Supply Costs Research Articles

Modeling the Water Supply Costs of the Algerian Municipalities

Modeling the Water Supply Costs of the Algerian Municipalities

Inpatient cost comparison of total and unicompartmental knee arthroplasty in patients with medial compartmental osteoarthritis using time-driven activity-based costing.

Using time-driven activity-based costing (TDABC), we sought to compare the total facility costs, comprising supply and personnel costs during the episode of care for the index procedure, in patients with isolated medial compartmental knee osteoarthritis (OA) undergoing unicompartmental knee arthroplasty (UKA) versus total knee arthroplasty (TKA). We conducted a retrospective analysis of 100 UKAs and 100 TKAs from 2019 to 2022. From a larger sample of 4899 TKAs and 137 UKAs, patients with isolated medial OA (Kellgren-Lawrence Grade <2 in other compartments) were radiographically identified. Demographic data included age, sex and body mass index, with comorbidities controlled using the Charlson comorbidity index. Facility costs were calculated using TDABC and standardized in cost units (CUs), a metric for comparing costs across procedures. Multiple regression analysis was used to assess the independent effect of TKA versus UKA on facility costs. TKA patients had similar operative times (TKA vs. UKA: 1.01×, p = 0.783) and supply costs (1.00×, p = 0.866), where 'x' denotes the relative cost ratio. However, TKA was associated with higher personnel costs (260.0 vs. 222.5 CUs [1.17×], p < 0.001) and total facility costs, both including (706.3 vs. 667.5 CUs [1.06×], p = 0.007) and excluding implants (353.8 vs. 312.5 CUs [1.13×], p < 0.001). Adjusted for demographics and comorbidities, TKA had increased facility costs, including (32.2 CUs, 95% confidence interval [CI]: 2.9-61.5, p = 0.031) and excluding implants (37.8 CUs, 95% CI: 15.2-60.3, p = 0.001). TDABC analysis revealed higher total facility costs for the index procedure in TKA, suggesting UKA may be a cost-saving alternative for isolated medial compartment knee OA. Level III, retrospective comparative study.

Does Transforaminal Endoscopic Lumbar Discectomy Provide More Value than Microdiscectomy? An Application of the Operative Value Index

BACKGROUND AND OBJECTIVES: A few studies have compared the value (outcomes per dollar spent) provided by transforaminal endoscopic discectomy (TED) vs microdiscectomy (MD) for lumbar disc herniations. Here, we attempt to address this gap using a novel Operative Value Index (OVI), which combines a procedure-specific patient-reported outcome with intraoperative cost data based on time-driven activity-based costing. METHODS: MD (n = 95) and TED (n = 23) performed by neurosurgeons at our institution from 2017 to 2022 were retrospectively identified. Time-driven activity-based costing was applied to identify both direct and indirect costs for all cases. Individual costs were obtained by direct observation, electronic medical records, and through consulting multiple departments (including business operations, sterile processing, plant operations, and pharmacy). Oswestry Disability Index (ODI) scores were prospectively collected at baseline and 3 months after surgery. Our primary outcome of interest was the OVI, defined as the percent change in the ODI per $1000 spent intraoperatively. Generalized linear mixed model regression was performed to assess whether TED was associated with significantly different OVI as compared to MD. Similar analyses were also performed for operative times and length of stay. RESULTS: The average intraoperative cost of a TED was $3698, as compared to $3410 for an MD. For both procedures, this total cost was largely driven by the cost of supplies and personnel. Multivariable regression revealed that MD was associated with significantly higher OVI (β-coefficient: 7.2, P &lt; .05) and lower operative times (β-coefficient: - 34.6 minutes, P &lt; .01) compared with TED, with no significant differences in length of stay (P = .17). CONCLUSION: When performed by surgeons at our institution from 2017 to 2022, MD was associated with a 7% greater improvement in ODI per $1000 spent intraoperatively. Continual assessment of value over time (both for established procedures and new techniques) will become increasingly important with the emergence of value-based care.

Cost analysis of adding hypertension and diabetes management into routine HIV care in Mbarara and Ibanda districts, Uganda.

In 2016, Uganda introduced services for hypertension and diabetes in selected HIV clinics. We evaluated the costs associated with scaling up these services in HIV clinics in Mbarara and Ibanda districts, Uganda. We estimated the annual costs of providing hypertension and diabetes services using an activity-based costing approach from the health system perspective in ten randomly selected HIV clinics in Mbarara and Ibanda districts. Cost inputs included 2023 data on costs of medications, health provider time, salaries, training costs, and monitoring costs. We determined the average annual cost and medication costs for hypertension and diabetes treatment per enrolled adult patient, stratified by type of health facility. The total annual cost of hypertension and diabetes management services in ten selected HIV clinics was estimated to be $413,850 (range: $8,386 - 186,973). The annual average clinic-level cost per enrolled patient was estimated at $14 (range: $7 - 31). Of the total annual cost, the cost of provider time for initial and follow-up visits represented the largest cost component in 5/10 clinics (mean: 37%, range [13-58%]). In 4/10 clinics, the major cost components were the costs of medication, diagnostic tests, and related supplies (mean: 37%, range [10-75%]). The average cost per enrolled adult patient was $11 at public facilities and $21 in private not-for-profit facilities. The average medication cost per patient for hypertension was $24 (range: $7 - 97) annually; $13 at public facilities and $50 at private not-for-profit facilities. For diabetes treatment, the average annual medication cost per patient was estimated at $14 (range: $6 - 35); $11 at public facilities and $22 at private not-for-profit facilities. Adding hypertension and diabetes management to routine HIV care might be feasible based on the estimated annual cost per patient. Hypertension and diabetes treatment was more costly in private not-for-profit facility-based clinics than at public facilities. This variation was primarily driven by higher medication procurement prices at private facilities, revealing a potential area for optimizing costs through improved procurement practices.

Aggregate Output Stability: Divergent Perspectives

The main objective of this article was to describe two asymmetric perspectives of the aggregate imbalance approach. Starting from the contrast of the Rational Expectations and Keynesian approaches, we analyze the characterization that the general reserve makes of the causes of inflation and the implications that it has on economic policy decisions. From the rational expectations approach, companies and workers form a kind of coherent group that jointly experiences fluctuations in the prices of their products and faces in unison the problem of signal extraction. On the other hand, the Keynesian approach to effective demand explains price fluctuations in principle as an expression of insufficient demand that generates involuntary unemployment. It was identified that the increase in margins during 2021 sought to pass on to consumers and end users of the goods and services of oligopolistic structures the increase in marginal costs induced by the fall in effective demand; resulting in an effect of price increases on the supply side or cost inflation.

What is the True Cost of Motion Preservation? A Time-Driven Activity-Based Cost Analysis of Anterior Cervical Discectomy and Fusion versus Disc Replacement

Total disc replacement (TDR) has become a viable alternative to anterior cervical discectomy and fusion (ACDF) for select patients. Although most comparative studies have assessed outcomes, cost differences remain largely uninvestigated. This information is critical as we move towards value-based reimbursement. To address this knowledge gap, we used time-driven activity-based costing (TDABC) to compare total intraoperative costs between the two procedures. Total cost was divided into direct (personnel and supply cost) and indirect costs (administrative and overhead costs). Individual costs were determined through direct observation, electronic medical records, and through querying multiple departments (including business operations, sterile processing, plant operations, and pharmacy). Timestamps for all involved personnel and material resources were documented, in conjunction with process mapping of the intraoperative period. Total intraoperative costs were estimated for all ACDFs (n=810) and TDRs (n=54) from 2017 to 2022. Regression analyses were performed to identify factors associated with total cost. A total of 810 and 54 patients underwent one- and two-level ACDFs and TDRs, respectively. The average total intraoperative cost for an ACDF was $6,776 +/- $2,808, compared to $12,026 +/- $4,235 for TDR. Supply cost accounted for the majority of total cost for both procedures ($4,173 +/- $2,225 for ACDF and $9,532 +/- $4,010 for TDR). On multivariable linear regression analysis, TDR was associated with roughly $3,885 of additional cost compared to ACDF (p<0.001), as well as $4,072 in additional supply cost (p<0.001), most of which was driven by the higher cost of implants (p<0.001). TDABC is a highly useful methodology for estimating differences in true costs between procedures and determining cost drivers. TDRs were associated with an additional $3,885 of total intraoperative cost as compared to ACDFs, the majority of which was driven by the cost of implants.

Biomass-Driven Polygeneration Coupled to Power-to-X: An Energy and Economic Comparison Between On-Site Electric Vehicle Charging and Hydrogen Production

The power-to-X strategy for passenger car applications offers a viable solution for using the surplus electrical power from renewable energy sources instead of exporting it to the grid. The innovative system proposed in this study allocates surplus electrical power from a building-integrated biomass-based Combined Cooling Heating and Power (CCHP) system to on-site applications and evaluates the energetic and economic benefits. The system comprises two key components: a 50 kW electric vehicle (EV) charging station for EVs and a 50 kW alkaline electrolyzer system for on-site hydrogen production, which is later dispensed to fuel cell electric vehicles (FCEVs). The primary goal is to decrease the surplus of electricity exports while simultaneously encouraging sustainable transportation. The system’s economic viability is assessed through two scenarios of fuel (e.g., biomass) supply costs (e.g., with and without fuel market costs) and compared to the conventional approach of exporting the excess power. The key findings of this work include a substantial reduction in surplus electricity exports, with only 3.7% allocated for EV charging and 31.5% for hydrogen production. The simple payback period (SPB) is notably reduced, enhancing economic viability. Sensitivity analysis identifies the optimal hydrogen system, featuring a 120 kW electrolyzer and a 37 kg daily hydrogen demand. The results underscore the importance of prioritizing self-consumed energy over exports to the national grid, thereby supporting integrated renewable energy solutions that enhance local energy utilization and promote sustainable transportation initiatives.

Type-II heterojunction Se-g-C3N4/ZnO coupled MnCo2O4 photocatalyst for enhanced levofloxacin hydrochloride degradation activated by peroxymonosulfate

The advanced oxidation process induced by photocatalysis under visible light undoubtedly possesses greater application potential and cost-effectiveness due to the high excitation energy supply costs. Here, we proposed a novel Type-II heterojunction Se-g-C3N4/ZnO (Se-CN/ZnO) and MnCo2O4 (MCO) photocatalyst for the efficient degradation of levofloxacin hydrochloride (LEV) activated by peroxymonosulfate (PMS) under sunlight. Analysis results confirmed the oxidation process was executed by Se-CN/ZnO synergistic MCO-activated PMS for the responsive degradation of LEV, achieving a removal efficiency greater than 98.6 % within 15 min (kinetic rate constant Kobs = 0.299 min−1), under optimal conditions ([Se-CN/ZnO (300 °C)]0 = 46 mg, [MCO]0 = 1.6 mg, [PMS]0 = 0.27 mM, [Aeration rate]0 = 146 mL/min, pH = 5.5). Effective interfacial transfer and spatial segregation of the photogenerated electron-hole were attributed to the stabilized Type-II energy band structure of Se-CN/ZnO, the rapid cyclic redox of metal ions Mnn+(n = 2,3,4) and Com+(m = 2,3) promoted the activation of PMS reduction of LEV through synergistic action of various endogenous substances. Analysis of the contribution of reactive oxygen species by electron paramagnetic resonance substantiated the dominant role of ·OH and O2·-, and the superiority of the degradation process was further validated with the analysis of the non-toxic and ecological safety characteristics of intermediates. The recommended method of eco-friendly and stable catalytic performance of LEV has engineering application prospects that are incomparable to many publicly available treatment methods.

Cost management analysis of Objective Structured Clinical Examination (OSCE): guide to the universities of medical sciences

BackgroundThe Objective Structured Clinical Examination (OSCE) is a crucial assessment tool for evaluating learners’ ability to apply theoretical knowledge in practical clinical situations. It is widely accepted by both students and educators, and the costs associated with conducting OSCE assessments vary depending on the field of study, how it is implemented, staffing needs, standardized patients, and duration of the examination. This study examines the expenses related to administering OSCEs in medical universities.MethodConducted from June to September 2023; this mixed-method study elucidated the cost intricacies of executing a two-day OSCE with 14 eight-minute stations for 100 nursing students. This process unfolds in two phases: a qualitative segment comprising text reviews and 45-minute in-depth interviews with faculty members and OSCE experts, leading to the development of a validated checklist, followed by a quantitative phase in which the tool was distributed to 25 faculty members and 5 specialists for completion.ResultThe examination costs were delineated into three primary components: time, human resources, equipment, consumables, and necessary supplies. In 2023, the total implementation cost of the OSCE for 100 students across 14 clinical stations was $1028.07, with an estimated per-learner cost of $37.50. Human resources incurred the highest expenditure ($1649.37); while supply costs were relatively lower ($1072.17). Educational infrastructure expenses were excluded because the study focused on the Nursing and Midwifery Faculty’s Clinical Skills Center.ConclusionVarious factors influence OSCE costs, including national production capabilities of medical supplies, institutional credibility, governance status, examination frequency, student demographics, assessor composition, station count, course content, and examinee volume. The insights derived from this comprehensive examination are significant as entry benchmarks for healthcare systems and higher-level academic evaluations. Understanding OSCE cost dynamics facilitates resource optimization and assessment strategy refinement, thereby improving medical education efficacy.

Assessment and predictive analysis of health professions students' proficiency in health economics and pharmacoeconomics in Southwest China: a cross-sectional study

ObjectivesThis study addresses the growing importance of health economics and pharmacoeconomics in preparing healthcare professionals for economic decision-making, particularly in China’s evolving healthcare system. Despite their significance, these subjects are inconsistently included in health education in Southwest China, making it crucial to assess students' proficiency and educational needs.MethodsA cross-sectional study was conducted from July to October 2023, involving medical and pharmaceutical programs across universities in Sichuan, Chongqing, Guizhou, and Yunnan. Data on students' knowledge, attitudes, and proficiency were captured using a structured questionnaire. Advanced statistical methods, including descriptive analysis, ANOVA, regression analysis, PCA, and Spearman correlation heatmaps, were employed for data analysis using IBM SPSS and Python. The sample consisted of 781 students, with the survey facilitated via the Questionnaire Star platform.ResultsThe survey revealed moderate comprehension of health economics and pharmacoeconomics among 781 health-related students, with an average knowledge score of 2.9. The majority were pharmacy students (45.58%) and aged 21–24 years (65.81%) with a significant female majority (64.92%). Academic year significantly influenced understanding, while gender differences were minimal. Spearman correlation indicated a strong linkage (0.78) between Supply and Demand and Cost Effectiveness, with minimal correlations between knowledge and attitudes towards the educational importance of health economics. Multiple regression analysis highlighted the impact of gender and academic progression on students' comprehension of Supply and Demand concepts, as well as the influence of knowledge levels on their attitudes towards the importance of health economics education. PCA indicated the complex structure of knowledge and attitudes.ConclusionsThe study found moderate knowledge levels in health economics among health professions students in Southwest China, with academic year affecting comprehension and minimal gender differences. Pharmacy students had higher proficiency in pharmaceutical-related areas, but gaps in complex topics like 'Economic Evaluation' highlight the need for targeted educational improvements to better prepare students for healthcare economic decision-making.

Assessing the Profit Impact of ARIMA and Neural Network Demand Forecasts in Retail Inventory Replenishment

This study investigates the integration of demand forecasting and inventory replenishment strategies to enhance retail profitability. A deterministic optimal replenishment model is utilized to analyze the predictive performance of various neural network architectures and ARIMA models using real sales data. The predictive accuracy and subsequent influence on optimal firm profits over a multi-period planning horizon is assessed. The Integer Programming model devised optimizes daily replenishment across multiple retail routes, taking into account sales revenue, supply costs, inventory holding, sales loss, and transportation expenses. The study is distinctive in its dual assessment: it evaluates both the accuracy of forecasting methods and their direct impact on profitability through systematic inventory decisions. Neural network architectures selected for minimizing error in product sales predictions have 6% lower mean squared error compared to Akaike Information Criterion minimizing ARIMA models. For longer horizon predictions necessary in performance gap grows larger, e.g., with %60 difference for predictions 15 days ahead. Predictions reflect as 1.6% higher profits on average, when neural network predictions and more efficient longer planning horizons of the optimization model are preferred. Planning 30 days ahead, optimizing with neural network predictions elicits 2.3% higher profits compared to profits attainable based on ARIMA predictions. Our findings illustrate how different forecasting methods can affect firm profitability by shaping inventory replenishment strategies. By merging mathematical optimization with time series forecasting, this research provides a comprehensive evaluation of how advanced predictive technologies can enhance retail inventory practices and improve profitability.

Research on How the Digital Economy Contributes to Achieving A High-Level and Balanced Development of the Elderly Care Service Industry

Abstract China’s aging population has gained significant attention. Population aging implies that the demand for elderly care services will be on the rise. However, China’s aging exhibits a notable characteristic of getting old prior to achieving affluence, which directly constrains the enhancement of the level of elderly care services. The Communist Party of China and the government attach considerable importance to the issue of population aging and pensions. The Third Plenary Session of the 20th CPC Central Committee adopted the Decision of the CPC Central Committee on Further Comprehensively Deepening Reform and Promoting Chinese-Style Modernization, emphasizing that “we should actively respond to population aging and improve the development of elderly care and elderly care industry policy mechanisms.” Regarding the supply of pension services, due to the professional and long-term nature of pension services, the supply cost remains high. The contradiction between the low level of demand and the high cost of supply might lead to the “low-level equilibrium trap” of the elderly service industry. The digital economy has achieved remarkable effects in promoting the elderly care service industry. It has played a vital role in optimizing the allocation of elderly care resources, reducing the cost of elderly care services, and creating a superior elderly care ecosystem. In this context, it holds considerable academic value and practical significance to study the impact of the digital economy on the development of pension service industry, to analyze the digital divide and bridge the path for the development of the pension service industry, and to explore the countermeasures and ideas of the digital economy to facilitate the high-level, balanced, and high-quality development of the pension service industry.

Budget Impact Analysis of Implementing Antenatal Care Recommendations for Positive Pregnancy Outcomes at Public Primary Facilities in Tanzania.

Tanzania recently changed its antenatal care (ANC) guidelines to reduce perinatal mortality and improve the experience of pregnancy care. The new guideline recommends increasing the number of ANC visits from four to eight and introducing one routine ultrasound scan, among other recommendations. We estimated the budget impact of implementing the new guideline compared to the previous focused ANC guideline at public dispensaries and health centers. In a dynamic Markov model, we prospectively followed annual cohorts of between 2.3 and 2.6 million pregnant women who will be attending ANC at dispensaries and health centers for 5years. We allowed a population of pregnant women into the model every year and women exit the model at delivery. We calculated the cost of medicines, medical supplies, and laboratory supplies required to produce services from a public health system perspective. Our model neither estimated condition-related costs nor health effects. The budget impact was calculated as the difference in the estimated costs between the two guidelines. We conducted scenario analyses to explore attending more visits and different assumptions to calculate the target population. We estimated that implementing the new ANC guideline would have a cumulative budget impact of around US$154 million over 5years. The budget required will increase from US$137 million under the focused ANC guideline to US$291 million under the new guideline. Laboratory supplies will consume 47% of the estimated budget under the new guideline. We expect the annual budget impact to be US$38 million in the first year of implementation and US$32 million in the fifth year. We assumed that by the fifth year, 82% of all pregnant women would have had four or more visits. The budget impact would increase to US$214 million, with the proportion of pregnant women attending four or more ANC visits reaching 90% within 5years. Scaling up the implementation of the new ANC guideline at public dispensaries and health centers may substantially increase the supplies required to produce ANC services, particularly laboratory supplies. Studies on the health impact of the new guideline are warranted to estimate the value for money.

A cooperative approach for generation and lines expansion planning in microgrid‐based active distribution networks

AbstractWith the growth of the load in the electricity networks, sufficient investment in the generation and lines expansion should be made in order to provide the energy needed by consumers with the lowest possible investment and operation costs. This issue is especially important in distribution networks, which are faced with the uncertainties of renewable energy generation and the development of microgrids and related issues.In this article, the planning of generation and lines expansion has been modeled with the aim of minimizing the total costs of microgrids, based on the cooperative approach. For this purpose, a bi‐level model has been developed; on the upper level, microgrids make investment decisions with a cooperative approach, and a constrained stochastic formulation has been developed with considering operational uncertainties on the lower level. Also, in this article, in order to ensure the supply of critical loads in island conditions, the self‐sufficiency index is defined. Three case studies have been considered to ensure the effectiveness of the developed model. In case 1, each microgrid will be able to supply its load only by generating of its units and purchasing from the retail market. In case 2, the possibility of trading with other microgrids in a non‐cooperative approach will also be available to the microgrids operators, and in case 3, microgrids can exchange energy with other microgrids in a cooperative manner. The simulation results showed that due to the possibility of using nearby microgrid resources, the cost of microgrid load supply in case 2 was reduced by 4.84% compared to case 1. Also, this cost in case 3 was reduced by 5.23% and 0.38%, respectively, compared to cases 1 and 2, due to the use of a cooperative manner in microgrid load providing.

Achieving gigawatt-scale green hydrogen production and seasonal storage at industrial locations across the U.S.

Onsite production of gigawatt-scale wind- and solar-sourced hydrogen (H2) at industrial locations depends on the ability to store and deliver otherwise-curtailed H2 during times of power shortages. Thousands of tonnes of H2 will require storage in regions where subsurface storage is scarce, which may only be possible using liquid organic H2 carriers. We evaluate aboveground system with a focus on providing technical insights into toluene/methylcyclohexane (TOL/MCH) storage systems in locations suitable for gigawatt-scale wind- and solar-powered electrolyzer systems in the United States. Here we show that the levelized cost of storage, at a national median of US dollar $1.84/kg-H2 is spatially heterogeneous, causing minor impact on the cost of H2 supply in the Midwest, and significant impact in Central California and the Southeast. While TOL/MCH may be the cheapest aboveground bulk storage solution evaluated, upfront capital costs, modest energy efficiency, reliance on critical materials and pre-sulfided catalysts, and greenhouse gas emissions from heating are opportunities for further development.

A Technical-Economic Assessment of Producing Hydrogen and Biofuels via Gasification of Biomass in Solar Hybridised Dual Fluidised Bed

In this work, the techno-economic performances of three conversion pathways using an upstream solar hybridised dual fluidised bed (SDFB) for biomass gasification were assessed. The annual solar share % over the solar multiple range of 1.4-3.4 varies between 7-17%, with the CO2 emissions avoided relative to the non-solar case varying between 7%-23%, using representative solar viability location in Australia. The projected break-even price varies between 5.5-6.1 AUD/kg (3.8-4.25 USD/kg) for hydrogen, 1.1-1.2 AUD/kg (0.75-0.85 USD/kg) for methanol, and 1.5-1.7 AUD/L (1.1-1.2 USD/L) for liquid fuels over the analysed oversize level of 1.4 to 3.4 at thermal storage capacity designs with less than 1% solar dumping rate for base case scenario. Overall, the derived break-even price from the SDFB gasifier configuration is higher than that of the non-solar gasifier case, yet this is dependent on the cost of supplement heat supply and carbon credit

Research on the Investment Value of BYD Based on SWOT, Financial, and Valuation Methods

Against the backdrop of environmental degradation, green energy transformation is a strategic measure to address climate change and promote green development. The new energy vehicle industry is experiencing an unprecedented period of rapid growth. As a leading player in this sector, BYD's development is virtually representative of the Chinese new energy vehicle industry. SWOT analysis, financial analysis, and valuation analysis are crucial criteria for assessing the development status of a company. Through the analysis of profitability, operational capability, and P/E ratio data, the development status, operational capability, market competitiveness, and growth potential of a company can be directly reflected. The results show vertical integration of supply chain and cost advantage is the main strength of BYD, however it has the weakness of excessive dependence on Chinese government subsidies. From the perspective of financial performance, it has great profitability and its operating capacity situation is good. Moreover, the valuation shows it is worth for investment. This provides decision-makers with information and suggestions on enterprise management, investment, and financing, helping investors and managers make rational decisions.

Classics in Chemical Neuroscience: Medetomidine.

Medetomidine is an FDA-approved α2-adrenoreceptor (α2-AR) agonist used as a veterinary sedative due to its analgesic, sedative, and anxiolytic properties. While it is marketed for veterinary use as a racemic mixture under the brand name Domitor, the pharmacologically active enantiomer, dexmedetomidine, is approved for sedation and analgesia in the hospital setting. Medetomidine has recently been detected in the illicit drug supply alongside fentanyl, xylazine, cocaine, and heroin, producing pronounced sedative effects that are not reversed by naloxone. The pharmacological effects along with the low cost of supply and lack of regulation for medetomidine has made it a target for misuse. Since 2022, medetomidine has been found as an adulterant in samples of seized drugs, as well as in toxicological analyses of patients admitted to the emergency department after suspected overdoses across several U.S. states and Canada. This Review will discuss the history, chemistry, structure-activity relationships, drug metabolism and pharmacokinetics (DMPK), pharmacology, and emergence of medetomidine as an adulterant in drug mixtures in the context of the current opioid drug crisis.

Cost of COVID-19 vaccine delivery in nine States in Nigeria via the U.S. Government Initiative for Global Vaccine Access

BackgroundIn 2022, the U.S. Centers for Disease Control and Prevention collaborated with implementing partners, African Field Epidemiology Network and Sydani Group, to support COVID-19 vaccination efforts in Nigeria. To characterize the costs of COVID-19 vaccination, this study evaluated financial costs per dose for activities implemented to support the intensification campaign for COVID-19 vaccination.MethodsThis retrospective evaluation collected secondary data from existing expenditure and programmatic records on resource utilization to roll out COVID-19 vaccination during 2022. The study included incremental financial costs of the activities implemented to support an intensification campaign for COVID-19 vaccination across nine states and six administrative levels in Nigeria from the perspective of the external donor (U.S. Government). Costs for vaccines and injection supplies, transport of vaccines, and any economic costs, including government in-kind contributions, were not included. All costs were converted from Nigerian Naira to 2022 U.S. Dollars (US$).ResultsThe estimated financial delivery cost of the COVID-19 vaccination intensification campaign was US$0.84 per dose (total expenditure of US$6.29 million to administer 7,461,971 doses). Most of the financial resources were used for fieldwork activities (86%), followed by monitoring and supervision activities (8%), coordination activities (5%), and training-related activities (1%). Labor (58%) and travel (37%) were the resource inputs that accounted for the majority of the cost, while shares of other resource inputs were marginal (1% for each). Most labor costs (79%) were spent on payments for mass vaccination campaign teams, including pay-for-performance incentives. By administrative level, the largest share of costs (46%) was for pay-for-performance incentives at the community, health facility, or campus levels combined, followed by local government area level (24%), community level only (15%), state level (9%), national level (3%), campus level only (1%), and health facility level only (< 1%).ConclusionsFindings from the evaluation can help to inform resources needed for vaccination activities to respond to future outbreaks and pandemics in resource-limited settings, particularly to reach new target populations not regularly included in routine childhood immunization delivery.

Drone Integration in Last-Mile Delivery Operations

Purpose: This research examines the integration of drone technology into last-mile delivery operations, focusing on its impact on supply chain efficiency, cost reduction, and sustainability. The study explores operational challenges, such as air traffic management, payload limitations, regulatory compliance, and public perception, providing a comprehensive understanding of how drones can reshape last-mile logistics. Methodology: The study employs a multi-faceted approach, combining historical analysis, in-depth case studies, and scenario planning to assess the impact of drone technology on last-mile delivery efficiency, cost optimization, and accessibility. Data is gathered from industry reports, interviews with logistics professionals, and regulatory documents. Thematic analysis is conducted to identify critical patterns, while scenario-based modeling offers insight into the potential outcomes of various integration strategies. A comparative evaluation of existing last-mile delivery methods against drone-based delivery models is also provided. Findings: The research reveals that drone technology offers significant potential for enhancing last-mile delivery efficiency, particularly in urban areas and remote locations, aligning with findings from studies like those by Murray &amp; Chu (2015). However, the study identifies considerable obstacles, including regulatory challenges, limited payload capacities, and public acceptance issues. Solutions such as airspace regulation frameworks, collaborative logistics networks, and advanced battery technologies are highlighted as critical enablers for successful drone integration. Contribution to Theory, Policy and Practice: This study contributes to the growing body of knowledge on drone technology's role in logistics by providing a comprehensive framework for businesses and policymakers to navigate the complexities of drone integration. It recommends actionable steps for integrating drones into last-mile delivery, bridging the gap between theoretical innovation and practical application. It provides policy recommendations for regulatory bodies to develop airspace management systems that support drone operations. For practitioners, the research offers a strategic guide to overcoming operational challenges, facilitating the adoption of drones as a sustainable solution for last-mile delivery.