Total Annual Cost Research Articles

Reverse design of molecule‐process‐process networks: A case study from HEN‐ORC system

AbstractThe integrated design of the heat exchanger network (HEN) and organic Rankine cycle (ORC) system with new working fluids is a complex optimization problem. It involves navigating a vast design space across working fluid molecules, ORC processes, and networks. In this article, a new two‐stage reverse strategy is developed. The optimal HEN‐ORC configurations and operating conditions, and the thermodynamic properties of the hypothetical working fluid are identified by an equation of state (EOS) free HEN‐ORC model in the first stage. With two developed group contribution‐artificial neural network thermodynamic property prediction models, working fluid molecules are screened out in the second stage from a database containing more than 430,000 hydrofluoroolefins (HFOs). The presented method is employed in two cases, where new working fluids are found. The total annual cost of Case 1 is 12%–22% lower than the literature, and the power output of Case 2 is 5%–8% higher than the literature.

Survival, treatment duration and costs of patients with prostate cancer treated with triptorelin in Italy: a study of administrative databases.

Several data support the efficacy/effectiveness, safety and favorable impact on quality of life of triptorelin treatment in patients with prostate cancer. However, little evidence is available concerning triptorelin use in the long term. We analyzed data on triptorelin treatment in patients with prostate cancer in an integrated Italian administrative database, covering around 6 million health-assisted subjects throughout the country. Patients with at least one prescription for triptorelin in the period 2010-2020 and with no evidence of metastasis were included and followed up until 2021. Overall survival (OS) and duration of treatment were analyzed using Kaplan-Meier curves, starting from the date of first prescription. The cohort included a total of 3,411 patients (mean age: 76.8 ± 8.7 years), of whom 1,326 (38.9%) were treated with triptorelin only and 2,085 (61.1%) with triptorelin combined with an anti-androgen. Overall, 847 (24.8%) patients with prostate cancer died and 1,037 (30.4%) had a treatment switch during the follow-up period, and both the median OS and median duration of treatment were not reached in both groups. The mean annual total cost per patient was estimated as 5,574 €, with almost half of the costs related to medication expenses (2,737 €). We found a long survival and duration of triptorelin treatment in this population of Italian patients with prostate cancer. This study with a long follow-up period further highlights the usefulness of healthcare utilization databases to integrate results obtained from clinical studies with those from everyday clinical practice.

Testing the unintended cost effects of health policies for generic substitutions: the case of China's National Volume-Based Procurement (NVBP) policy.

Generic substitutions are globally considered to contain health expenditures. Yet it is uncertain whether the costs would spill over to other medicines or health services. Contextualizing China's National Volume-Based Procurement (NVBP) policy, which promoted generic substitution, this study tests the changes in patients' utilisation of generic medicines and whether the costs shift to other pharmaceutics or health services post-policy. This population-based, matched, cohort study uses claims data from Tianjin, China in 2018-2020. We focus on Amlodipine, the most commonly used calcium channel blocker with the largest volume. We build comparable post-policy cohorts: Non-switchers who kept using originator Amlodipine, Pure-switchers who loyally switched to generic Amlodipine, and Back-switchers who switched back-and-forth; and compare between each matched pair, respectively, of their annual healthcare costs and that broken down by components, and patients' use of and adherence to Amlodipine post-policy. 1185 Pure-switchers, 1398 Back-switchers, and 2330 Non-switchers are identified (mean age: 63.0 years; 58.5% men). For the matched pairs, Pure-switchers (N=772) incurred an annual total medical costs of CNY 9213.5, 12.2% lower than Non-switchers (N=1544, absolute difference CNY -1309.3, 95%CI: [-2645.8, -19.6]). The cost reduction only results from Amlodipine prescriptions in outpatient encounters, and are equally born on health plans and the enrolees. Pure-switchers and Non-switchers are not different in costs from other medicines, nor from other items including tests, surgeries, beds, and medical consumables for hypertension-related encounters/admissions. Pure-switchers had higher daily dosage and better adherence to Amlodipine than Non-switchers as well. The differences between Back-switchers and Non-switchers show similar trends but are less profound. China's NVBP policy is effective to control pharmaceutical costs. No unintended cost effects have yet been identified in the short run. Other countries may learn from China on the comprehensive sets of auxiliary policies, including listing, bidding, purchasing, and reimbursing, to better promote generic substitutions.

Studying performance, energy, exergy, economic, environmental, and sustainability analyses of solar still using different storage materials

The main goal of this study is to investigate the performance, energy, exergy, economic, environmental, and sustainability analyses of single-slope solar still using different sensible storage materials. Three different storage materials were used: pebbles and basalt, which are common storage materials, and aluminum dross, which is a new storage material. The performance of still with storage material was compared to that of the traditional solar still. The study findings indicated that, compared to a conventional solar still, using pebbles, basalt, and aluminum dross increased water productivity by 7 %, 11.4 %, and 21.2 %, respectively. The thermal efficiency increased by 5.4 %, 15.7 %, and 22 % for pebbles, basalt, and aluminum dross, respectively. The increase in exergy efficiency was 43 %, 15.3 %, and 22 % for pebbles, basalt, and aluminum dross, respectively. Based on sustainability analysis, aluminum dross achieved the lowest payback time based on energy which was lower than three years, followed by basalt and pebbles. Also, aluminum dross achieved the highest energy production factor, followed by basalt and pebbles. The total annual cost was $22.73, $25.4, and $26.91 for pebbles, basalt, and aluminum dross, respectively. The exergo-economic based on energy and exergy was the highest for aluminum dross followed by basalt and pebbles. The environmental analysis revealed that the mitigated carbon dioxide by pebbles, basalt, and aluminum dross was 5.59 tons, 7.23 tons, and 8.21 tons, respectively. In conclusion, regardless of aluminum dross having the highest annual cost, it achieved the highest water productivity and efficient operation based on environmental and sustainability levels.

Optimum Planning of Carbon Capture and Storage Network Using Goal Programming

Carbon capture and storage (CCS) is a critical technology used for mitigating climate change by capturing carbon dioxide emissions from industrial sources and storing them underground to prevent their release into the atmosphere. Despite its potential, optimizing CCS systems for cost-effectiveness and efficiency improvement remains a significant challenge. In this paper, the optimization of CCS systems through the development and application of two mathematical optimization techniques is introduced. The first technique is based on using a superstructure optimization model, while the second technique relies on applying a goal programming optimization model. These models were solved using LINGO software version API 14.0.5099.166 to enhance the efficiency and cost-effectiveness of CCS systems. The first model, seeking to maximize the exchange of CO2 flowrate from sources to sinks, achieved a CO2 capture rate of 93.36% with an annual total cost of USD 1.175 billion. The second model introduced a novel mixed-integer non-linear programming (MINLP) approach for multi-objective optimization, targeting the minimization of total system cost, alternative storage, and unutilized storage while maximizing CO2 load exchange. The application of the second model, when prioritized to maximize CO2 flowrate exchange using the goal programming technique, resulted in a cost reduction of 36.46% and a CO2 capture rate of 75.87%. In contrast, when the second model prioritized minimizing the total annual cost, a 48% cost reduction was achieved, and the CO2 capture rate was decreased by 68.37%. A comparison of the two models’ results is presented. The results showed that the second model, with the priority of maximizing CO2 capture, provides the best economic–environmental objective balance, which offers notable cost reductions while keeping an efficient CO2 capture rate. This study highlights the potential of advanced mathematical modeling in increasing the feasibility of CCS as one of the very important strategies of mitigating climate change and reducing global warming.

Societal costs of older adults with low back pain seeking chiropractic care: findings from the BACE-C cohort study

BackgroundTo describe the societal costs during one year of follow-up among older adults seeking chiropractic care due to a new episode of low back pain (LBP), and to determine what factors predict high societal costs in this population.MethodsProspective cohort study, within chiropractic private practices (n = 38) in the Netherlands. 223 people ≥ 55 years of age with a new episode of LBP seeking chiropractic care participated. The primary outcome was total societal costs. High societal costs were defined as patients with costs in the top 20th percentile. The final prediction models were obtained using forward selection. Results were presented for the total population and stratified for retirement status. The model’s prognostic accuracy (Hosmer–Lemeshow X2, Nagelkerke’s R2) and discriminative ability [area under the receiver operating curve (AUC)] were assessed, and the models were internally validated using bootstrapping.ResultsThe mean total annual societal cost per patient was €5297 [95% confidence interval (CI): 4191–6403]. The biggest cost driver was presenteeism (65% of total costs), and costs were higher among non-retired participants (€7759; 95% CI 6047–9470) than retired participants (€1892; 95% CI 1088–2695). In the total population, younger age [odds ratio (OR): 0.87 for each additional year; 95% CI 0.80–0.95], being male instead of female (OR 2.96; 95% CI 1.19–7.44), less alcohol intake (OR 0.49; 95% CI 0.20–1.19), working instead of retirement (OR 9.37; 95% CI 1.83–48.04), and more disability at baseline (OR 1.08; 95% CI 1.00–1.16) were found to be predictive of high societal costs. Working was found to be the strongest predictor for high societal costs. After internal validation, the model’s fit was good, it’s explained variance was moderate (28%) and their AUCs could be interpreted as moderate (0.85). For non-pensioners, the same predictive factors were identified as for the entire population. The costs for the retired participants showed too little variation to be able to predict high costs.ConclusionsThis study estimated the mean total annual societal cost of older adults seeking chiropractic care due to a new episode of LBP at €5297 (95% CI 4191–6403).These costs were mainly due to high levels of presenteeism, and extensively differed based upon work status.

Size optimization of standalone wind-photovoltaics-diesel-battery systems by Harris hawks optimization (HHO): Case study of a wharf located in Bushehr, Iran

The global increase in energy demand has led to a growing focus on renewable energy sources as a potential solution. This study examines the annual total cost of optimized off-grid hybrid multi-resource systems, considering various configurations of Wind Turbines (WT), Photovoltaics (PV), Diesel Generators (DG), and Batteries (Bat). The research focuses on an oil dock in Bushehr, Iran, as a case study. The optimization process employs the Harris Hawk Optimization (HHO) algorithm – which is used for the first time for hybrid configuration and optimal sizing in this paper-, a nature-inspired, population-based optimization technique. This algorithm’s performance is compared to conventional optimization methods to assess its efficiency. The study’s methodology involves: (1) Explaining the economic relationships for each energy source, (2) Formulating a cost function, (3) Using the HHO algorithm to minimize the total cost of the renewable energy-based hybrid systems. The HHO algorithm is inspired by the hunting behavior of Harris hawks, specifically their “wonder attack” strategy. This novel approach to optimization aims to find the most cost-effective configuration of energy sources for the given scenario. Key findings of the study include the HHO algorithm demonstrated superior efficiency compared to Particle Swarm Optimization (PSO) and Gray Wolf Optimizer (GWO) across all configurations tested. The most cost-effective configuration was found to be a combination of photovoltaics, batteries, and diesel generators. This setup had the lowest total annual cost among all configurations examined. The optimal system consisted of 450 photovoltaic units, 9 battery units, and 2 diesel generator units, with a minimum annual cost of approximately $355,525. These results highlight the potential of the HHO algorithm in optimizing renewable energy systems and demonstrate the complex trade-offs between cost and environmental impact in hybrid energy configurations. The study contributes valuable insights to the field of renewable energy system design and optimization, particularly for off-grid applications in industrial settings.

Economic burden of cardiovascular diseases among elderly patients in Iran: a case from a developing country

BackgroundCardiovascular diseases (CVDs) are the leading cause of mortality and morbidity worldwide, particularly among the aging population. This study aims to evaluate the economic burden of CVDs among Iranians aged 60 years and older.MethodsA cost-of-illness study was conducted using a prevalence-based approach from a societal perspective. Cost analysis employed the bottom-up micro-costing method to assess direct medical and non-medical costs, while indirect costs were calculated using the human capital approach. Data were sourced from medical records of individuals aged 60 and older with CVDs registered in the hospital information systems of public and private hospitals in southeastern Iran. Additionally, structured face-to-face interviews were conducted with 160 caregivers or relatives serving as companions of elderly patients, using a structured questionnaire to gather data on healthcare utilization. Sensitivity analyses were performed, along with projections of the future economic burden of CVDs.ResultsThe annual total cost of CVDs among people aged 60 years and above in Iran was estimated at US$ 1,885,091,171.7 (about 1.88 billion), equivalent to 1.27% of the Iran’s GDP in 2021. Direct medical costs accounted for 90.62% of the total, with 54.72% attributed to ambulatory care. The average cost of CVDs per patient was US$ 446.2. The results of two-way sensitivity analysis provided an estimated cost range between US$ 1.2 billion and US$ 2.7 billion. By 2030, the total cost of CVDs is projected to reach US$ 21 billion.ConclusionsThe elderly population with CVDs imposes a growing economic burden on Iran’s healthcare system and society. This underscores the urgent need for effective and cost-effective interventions to prevent and manage CVDs in Iran.

Costs of Disabling Musculoskeletal Pain in Children and Adolescents: A Cost-of-Illness Prospective Cohort Study.

OBJECTIVES: To (1) estimate the economic cost of disabling musculoskeletal pain in children and adolescents from a health care and societal perspective, (2) identify the characteristics of children and adolescents with higher costs, and (3) estimate the economic cost of children's pain to Brazil. DESIGN: Prospective cohort study. METHODS: We recruited children and adolescents with disabling musculoskeletal pain from public and private schools. The economic cost associated with disabling musculoskeletal pain was reported by parents each month for 1 year. The cost categories were health care, lost productivity, and patient/family costs. The sum of the categories resulted in the societal costs. Costs were reported using means, standard errors, medians, interquartile ranges, confidence intervals, and sum for each cost category. We compared participant characteristics between groups with low and high costs, and estimated the health and social cost of children's pain to the Brazilian federal budget. RESULTS: We included 237 children and adolescents with mean age of 11.8 years (standard deviation, 2.9). Total annual health care costs were $29.58 and $103.13 for health insurance/public health care and out-of-pocket, respectively, per child. Total annual societal costs were $177.62 per child. Individuals in low socioeconomic class E (with a monthly income of up to R$403.00) reported that heavy backpack weight, practice of fewer days of sports, and more negative psychosomatic symptoms were associated with higher health care costs. The annual costs to Brazil from the societal perspective was $1 001 329 553. CONCLUSION: Disabling musculoskeletal pain in children and adolescents in Brazil imposes a serious economic burden of up to $1 billion on the federal budget. J Orthop Sports Phys Ther 2024;54(12):1-10. Epub 4 November 2024. doi:10.2519/jospt.2024.12735.

Multi-objective optimization and performance evaluation for the recovery of isopropanol and benzene from effluent via side-stream extractive distillation with intermediate reboiler processes

Side-stream extractive distillation typically requires the introduction of expensive high-pressure steam, which is not conducive to economic benefits. A heuristic approach is to introduce an intermediate reboiler in side-stream extractive distillation to reduce the use of high-pressure steam and thus lower economic costs. In this article, three side-stream extractive distillation with intermediate reboiler processes are proposed to recover the benzene and isopropanol from chloramphenicol production effluent. Taking into account economic, environmental, and entropy production indicators, an evolutional genetic algorithm is used to conduct the multi-objective optimization for the three processes. After obtaining the optimal operation parameters, the corresponding heat integration processes are proposed. Following that, the six process are compared to the optimal double side-stream extractive distillation process (D-SSED) in literature. It indicates that all six processes have good economic potential, especially the single side-stream extractive distillation with intermediate reboiler process with heat integration (S-SSEDIR-2-HI), which is the optimal scheme. Compared to the D-SSED process, it can reduce total annual cost (TAC) by 29.02 %, CO2 emission by 36.14 %, and entropy production by 44.07 %.

Health care utilization among Medicare beneficiaries with newly diagnosed back pain

BackgroundLow back pain (LBP) is the most common medical cause of disability among adults 65 or older. No previous study has characterized health care costs and treatment patterns of LBP among Medicare beneficiaries. MethodsThis retrospective cohort study quantifies health care utilization costs among Medicare beneficiaries with newly diagnosed LBP, compares costs between patients managed operatively and nonoperatively, identifies costs associated with treatment guideline nonadherence, and characterizes opioid prescribing patterns. Patients were queried via ICD codes from a 20% random sample of Medicare claims records. Patients with concomitant or previous “red flag” diagnoses, neurological deficits, or diagnoses that could cause nondegenerative LBP were excluded. Total costs of care in the year of diagnosis were calculated and stratified by operative versus nonoperative management. To assess for guideline adherence, utilization and costs of different services were tabulated. Opioid prescription patterns were characterized by quantity, cost, duration, and medication type. ResultsAbout 1,269,896 patients were identified; 23,919 (1.8%) underwent surgery. These accounted for 7% of the cohort's total cost ($514 million total, $21,496 per person). Patients treated nonoperatively accounted for over $7 billion in costs ($5,880 per person; p<.001). Within the nonoperative cohort, 626,896 (50.3%) patients were nonadherent to current guidelines for conservative management of LBP. Guideline nonadherence increased total annual costs by $4,012 per person ($7,873 for nonadherent vs. $3,861 for adherent patients, p<.001). About 460,867 opioid prescriptions were filled for 303,796 unique patients (23.9%) within 30 days of LBP diagnosis. Within the nonsurgical cohort, patients nonadherent to imaging guidelines were more likely to have an opioid prescription within this window than adherent patients (26.5% vs. 21.2%; p<.001). ConclusionsNonoperative management of LBP is associated with significantly lower costs per patient. Early imaging and opioid prescription are significant drivers of excess cost. Adherence to proposed treatment guidelines can save over $2.8 billion in total health care costs.

Pressure-Swing Heterogeneous Azeotropic Distillation for Energy-Efficient Recovery of Ethyl Acetate and Methanol from Wastewater with Expanded Feed Composition Range

This article tends to address the limitations of heterogeneous azeotropic distillation (HAD) for separating Serafimov's class 2.0-2b mixtures, such as ethyl acetate/methanol/water. The feasibility of proposed HAD is constrained by a narrow feed composition range, as thoroughly analyzed through thermodynamic insights in this work. To address these limitations, we propose pressure-swing heterogeneous azeotropic distillation (PSHAD), which allows for a broader application range in feed composition and facilitates heat integration for enhanced economic performance. Thermodynamic insights explore the economic viability and feasibility of PSHAD as feed composition and operating pressure vary. The applicable feed concentration range for PSHAD is determined by liquid-liquid region area and maximum allowable pressure. A parallel genetic algorithm optimizes the processes to minimize total annual cost (TAC). Both PSHAD and the heat-integrated configuration demonstrate superior performance compared to the best process in published literature (i.e., intensified extractive distillation), achieving TAC reductions of 26.46% and 46.22%, respectively.

Advancing biopharmaceutical manufacturing: economic and sustainability assessment of end-to-end continuous production of monoclonal antibodies

Monoclonal antibodies (mAbs) have become essential therapeutics for treating various diseases. The robust, cost-effective, and sustainable production of mAbs is crucial due to their growing clinical and commercial demand. Advances in bioprocessing, such as improved cell lines, perfusion bioreactors, multicolumn chromatography, and automation, can significantly increase productivity, making treatments more accessible. Streamlining the production process also aligns with environmental sustainability by reducing waste and energy consumption. This study quantifies the economic and environmental impacts of incorporating recent advances into end-to-end continuous bioprocessing of mAbs. The results demonstrate that, compared with an optimized best-in-class fed-batch process (with 15 g/l titer and multicolumn chromatography), continuous manufacturing can reduce the total annual production costs, facility footprint, plastic waste, and CO2 emissions by up to 23%, 51%, 57%, and 54%, respectively, in a multiproduct facility producing clinical and commercial lots. Additionally, uncertainty analysis indicates that these gains are even more substantial under demand fluctuations.

Real-World Healthcare Resource Utilization, Healthcare Costs, and Injurious Falls Among Elderly Patients with Geographic Atrophy.

This study assessed the clinical and economic burden of geographic atrophy (GA) using real-world data from elderly patients with Medicare Advantage plans in the United States. A retrospective cohort design of patients with GA only, GA + visual impairment (GA + VI), GA + blindness (GA + B), and patients without GA were identified using administrative healthcare claims data from Optum Clinformatics Data Mart. Inverse probability of treatment weighting controlled for confounding when comparing patients with GA only vs without GA, GA + VI vs GA only, and GA + B vs GA only. Endpoints included all-cause and ophthalmic condition-related healthcare resource utilization (HRU), injurious falls, and healthcare costs. HRU and injurious falls were assessed per-person-per-year and per 100 person-years, respectively. Cohorts were compared using rate ratios, 95% confidence intervals (CIs), and p-values from weighted Poisson regression models. Healthcare costs were evaluated per-person-per-year using mean cost differences, 95% CIs, and p-values from weighted linear regression. The study included 18,119 patients with GA only, 2,285 with GA + VI, 1,716 with GA + B, and 72,476 patients without GA. Higher rates of all-cause hospitalizations (RR [95% CI]: 1.08 [1.03, 1.12]), outpatient visits (1.08 [1.05, 1.10]), other visits (1.14 [1.08, 1.21]), and falls with head injuries (1.24 [1.05, 1.45]) were observed in patients with GA vs without GA (P<0.05). GA was associated with higher annual all-cause total healthcare costs, spending an average of $1,171 more after adjustment (P<0.05). Progression to GA + VI and GA + B was associated with a more pronounced burden. The clinical and economic burden of GA is substantial and escalates as the disease advances. These findings suggest early intervention aimed at slowing GA progression may help to mitigate the healthcare burden associated with advancement of GA to visual impairment and blindness.

A collaborative planning of PCCs siting and transmission network expansion for super large‐scale offshore wind clusters

AbstractThe integration of super large‐scale offshore wind clusters into the onshore power grid brings challenges for the flexibility of the transmission network. Therefore, this paper proposes a two‐stage collaborative planning of points of common coupling siting and transmission network expansion for super large‐scale offshore wind clusters, based on a multi‐voltage‐level stratified integration mode which enables offshore wind power to transmit to larger regions for accommodation. At first, the transmission network flexibility indexes are established. Then, a two‐stage collaborative planning model for points of common couplings siting and transmission network expansion is proposed, which comprises a collaborative planning model and an optimal power flow operation model. The proposed model reduces wind curtailment and load shedding by optimizing the annual total cost and flexibility transmission capability of the network. Finally, the effectiveness of the proposed method is verified using a modified IEEE 30‐bus system and a 65‐bus system.

Multi-energy synergistic planning of distributed energy supply system: Wind-solar-hydrogen coupling energy supply

This study is to improve the efficiency of energy utilization with the continuous growth of global energy demand and the increasingly severe environmental problem. A hydrogen-containing distributed energy supply system is proposed, which includes a hydrogen energy subsystem. The main driver of the system is renewable energy, while hydrogen energy is used as a carrier to assist the flow of energy. This study proposes an improved following electric load (FEL) strategy based on a comprehensive consideration of energy interactions within the system, and designs an optimal configuration model aimed at improving its economic, environmental and energy benefits. In addition, an improved rime algorithm (IRIME) is proposed, whose convergence performance and solution stability are greatly improved. A multi-objective optimization algorithm with better convergence performance, multi-objective improved rime algorithm (MO-IRIME), is proposed for solving the optimal configuration model to obtain the optimal capacity of the equipment inside hydrogen-containing distributed energy supply system. The total annual cost is reduced by 44.80 %, the primary energy consumption by 68.47 % and the pollutant gas emissions by 75.79 % compared to the reference system. In addition, the way of interaction and coordination of multiple energy sources in the daily cycle is analyzed.

Heat Pump-Assisted Extractive Pressure-Swing Distillation with Integrated Feed Preconcentration/Solvent Recovery for Isopropanol-Benzene-Water Separation

Recently, heat-integrated pressure-swing distillation (HIPSD) has been explored for recovering isopropanol and benzene from wastewater, but the process remains highly energy-intensive. Given the dilute nature of the feed, intensified extractive distillation with an integrated preconcentration column (IED) is more suitable. However, previous researches have often overlooked the critical role of pressure and lacked rigorous optimization of operating pressure in such systems. In this article, we developed novel extractive pressure-swing distillation with integrated feed preconcentration/solvent recovery column (IEPSD) by introducing a pressure-swing configuration and incorporate energy-saving technologies to achieve more sustainable and cost-effective separation processes. First, thermodynamic analysis is conducted to explore the effect of pressure on extractive pressure-swing distillation. Then, a parallel genetic algorithm is applied for rigorous optimization, followed by the application of heat integration and heat pump. The IEPSD is superior to IED in terms of total annual cost (TAC) and CO2 emission. With the inclusion of energy-saving technologies, IEDHI and IEPSDHI further reduced TAC by 5.29% and 7.40%, and cut CO2 emissions by 25.18% and 24.03%, respectively, compared to their base processes. The use of a heat pump is particularly advantageous for IEPSD due to its lower boiling temperatures under vacuum pressure, leading to the development of IEPSDHIHP, which offered an additional 22.36% CO2 reduction and marginally lower TAC than IEPSDHI. Ultimately, IEPSDHIHP proves to be the best option, offering a 51.15% TAC reduction and 68.42% CO2 emissions reduction compared to HIPSD. In summary, the developed IED and IEPSD processes, especially with heat integration and heat pump technologies, offer significant economic and environmental advantages over conventional HIPSD.

Sex-specific clinical outcomes and healthcare resource utilization in the 5 years following hospitalization for heart failure

Abstract Background Heart failure (HF) a leading cause of hospitalization, and sex differences in care have been described. Purpose We assessed sex-specific clinical outcomes and healthcare resource utilization following hospitalization for HF. Methods This was an exploratory analysis of patients hospitalized for HF across 10 Canadian hospitals enrolled in the Patient-Centred Care Transitions in HF pragmatic cluster-randomized trial. Primary outcome was all-cause mortality. Secondary outcomes included all-cause readmissions, HF readmissions, emergency department (ED) visits, and healthcare resource utilization. Outcomes were obtained via linkages with administrative datasets. Results The 4441 patients (50.7% female) had high event rates. At 5 years of follow-up, 63.6% male and 65.5% of male and female patients, respectively, had died (p=0.19); 85.4% and 84.4% of male and female patients, respectively, were readmitted with no sex differences in mean [SD] all-cause readmissions (males, 2.8 [7.8] and females, 3.0 [8.4], p=0.54) or HF readmissions (males, 0.9 [3.6] and females, 0.9 [4.5], p=0.80) per person. The mean (SD) annual total healthcare costs per patient was $80334 (116762) for males and $81010 (112625) for females, with no sex difference (p=0.90); however, there were sex differences in cost breakdown: males incurred greater costs from specialist, hemodialysis, and day surgical care, and females incurred greater costs from home visits and long-term care. Conclusions Males and females were at similarly high risk of mortality and readmissions, and had similar total healthcare costs following hospitalized for HF. Notwithstanding similar risks, males received relatively more specialist and invasive care, and females received relatively more supportive care.

Energy and cost-efficient ionic liquids extractive distillation for producing electronic and polymer-grade propylene with emphasis on feedstock variability

The separation of propylene/propane is the main source of electronic or polymer-grade propylene. However, the current industrial method faces significant challenges due to high theoretical stages and energy consumption. In this work, an extractive distillation process using ionic liquids (ILs) 1-butyl-3-methylimidazolium trifluoroacetate ([BMIM][TFA]) is proposed to overcome these difficulties. Based on quantum chemical calculations, the mechanism of separation of propylene/propane is analyzed, and the mechanism behind the performance differences of various anions is explored. Optimal designs for extractive distillation processes are investigated for varying propylene/propane feed compositions, targeting electronic and polymer-grade propylene. A comparison of traditional distillation, heat pump distillation, and ILs extractive distillation evaluates both energy consumption and economic factors. The results suggest that both the cation and anion contribute to the separation of propylene/propane, with the cation having a greater effect than the anion. The separation is enhanced by the π-π stacking, C-H···π, and π···H···O interactions between [BMIM][TFA] and propylene, which strengthen the affinity for propylene over propane. Compared to traditional distillation, ILs extractive distillation reduces energy costs by 64.1% to 82.1% for polymer-grade propylene and by 69.5% to 84.0% for electronic-grade propylene, with theoretical stages dropping from 210–240 to 46–78 and 250–280 to 64–98, respectively. It also cuts total annual cost by 2.0% to 37.4% for polymer-grade and 7.4% to 39.2% for electronic-grade propylene compared to heat pump distillation. The extractive distillation using [BMIM][TFA] performs best, indicating substantial potential for separating propylene/propane.

Real-World Clinical and Healthcare Resource Burden Among Burosumab-Naïve Patients With Familial Hypophosphatemia.

To examine the real-world clinical and healthcare resource burden of familial hypophosphatemia (FH). In a retrospective, observational cohort study using MarketScan claims data from 2017 to 2021, clinical characteristics and healthcare resource utilization (HCRU) and costs were compared between burosumab-naïve pediatric and adult patients with ≥ 1 FH diagnosis code and matched controls without FH. Patient characteristics were evaluated at baseline, and disease characteristics, HCRU, and costs were evaluated over a 12-month follow-up period. Outcomes were analyzed descriptively. Costs were additionally analyzed using multivariate regression models. Overall, 570 patients with FH and 1710 non-FH matched controls were included. Approximately 10% of study participants were aged < 18 years. Patients with FH had 7.8-fold higher mean baseline comorbidity (Charlson Comorbidity Index). The prevalence of morbidities over the 12-month follow-up period was higher in patients with FH than controls, including renal disease (33% vs 3%), arthralgia (25% vs 10%), osteoarthritis (17% vs 6%), and delayed growth/walking difficulty (16% vs 2%; all P < .001). All-cause HCRU was significantly greater for patients with FH than controls over follow-up, including the proportion of patients with at least one inpatient admission (60% vs 4%), outpatient emergency room visit (52% vs 16%), and outpatient pharmacy prescription (96% vs 71%; all P < .001). The mean annual total healthcare cost per patient was also 22.6-fold higher for patients with FH than controls (adjusted cost difference = $129 643; P < .001). Differences were apparent across all age groups. Compared with non-FH matched controls, burosumab-naïve patients with FH experienced multiple morbidities and had substantially higher HCRU and costs.