the restoration quality of architectural heritage in China, leading to fewer repeated repairs and significant savings in manpower and material costs. Ultimately, AHL2 was applied in the restoration of the Confucius Temple, proving its efficacy and alignment with traditional construction requirements. This research provides valuable theoretical and practical insights for enhancing the preservation of architectural heritage.

Explainable drug repurposing via path based knowledge graph completion

Drug repurposing aims to find new therapeutic applications for existing drugs in the pharmaceutical market, leading to significant savings in time and cost. The use of artificial intelligence and knowledge graphs to propose repurposing candidates facilitates the process, as large amounts of data can be processed. However, it is important to pay attention to the explainability needed to validate the predictions. We propose a general architecture to understand several explainable methods for graph completion based on knowledge graphs and design our own architecture for drug repurposing. We present XG4Repo (eXplainable Graphs for Repurposing), a framework that takes advantage of the connectivity of any biomedical knowledge graph to link compounds to the diseases they can treat. Our method allows methapaths of different types and lengths, which are automatically generated and optimised based on data. XG4Repo focuses on providing meaningful explanations to the predictions, which are based on paths from compounds to diseases. These paths include nodes such as genes, pathways, side effects, or anatomies, so they provide information about the targets and other characteristics of the biomedical mechanism that link compounds and diseases. Paths make predictions interpretable for experts who can validate them and use them in further research on drug repurposing. We also describe three use cases where we analyse new uses for Epirubicin, Paclitaxel, and Predinisone and present the paths that support the predictions.

Optimal scheduling and management of grid‐connected distributed resources using improved decomposition‐based many‐objective evolutionary algorithm

AbstractThis paper emphasizes the integration of wind and photovoltaic (PV) generation with battery energy storage systems (BESS) in distribution networks (DNs) to enhance grid sustainability, reliability, and flexibility. A novel multi‐objective optimization framework is introduced in this study to minimize energy supply costs, emissions, and energy losses while improving voltage deviation (VD) and voltage stability index (VSI). The proposed framework comprising normal boundary intersection (NBI) and decomposition‐based evolutionary algorithms (DBEA) determines the optimal siting and sizing of renewable‐based distributed resources, considering load demand variations and the intermittency of wind and solar outputs. The comparative analysis establishes that the proposed strategy performs better than many contemporary algorithms, specifically when all the objective functions are optimized simultaneously. The validation of the proposed framework was carried out on the standard IEEE‐33 bus test network, which demonstrates significant percentage savings in energy supply costs (49.6%), emission rate (62.2%), and energy loss (92.3%), along with enormous improvements in VSI (91.9%) and VD (99.8953%). The obtained results categorically underline the efficiency, reliability, and robustness of the proposed approach when employed on any complex distribution network comprising multiple renewable energy sources and battery storage systems.

Using Interventional Pharmacoeconomic Clinical Trials and Outcomes-Based Contracts to Repurpose Generic Drugs with Cost-Savings

The inability to enforce a monopoly price over low-cost therapies, such as repurposed generic drugs by using patents for new medical uses, means that pharmaceutical companies are not interested to develop these potentially lifesaving therapies, even if clinical trials would be significantly cheaper. With the cost of new drugs increasing unsustainably, new financial models are needed that can incentivize the development of such low-cost therapies, by leveraging the cost-savings they generate for payors. For example, by conducting a trial comparing a low-cost generic drug to an expensive patented drug, the cost-savings from patients taking a low-cost therapy rather than an expensive drug during the trial itself can exceed the cost of running the clinical trial, which means it is “self-funding,” while also potentially improving patient outcomes due to better safety, efficacy, convenience, or accessibility. This is referred to as “interventional pharmacoeconomics” or a “revolving research fund” and allows the sponsorship of clinical trials that can be entirely funded by payors. “Prize-like” outcomes-based contracts or advance market commitments can also be combined with such self-funding trials to incentivize obtaining regulatory approval and solve the “last-mile” problem. Self-funding trials can provide significant cost-savings for payors without financial risk. This article illustrates a four-step process for conducting such self-funding trials and other ethical, commercial, political, and legal barriers that need to be overcome in order to scale this novel and practically unlimited source of funding for the development of low-cost therapies.

Decision-focused learning under decision dependent uncertainty for power systems with price-responsive demand

Contemporary power systems are experiencing a growing integration of flexible resources on the consumer side. Different from flexible demand that submits specific bids to energy markets, price-responsive demand (PRD) adjusts its power consumption without notice, simply based on the resulting electricity prices as well as internal priorities and limitations. In this paper, we demonstrate how a high penetration of PRD (the behavior of which is invisible to the operator during the day-ahead unit commitment stage) results in systematic inefficiency costs and formulate the so-termed decision-focused learning problem of learning to provide a demand forecast which, once fed as an input to the operator’s economic dispatch optimization problem, results in an efficient dispatch. Interestingly, the prescribed demand forecast affects the resulting prices, which in turn affect the actual demand realization, giving rise to a decision-dependent uncertainty. Motivated by the problem’s hard-to-evaluate objective function, we solve it using Bayesian optimization. The empirical evaluations demonstrate significant savings in the effective real-time system cost, compared to the current practice of using the default demand forecast. Moreover, the method is shown to achieve a system cost that is fairly close to the one achieved by a system that fully integrates PRD into the day-ahead process; but without requiring any change in the operator’s existing dispatch algorithm while avoiding all efforts necessary for the integration of flexible demand, which is a widely pursued field of ongoing research.

Healthcare costs related to respiratory syncytial virus in paediatric intensive care units in the Netherlands: a nationwide prospective observational study (the BRICK study)

The implementation of the approved respiratory syncytial virus (RSV) preventive interventions in immunisation programmes is advancing rapidly. Insight into healthcare costs of RSV-related paediatric intensive care unit (PICU) admissions is lacking, but of great importance to evaluate the impact of implementation. Therefore, this study aimed to determine the total annual RSV-related paediatric intensive care healthcare costs in the Netherlands. A nationwide prospective, observational, multicenter study was performed from September 2021 until June 2023. The total annual RSV-related healthcare costs on PICUs in the Netherlands were calculated using RSV-related costs (subgroup I) and consequential costs (subgroup II and III). Subgroup I comprised all PICU admitted infants ≤12 months of age with laboratory-confirmed RSV infection. Subgroup II and III consisted of postponed elective PICU admissions and refused acute PICU admissions due to RSV-related lack of PICU capacity. A total of 424 infants with RSV-related PICU admission were included. Median age at PICU admission was 46 days (IQR 25-89). The median length of PICU admission was 5 days (IQR 3-8). The total RSV-related PICU costs are € 3,826,386 in 2021-2022, and € 3,183,888 in 2022-2023. Potential costs averted by RSV preventive interventions is € 1.9 to € 2.6 million depending on season, and the duration of protection. RSV-related PICU admissions cost €3.1 to €3.8 million in the Netherlands during one season. The introduction of new RSV preventive interventions into the Dutch immunisation programme will generate significant cost-savings on PICUs and decreases the admission burden of PICUs. None.

Validation of a qualitative real-time PCR assay for the detection of Candida auris in hospital inpatient screening.

This study overviews the validation and implementation of a molecular screening tool for the detection of Candida auris in a College of American Pathologist-accredited clinical laboratory. This molecular laboratory-developed test is both highly sensitive and specific and has significant health-system cost-savings associated with significantly reduced turn-around-time compared to traditional standard-of-care culture-based work up. This method and workflow is of interest to support clinical microbiology diagnostics and to help aid in hospital inpatient, and infection prevention control screening.