Total Expenses Research Articles

Psychological distress in heart failure patients: Implications for healthcare utilization and expenditure.

Psychological distress is prevalent among heart failure (HF) patients, yet its impact on healthcare expenditure and utilization remains understudied. The aim of this study was to investigate the prevalence of psychological distress in HF patients and its impact on healthcare expenditure and utilization. We analysed data from the Medical Expenditure Panel Survey from January 2016 to December 2021, focusing on adults diagnosed with HF. We assessed the prevalence of psychological distress using the Kessler 6 (K6) questionnaire and examined its association with healthcare utilization and expenditures through multivariate regression models, adjusting for relevant covariates. Among 10 681 886 HF patients, 6.8% experienced psychological distress. The mean age was 69.9 years, and 50% were female. Multivariable analysis revealed significant associations between psychological distress and smoking (adjusted odds ratio [aOR] 2.87), Charlson comorbidity index ≥3 (aOR 3.05), and sleep disorders (aOR 2.82). Protective factors included exercise (aOR 0.40), higher education (aOR 0.89) and higher income levels (middle-income: aOR 0.19, high-income: aOR 0.20). HF patients with psychological distress incurred significantly higher annual total expenses ($14 709, p < 0.01), with inpatient costs ($6014, p = 0.02) and office-based expenses ($3993, p = 0.04) being notably elevated. Additionally, these patients exhibited more frequent annual emergency room visits (0.07 visits, p < 0.01), hospital discharges (0.2 discharges, p = 0.01), and nights spent in the hospital (1.4 nights, p < 0.01). Psychological distress in HF patients is associated with significantly higher medical expenditure and healthcare utilization. These findings underscore the need for integrated care approaches and present possible areas for intervention to address this significant healthcare burden.

The Impact of ERAS and Multidisciplinary Teams on Perioperative Management in Colorectal Cancer.

The Enhanced Recovery After Surgery (ERAS) protocol, a comprehensive multimodal approach, aims to mitigate surgical stress, expedite recovery, and improve postoperative outcomes. Its implementation has notably advanced perioperative care in colorectal cancer surgeries. Integrating ERAS with multidisciplinary collaboration, involving surgery, anesthesia, nursing, and nutrition, may further enhance patient outcomes, making it a significant focus in clinical practice. This study assessed the effectiveness of integrating the ERAS model with multidisciplinary collaboration during the perioperative period in colorectal cancer patients. A total of 117 patients scheduled for elective surgery at Haiyan People's Hospital between August 2023 and April 2024 were randomly assigned to either a control group (n = 59), receiving traditional care, or an experimental group (n = 58), receiving ERAS-based multidisciplinary care. Key outcomes related to postoperative rehabilitation were evaluated. Patients in the ERAS group demonstrated significantly shorter hospital stays, quicker catheter removal, and earlier mobilization compared to the control group (P < 0.0001 for all). Additionally, the ERAS group exhibited reduced postoperative inflammatory responses, as indicated by significantly lower interleukin-6 levels on the first postoperative day (P = 0.0247). The quality of life was significantly higher in the ERAS group (P < 0.05). Furthermore, the ERAS group incurred lower total hospitalization expenses than the control group (P = 0.0011). These findings confirm the benefits of the ERAS protocol in enhancing postoperative recovery in colorectal cancer surgeries. The study highlights the importance of a multidisciplinary approach in optimizing patient outcomes and reducing the burden on hospital resources.

Fast and Efficient Mitigation of Coupled Axial-Torsional Drillstring Vibrations through State-Feedback Linear-Quadratic-Integral (LQI) Control

Summary In the exploitation of subsurface hydrocarbon and geothermal energy, more than 50% of total expenses are typically attributed to drilling and well completion. Coupled triaxial vibrations in the drilling system, excited by various mechanical, hydraulic, and geological sources, are major causes of premature downhole tool failures, excessive bit damage, compromised hole quality, reduced rate of penetration (ROP), and increased nonproductive time. Drillstring dynamic models, shock absorption tools, and controllers have been developed since the 1960s to understand and mitigate detrimental vibrations in the drilling system, aiming for smoother and more efficient operations. With advancements in measurement/logging while drilling technologies, rig equipment, mud pulse/wired pipe telemetry, and the digitalization of drilling engineering, a foundation has been established for proactive drilling vibration detection, analysis, and control to achieve efficient and safe drilling. In this study, a reduced-order axial-torsional drillstring dynamic model with soft string lateral contacts is first developed. Nonlinear drilling boundary conditions and inputs, such as bit-rock interactions (BRIs) with torque-on-bit (TOB) velocity-weakening effects, wellbore-drillstring contacts/friction, drillstring gravity, mud buoyancy, and more, are defined within the modeling framework. Equilibrium states and linearization of the model are derived for any given weight-on-bit (WOB) and rotational speed (RPM) setpoints, 3D well trajectories, and drillstring dimensions. A linear-quadratic-integral (LQI) controller is developed and tested for drillstring vibration suppression using a 6,562 ft (2000 m) drillstring model. In comparison to commercially available controllers for stick/slip mitigation, which are designed based on impedance matching and only address the decoupled drillstring torsional dynamics, the proposed state-feedback LQI controller emphasizes the coupling between the axial and torsional drillstring dynamics by simultaneously controlling WOB and RPM. Simulation results demonstrate that the LQI controller can suppress stick/slip and stabilize downhole WOB within 7 seconds, while a commercial drilling controller takes more than 35 seconds to achieve the same. Additionally, valuable insights and potential future directions for nonlinear drillstring vibration mitigation and drilling controller design are provided. With its fast drilling dysfunction stabilization time, small downhole RPM/WOB overshoots, minimal rig control inputs, robustness against drilling nonlinearities, and high efficiency, the proposed multi-input-multi-output state-feedback drilling controller holds great potential for application in proactive drilling vibration control, drilling automation, and real-time drilling optimization.

Beyond the Bottom Line: Assessing Charity Care, Community Benefits, and Tax Exemptions in Nonprofit Hospitals

SUMMARY Goal This study aimed to compare the value of tax exemptions and community benefits across various nonprofit hospitals and show how hospital and geographical characteristics can explain the values. Methods Data from 2017 to 2021 Internal Revenue Service Form 990s were used to evaluate 17 types of community benefits in nonprofit hospitals and assess six categories of tax benefits. Descriptive analyses compared charity care, community benefits, and estimated tax exemptions among nonprofit hospitals while considering variations in teaching status, location (rurality), and US region. Additionally, random effect regression analyses, both unadjusted and adjusted, explored the connection between the community benefit-to-expense ratio and a range of hospital and geographical features. Principal Findings Between 2017 and 2021, nonprofit hospitals allocated, on average, 8.8% of their total expenses to 17 types of community benefits, with 1.8% of their expenses dedicated to charity care; 5.2% benefited from tax exemptions. There were significant disparities among nonprofit hospitals, as 24.0% received more tax benefits than they spent on community benefits, and 81.0% received more than their charity care expenditures. The characteristics and location of nonprofit hospitals influenced the provision and composition of community benefits. Teaching hospitals allocated a higher percentage of total community benefits compared to nonteaching hospitals (9.2% vs. 8.6%). The top three categories in teaching hospitals were Medicaid shortfall, charity care, and unreimbursed education, whereas nonteaching hospitals focused more on charity care and subsidized health services, in addition to Medicaid shortfall. Furthermore, the location of a nonprofit hospital impacted the distribution of community benefits. Rural hospitals prioritized Medicaid shortfall, subsidized health services, and charity care, while urban hospitals concentrated more on Medicaid shortfall, charity care, and subsidized health service (in that order). The regression results showed that system affiliation and location in the Southern region of the United States were positive predictors of charity care spending at nonprofits. Practical Applications Lack of transparency and explicit requirements from federal agencies and states for what is necessary to receive tax benefits results in wide variations in community benefits spending by nonprofit hospitals. Some receive more in tax benefits than they provide in community benefits, and three-quarters of all nonprofit hospitals receive more in tax benefits than they provide in charity care. Developing a more explicit definition of community benefits can make all nonprofit hospitals more accountable.

Serum Vitamin D Testing – A Necessity Or An Injudicious Expenditure

Objective: To evaluate the serum vitamin D levels and to determine the justification for vitamin D testing in patients. Study Design: Cross-Sectional study. Place and Duration of Study: Department of Chemical Pathology, Armed Forces Institute of Pathology Rawalpindi, Pakistan from Oct to Dec 2022. Methodology: Patients of either gender coming for vitamin D level estimation were included. Vitamin D levels were analyzed on Immunoassay auto-analyzer. Data was analyzed using SPSS version 26. Results: Out of 249 patients, 87(34.9%) were male while 162(65.1%) were female, with mean age 41.09±19.10 years and mean Vitamin D levels 73.08±45.86nmol/l. None of the patients (0%) had vitamin D deficiency, 174(69.9%) had vitamin D insufficiency, 72(28.9%) had vitamin D sufficiency, while 3(1.2%) had vitamin D excess. Major reasons for Vitamin D testing was bone pains, which were present in 72(28.9%) patients. A significant difference in vitamin D levels according to reason of testing (p&lt;0.05) was observed. Total expense on vitamin D testing for 249 patients was PKR 722100/- (249x2900), as compared to cost of supplementation PKR 199200/- (249x800) in clinical suspected cases. Conclusion: Majority of patients that tested for vitamin D were in lower risk group, and were not vitamin D deficient, with bone pains being the complaint due to which most patients were tested.

Comparative techno-economic and carbon footprint analysis of 2,3-butanediol production through aerobic and anaerobic bioconversion of carbon dioxide with green hydrogen

Renewable CO2 and hydrogen have the potential to be the feedstocks of a decarbonized chemical industry, and biochemical conversions offer new alternatives for the industry. There are two options among chemolithotrophic bacteria capable of CO2 fixation: under aerobic conditions, through the use of the Calvin-Benson-Basham cycle, known to produce large-chain compounds, and under anaerobic conditions, through the Wood-Ljungdahl pathway, known to produce short-chain organic molecules. Here, we report a comparison of both bioconversions, made at a simulated industrial scale, considering techno-economic and environmental variables, and using renewable CO2 and H2 as feedstocks. 2,3-butanediol, a mid-range chain compound that can be produced via both routes, was selected for comparison. The comparison was set up in Chile due to expected low-cost renewable hydrogen and renewable CO2 availability. The assessment showed that the minimum selling price of 2,3-butanediol in the anaerobic case was higher (3.91 (USD kg−1)) than in the aerobic case (3.36 (USD kg−1)), with hydrogen being the largest expense in both processes (50 % and 70 % of total expenses respectively). Further, owing to metabolic restrictions, the anaerobic process required almost five times more CO2 than the aerobic process to produce the same amount of 2,3-butanediol. A Monte Carlo analysis showed that in most scenarios the aerobic process was more economically favorable. In environmental terms, the aerobic process had a smaller carbon footprint in all the evaluated scenarios. Therefore, the results suggest that the aerobic process is a more suitable alternative to anaerobic bacteria-based processes for producing 2,3-butanediol from renewable CO2 and hydrogen.

A comprehensive quantitative lifecycle cost and environmental impact analysis model for computing infrastructure

This paper presents a comprehensive quantitative model for quantitative assessment of the lifecycle costs and environmental impacts of computing infrastructure, with a focus on internet data centers (IDCs) and high-performance computing (HPC) facilities. The key innovation lies in the integration of interdisciplinary cost evaluation and carbon emission methods for the establishment of this quantitative model. This framework, which outlines key cost components and carbon emission factors, enables the calculation of total costs, electricity expenses, and greenhouse gas emissions throughout the lifecycle of infrastructure. With IDCs as a case study, the research clarifies the intricate cost structure associated with equipment procurement, energy usage, land acquisition, and operational expenses. This paper provides an in-depth understanding of the cost structure and environmental impact of computing infrastructure in support of sustainable decision-making in its development.•Based on established cost estimation methods, such as Lifecycle Cost Analysis (LCCA) and the Analogous Estimating Method, this study examines costs across construction and operation phases.•The Emission Factor Method is used to quantify environmental impact, emphasizing the significance of regional energy mix and power usage effectiveness (PUE).

A Comprehensive Intervention Program for Postoperative Delirium Prevention in Elderly Patients Undergoing Cardiac Surgery

PurposeTo explore the application effect of a comprehensive intervention program for postoperative delirium (POD) prevention. DesignDescriptive and comparative study. MethodsThis study included 82 elderly patients who underwent cardiac surgery as the control group to receive routine perioperative care. Seventy seven elderly patients who underwent cardiac surgery were selected as the observation group and received a comprehensive intervention program for POD prevention. This study further compared the length of stay in the hospital, nutritional status, pain score, and sleep quality between the two groups after intervention. FindingsThe postoperative length of stay in the hospital of the observation group was shorter than that of the control group (12.60 ± 2.97 vs 17.30 ± 7.10), and the incidence of POD was lower than that of the latter group (24.68% vs 47.56%, X2 = 8.976, P = .003). The pain scores of the observation group were lower than those of the control group (F = 195.381, P < .001). There was significant difference that the sleep quality score of the observation group was higher than that of the control group (F = 219.20, P < .001). The levels of albumin and hemoglobin in the observation group were higher than those in the control group (54.38 ± 5.87 vs 38.40 ± 3.11; 124.64 ± 13.18 vs 109.00 ± 10.20). The observation group had shorter mechanical ventilation duration, intensive care unit stay, and lower total hospital expenses compared with the control group (P < .05). ConclusionsThe comprehensive intervention program for POD prevention based on evidence-based medicine has a positive effect. In addition, it can also improve patients' pain, sleep quality, and nutritional status.

Analisis perlakuan akuntansi sewa berdasarkan PSAK No. 73 pada PT. PLN (Persero) Unit Induk Distribusi Suluttenggo

State-Owned Enterprises (BUMN) must follow changes in the applicable accounting standards policy. This includes the lease accounting policy in accordance with PSAK No. 73. These standards are designed to ensure consistency and transparency in financial reporting. The transition from PSAK No. 30 to PSAK No. 73 will have a significant impact on the accounting treatment of leases and the company's financial statements. This study will analyse the accounting treatment of leases and their impact on State Electricity Company (PT PLN Persero) Unit Induk Distribusi Suluttenggo. This study employs a qualitative research method with a descriptive analysis approach. The data was obtained through interviews with the relevant parties and a thorough examination of the company's financial statements. The results clearly show that the company's accounting treatment of leases is in line with PSAK No. 73. However, there are some areas where the presentation of leases could be improved. The transition has had a positive impact on the company's financial statements, with an increase in total assets and liabilities due to the recognition of lease assets and liabilities on the balance sheet and a decrease in total operating expenses.

Socio-Economic Characteristics of Producers and Economic Size Classes of Enterprises According To Typologies and Risk Attitudes in TR21 Region

The aim of this study was to determine the typologies of agricultural enterprises operating in the TR21 Region according to the Farm Accounting Data Network methodology and the risk attitudes of the producers. According to the typologies and risk attitudes of the enterprises, the socio-economic characteristics of the producers and the economic size classes of the enterprises were determined. As a result of sampling based on a 95% confidence interval and a 10% margin of error, the number of enterprises surveyed was determined as 334. While 63.77% of the enterprises were specialized in field crops, 25.45% engaged in mixed livestock and plant production. Additionally, 7.49% were specialized in pasture livestock and 3.29% were in the perennial plant farming group. In the enterprises examined, 55.09% of the producers were classified as risk-averse and 44.91% as risk-lover. Of the average land holdings, 71.25% was property and 28.75% was rented land. It was noteworthy that the land rental rate in risk-lover enterprises was higher than in risk-averse enterprises. It was concluded that risk-lover enterprises had higher production value in both plant production and animal production, and risk-averse enterprises were engaged with product and animal diversity as they avoided taking risks. On average, in risk-lover enterprises, 53.64% of the operating expenses were vegetative special expenses and 46.36% were animal special expenses. In risk-averse enterprises, the share of vegetative special expenses in total expenses was 47.15%, and the share of animal special expenses was 52.85%. Compared to the average of enterprises and all enterprise typologies, standard gross profit was found to be higher in risk-lover enterprises. In enterprise typology groups, the average ESU values of the enterprises varied between 10.88 and 33.80 ESU. According to enterprise typologies, risk-averse agricultural enterprises in specialized field crop farming and perennial plant farming were in the below-medium enterprise class, while other enterprise groups were in the above-medium enterprise class.

Effects of traditional Chinese medicine on outcomes and costs of dementia care: results from a retrospective real-world study

ObjectivesThis study aims to assess the impact of Traditional Chinese Medicine (TCM) on dementia patients, utilizing real-world data. Specifically, it seeks to evaluate how TCM influences clinical outcomes by examining changes in the Clinical Dementia Rating (CDR) and Mini-Mental State Examination (MMSE) scores, as well as its effect on medical expenses over a two-year period. Data from a multi-center research database spanning from 2004 to 2021 will be used to achieve these objectives, addressing the current gap in empirical data concerning intuitive outcomes and cognitive function assessments.MethodsPropensity score matching was adopted to improve comparability among the intervention and control groups. Due to repeated dependent variable measurements, the generalized estimating equation was used to control for socio-demographic characteristics, regional characteristics, and Western medicine treatments for dementia.ResultsAfter propensity score matching, a total of 441 research subjects were included: 90 in the TCM intervention group and 351 in the non-TCM intervention group. The results of multivariate regression analysis showed that compared with the non-TCM intervention group, the MMSE scores in the TCM intervention group increased by 0.608 points each year. The annual change in CDR scores in the TCM intervention group was 0.702 times that of the non-TCM utilization group. After TCM intervention, annual outpatient expenses increased by US$492.2, hospitalization expenses increased by US$324.3, and total medical expenses increased by US$815.9, compared with the non-intervention group.ConclusionsTCM interventions significantly decelerate cognitive decline in dementia patients, evidenced by slower reductions in MMSE scores and mitigated increases in CDR scores. However, these benefits are accompanied by increased medical expenses, particularly for outpatient care. Future healthcare strategies should balance the cognitive benefits of TCM with its economic impact, advocating for its inclusion in dementia care protocols.

Green synthesis of silver, starch, and zinc oxide mediated nanoparticles with probiotics and plant extracts, their characterization and anti-bacterial activity

Nanotechnology has various applications in all branches of science, including engineering, medicine, pharmacy, and other related fields. Conventional techniques, such as the chemical reduction approach, which produces nanoparticles (NPs) using various hazardous chemicals, offer several health risks due to their toxicity and raise serious environmental concerns. In contrast, other techniques are expensive and need a lot of energy. More than 70 % of pathogenic bacterial strains have developed resistance to at least one class of antibiotics, leading to an increase in life-threatening bacterial infections that pose a significant health risk. However, the creation of NPs by biogenic synthesis is risk-free for the environment and clean enough for biological use. This study was aimed at synthesis of novel Moringa oleifera mediated starch capped silver-zinc NPs and green synthesis of ZnO nanoparticles from Aloe vera, papaya, and Lactobacillus plantarum. Antimicrobial activity of both NPs was tested against Gram-negative antibiotic-resistant bacteria Pseudomonas aeruginosa, Gram-positive bacteria Staphylococcus aureus (ATCC 6538), and two foodborne pathogens Listeria monocytogenes and Campylobacter jejuni. Ultraviolet–visible spectroscopy, Fourier Transform Infrared Spectroscopy, and Scanning Electron Microscopy were used for characterization. Majority of the research studies stress the flexibility, repeatability, and desirable features of the metals, polymers, and plant components employed in the production of biomedical nanoparticles. Such an intuitive approach provides several advantages, particularly a reasonable total expense, compliance with healthcare and pharmaceutical implementations, and the ability to produce massive volumes for industrial use. The novelty of the presented work lies in the unusual combination of silver, starch, and zinc oxide nanoparticles using Moringa oleifera, which is an eco-friendly alternative to chemical-based methods. This research exhibits the formation of well-defined nanoparticles with strong antibacterial activity against a wide range of pathogens, giving us insights into their potential applications in various biomedical fields.

Internal Audit of an Oral Pathology Laboratory: Perspectives on Finances and Operational Management.

Background Internal audits are essential tools for enhancing the operational efficiency, quality, and effectiveness of healthcare departments. Audits enable the departments and laboratories to meet the changing needs of the healthcare environment by giving a detailed picture of the department's operations and highlighting areas for possible growth and development. Aims and objectives This study focuses on the biopsies received in the Oral Pathology Department at Saveetha Dental College, aiming to evaluate biopsy trends, financial performance, and resource utilization over one year. Materials and methods The oral pathology department audit covered the period from 1st April 2023 to 31st March 2024. The institutional human ethical committee and scientific review board approved the retrospective audit. It involved a comprehensive analysis of biopsy data, financial records, and material usage. Data on different biopsy types (excisional, incisional, frozen sections), immunohistochemistry, cytology, and special stains were collected and analyzed across four quarters. Financial performance was assessed by comparing total income and expenses, while resource utilization was examined through the use of histopathological blocks and other consumables. Statistical analysis (chi-square) was performed using IBM SPSS Statistics for Windows, Version 23 (Released 2015; IBM Corp., Armonk, New York, United States). A P-value less than 0.05 was considered statistically significant. Results We received 1100 cases during the study period. Excisional biopsies were the most common, with 474 (43.09%) cases, followed by incisional biopsies with a total of 432 (39.27%). Out of total cases of 1100, the second quarter (July-September 2023) had the highest case volume of 305 (27.72%), while the third quarter (October-December 2023) recorded the lowest of 250 (22.72%) cases. A financial audit revealed an annual deficit of ₹1,03,321 primarily due to higher expenses towards laboratory reagents. The overall expense incurred per case was ₹448.5. Tissue blocks cost ₹85.23 per case (19.00%) of the average cost per case. The chi-square test analysis was insignificant among the different types of biopsies and the reagent consumption across the four quarters. Conclusion The audit identified critical areas for improvement in both clinical workload and financial management. High volumes of biopsies, but net financial deficits highlight the need for better cost management and resource utilization strategies to maintain sustainability without compromising diagnostic quality.

6608 Racial Disparities In Outcomes of Hyperosmolar Hyperglycemic State- A National Inpatient Sample Analysis

Abstract Disclosure: S. Karki: None. S. Neupane: None. B. Neupane: None. L.F. Chavez: None. Introduction: Numerous studies have explored variations in access to healthcare among racial and ethnic groups, revealing disparate challenges in insurance coverage and other healthcare services. Hyperosmolar Hyperglycemic State (HHS) or Hyperosmotic Hyperglycemic Nonketotic State (HHNK) represents a severe complication associated with type 2 diabetes mellitus. Objective of the study:To investigate if there are any racial disparities between white and black populations with the diagnosis of HHS, focusing on outcomes such as mortality rates, length of stay (LOS), hospital costs, and other outcomes. Methods: Retrospective data encompassing adult patients (age &amp;gt;18) with HHS between 2017 and 2020 were extracted from the National Inpatient Sample (NIS). Employing STATA as the data analysis tool, the International Classification of Diseases (ICD-10) was utilized to select disease and outcome codes. Multivariate regression analysis adjusted for relevant variables determining the adjusted odds ratio (aOR). Proportions were compared using the Fisher exact test, while continuous variables were assessed via the student t-test. The study's primary outcome was mortality, with secondary outcomes including LOS, total hospitalization costs, Acute Coronary Syndrome (ACS), septic shock, pulmonary edema, Acute Respiratory Failure (ARF), mechanical ventilation, Acute Respiratory Distress Syndrome (ARDS), Acute Kidney Injury (AKI), and Cerebrovascular Accident (CVA). Results: Among 181,720 HHS-diagnosed patients, 84,140 were white, and 58,645 were black. White patients exhibited a $2,741 higher total hospital expenses compared to their black counterparts. Rates of septic shock (aOR=0.78, 5.26% vs. 4.1%, p&amp;lt;0.001) and ARF (aOR=0.83%, 10.54 vs. 9%, p&amp;lt;0.001) were elevated in whites compared to blacks. Conversely, rates of AKI were higher in blacks (aOR=1.48, 58.29% vs. 50.58%, p&amp;lt;0.001) compared to whites. No statistically significant differences in mortality rates, mean LOS, ACS, pulmonary edema, mechanical ventilation, ARDS, and CVA were observed. Conclusion: Whites demonstrated increased rates of total hospital expenses, septic shock, and ARF compared to blacks, while blacks exhibited higher rates of AKI. No significant differences were observed in mortality rates, LOS, ACS, pulmonary edema, mechanical ventilation, ARDS, and CVA. Presentation: 6/2/2024

Developing microalgae harvesting: Enhanced efficiency with magnetite-urea nanocomposites for sustainable astaxanthin biorefinery

Harvesting costs, accounting for 15–30 % of total expenses, are a major bottleneck in microalgae biorefinery due to low cell density and energy-intensive processes. This study investigates Fe3O4-Urea (Fe@urea) nanocomposites (NCs) to replace conventional methods and improve the harvesting efficiency (HE) of Chlorella zofingiensis, known for its high lipid and astaxanthin content. Urea-coated magnetite nanoparticles (NPs) with additional functional groups significantly improved harvesting performance across all pH levels compared to conventional Fe3O4 NPs. HE was evaluated using both optical density and cell counting methods, with the latter proving superior results by eliminating interference from unreacted salts and debris. Optimization of nanocomposite concentrations and culture pH with Fe@urea achieves 95 % HE at 800 mg L−1 and pH 3–4. The Langmuir and Freundlich models confirmed the nanocomposite's multifaceted capabilities. Characterization techniques included SEM, FTIR, EDX, zeta potential analysis, and TEM. This innovative approach can revolutionize large-scale microalgae biorefineries, enhancing sustainable biofuel and bioproduct production and supporting the Sustainable Development Goal of Affordable and Clean Energy (SDGs 7).

The impact of new VAT enforcement on financial performance: Evidence from Saudi Arabia non-financial listed companies using the event study and ARMA model

This paper examines the influence of the new 15 % Value Added Tax (VAT) enforcement on non-financial listed companies in Saudi Arabia. By comparing financial data from 2019, before the VAT implementation and the COVID-19 pandemic, with data from 2020, during both the VAT increase and the pandemic, the research aims to uncover the consequences of this tax policy change. Utilizing charts, tables, and an event study analysis approach with the Autoregressive Moving Average (ARMA) model, we investigated key financial indicators such as Shareholders' Equity (SE), Total Income (TI), Total Revenues (TR), Net Income (NI), Total Expenses (TE), Other Changes in Operating Activity (COA), and Cash at the End of the Period (CEP). The findings reveal significant financial impacts, highlighting companies' challenges due to the increased tax burden. Shareholders' Equity dropped from an average of 11.55 million to 4.57 million, and Total Income and Total Revenues decreased from approximately 1.73 million to 316,234 and from 1.95 million to 331,605, respectively. Net Income sharply declined from 406,109 to 74,624, and Total Expenses decreased from about 1.18 million to 223,495. Other Changes in Operating Activity shifted from a negative mean of −168,936 to a positive 523,520, and Cash at the End of the Period fell from 1.99 million to 666,663. These results suggest that the VAT increase has significantly strained companies' financial performance, emphasizing the need to consider such tax reforms carefully, particularly in developing countries. The study concludes that while the VAT increase aims to enhance government revenues, it imposes substantial financial strain on companies, potentially leading to long-term economic repercussions. Policymakers should consider these implications and implement practical measures to optimize the VAT system and support business resilience in the face of such reforms.

Plate osteosynthesis of phalanx fractures using wide-awake local anesthesia no tourniquet technique is cost-effective and associated with less postoperative pain.

The wide-awake local anesthesia no tourniquet (WALANT) technique, which is based on the local infiltration of lidocaine and epinephrine, is widely used in hand and wrist surgery. However, few studies have been conducted on the cost-benefit analysis of phalanx fracture surgery using the WALANT technique. This study aimed to investigate the clinical condition, time spent on anesthesia and operation. We also perform an economic analysis among general anesthesia, local anesthesia with a tourniquet, and the WALANT technique for plate fixation of phalanx fractures. This retrospective study included all patients with single phalanx fractures who underwent open reduction internal fixation with plating between January 2015 and December 2019. Patients were divided into three groups according to the anesthesia method: general anesthesia with a tourniquet (GA group), local anesthesia with a tourniquet (LA group), and the WALANT technique (WALANT group). Data, including demographics, anesthesia and surgical time, postoperative pain score, and vomiting ratio, were collected and analyzed. A total of 62 patients were included in this study. Of the 62 patients, 15 were included in the GA group, 32 in the LA group, and 15 in the WALANT group. No complications were reported during surgery or follow-up in either group. The GA group exhibited a significantly longer anesthesia time than the other two groups, with an average of 32.4 min. However, no significant difference in surgical time was observed among the three groups. The WALANT group exhibited a significantly lower postoperative pain score than the other two groups. The additional cost of general anesthesia was approximately 350 US dollars (USD), accounting for approximately one-third to one-fourth of the total expenses for phalanx surgery. Open reduction with plate fixation of phalanx fractures using the WALANT technique and local anesthesia was cost-effective compared with general anesthesia. Patients who underwent phalanx fracture surgery using the WALANT technique experienced less pain on the first postoperative day than those who underwent surgery using general or local anesthesia with a tourniquet because of the adequate tumescent technique and not using a tourniquet during surgery.

Optimization of Cost-Based Hybrid Flowshop Scheduling Using Teaching-Learning-Based Optimization Algorithm

A cost-based hybrid flowshop scheduling (CHFS) combines flow shop and job shop elements, with cost considerations as a key indicator. CHFS is a complex combinatorial optimization challenge encountered in real-world manufacturing and production environments. This paper investigates the optimization of a CHFS problem using the Teaching Learning-Based Optimization (TLBO) algorithm. Effective CHFS is crucial for achieving production balance, reducing costs, and improving customer satisfaction. The authors formulate the CHFS scheduling problem and propose applying the TLBO algorithm to minimize total costs, including labor, energy, maintenance, and delay expenses. The performance of the TLBO technique is evaluated through computational experiments on various CHFS problem instances. The results demonstrate the effectiveness of the TLBO algorithm, which achieved the best results in 42% of the test cases, surpassing other algorithms like the Grey Wolf Optimizer and Particle Swarm Optimization. Additionally, the TLBO algorithm had the highest average performance ranking across the comparative algorithms. The study highlights the potential of the TLBO algorithm as an efficient optimization tool for complex manufacturing scheduling problems.

Clinical efficacy of enhanced recovery surgery in Da Vinci robot-assisted pancreatoduodenectomy

Da Vinci robot-assisted pancreaticoduodenectomy offers advantages, including minimal invasiveness, precise, and safe procedures. This study aimed to investigate the clinical effectiveness of implementing enhanced recovery after surgery (ERAS) concepts in Da Vinci robot-assisted pancreaticoduodenectomy. A retrospective analysis was conducted on clinical data from 62 patients who underwent Da Vinci robot-assisted pancreaticoduodenectomy between January 2018 and December 2022. Among these patients, 30 were managed with ERAS principles, while 32 were managed using traditional perioperative management protocols. Surgical time, intraoperative blood loss, postoperative oral intake time, time to return of bowel function, time to ambulation, visual analog scale (VAS) pain scores, fluid replacement volume, length of hospital stay, total hospital expenses, complications, and patient satisfaction were recorded and compared between the two groups. Postoperative follow-up included assessment of postoperative functional scores, reoperation rates, SF-36 quality of life scores, and survival rates. The average follow-up time was 35.6 months (range: 12–56 months). There were no statistically significant differences in general characteristics, including age, surgical time, intraoperative blood loss, and preoperative medical history between the two groups (P > 0.05). Compared to the control group, the intervention group had an earlier postoperative oral intake time, faster return of bowel function, rapid ambulation, and shorter hospital stays (P < 0.05). The intervention group also had lower postoperative VAS scores, lower fluid replacement volume, lower total hospital expenses, and a lower rate of complications (P < 0.05). Patient satisfaction was higher in the intervention group (P < 0.05). There were no statistically significant differences between the two groups in two-year functional scores, reoperation rates, quality of life scores, and survival rates (P > 0.05). Implementing ERAS principles in Da Vinci robot-assisted pancreaticoduodenectomy substantially expedited postoperative recovery, lowered pain scores, and diminished complications. However, there were no notable differences in long-term outcomes between the two groups.

Associations between income/employment status and diabetes care processes, health behaviors, and health outcomes in Japan: A cross-sectional study using claims data linked to a questionnaire survey.

We aimed to explore the associations between income/employment status and diabetes care processes, health behaviors and health outcomes. This cross-sectional study used health insurance claims data between April 2021 and March 2022, and a questionnaire survey between December 2022 and January 2023 in Tsukuba City. The study analyzed the participants with diabetes (other than type 1) from those selected by stratified random sampling. We evaluated diabetes care processes, health behaviors and health outcomes by calculating weighted proportions among the groups. We also assessed the associations between income/employment status and these variables using multivariable modified Poisson regression models. Of the 264 identified participants, 161 (64.2%) were men and 168 (72.8%) were aged ≥65 years old. Compared with the low-income groups, the high-income group had a higher proportion of sodium-glucose cotransporter 2 inhibitors or glucagon-like peptide-1 receptor agonists use (adjusted risk ratio [aRR] 1.70, 95% confidence interval (CI) 1.07-2.72), a higher proportion of attendance to annual health checkups for ≥2 years (aRR 1.68, 95% CI 1.07-2.64) and a lower proportion of all-cause hospitalization (aRR 0.15, 95% CI 0.04-0.48); additionally, the middle-income group had a lower proportion of high total outpatient medical expenses (aRR 0.57, 95% CI 0.35-0.92). Compared to the no work time group, the full-time work group had a lower proportion of exercise habits (aRR 0.59, 95% CI 0.35-0.99) and a higher proportion of good self-reported health (aRR 2.08, 95% CI 1.22-3.55). Several variables were associated with income/employment status. Policy intervention should focus on high-risk groups identified by considering these associations.