System Cost Research Articles

Optimizing power system efficiency and costs in smart buildings with renewable resources

The increasing industrial development and energy demand have necessitated the maximization of available energy use and the deployment of renewable resources. Effective energy management, optimal modeling, and efficient planning are essential to transform the power system into a high-efficiency, optimal model. This study focuses on the initial step of modeling smart buildings (SBs) equipped with non-responsive devices and renewable photovoltaic sources. A comprehensive energy management (EM) plan is formulated for these buildings, incorporating the KNX protocol for solar energy system management. Batteries are integrated into the building model to store energy during periods of low consumption and serve as generators during peak load conditions, with the primary goal of minimizing power system losses and related costs. To address the complexity of this model, whale optimization algorithm (WOA) is employed for optimization. Optimal candidate buses are selected for interconnected building management based on a suggested sensitivity analysis to minimize losses. Cost performance is then assessed, considering energy production and sales. The findings indicate that substantial control of operating costs can be achieved through strategic management of battery charging and discharging, as well as the utilization of photovoltaic units. The proposed model is evaluated across various scenarios using a test system comprising 30 modified system, demonstrating its effectiveness in enhancing energy efficiency and management.

Multiple Sclerosis Disease-Modifying Therapy Use in the Department of Veteran Affairs and Medicare: A Comparative Analysis

BackgroundHigh-cost disease-modifying therapies (DMT) for multiple sclerosis (MS) have created affordability challenges for people with MS (PwMS) and payers. The Department of Veterans Affairs (VA) is the largest integrated healthcare system in the US and uses a variety of approaches to manage utilization and cost of MS DMT. The objective of this paper is to compare national utilization trends in the VA to the US Medicare program, another large federal public healthcare program. MethodsCounts of PwMS prescribed DMT from 2012 to 2021 in the VA and Medicare programs were used to estimate changes utilization over this period. For each DMT, we estimated the proportion of all DMT users treated in each year. Trends in utilization were compared to identify differences in how these systems manage DMT use. We compared demographics and DMT use between PwMS in the VA to previously published estimates from a Medicare cohort of PwMS. ResultsDMT use in PwMS was comparable in VA and Medicare programs (65.9% vs 69.7%). In younger (<50 years) PwMS, DMT use was more prevalent in the VA compared to Medicare (85.8% vs 76.9%). Between 2012 and 2021, the proportion of patients on DMT using a lower-efficacy agent (interferon beta and glatiramer) declined in both the VA (90% to 32%) and Medicare (81% to 38%). Oral DMT use (primarily fumarates and sphingosine 1-phosphate [S1P] modulators) increased to a similar degree such that by 2021, 39% of patients in both systems were receiving oral DMT. Use of high-efficacy B cell depleting DMT (ocrelizumab, ofatumumab, and rituximab) was consistently higher in the VA than in Medicare. Despite the approval of generic glatiramer and dimethyl fumarate in 2015 and 2020 respectively, 49% of glatiramer and 58% of fumarate utilization in the Medicare program continued to be for a branded product in 2021. ConclusionsGreater DMT use among younger PwMS along with more frequent use of high-efficacy B cell depleting DMT in VA has the potential to reduce disability and attendant healthcare system costs. Generic DMT adoption in the Medicare program was lower than might be expected. Future studies should evaluate the relationship between DMT utilization, costs, and health outcomes in these populations.

Optimal Configuration of Electricity-Heat Integrated Energy Storage Supplier and Multi-Microgrid System Scheduling Strategy Considering Demand Response

Shared energy storage system provides an attractive solution to the high configuration cost and low utilization rate of multi-microgrid energy storage system. In this paper, an electricity-heat integrated energy storage supplier (EHIESS) containing electricity and heat storage devices is proposed to provide shared energy storage services for multi-microgrid system in order to realize mutual profits for different subjects. To this end, electric boiler (EB) is introduced into EHIESS to realize the electricity-heat coupling of EHIESS and improve the energy utilization rate of electricity and heat storage equipment. Secondly, due to the problem of the uncertainty in user-side operation of multi-microgrid system, a price-based demand response (DR) mechanism is proposed to further optimize the resource allocation of shared electricity and heat energy storage devices. On this basis, a bi-level optimization model considering the capacity configuration of EHIESS and the optimal scheduling of multi-microgrid system is proposed, with the objectives of maximizing the profits of energy storage suppliers in upper-level and minimizing the operation costs of the multi-microgrid system in lower-level, and solved based on the Karush-Kuhn-Tucker (KKT) condition and Big-M method. The simulation results show that in case of demand response, the total operation cost of multi-microgrid system and the total operation profit of EHIESS are 51,687.73 and 11,983.88 CNY, respectively; and the corresponding electricity storage unit capacity is 9730.80 kWh. The proposed model realizes the mutual profits of EHIESS and multi-microgrid system.

Analysis of the Heat Transfer Performance of a Buried Pipe in the Heating Season Based on Field Testing

Ground source heat pump (GSHP) systems have been widely used in the field of shallow geothermal heating and cooling because of their high thermal efficiency and environmental friendliness. A borehole heat exchanger (BHE) is the key part of a ground source heat pump system, and its performance and investment cost have a direct and significant impact on the performance and cost of the whole system. The ground temperature gradient, air temperature, seepage flow rate, and injection flow rate affect the heat exchange performance of BHEs, but most of the research on BHEs lacks field test verification. Therefore, this study relied on the results of a field thermal response test (TRT) based on a distributed optical fiber temperature sensor (DOFTS) and site hydrological, geological, and geothermal data to establish a corrected numerical model of buried pipe heat transfer and carry out the heat transfer performance analysis of a buried pipe in the heating season. The results showed that the ground temperature gradient of the test site was about 3.0 °C/100 m, and the temperature of the constant-temperature layer was about 9.17 °C. Increasing the air temperature could improve the heat transfer performance. The temperature of the surrounding rock and soil mass of the single pipe spread uniformly, and the closer it was to the buried pipe, the lower the temperature. When there is groundwater seepage, the seepage carries the cold energy generated by a buried pipe’s heat transfer through heat convection to form a plume zone, which can effectively alleviate the phenomenon of cold accumulation. With an increase in seepage velocity, the heat transfer of the buried pipe increases nonlinearly. The heat transfer performance can be improved by appropriately reducing the temperature and velocity of the injected fluid. Selecting a backfill material with higher thermal conductivity than the ground body can improve the heat transfer performance. These research results can provide support for the optimization of the heat transfer performance of a buried tube heat exchanger.

Potential Evaluation of Twin-Screw Air Expanders with Dual-Lead Rotors Used in PEMFC Systems

The reduction in the power cost of air supply systems has emerged as a critical challenge in the development of polymer electrolyte membrane fuel cells. This study proposes the use of dual-lead rotors to improve the performance of twin-screw expanders for the purpose of boosting expanders’ recovery power and consequently lowering the power cost of the air supply subsystem, which is hardly investigated in previous publications. For this purpose, a mathematical model is built to assess the potential of improving the expander performance by means of the dual-lead rotors. And the influence of lead and length of the high-pressure rotor segment and overall rotor length are analyzed. The results demonstrate that the smaller lead and larger length of the high-pressure rotor segment result in better geometric characteristics and thus thermodynamic performance. For example, case #4 with dual-lead rotors exhibits a larger rotating angle at the suction end and a larger suction area than those of constant-lead rotors by 43° and 100%, respectively, which further lower the suction pressure loss. Compared with constant-lead rotors, the maximum increments in the mass flowrate and indicated power are observed as 45% and 25.4%, respectively. However, the dual-lead rotors could not effectively contribute to an increase in the isentropic indicated efficiency of twin-screw expanders due to the severe leakage, and hence, it becomes crucial to address the leakage issues in twin-screw expanders.

Same-day discharge coronary interventions: How to succeed?

Percutaneous coronary interventions (PCI) are the cornerstone of treatment in patients with coronary artery disease, generating substantial costs for the healthcare system. Considerable improvements in PCI technique, stent technology, and antiplatelet therapy led to a complication rate of <5%, a success rate of >95%, and lack of routine cardiothoracic surgical support. Thereby, the concept of same-day discharge following PCI has been proposed due to comparable efficacy, safety, and socioeconomic benefits of inpatient PCI. Although single-vessel disease was the primary indication for outpatient (OP) PCI, more complex scenarios such as multivessel disease, left main disease, and chronic total occlusions were also shown to be feasible and safe in the OP setting. Currently, available data show that OP PCI leads to cost optimization, increased capacity of PCI centers, decrease in the nosocomial infections rate, and increased patient satisfaction, along with good clinical outcomes. Although OP PCI seems promising in a subset of well-prepared and compliant patients without severe comorbidities, there are some challenges to overcome before its routine implementation. To prevent unnecessary hospitalization and unsafe same-day discharges, interventional cardiology teams should be trained to perform reliable risk-benefit assessments. Standardized forms should be created to obtain informed consent and instruct OP PCI patients and their relatives about postprocedural management. Here, we summarize the available data on OP and inpatient PCI outcomes, discuss the opportunities and challenges of OP PCI, and propose a periprocedural patient management checklist to facilitate the implementation of OP PCI in interventional cardiology centers.

SSBI counteraction technology in a single photodetector-based direct detection system receiving an independent dual-single sideband signal

To further meet the large capacity, high spectrum efficiency (SE), reduce the signal-signal beat interference (SSBI) of the independent dual single sideband (ISB) system and the complexity of the receiver, we propose an iterative signal-signal beat interference counteraction (ISSBIC) algorithm to suppress SSBI. The 16-Gbps left sideband and the 16-Gbps right sideband signals in the ISB system are quadrature phase-shift keying (QPSK) modulated. After standard single-mode fiber (SSMF) transmission, the LSB and RSB signals are synthesized to a 16-quadrature amplitude modulation (QAM) signal after conversion through the photodetector (PD) square law. The simulation results show that the ISSBIC with just 2 iterations is superior to Kramers–Kronig (KK) receiver in processing the system error bit. In the meantime, the ISSBIC requires a sampling rate of 20GSa/s, whereas KK requires 40GSa/s. Moreover, the proposed ISSBIC algorithm has a simpler complexity. According to the simulation results, the suggested ISSBIC receiver can lower the ADC requirements and system costs, which opens up a wide range of applications in multiplex and higher SE transmission systems.

Techno-economic study for photovoltaic battery-free irrigation systems in an arid area for olive fields in Western West Al Minya, Egypt

Due to rain scarcity, artificial irrigation became an environmentally critical application for crop production. Proper irrigation is essential to maximize water use efficiency and plant biomass. Using clean energy sources is currently a trend that is sweeping the globe. To achieve this, we propose a solar-powered irrigation system. This study considers alternative irrigation systems using photovoltaic solar systems to pump water from deep wells for new land reclamation, whereas groundwater is the only source. The main objective is to evaluate various PV-powered pumping systems in Egypt's Western West Al Minya area. Two systems were nominated by considering the annual savings: the conventional irrigation Diesel system and a Photovoltaic (PV) battery-free irrigation system. The second system requires isolated pipes so solar radiation does not affect water temperature and avoids damage to plant roots. The 192 kW PV system was sized to operate a 60 KW water pumping system, with a required area of 1920 m2 for implementation. Direct irrigation using PV systems proved the best economical solution since it incurs the fewest costs of $0.015/m3 for 100–120 m well depth, compared with $0.073/m3 from the conventional system. As a result, the proposed PV-pumping system reduced the overall system cost by around 80% concerning the conventional system.

Determination of converter parameters for high-voltage electromechanical systems of stationary installations of industrial fans

Purpose. To study the electromagnetic processes in the circuit of the phase rotor of a high-voltage induction motor connected to the network through a step-up converter, to determine the parameters of the converter and their relationship with the voltage gain to ensure the optimal level of energy efficiency of the electromechanical system. Methodology. Methods of theoretical electrical engineering for the construction of a rotor circuit replacement scheme for an induction motor with a step-up converter, methods for solving a system of first-order differential equations, analytical methods. Findings. The expediency of using a converter that combines the rotor circuit of a high-voltage induction motor with the power supply network and provides regulation of the rotor EMF with the recovery of the slip energy of the induction motor rotor to the power supply network has been proved. This will ensure speed control of powerful high-voltage induction motors on the rotor side with an EMF of up to 600 V and significantly reduce the cost of a high-voltage electromechanical system. A methodology for determining the converter gain and the parameters of the rotor circuit of the electromechanical system is proposed, which allows determining the transformation ratio of the matching transformer at the optimal value of the voltage gain. The conditions of trouble-free operation of the inverter at the moment of start-up of the electromechanical system are determined. Achieving these conditions is ensured by determining the delay of the control signal to the power keys of the inverter of a step-up converter. The correlation between the voltage gain and the equivalent resistance of the rotor circuit of the electromechanical system is established. Originality. The ratio of the voltage gain to the equivalent resistance of the rotor circuit of the electromechanical system is established, which will ensure the matching of the rotor EMF with the voltage of the power supply network while maintaining a high level of energy efficiency. Practical value. A methodology for determining the gain and parameters of a step-up converter is proposed, which allows determining the transformation ratio of a matching transformer at the optimal value of the voltage gain. The proposed methodology can be applied to the modelling of complex powerful high-voltage electromechanical systems, especially for stationary installations of industrial fans.

Methodology for determining the heat distribution in disc brakes of mine hoisting machines

Purpose. To study the course of heat phenomena in disc brakes using modern computing systems in order to determine and substantiate the operating parameters for the hoisting machine components. Methodology. The research uses software packages, with the help of which a computational-theoretical apparatus is developed for heat mode modeling processes. In particular, the mentioned function is used in the SolidWorks Simulation software with the ability to evaluate the errors of the calculation results. Findings. In the course of the research, the dependence of the hoisting machine disc brake performance on the operating parameters of its components was determined. The research has led to a better understanding of the heat transfer processes in disc braking devices, as well as the ability to study the friction response of various materials and determine optimal parameters that help improve the performance of braking systems. The effectiveness has been proven of the proposed method for analyzing the heat distribution processes of the mine hoisting machine drum components under the influence of operating and emergency braking modes. Originality. For the first time, a methodology for calculating the heating temperature distribution along the brake rim plane during a safety stop has been developed and substantiated. A method has also been developed for determining the temperature field arising under steady-state heating conditions, which occur after repeated operating braking and cooling of the device. In this case, when using the formula for determining the temperature on the brake rim surface, the sample length, the relative velocity between the friction components and the heat flow distribution coefficient are taken into account. The brake disc geometric model developed in the SolidWorks software package makes it possible to study the temperature change on the device rim in real time. Practical value. The proposed design improvement based on the research results of heating processes should improve vehicle safety. The cost of braking systems is expected to be reduced through the use of optimal materials and production technologies. The software methods for modeling and analyzing the temperature influence on brake discs of the Mine Hoisting Machine (MHM) have been improved. Based on the research results, recommendations have been developed for the optimum braking process of machines in various operating conditions.

Perancangan dan Analisis Tekno Ekonomi PLTS On-Grid System sebagai Supply Energi Listrik Masjid Al-Istiqamah Politeknik Negeri Jember

The increasing energy demand is directly proportional to the growing population and technological advancements. The energy needs in Indonesia largely rely on fossil fuels, which are limited and environmentally unfriendly due to their emission characteristics. The potential of solar energy in Indonesia is around 4.8 kWh/m2, making it a renewable and environmentally friendly energy source that can be utilized for Solar Power Plants (PLTS). The aim of this research is to design an on-grid PLTS system and conduct techno-economic analysis using PVSyst software. This design requires 14 Longi Solar/LR5-72HPH-550M solar panels and 1 Huawei SUN2000-6KTL-M1 inverter. The estimated electricity production is 10,852 kWh/year in the first year. The initial investment cost for this PLTS system is Rp. 120,343,517.00, with estimated savings over 25 years amounting to Rp. 270,115,412.00. Economically, based on the feasibility analysis using the LWBP tariff calculation method, the NPV is Rp. 2,174,707.00, BCR is 1.68, and PBP is 11.8 years. Meanwhile, based on the feasibility analysis using the LCoE calculation method, the NPV is Rp. 74,877,690.00, BCR is 2.61, and PBP is 7.5 years. Based on the conducted research, the construction of this PLTS is deemed feasible to be implemented.

Stochastic optimization of a hybrid photovoltaic/fuel cell/parking lot system incorporating cloud model

The interaction and optimization of electric parking lots (EPLs) with hybrid renewable energy to exchange power and improve the system load reliability has been welcomed systems in energy industry, but it is accompanied by challenges such as uncertain parameters, and also implementing the optimal energy management. This paper proposes a novel stochastic optimization framework for a hybrid energy system including photovoltaic resources, hydrogen storage based-fuel cell integrated with an EPL (PV/FC/EPL) aiming for minimization of the total net present cost (TNPC) while ensuring the maximum probability of power shortage (PPSHmax) to meet a commercial load in Tianjin, China using the real meteorological data. A new improved kepler optimization algorithm (IKOA) utilizing the golden sine strategy is applied to optimize system component sizes and EPL charge/discharge. In a deterministic scenario, the optimal system configuration ensures cost-efficiency and reliability for load supply. Also, a new stochastic modeling framework is proposed using the Cloud Model (CM) to evaluate the effect of uncertainties in irradiance, temperature, and system demand on TNPC and PPSH. Deterministic findings reveal enhanced reliability and reduced TNPC through FC and EPL overlap during power shortages, compared to systems lacking EPL. Specifically, TNPC and PPSH are $8,632,643 and 1.45 %, respectively, for PPSHmax = 2 % over 20 years of operation. However, stochastic optimization demonstrates a 10.82 % increase in TNPC and an 8.67 % decrease in PPSH compared to the deterministic model under PPSHmax = 2 %, indicating heightened cost and reduced reliability when uncertainties are considered. This underscores the efficacy of the cloud model-based stochastic approach in addressing uncertainty in hybrid system optimization. Also, it reveals fluctuations in optimal cost and reliability values with changes in cloud droplet distribution around the expected value, emphasizing the significance of stochastic modeling for robust decision-making in hybrid energy systems. Moreover, evaluating the incorporating the penalty for the system's inability to supply the load, changing the storage investment cost, and interest rate variations on the system optimization cleared considerable effect of the system cost and reliability.

Machine Learning Approach to Injury Monitoring in Children and Adolescents

Abstract Pediatric injuries are common and associated with individual suffering and costs for the healthcare systems and society. The incidence of injuries among children in Switzerland has so far been insufficiently monitored. Emergency department patient records can be a valuable database to assess medically relevant injuries and gain information for monitoring and evidence-based prevention. The talk will outline our stepwise development of a machine-learning program for a pediatric injury monitoring system and lessons learnt. In this feasibility study we draw on electronic case histories of children treated for injuries between 2018 and 2022 at the University Children’s Hospital Zürich emergency department (N= to 30’884). The ML- approach follows different steps: step 1. utility evaluation of electronic pediatric patient records regarding ML and injury monitoring and prevention requirements in a test-sample of 100 electronic pediatric case histories; step 2. choice/adaptation of coding tree; step 3. coder training and inter-coder reliability testing; step 4. manual annotation of a sub-sample (n 1000) of the electronic pediatric patient records, step 5. design and testing of the ML program in an iterative process, and step 6. performance testing in a random sample of pediatric patient records. First lessons learnt indicate that electronic case history data contain relevant data and fulfill requirements for monitoring and prevention purposes. The IDB coding system proved too complex and detailed for the pediatric data base, providing too few examples for the ML-learning process, and needed to be adapted. Initial data analyses indicate the majority of cases are classified as less severe (73%) and only few (&amp;lt;1%) as very severe but the later provide the most detailed data. ML is a promising approach and makes use of hospital data for a national monitoring of pediatric injuries in Switzerland.

Exploring changes in the distribution of health status in type 2 diabetes over time - methodological aspects for estimating years lost due to disability for Germany

Abstract Knowledge of the severity distribution (SD) of certain diseases is crucial for calculating the years lost due to disability (YLD), as the time spent with a disease is explicitly weighted on the health state level. Depending on the disease, different severity levels are considered. In most cases, the SDs vary from mild, moderate, severe to most severe. This is different in the context of diabetes, where an explicit distinction is made according to the sequelae resulting from the disease progression. In general, these include diabetic neuropathy (with foot ulcers or amputations) and (mild or moderate) vision impairments including blindness due to diabetic retinopathy. These complications cause a considerable loss of quality of life for those affected and high costs for the healthcare system. However, the progression of many of the sequelae can be avoided through (secondary) preventive measures. Estimating the degree of severity is therefore an important indicator of the population affected and in need for care. Due to a lack of data, the Global Burden of Disease Study often uses time-invariant and regionally fixed SDs. Important insights as to the temporal variance of SDs thus remain unnoticed. As part of the BURDEN 2020 pilot project in Germany, SD for diabetes-related complications were estimated from routine health insurance data for the year 2017. In a follow-up project (BURDEN 2.0), these results will also be available for the years 2017 to 2022. If there are any changes in the proportion of individual health conditions, implications can be generated from routine healthcare data of those affected. The SDs overall and according to certain sequelae will be presented over time and discussed. Also, the resulting YLD over time for type 2 diabetes will be examined, including changes in the prevalence of the disease. This makes it possible to analyse and interpret the burden of disease due to diabetes during the years 2017 to 2022.

AI-Enhanced Allergy Diagnostics: Streamlining Healthcare and Reducing Costs

Abstract Issue/Problem WHO projects a shortfall of 10 million health workers by 2030. One area particularly lacking technological support is allergy diagnostics. The World Allergy Organization recognizes skin tests as the gold standard for allergy diagnostics, yet these tests are still manually assessed. General practitioners lack the time and tools, leading them to focus on treating the symptoms without addressing the causes. Description of the problem Symptomatic treatment of allergy can lead to the development of asthma in 30-40% of patients, increasing healthcare costs and causing lost productivity. The shortage of allergists further exacerbates this issue in many countries. Results Research conducted by the Military Institute of Medicine in Warsaw, in collaboration with a company producing automated allergy testing systems, explored a solution for allergy diagnostics, analyzing the entire process from the patient’s initial visit to desensitization therapy. The solution uses AI algorithms to reusable existing patient data and analyze patient history, correlate symptoms, medications, and allergen exposure, streamlining diagnostics and treatment. Patients at high risk undergo a computer-assisted interview to determine allergen panels. The only manual step is applying allergens to the skin, after which AI performs the reading and diagnosis. Clinical trials involving around 300 patients demonstrated high sensitivity and specificity, along with significant time savings for allergists and other medical staff, averaging 40 minutes per patient. The HTA evidence base will be ready by the end of this year. Lessons The integration of this AI-supported diagnostic method can eliminate bottlenecks in allergy diagnostics, improving health outcomes and reducing healthcare costs. However, its effectiveness depends on having at least few years of patient treatment data available. Without access to patient data, the method can be used in part to objectify PRICK test readings. Key messages • AI-supported diagnostics streamline allergy testing, reducing time and costs in the healthcare system. • The most accurate technique currently available for the automated reading of test results is that which evaluates the response to an allergen in the dermis in two spectra.

Design of a dual-focal-plane head-up display system using double freeform mirrors

This paper presents the design of a dual-focal-plane head-up display (HUD) system utilizing double freeform mirrors. The system is specifically developed for automotive applications, aiming to enhance driving safety and experience by projecting vehicle information within the driver’s line of sight. Compared to the traditional WHUD, the ARHUD offers a broader field of view and a greater virtual image distance. If the ARHUD system has double focal planes, it can separately display basic and interactive driving information to drivers, which is currently a significant research direction in the ARHUD system design. The proposed design only uses double freeform mirrors and uses a single display source for both focal planes, thus reducing the overall system complexity, assembly difficulty, and cost. Detailed design methods and results are discussed, showcasing the system’s good imaging performance and compact structure, which provide valuable insights for the development of next-generation dual-focal-plane HUDs for vehicles. The proposed system demonstrates significant advancements in reducing fabrication and testing difficulties compared to traditional dual-focal-plane HUD designs. The study’s findings contribute to the future development of dual-focal-plane head-up display systems.

The potential effects of methotrexate on cardiovascular outcomes in rheumatoid arthritis patients: a multi-institutional analysis

Abstract Introduction and Purpose The association between rheumatoid arthritis (RA) and increased risk of developing cardiovascular disease has been previously described. Recent studies have also shown that methotrexate may reduce the risk of cardiovascular events in patients with RA but have been limited by small sample size and/or demographic constraints. Methotrexate is a first-line drug treatment for RA and works by suppressing multiple anti-inflammatory and immune reactions, thereby reducing the inflammation that promotes progression of cardiovascular disease in these patients. The goal of this study is to evaluate the potential benefit of methotrexate use on cardiovascular outcomes in patients with RA on a larger scale by utilizing a large international medical record database. Methods The TriNetX Diamond network was used for this study. Two cohorts were generated for comparison by using International Classification of Disease 10 (ICD-10) codes. Both cohorts included adult patients with a diagnosis of rheumatoid arthritis (M06) and both were excluded from being treated with the following biologic therapies: etanercept, infliximab, adalimumab, golimumab, and certolizumab pegol. One cohort was on active treatment with methotrexate while the other was excluded from being on it. The cohorts were then balanced for age, gender, race, ethnicity, presence of known coronary artery disease (I20-I25) and history of prior cardiovascular diseases (Z86.7) by propensity score matching and use of the greedy nearest neighbor algorithm. This resulted in 471,054 patients in each arm. They were then compared for the outcomes of acute myocardial infarction, chronic ischemic heart disease, congestive heart failure, and death at 5 years. Results Untreated RA patients were 11% more likely to develop myocardial infarction (RR 1.11, 95% CI (1.09,1.14), P value &amp;lt;0.0001) and 14% more likely to develop chronic ischemic heart disease (RR 1.14, 95% CI (1.13,1.15), P value &amp;lt;0.0001). CHF incidence was 21% higher (RR 1.21, 95% CI (1.19,1.22), P value &amp;lt;0.0001) in the untreated group, but 5-year mortality in the two groups was comparable at around 8.2% (RR 0.98, 95% CI (0.97,0.997), P value 0.016). Conclusion This study confirms that methotrexate is associated with fewer cardiovascular events in RA patients, especially congestive heart failure. Although the use of methotrexate in patients with RA did not result in a mortality benefit, treatment may offer substantial improvements in patient morbidity and healthcare system cost. These benefits were seen in a sample of greater than 900,000 patients representing every adult demographic. These data reaffirm the previously described association between RA and cardiovascular disease and support the initiation of treatment with methotrexate for any adult patient with RA. Watchful waiting is associated with a higher incidence of adverse events in this population.

Modeling Systems with Dependent Catastrophic and Degradation Failures Incorporating Uncertainty

This research examines the interval-valued availability and cost of a competing-risk system with dependent catastrophic and degradation failures incorporating uncertainty. Uncertainty indicates that the probability of the successful operation of the system is not precisely known. The considered system has three states: normal, degraded, and totally failed. While degradation failures lessen the system’s overall effectiveness and lead it to a degraded state, a catastrophic failure abruptly terminates the system’s operations and results in a totally failed state. The interrelationship between these two failures is illustrated by the fact that each degradation failure elevates the possibility of a catastrophic failure. To identify a failure, sequential inspections are performed on the system. If the system is found to be degraded, a minimal repair is executed. If a catastrophic failure is detected, a corrective repair is performed. By integrating the aforesaid points, a theorem describing the upper and lower limits of the model’s reliability is derived. Furthermore, some theorems defining the bounds of point availability, long-run availability, and the average long-run cost rate are established. A numerical example of an aluminum electrolytic capacitor is taken to demonstrate the results.

Cost-effectiveness analysis of genotype-guided optimization of major depression treatment in Qatar.

Pharmacogenetic testing improves the efficacy and safety of antidepressant pharmacotherapy for moderate-severe major depressive disorder by identifying genetic variations that influence medication metabolism, and adjusting treatment regimens accordingly. This study aims to assess the cost-effectiveness of implementing a pharmacogenetic testing approach to guide the prescription of antidepressants. From the public hospital perspective, we developed a two-stage decision tree diagram of a short-term 6-week follow up, and a lifetime Markov model with 3-month cycles. The analysis compared the current standard of care with the alternative strategy of Pharmacogenetic-guided (multi-gene panel) testing in adult patients with moderate-severe major depressive disorder. Clinical outcomes and utilities were obtained from published studies, while healthcare costs were locally available. The short-term incremental cost-effectiveness ratio was against treatment response without side effects and without relapse, and against treatment response with/without side effects and without relapse. The long-term incremental cost-effectiveness ratio was against the quality-adjusted life year gained and years of life saved. Adopting the pharmacogenetic-guided therapy for adult patients with moderate-severe major depressive disorder in Qatar resulted in cost savings of Qatari Riyal 2,289 (95% confidence interval, -22,654-26,340) for the health system. In the short term, the pharmacogenetic-guided testing was associated with higher response rates without side effects and without relapse (mean difference 0.10, 95% confidence interval 0.09-0.15) and higher response rates with or without side effects and without relapse (mean difference 0.05, 95% confidence interval 0.04-0.06). For long term, the pharmacogenetic-guided testing resulted in 0.13 years of life saved and 0.06 quality-adjusted life year gained, per person, along with cost savings of Qatari Riyal 46,215 (95% confidence interval-15,744-101,758). The sensitivity analyses confirmed the robustness of the model results. Implementing pharmacogenetic testing to guide antidepressant use was found to improve population health outcomes, while also significantly reducing health system costs.

Data-driven stochastic dynamic economic dispatch for combined heat and power systems using particle swarm optimization

In modern power systems, the uncertain behavior of renewable energy sources (RESs) may result in deviations from the optimal operating dispatches for the various power sources. The electric power generation from Combined Heat and Power (CHP) units is characterized by high efficiency with less pollution. To use CHP units more efficiently, the dynamic economic dispatch problem is applied to obtain the optimal power and heat sources’ outputs to satisfy heat and power demands while meeting the different operational constraints. In this paper, data-driven stochastic optimization is used to model these uncertainties utilizing the Generative Adversarial Networks in scenario generation that are accurate and do not require fitting models or modeling probability distributions. Then, the Fast Forward Selection technique is used to decrease the number of scenarios to improve system tractability. The results obtained indicate that the variability in electrical load, photovoltaic (PV), and wind turbine (WT) output significantly impacts the overall operational costs of the power system. Therefore, it is essential to incorporate the uncertainties associated with electrical load, PV, and WT when aiming for accurate results in economic dispatch. the study found that the overall operation cost of the dynamic economic dispatch of the electrical system for 24 hours after integrating RES achieved a daily savings of 2.5 % in the first scenario. Furthermore, the findings demonstrate that RESs positively contribute to reducing the total operational costs of the power system. The economic dispatch of CHP systems is influenced by the integration of RESs and the uncertainties associated with electrical parameters.