Total Service Costs Research Articles

(Retracted) Mobile edge computing task scheduling and device cooperation algorithm based on deep learning

With the changes in the era of science and technology, the emergence of 5G technology makes a communication speed leap, and the delay is also getting shorter and shorter. At present, the computing power of computing equipment is also steadily improving. As one of its key technologies, mobile edge computing (MEC) is becoming more and more important. Here, we introduce MEC task scheduling and device collaboration algorithms based on deep learning. Aiming at the multi-task joint optimization scheduling strategy microtearing mode to minimize the total service cost of multiple tasks, we establish a theoretical optimization model of multi-task joint scheduling and use the model to design a multi-task cloud collaborative optimization scheduling algorithm based on Livepeer Token rules. We propose a deep-learning device collaboration algorithm based on alternating direction multiplier. The sub differential algorithm and the improved conjugate gradient method are designed to solve the sub problem respectively. This paper simulates the proposed deep-learning task scheduling algorithm and device collaboration algorithm. The simulation results show that, in the task scheduling algorithm, the proposed algorithm reduces the cost of completing the task, but in the total task time, this algorithm has a certain gap compared with other algorithms. In the equipment collaboration algorithm, with the increase of the n value, the algorithm converges in a certain iteration increment; in terms of algorithm convergence, the algorithm needs 142 iterations at most to achieve convergence, and the fastest speed only needs 17 iterations. In the experiment based on real data sets, the proposed algorithm is also better than the other two algorithms. From these results, we can see that the proposed algorithm has good convergence, stability, and scalability, and it has excellent performance in task scheduling and device collaboration of MEC.

Integration of conventional and customized bus services: An empirical study in Beijing

In recent years, customized bus (CB) service has become an innovative model for public transportation in China. Its ability to provide advanced, timely, personalized, and flexible service has made it very popular. However, previous studies have ignored its diversion effect: How can CB service help conventional buses reduce on-board crowding during rush hours? In this paper, we optimize conventional and CB buses as a whole based on an empirical study in Beijing. We propose a new model to compare the cost of single conventional buses (Single Con) and the integration of conventional and customized buses (Con+ CB). Passenger diversions from conventional buses to CB ones are specifically considered. To do this we explicitly measure the on-board crowding cost of conventional buses by load factor and distance factor. Real-world data from Beijing, China, are employed to assess the model. We obtained the departure arrangements and the corresponding costs under different demand cases. The results are analyzed and compared. Sensitivity analyses are then conducted to study the effects of line-haul distance and load factor on cost. The results show that (1) adding new modes of transportation does not always significantly reduce the total cost of bus service; (2) CB buses can effectively ease congestion on conventional buses only at high demand densities but not at low densities; (3) crowding cost increases caused by the distance factor far exceed those caused by the load factor.

Poor disease knowledge is associated with higher healthcare service use and costs among patients with cirrhosis: an exploratory study

BackgroundOptimal management of cirrhosis is complex, and patients often lack knowledge and skills, which can affect self-management. We assessed patient knowledge about cirrhosis and examined whether knowledge was associated with clinical outcomes, healthcare service use, and healthcare costs. A cross-sectional ‘knowledge survey’ was conducted during 2018–2020. We assessed patient knowledge about cirrhosis and explore whether knowledge was associated with clinical outcomes, healthcare service use, and costs.MethodsPatients with cirrhosis (n = 123) completed a ‘knowledge survey’. We calculated the proportion of correct answers to eight questions deemed to be “key knowledge” about cirrhosis by an expert panel, and dichotomized patients as ‘good knowledge’/‘poor knowledge’. Clinical data, healthcare costs, and health-related quality of life (SF-36) were available.Results58.5% of patients had ‘good knowledge’ about cirrhosis. Higher education level was associated with higher odds of having ‘good knowledge’ about cirrhosis (adjusted-OR = 5.55, 95%CI 2.40–12.84). Compared to patients with ‘poor knowledge’, those with ‘good knowledge’ had a higher health status in the SF-36 physical functioning domain (p = 0.011), fewer cirrhosis-related admissions (adjusted incidence rate ratio [IRR] = 0.59, 95%CI 0.35–0.99) and emergency presentations (adj-IRR = 0.34, 95%CI 0.16–0.72), and more planned 1-day cirrhosis admissions (adj-IRR = 3.96, 95%CI 1.46–10.74). The total cost of cirrhosis admissions was lower for patients with ‘good knowledge’ (adj-IRR = 0.30, 95%CI 0.29–0.30).ConclusionPoor disease knowledge is associated with increased use and total cost of healthcare services. Targeted educational interventions to improve patient knowledge may be an effective strategy to promote a more cost-effective use of healthcare services.

Collaborative scheduling of spare parts production and service workers driven by distributed maintenance demand

We analyse the joint scheduling of spare parts production and service workers driven by distributed maintenance demand. For each failure, a service worker and a necessary spare part must be assigned for on-site maintenance. In particular, the spare part is not supplied from stock, but is delivered directly from the factory to the maintenance site through just-in-time production. Spare parts production and worker allocation are integrated to optimize two objectives: customer satisfaction and total service cost. To solve the problem, we first construct a mathematical model. Subsequently, a modified non-dominated neighbor immune algorithm (MNNIA) is proposed, in which a knowledge-based initialization rule, an idle time insertion method, and two problem-specific local search operators are developed to enhance exploitation. Extensive experiments and comparisons are conducted to demonstrate the superiority of MNNIA. Furthermore, compared with that of the separate decision-making mode of spare parts production and worker arrangement, the effectiveness of the integrated scheduling mode is verified.

Adequate funding of comprehensive community-based programs for key populations needed now more than ever to reach and sustain HIV targets.

IntroductionGlobally, over half of the estimated new HIV infections now occur among key populations, including men who have sex with men, sex workers, people who inject drugs, transgender individuals, and people in prisons and other closed settings, and their sexual partners. Reaching epidemic control will, for many countries, increasingly require intensified programming and targeted resource allocation to meet the needs of key populations and their sexual partners. However, insufficient funding, both in terms of overall amounts and the way the funding is spent, contributes to the systematic marginalization of key populations from needed HIV services.DiscussionThe Joint United Nations Programme on HIV/AIDS (UNAIDS) has recently highlighted the urgent need to take action to end inequalities, including those faced by key populations, which have only been exacerbated by the COVID‐19 pandemic. To address these inequalities and improve health outcomes, key population programs must expand the use of a trusted access platform, scale up differentiated service delivery models tailored to the needs of key populations, rollout structural interventions and ensure service integration. These critical program elements are often considered “extras,” not necessities, and consequently costing studies of key population programs systematically underestimate the total and unitary costs of services for key populations. Findings from a recent costing study from the LINKAGES project suggest that adequate funding for these four program elements can yield benefits in program performance. Despite this and other evidence, the lack of data on the true costs of these elements and the costs of failing to provide them prevents sufficient investment in these critical elements.ConclusionsAs nations strive to reach the 2030 UNAIDS goals, donors, governments and implementers should reconsider the true, but often hidden costs in future healthcare dollars and in lives if they fail to invest in the community‐based and community‐driven key population programs that address structural inequities. Supporting these efforts contributes to closing the remaining gaps in the 95‐95‐95 goals. The financial and opportunity cost of perpetuating inequities and missing those who must be reached in the last mile of HIV epidemic control must be considered.

A reliability-and-cost-based framework to optimize maintenance planning and diverse-skilled technician routing for geographically distributed systems

We present an agile maintenance framework where technician assignment and maintenance schedules are planned jointly to ensure timely operation and maintenance (O&M) services. Such an agile framework can quickly respond to organizational scheduling requirements while controlling service costs and not compromising machine reliability. For preventive maintenance (PM) and replacement tasks, a diverse-skilled technician organizing and routing model (D-STORM) is developed for geographically distributed systems with the following decision variables: (1) the scheduled maintenance start time, (2) the appropriate maintenance level (i.e. PM or replacement) for a network of machines, (3) the composition of technician teams subject to constraints controlling the number of technicians per team and their skill levels, (4) the optimal service route for each team. And the two objectives are: (1) maximizing the total reliability improvement and (2) minimizing the total service cost. Other than traditional maintenance policies, we propose a machine-team-technician assignment approach to provide a flexible and unified maintenance framework that can incorporate diverse-skilled technicians and multi-level maintenance operations. Numerical studies show significant advantages in terms of improved reliability and reduced costs, providing a set of alternative solutions for global original equipment manufacturers (OEMs). Moreover, Pareto solutions help OEMs to adopt the most appropriate maintenance scheme for their practices.

A discrete multi-objective grey wolf optimizer for the home health care routing and scheduling problem with priorities and uncertainty

In China, with the acceleration of the population aging, the demand for home health care is growing rapidly. However, the available caregivers are insufficient to serve all the customers who make an appointment in advance. Besides, there are actually some uncertain parameters such as travel and service times when implementing the given schedule. Hence, this paper presents a home health care routing and scheduling problem (HHCRSP) by considering customers’ priorities and times uncertainty. A fuzzy multi-objective optimization model is established to maximize the total priority of all visited customers and minimize the total service cost. Jimenez’s method is utilized to transform the fuzzy parameters in the model. A discrete multi-objective grey wolf optimizer (DMOGWO) is proposed to solve the model. In the DMOGWO, the heuristic rule of priority maximum-earliest service is designed to generate the initial solution. An individual position updating mechanism is developed to make the algorithm suitable for discrete search space. Subsequently, three neighborhood structures are designed to enhance the local search ability of the algorithm. Finally, the DMOGWO is compared with CPLEX, MOGWO, MOPSO, NSGA-II and NSGA-III. Experimental results indicate that the proposed DMOGWO is competitive in convergence, diversity and distribution of the solutions on many instances. This shows that the proposed DMOGWO can effectively solve the home care routing and scheduling problem.

Utilization of emergency services for severe hypoglycemia in people with diabetes in France: A study based on the national health insurance database

AimsTo estimate the number of people with diabetes (PWD) requiring emergency services for severe hypoglycemia (SH) in France and the associated costs. MethodsPWD were identified using the National Health Insurance database (SNDS). Type of diabetes was determined by the medications used. Matching of the emergency department (ED) visits database (RPU) and the SNDS was used to identify ED visits for SH in 2016 and 2017. SH was identified in the RPU using specific ICD-10 codes. The main SH-related costs analyzed were costs of ED visits, hospitalization, and transport. ResultsOf 3,236,600 PWD in 2017, 781,084 had at least one ED visit (11.5% type 1 diabetes [T1D]) and 9,160 patients had at least one ED visit for SH (40.2% T1D; 55.9% male; mean age 63.0 years; mean diabetes duration 17.2 years). Nearly 50% of ED visits for SH led to immediate hospitalization. The total cost of emergency services for SH was €12.39 million. The mean (SD) cost per patient was €1,352 (€2,540). ConclusionsSH accounts for nearly 1% of ED visits in PWD, and nearly half of these patients are hospitalized during the visit. Beyond the patient impact, SH is associated with a substantial economic burden.

Cost of cancer management by stage at diagnosis among Medicare beneficiaries

Objective Estimate the annual cost of care in the 5 years following a cancer diagnosis for 17 invasive cancer types, by stage at diagnosis. Methods We used 2012–2016 data from the Surveillance, Epidemiology, and End Results (SEER) registry-Medicare claims database to examine cost of care among Medicare beneficiaries with a confirmed cancer diagnosis based on International Classification of Diseases for Oncology, Third Edition histology codes reported in SEER. Beneficiaries contributed to the annual cost calculations (Years 1–5) using their observed time after diagnosis. Beneficiaries were continuously enrolled in fee-for-service Medicare Parts A/B and Part D during follow-up. Total, inpatient, outpatient, and pharmacy cancer-related service costs were calculated. Results From 2012 to 2016, we identified 597,778 Medicare beneficiaries with incident cancer diagnosis within 5 years (Stage I, II, III, and IV: 32.6%, 33.4%, 15.9%, and 18.0%, respectively). In Year 1, mean (standard deviation) total costs for Stage I diagnoses varied from $7640 ($17,378) (prostate) to $94,636 ($117,636) (pancreas). Total costs increased by stage and reached $58,783 ($92,344) (prostate) to $156,982 ($175,009) (stomach) for Stage IV diagnoses in Year 1. Costs in Year 1 were significantly higher for Stage IV diagnoses than for earlier stages across all cancer types. In Years 2–5, total costs were lower than in Year 1 but continued to increase by stage. Conclusions Beneficiaries diagnosed at later stages of cancer have higher costs of care (up to 7 times as much) than those diagnosed at earlier stages. Earlier cancer diagnosis may lead to more efficient treatment and decreased management cost.

Cost Analysis of Individual Outpatient and Emergency Pharmacy Services in the Kingdom of Saudi Arabia

PTB Reports,2022,8,1,12-18.DOI:10.5530/PTB.2022.8.2Published:April 2022Type:Research ArticleAuthors:Mona Yaser Alsheikh, Raghad Abdulaziz Alasmari, Asma Saqer Alamri, Bandar Awwadh Alosaimi, and Yousef Ahmed Alomi Author(s) affiliations:Mona Yaser Alsheikh,* PharmD, MSc,PhD, FHEA Department of Clinical Pharmacy, College of Pharmacy, Taif University, KSA. Raghad Abdulaziz Alasmari, Pharm D College of Pharmacy, Taif University, KSA. Asma Saqer Alamri, Pharm D College of Pharmacy, Taif University, KSA. Bandar Awwadh Alosaimi, Pharm D College of Pharmacy, Taif University, KSA. Yousef Ahmed Alomi, BSc. Pharm, MSc. Clin Pharm, BCPS, BCNSP, DiBA, CDE Critical care Clinical Pharmacists, TPN Clinical Pharmacist, Freelancer Business Planner, Content Editor, and Data Analyst, Riyadh, KSA. Abstract:Objectives: In this study, we aimed to explore the cost of Individual outpatient and emergency pharmacy services in the Kingdom of Saudi Arabia. Methods: This is a descriptive analysis crosssectional and questionnaire-based study. We used an electronic survey questionnaire with a judgment sampling system to obtain responses. The structured questionnaire consisted of two parts written in English and Arabic. The first part collected the demographic information of the responders based on multiple-choice questions. The second part contained questions for measuring the personal cost, including the salary cost of a head of ambulatory care or outpatient pharmacist, a clinical pharmacist working at ambulatory care, pharmacist and pharmacy technician, and secretary and porter per hour. The cost was calculated for the preparation time of each medication. The total costs of the place’s overhead cost and cost of equipment used for the outpatient and emergency pharmacy services. Furthermore, the purchased materials and supplies and the non-salary cost were calculated. All costs were used in the US dollar currency. The data were collected through the Survey Monkey system and analyzed using Microsoft Excel version 2020. Results: The total of judgment responders was six directors of pharmacy. Five were responsible for outpatient pharmacy services, and one was responsible for emergency pharmacy. The majority of the outpatient and emergency pharmacy directors had work experience as pharmacy administrators for more than four years. The total cost of outpatient pharmacy services was 1581.95 USD, whereas the cost of emergency pharmacy services was 729.86 USD. The majority of the cost came from personnel cost from the outpatient pharmacy (1288.15 USD, 81.43%) followed by emergency pharmacy (465.28 USD, 63.75%) and material and supply cost (205 USD, 13.01%) at the outpatient pharmacy and emergency pharmacy services (228.89 USD, 31.36%). Conclusion: This study conducted the cost analysis of separate outpatient and emergency pharmacy services. Standardized pharmacy administrative and clinical activities are required, and we recommend more additional studies with a large sample size in the Kingdom of Saudi Arabia. Keywords:Cost, Emergency, Kingdom of Saudi Arabia, Outpatient, Pharmacy, SeparateView:PDF (165.7 KB) PDF PDF Images Cost Analysis of Individual Outpatient and Emergency Pharmacy Services in the Kingdom of Saudi Arabia

Развитие современных форм и технологий банковского обслуживания

The article reveals the problem of effective interaction of bank employees with customers, as well as the technological and innovative component of these relations. Currently, banks are focusing on the needs of the client and their satisfaction, on expanding the customer base and market share, which push the increase in profits into the background. It is this fact that forces credit institutions to invest in new projects to serve customers, while not causing inconvenience in the provision of services. The authors consider the possibility of improving existing forms of banking services by introducing new technologies and using biometrics technologies, which significantly reduce the time spent by client managers on departure and costs. To implement projects, the bank needs to attract partners in the face of IT companies and developers, as well as invest in the development of biometric technologies. The interaction of client managers of large, medium and small businesses, other clients – legal entities and individual entrepreneurs was chosen as the object of the study. The article analyzes the main forms of banking services and presents the classification of the remote form. The authors analyze the number of accounts with remote access for the period 2015-2020. Using the formula of the total cost of service, the authors reveal the effectiveness of the introduction of remote technologies by banks over the traditional form of service. The article also highlights focusing of modern banks on offering ecosystem products to customers, and analyzes the profitability of these activities. Based on the report on financial results, calculations were made and a forecast of the profitability of the implemented project was made using indicators of the present net income and the rate of return. Statistical data from the official websites of banks and the Federal State Statistics Service, as well as articles, other information materials of printed publications and Internet resources were used as an information base. In the course of the research, the authors used methods of statistical and comparative analysis, and gave a list of relevant sources.

Cost-effectiveness analysis of combined cognitive and vocational rehabilitation in patients with mild-to-moderate TBI: results from a randomized controlled trial

BackgroundTraumatic brain injury (TBI) represents a financial burden to the healthcare system, patients, their families and society. Rehabilitation interventions with the potential for reducing costs associated with TBI are demanded. This study evaluated the cost-effectiveness of a randomized, controlled, parallel group trial that compared the effectiveness of a combined cognitive and vocational intervention to treatment as usual (TAU) on vocational outcomes.MethodsOne-hundred sixteen participants with mild-to-moderate TBI were recruited from an outpatient clinic at Oslo University Hospital, Norway. They were randomized to a cognitive rehabilitation intervention (Compensatory Cognitive Training, CCT) and Supported Employment (SE) or TAU in a 1:1 ratio. Costs of CCT-SE and TAU, healthcare services, informal care and productivity loss were assessed 3, 6 and 12 months after study inclusion. Cost-effectiveness was evaluated from the difference in number of days until return to pre-injury work levels between CCT-SE and TAU and quality-adjusted life years (QALYs) derived from the EQ-5D-5L across 12 months follow-up. Cost-utility was expressed in incremental cost-effectiveness ratio (ICER).ResultsThe mean total costs of healthcare services was € 3,281 in the CCT-SE group and € 2,300 in TAU, informal care was € 2,761 in CCT-SE and € 3,591 in TAU, and productivity loss was € 30,738 in CCT-SE and € 33,401 in TAU. Costs related to productivity loss accounted for 84% of the total costs. From a healthcare perspective, the ICER was € 56 per day earlier back to work in the CCT-SE group. Given a threshold of € 27,500 per QALY gained, adjusting for baseline difference in EQ-5D-5L index values revealed a net monetary benefit (NMB) of € -561 (0.009*27,500–979) from the healthcare perspective, indicating higher incremental costs for the CCT-SE group. From the societal perspective, the NMB was € 1,566 (0.009*27,500-(-1,319)), indicating that the CCT-SE intervention was a cost-effective alternative to TAU.ConclusionsCosts associated with productivity loss accounted for the majority of costs in both groups and were lower in the CCT-SE group. The CCT-SE intervention was a cost-effective alternative to TAU when considering the societal perspective, but not from a healthcare perspective.Trial registrationClinicalTrails.gov NCT03092713.

Estimation the medical cost of multiple sclerosis in Iran; 2019\u20132020

BackgroundDue to the high and increasing economic burden of chronic diseases, including Multiple sclerosis (MS), we aimed to investigate the medical cost of MS in Iran.MethodsThis is a descriptive cross-sectional study which conducted using comprehensive national prescription data from Iran’s Health Insurance Organization (IHIO) and rehabilitation data from Ministry of Health and Iran Welfare Organization. The time period considered for this study was 2019–2020. In order to calculate the medical cost of MS, the cost-of-illness (COI) method was used based on the prevalence-based approach and the cost of medications, determining and diagnosing the MS risk, follow-up and rehabilitation was estimated.ResultsThe total medical cost of MS in Iran in 2019–2020 was estimated at $238,124,160, which medications and rehabilitation services had the largest share in the medical cost of MS in Iran with 80 and 19%, respectively, and the cost share of determining and diagnosing of the disease risk accounted for about less than 1%. The total medication cost was estimated to be equal to $192,298 thousand. The total cost of determining and diagnosing of the MS risk was estimated at $348,574 and the total cost of rehabilitation services for all MS subgroups in 2019–2020 was estimated at $45,477,205.ConclusionsResults of calculating the medical cost of MS in Iran in 2019–2020 showed a significant burden on the Iranian health care system and society, among which the medication cost had the largest share, which requires serious attention of health system policymakers.

Decreasing e-waste through reliability enhancement encouraged by performance-based contracting

PurposeIn the last 20 years, e-waste has become a serious issue resulting from an overwhelming amount of electronics consumption. However, there has been limited research on how to decrease such waste in a structured manner. Toward study was to use a simulation methodology to investigate the dynamics of upfront investment in reliability enhancement promoted by performance-based contracting (PBC), based on the number of spare parts and duration of the contract.Design/methodology/approachThe present research first details the relevant mathematical equations and uses game theory to demonstrate the utility for supplier and buyer relationships. Next, the effects of reliability enhancement, spare partsPBC are analyzed using a BlockSim simulation model.FindingsThe results indicate strong relationships among system design cost, reliability, availability and service cost. The authors found that investment in reliability increases system availability while reducing total service costs. Furthermore, increasing the spare parts inventory was determined to have less influence on the readiness of highly reliable systems. The findings support the notion that PBC reduces e-waste by increasing system availability, incentivizing upfront investment in reliability growth.Research limitations/implicationsRecognition of these findings in the context of buyer–supplier relationships will help managers better understand the value of upfront reliability investment, reducing maintenance, repair and overhaul requirements, avoiding the need to plan for extra spare parts and minimizing volume and the resulting e-waste.Practical implicationsThis study also clarifies the uncertainty associated with upfront investment and provides potential incentives for suppliers.Originality/valueThe main contribution of this study is its use of PBC for e-waste reduction, highlighting the effects of upfront investment in reliability enhancement. The authors applied a game theory model to illustrate the relationship between incentives and upfront investment and demonstrate how increased levels of spare parts can be counterproductive to achieving readiness, reducing inventory and consequent e-waste.

Sustainable and Robust Home Healthcare Logistics: A Response to the COVID-19 Pandemic

Today, research on healthcare logistics is an important challenge in developing and developed countries, especially when a pandemic such as COVID-19 occurs. The responses required during such a pandemic would benefit from an efficiently designed model for robust and sustainable healthcare logistics. In this study, we focus on home healthcare logistics and services for planning the routing and scheduling of caregivers to visit patients’ homes. Due to the need for social distancing during the COVID-19 pandemic, these services are highly applicable for reducing the growth of the epidemic. In addition to this challenge, home healthcare logistics and services must be redesigned to meet the standards of a triple bottom line approach based on sustainable development goals. A triple bottom line approach finds a balance between economic, environmental, and social criteria for making a sustainable decision. Although, recently, the concept of green home healthcare has been studied based on the total cost and green emissions of home healthcare logistics and services, as far as we know, no research has been conducted on the formulation of a triple bottom line approach for home healthcare logistics and services. To achieve social justice for caregivers, the goal of balancing working time is to find a balance between unemployment time and overtime. Another contribution of this research is to develop a scenario-based robust optimization approach to address the uncertainty of home healthcare logistics and services and to assist with making robust decisions for home healthcare planning. Since our multi-objective optimization model for sustainable and robust home healthcare logistics and services is more complex than other studies, the last novel contribution of this research is to establish an efficient heuristic algorithm based on the Lagrangian relaxation theory. An initial solution is found by defining three heuristic algorithms. Our heuristic algorithms use a symmetric pattern for allocating patients to pharmacies and planning the routing of caregivers. Then, a combination of the epsilon constraint method and the Lagrangian relaxation theory is proposed to generate high-quality Pareto-based solutions in a reasonable time period. Finally, an extensive analysis is done to show that our multi-objective optimization model and proposed heuristic algorithm are efficient and practical, as well as some sensitivities are studied to provide some managerial insights for achieving sustainable and robust home healthcare services in practice.

Assessment of ecosystem services of water resources of port water areas by the amount of water rent

Ecosystem services of the marine environment can be considered as ecological, economic and social components of sustainable development, but at present, they are not fully evaluated. In this regard, the article sets the task of identifying and valuing ecosystem services in port waters. As a result of the study, the attribution of the benefits created by the port waters to the ecosystem services of the marine environment is justified, their division into two categories is carried out—into providing and supporting services, a methodology for their cost estimation is proposed. It is proposed to calculate ecosystem services by the amount of port water rent, which is understood as the residual income in port activities after deducting from it all costs and profit margins on fixed assets of port infrastructure. According to this methodology, calculations of the total cost of ecosystem services of port water areas for Russia as a whole and specific values of the cost of ecosystem services per 1 km² of port water area for all seaports of the country were carried out. Supporting services are proposed to be assessed by the rent of assimilation potential formed when compensatory measures are not carried out for environmental damage caused by port activity. According to the results of calculations, it was revealed that the total port rent is approximately 33–38 billion rubles. At the same time, payments for the use of water resources in the waters of seaports entering the budget system amount to an insignificant part of this value—0.17 %, which indicates the inefficiency of the current payment system. To correct the situation, an algorithm for calculating fees for ecosystem services in port waters with the inclusion of an environmental component is proposed, the maximum share of port water rent (10 %) is justified, without disturbing the balance between the state and private structures. The significance of the work carried out is to substantiate a new category of ecosystem services of the marine environment, ecosystem services of port waters, and to show the possibility of using their valuation for management purposes, including through the formation of additional budget revenues.

Vessel Scheduling and Bunker Management With Speed Deviations for Liner Shipping in the Presence of Collaborative Agreements

Vessels face uncertain factors during a voyage, such as bad weather and harsh sea conditions along a route in container liner shipping. As such, the real vessel speed during each leg of a voyage often deviates from the planned one, which may lead to fluctuations in vessel schedule and bunker consumption. This paper investigates the problem of vessel scheduling and bunker management with speed deviations (VSBMSD) for liner shipping in the presence of collaborative agreements. By establishing the worst-case scenario of the maximum bunker consumption function with vessel sailing speed as an independent variable, we develop a mixed-integer nonlinear programming model to minimize the total liner shipping route service cost. A piecewise linear secant approximation method is designed, and then a CPLEX solver is used to solve the problem. The results of the computational experiments conducted for the AEMX route indicate that VSBMSD in the presence of collaborative agreements can enable shipping companies to design vessel schedules reasonably and reduce the total cost of liner shipping route service by at least 2.95% compared to the results from similar studies.

Using the Workload Indicator of Staffing Need (WISN) – Method to model the HR requirements and costs of Health Care Services in Kyrgyzstan

Health Care systems are facing several challenges. The lack of resources, such as health workers, costing and financing are open and urgent questions in Health Care Systems. Tools from HRManagement (e.g. the Workload Indicator of Staffing Need (WISN) – method, WHO - HR-Management Tool) and Cost-Accounting can help to improve current financing and further develop healthcare reimbursement systems, such as DRG-Systems. Based on empirical data and interviews with healthcare professionals from multiple healthcare institutions in Kyrgyzstan the WISN method was applied to calculate human resource needs in a new perinatal health centre in Bishkek, Kyrgyzstan. The results of the analysis show that it is possible to calculate the required personal resources using the WISN method. Additionally, WISN can be used to calculate personnel costs. The results also show that in combination with material costs, e.g. from a DRG – Cost – Matrix, such as the G-DRG-Report Browser, it is possible to calculate the total costs of healthcare services and to use this as the basis for the reimbursement system. WISN in combination with additional Cost-Accounting systems is a good way to calculate the total costs for an intervention in a healthcare institution, e.g. a hospital. These tools can help to make financing in healthcare more transparent and efficient.

A prospective randomised controlled mixed-methods pilot study of home monitoring in adults with cystic fibrosis.

Background:Home monitoring (HM) is able to detect more pulmonary exacerbations (PEx) than routine care (RC) in individuals with cystic fibrosis (CF), but there is currently no evidence for benefits in health outcomes. Patient experiences of using HM and a health economics assessment have not been rigorously assessed to date. This study aimed to assess the effects of HM on hospital admissions, quality of life, antibiotic requirements, exacerbation frequency, lung function, nutritional outcomes, anxiety, depression, costs and health outcomes, as well as the qualitative effects on the patient experience.Methods:This randomised controlled mixed-methods pilot study recruited CF adults cared for in one large regional CF centre. Participants were randomly allocated 1:1 to the intervention cohort [twice-weekly HM of symptoms measured by the Cystic Fibrosis Respiratory Symptom Diary – Chronic Respiratory Infection Symptom Score (CFRSD-CRISS) and forced expiratory volume in one second (FEV1)] or a control cohort (routine clinical care) for the 12-month study period. Measurements were recorded at study visits at baseline, 3, 6, 9 and 12 months. Spirometry, body weight, comorbidities, medications, hospital inpatient days, courses of antibiotics (oral and intravenous) and PEx (defined by the modified Fuchs criteria) were recorded at each study visit. Health status, capability and cost-effectiveness were measured at each study visit by the Hospital Anxiety and Depression Scale (HADS), the ICEpop CAPability measure for Adults (ICECAP-A), EuroQol 5 dimensions (EQ-5D-5L) questionnaire and an adapted resource use questionnaire. The patient experience of HM was assessed by semi-structured qualitative interviews at baseline and 12 months.Results:Eighty-eight participants were recruited, with 44 (50%) randomised to receive HM and 44 (50%) randomised to receive RC. Patient hospital inpatient bed days per annum and overall health-related quality of life were similar between the groups. Protocol-defined PEx requiring intravenous and oral antibiotics were detected more frequently in the HM group, with no other differences between the groups in the secondary outcomes. The total mean National Health Service (NHS) costs were approximately £1500 more per patient for the RC arm than the HM group. The qualitative analysis demonstrated that the patient experience of HM was generally positive and overall the intervention was well accepted.Conclusion:The findings of this trial confirm that HM is effective in detecting PEx in adults with CF. There were no significant differences in hospital inpatient bed days and overall health-related quality of life between the groups. Despite the cost of the HM equipment and the salary of the research fellow to respond to the results, health economics analysis suggests the intervention was less expensive than RC. HM was generally well accepted, with most participants reporting that it resulted in them feeling more empowered and reassured.Trial registrationThe study protocol was registered with Clinicaltrials.gov (NCT02994706) on 16 July 2014 and published in a peer reviewed journal.Data from this trial has been presented in abstract form at the ECFS Conference in Lyon in September 2020.

An Optimal Charging Solution for Commercial Electric Vehicles

New government regulations and incentives promote the deployment of commercial electric vehicles to reduce carbon emissions from gasoline-fueled vehicles. For commercial electric vehicles (CEVs) operating in a fleet, charging processes are often performed at the depot where they begin and end their daily driving cycles, as well as at public stations on their routes. With the large penetration of CEVs in depots, simultaneous charging increases peak demand, which in turn impacts the electric network and increases the demand cost of a facility. These depot charging conditions influence the charging schedules of CEVs along their routes and the total service cost of logistic companies. This paper investigates optimal charging problems for CEVs that are supported by charging stations at depot and on-route public charging stations. The optimal charging and routing problems of CEVs are modelled as an optimization problem and relevant solutions are provided. The charging variants considered in the optimization model are peak demand of depot charging, time of use tariffs during the day, partial recharging, waiting times and characteristics of public stations. The results indicate the effectiveness of the developed algorithm in achieving optimal routes that maximize the benefits of logistics companies provided all constraints are satisfied.