Neglecting preventive healthcare policies has contributed to the global surge in chronic diseases, increased hospitalizations, declining quality of care, and escalating costs. Non-communicable diseases (NCDs)—notably cardiovascular conditions, diabetes, and cancer—consume over 80% of healthcare expenditure and account for more than 60% of global deaths, which are projected to exceed 75% by 2030. Poor diets, sedentary lifestyles, regulatory loopholes, and underfunded public health initiatives are driving this crisis. Compounding the issue are flawed policies, congressional lobbying, and conflicts of interest that prioritize costly, hospital-based, symptom-driven care over identifying and treating to eliminate root causes and disease prevention. Regulatory agencies are failing to deliver their intended functions. For instance, the U.S. Food and Drug Administration’s (FDA) broad oversight across drugs, devices, food, and supplements has resulted in inefficiencies, reduced transparency, and public safety risks. This broad mandate has allowed the release of unsafe drugs, food additives, and supplements, contributing to the rising childhood diseases, the burden of chronic illness, and over-medicalization. The author proposes separating oversight responsibilities: transferring authority over food, supplements, and OTC products to a new Food and Nutraceutical Agency (FNA), allowing the FDA to be restructured as the Drug and Device Agency (DDA), to refocus on pharmaceuticals and medical devices. While complete reform requires Congressional action, interim policy shifts are urgently needed to improve public health. Broader structural changes—including overhauling the Affordable Care Act, eliminating waste and fraud, redesigning regulatory and insurance systems, and eliminating intermediaries are essential to reducing costs, improving care, and transforming national and global health outcomes. The information provided herein can serve as a White Paper to help reform health agencies and healthcare systems for greater efficiency and lower costs in the USA and globally.
Taiwo Bintu Ayinde, Charles F. Nicholson, Benjamin Ahmed
Abstract Achieving Net Zero Emissions in vegetable production systems is a critical challenge in dryland climates of low- and middle-income countries, yet limited data exists to assess the feasibility of such systems. This study employs life cycle inventory methods to evaluate key performance metrics, including yield per land area, production costs, cumulative energy demand (CED), global warming potential (GWP), and water use (WU) for Controlled Environment Agriculture (CEA) in screen houses and field-based tomato production systems in Northern Nigeria. The findings reveal that CEA, despite its high production cost of ₦24,070.80 per m², achieves the highest yield of 28.57 kg per m². Additionally, CEA demonstrates superior efficiency, exhibiting the lowest C ED (0.025 MJ/kg) and GWP (0.76 kg CO₂-eq/kg). In contrast, rainfed field production, while having the lowest cost (₦58.45 per m²), results in the lowest yield (0.08 kg/m²) and the highest GWP (34,545.8%). Irrigated field production performs moderately, with a production cost of ₦150.38 per m², a yield of 0.22 kg per m², and a GWP of 12,572.4%. A key factor influencing yield variation across production systems is the difference in tomato varieties cultivated in open-field and CEA environments. CEA relies on hybrid varieties optimized for controlled conditions, whereas open-field farming utilizes varieties adapted to outdoor environmental fluctuations, contributing to disparities in yield potential. This study highlights the trade-offs between cost, yield, energy efficiency, and environmental impact across different production models. The results underscore the advantages of adopting more efficient and controlled cultivation methods like CEA, offering potential pathways for sustainable and environmentally responsible agricultural practices in regions facing climate and resource constraints.
Yuan-Cheng Cheng, Cai-Han Xie, Yu-Chen Chen
et al.
Abstract Background Parental care benefits offspring but comes with costs. To optimize the trade-off of costs and benefits, parents should adjust care based on intrinsic and/or extrinsic conditions. The harm to offspring hypothesis suggests that parents should invest more in younger offspring than older offspring because younger offspring are more vulnerable. However, this hypothesis has rarely been comprehensively tested, as many studies only reveal an inverse correlation between parental care and offspring age, without directly testing the effects of offspring age on their vulnerability. To test this hypothesis, we studied Kurixalus eiffingeri, an arboreal treefrog with paternal care. We first performed a field survey by monitoring paternal care during embryonic development. Subsequently, we conducted a field experiment to assess the prevalence of egg predators (a semi-slug, Parmarion martensi) and the plasticity of male care. Finally, we conducted a laboratory experiment to assess how embryo age affects predation by P. martensi. Results Our results showed that (1) male attendance and brooding frequency affected embryo survival, and (2) males attended and brooded eggs more frequently in the early stage than in the late stage. The experimental results showed that (3) males increased attendance frequency when the predators were present, and (4) the embryonic predation by the semi-slug during the early was significantly higher than in the late stage. Conclusions Our findings highlight the importance of paternal care to embryo survival, and the care behavior is plastic. Moreover, our results provide evidence consistent with the predictions of the harm to offspring hypothesis, as males tend to care more for younger offspring which are more vulnerable.
Abstract Antimicrobials reserved for human medicines are permitted for companion animals and it is important to understand multidrug-resistant pathogens recovered from companion animals in terms of epidemiological correlation with human pathogens and possibility of transmission to human-beings. Seventeen of each CTX-M-type extended-spectrum beta-lactamase-producing Escherichia coli (ESBL-EC) and Klebsiella pneumoniae (ESBL-KP) canine isolates were assessed. Entire genomes of the 34 isolates were sequenced. Plasmid transfer and relative growth rates were assessed at differed temperature conditions indicating the body temperature of dogs, that of human-beings, and environment. ESBL-ECs were clonally diverse, while ESBL-KPs were not. The ESBL-ECs carried the bla CTX−M−15 gene in plasmids and the bla CTX−M−14-like gene either in chromosomes or in plasmids. The ESBL-KPs possessed the bla CTX−M−15 gene in plasmids (n = 15). One of the isolates carried another bla CTX−M−15 gene in a chromosome simultaneously and the other isolate had an additional bla CTX−M−9 gene-harbouring plasmid, together. Two ESBL-KP isolates carried the bla CTX−M−14 gene in plasmids. Plasmid transfer ESBL-EC to K. pneumoniae was efficient and the differed biological costs by temperature was much more in ESBL-EC than in ESBL-KP. Intersectoral dissemination of ESBL-ECs occurred mainly by horizontal gene transfer, while that of ESBL-KPs occurred by clonal dissemination.
In the perioperative environment, the safety and wellbeing of nursing staff are paramount for ensuring the delivery of high-quality, safe and sustainable health care services. Various factors contribute to the wellbeing of perioperative nurses, and significantly influence their decisions to stay in their current roles or seek employment elsewhere. The implications of high turnover rates among perioperative nurses extend beyond individual job satisfaction to encompass broader consequences for hospital systems, including compromised quality of patient care and increased operational costs.
While the existing body of research on the wellbeing of perioperative nurses is relatively limited, available findings underscore the critical importance of staff wellbeing within the health care sector. These findings highlight the urgent need for proactive initiatives to promote the wellbeing of perioperative nursing professionals.
This discussion paper aims to comprehensively explore wellbeing within the context of perioperative nursing. It will delve into the various domains and characteristics of wellbeing related to perioperative nurses, shedding light on the intricate relationship between wellbeing and turnover intentions in this specialised nursing setting. Furthermore, the paper will discuss current interventions designed to promote the wellbeing of nurses.
Humaira Humaira, Sadili Rachmat, Sarjana Sri
et al.
This study introduces an innovative framework for planning integrated tariffs in public transportation, focusing on Ibu Kota Negara, a strategic national region of Indonesia. As Banjarmasin aims to establish a modern, inclusive, and affordable transportation network. This study aims to determine fleet needs, integration rates based on vehicle operational cost calculations, ability to pay integration rates and an effective subsidy scheme for Trans Banjarbakula and Trans Banjarmasin. A quantitative approach is applied in this study through analysis of fleet needs, determining vehicle operational costs, the stated preference method and developing a mechanism for providing subsidies to encourage accelerated integration of bus operations. The results stated that fleet needs were identified as having the highest value in trip requirements during the morning peak based on the value of vehicle operational costs, ability to pay and referring to the provision of subsidies by the government to adjust integrated tariffs based on the community’s ability to pay with planned scenario tariffs. A key novelty of this research lies in its proposed socialization initiatives that promote integrated tariff education, facilitating the transition to a smart cardbased payment system. This model promises substantial benefits for users and policymakers, laying a foundation for sustainable, cohesive urban transit solutions in national urban centers.
Aili Amupolo, Sofia Nambundunga, Daniel S. P. Chowdhury
et al.
This paper examines different off-grid renewable energy-based electrification schemes for an informal settlement in Windhoek, Namibia. It presents a techno-economic comparison between the deployment of solar home systems to each residence and the supplying power from either a centralized roof-mounted or ground-mounted hybrid microgrid. The objective is to find a feasible energy system that satisfies technical and user constraints at a minimum levelized cost of energy (LCOE) and net present cost (NPC). Sensitivity analyses are performed on the ground-mounted microgrid to evaluate the impact of varying diesel fuel price, load demand, and solar photovoltaic module cost on system costs. HOMER Pro software is used for system sizing and optimization. The results show that a hybrid system comprising a solar photovoltaic, a diesel generator, and batteries offers the lowest NPC and LCOE for both electrification schemes. The LCOE for the smallest residential load of 1.7 kWh/day and the largest microgrid load of 5.5 MWh/day is USD 0.443/kWh and USD 0.380/kWh, respectively. Respective NPCs are USD 4738 and USD 90.8 million. A sensitivity analysis reveals that variation in the fuel price and load demand changes linearly with system costs and capacities. However, reducing the PV module price in an energy system that includes wind and diesel power sources does not offer significant benefits. Furthermore, deploying an energy system that relies on fossil fuels to each residence in an informal settlement is not environmentally responsible. Unintended negative environmental impacts may result from the mass and simultaneous use of diesel generators. Therefore, a microgrid is recommended for its ability to control the dispatch of diesel generation, and its scalability, reliability of supply, and property security. A roof-mounted microgrid can be considered for piloting due to its lower initial investment. The electricity tariff also needs to be subsidized to make it affordable to end-users. Equally, government and community involvement should be prioritized to achieve long-term economic sustainability of the microgrid.
In two same-different matching experiments we investigated whether transposed-character effects can be modulated by the horizontal displacement or inter-character spacing of target stimuli (strings of 6 consonants, digits, or symbols). Reference and target stimuli could be identical or differed either by transposing or substituting two characters. Transposition costs (greater difficulty in detecting a difference with transpositions compared with substitutions) were greater for letter stimuli compared to both digit and symbol stimuli in both experiments. In Experiment 1, half of the targets were displayed at the center of the screen and the other half were shifted by two character-positions to the left or to the right, whereas the reference was always presented at the center of the screen. Target displacement made the task harder and caused an increase in transposition costs whatever the type of stimulus. In Experiment 2, all stimuli were presented at the center of the screen and the inter-character spacing of target stimuli was increased by one character space on half of the trials. Increased spacing made the task harder and paradoxically caused an increase in transposition costs, but only significantly so for letter stimuli, and only in the discriminability (d') measure. These results suggest that target location and inter-character spacing manipulations caused an increase in positional uncertainty during the processing of location-specific complex features prior to activation of a location-invariant representation of character-in-string order. The hypothesized existence of a letter-specific order encoding mechanism accounts for the greater transposition costs seen with letter stimuli, as well as the greater modulation of these effects by an increase in inter-character spacing seen in discriminability (d').
Natalie Frede, Eva Rieger, Raquel Lorenzetti
et al.
Respiratory tract infections (RTIs) are the most common infections in patients with rheumatic diseases under immunosuppressive treatment and may contribute to morbidity and mortality as well as increased healthcare costs. However, to date only limited data on infection risk in spondyloarthritis (SpA) patients are available. In this study we assessed the occurrence of respiratory tract infections in a monocentric real-world cohort consisting of 330 patients (168 psoriatic arthritis and 162 axial spondyloarthritis patients) and determined factors associated with increased infection risk. Out of 330 SpA patients, 89.3% had suffered from ≥ 1 upper respiratory tract infection (URTI) and 31.1% from ≥ 1 lower respiratory tract infection (LRTI) within the last two years. The most common URTIs were rhinitis and laryngitis/pharyngitis with 87.3% and 36.1%, respectively. Bronchitis constituted the most common LRTI, reported in 29.7% of patients. In a multivariate binomial logistic regression model occurrence of LRTI was associated with chronic lung disease (OR 17.44, p=0.006), glucocorticoid therapy (OR 9.24, p=0.012), previous history of severe airway infections (OR 6.82, p=0.013), and number of previous biological therapies (OR 1.72, p=0.017), whereas HLA B27 positivity was negatively associated (OR 0.29, p=0.025). Female patients reported significantly more LRTIs than male patients (p=0.006) and had a higher rate of antibiotic therapy (p=0.009). There were no significant differences between axSpA and PsA patients regarding infection frequency or antibiotic use. 45.4% of patients had required antibiotics for respiratory tract infections. Antibiotic therapy was associated with smoking (OR 3.40, p=0.008), biological therapy (OR 3.38, p=0.004), sleep quality (OR 1.13, p<0.001) and age (OR 0.96, p=0.030). Hypogammaglobulinemia (IgG<7g/l) was rare (3.4%) in this SpA cohort despite continuous immunomodulatory treatment.Awareness of these risk factors will assist physicians to identify patients with an increased infection risk, who will benefit from additional preventive measures, such as vaccination and smoking cessation or adjustment of DMARD therapy.
Kennedy Mwacalimba, Deborah Amodie, Lisa Swisher
et al.
Background: Heartworm disease (HWD) is a potentially fatal condition caused by the nematode Dirofilaria immitis. It is endemic in North America, and the American Heartworm Society recommends that owned dogs be on a Food and Drug Administration-approved HWD preventive year-round. The objective of this study was to compare the 12-month HWD preventive purchase compliance rates of injectable moxidectin (ProHeart® 6) and the dose equivalent in monthly HWD preventives and their associated economic value to the veterinary hospital.Methods: This study used retrospective anonymized transactional data of 7,926,392 unique dogs from 3,737 companion animal practices across the US for the period 2014–2017. Compliance was defined using American Heartworm Society guidelines. Comparisons were purchases of a 6-month moxidectin injection or six doses of any monthly HWD or HWD combination preventive product, tracked for the next preventive purchase 5–7 months later. Total revenue, HWD prevention cost, 12-month repurchase compliance, and patient retention were calculated. Data were expressed on an annualized basis. Compliance comparisons were calculated based on proportion analysis with the SAS ProbNorm function (SAS 9.4, Cary, NC), using a two-sided t-test, at the 5% level of significance (P < 0.05).Results: At 51.7%, annual compliance with injectable moxidectin was higher than the dose equivalent in monthly HWD preventives, which was 24.4% (P = 0.0001). Eighty-five percent of patients on injectable moxidectin recorded additional transactions during the first visit (average invoice of $161), compared with only 55% of pet owners who purchased monthly HWD prevention (average invoice $141) or monthly HWD combination (average invoice of $171). The average costs of 6 months of HWD preventives were as follows: injectable moxidectin, $48 (29.7% of the total visit invoice); monthly HWD prevention, $45 (31.0% of the total invoice); and monthly HWD combination, 95 (55.6% of the total visit invoice). Finally, dogs receiving injectable moxidectin had a higher proportion of patients with repeat injections within 12 months between 2014 and 2017, with 68% retention rate after 4 years. In comparison, the six-dose monthly HWD cohort retention rate dropped to 55% by 2017.Conclusions: Dogs receiving injectable moxidectin had higher HWD preventive compliance, generated more practice revenue, and had a higher rate of practice retention compared with monthly HWD products.
ABSTRACT IMPACT: A single seismocardiography (SCG) parameter has been shown to accurately classify aortic valve disease (AVD) status in healthy controls and AVD patients. This could support development of SCG as a quick, inexpensive screening tool to better tailor MRI examination to patients’ needs. OBJECTIVES/GOALS: MRI is used commonly for monitoring of aortic valve disease (AVD), but it has high costs. We hypothesize that energy in seismocardiograms (SCG)’‘ signals from chest surface vibrations’‘ is different between healthy controls and AVD patients, and we evaluate potential efficacy of using SCG to recommend MRI only for patients with flow abnormalities. METHODS/STUDY POPULATION: With IRB approval, 45 healthy control subjects (47 ±18years, 18 female) and 9 patients (63 ±16years, 2 female) with aortic valve disease history and known flow abnormalities were recruited. SCG signals were acquired supine, immediately prior to MRI of thoracic aortic blood flow at 1.5T with a time-resolved phase contrast (4D Flow) sequence.
Objectives Over the past few decades, Iran has faced rapid demographic changes, including a sharp decline in birth rates and increased life expectancy. This has led to an increase in the average age of the population and an increase in the percentage of the elderly people which is called “the phenomena of aging”. The occurrence of this phenomenon in Iran is rapidly increasing, and therefore the Iranian community has limited opportunity to prepare for the aging challenges. One of the major challenges for the aging population is the rising health care costs due to the elderly's need for a variety of health services, which causes many households with elderly members to face significant economic problems. This study aims to evaluate the effect of the presence and age of elderly members on health care costs of the households in Iran.
Methods & Materials This study is a secondary analysis using 2016 national household, expenditure and income survey data . Sample size was 19337 households in rural areas and 18809 households in urban areas (total= 38146) in Iran. Linear regression analysis in STATA V. 14 was used to test the effect of variables on health care costs of households with and without elderly members.
Results There was a significant association between the presence of an elderly member in the household and increase in total health care expenditure and medical expenses, such that for one increase in the number of elderly members, total health care expenditure increased by 390,000 Tomans, and medical expenses increased by 195,000 Tomans. In terms of age, families with an elderly member aged 75-79 years had the highest care costs, while those with an elderly member aged 80 and more had the least cost increase. Moreover, household income, having a smoker member, having an income-earner member, living in urban areas, household head education, and health development rate of the province of residence had significant association with total health care expenditure and medical expenses of households. However, no association was found between having health insurance and medical expenses.
Conclusion Since the presence of an elderly member significantly increase the household health costs, future policies should be planned to support the families with elderly members. The health care system of Iran should also be prepared to meet to the health and medical needs of future ageing population.
Uncertainty, a critical factor of causing congestion and extra travel costs in the commute, can be mitigated by providing information. This paper studies the welfare effects of accurate pre-trip information on departure time and route choices in the morning commute under binary stochastic bottleneck capacity. We consider a classical two-route network. Each route has a single bottleneck where congestion occurs during the rush hours. The two routes' bottleneck capacities vary from day-to-day due to events such as bad weather, accidents, and temporary road closures. We derive all equilibrium solutions in consideration of the differences between routes in free-flow travel time, the shadow value of travel time, the severity of bottleneck capacity reductions, and the degree of correlation between two routes in travel conditions. Furthermore, we investigate the benefit changes from zero-information to full-information and prove that accurate pre-trip information about the bottleneck conditions is strictly welfare-improving. Finally, these theoretical results are supplemented by case studies that show examples of benefit gains from pre-trip information.
Xiao Song, Paola Pendenza, María Díaz Navarro
et al.
In order to meet the demand for high-quality fruit and vegetable (F&V) products, a wide variety of novel non-thermal processing (NTP) technologies are under development. This study used a qualitative focus group approach to investigate consumers’ perception and attitudes towards non-thermally processed F&V products among young (18–30 years old) and middle-aged (45–60 y.o.) consumers across six European countries: Denmark, Germany, Italy, Serbia, Spain, and the Netherlands. Findings show that the expected benefits and social concerns are important factors which affect consumers’ attitudes toward non-thermally processed F&V. Extending shelf-life, being healthier and more nutritious, and better hygiene and safety were important benefits, whilst impacts on product quality, safety risks, higher price and environmental costs were the concerns most often mentioned by participants. However, due to a lack of knowledge and trustworthy information sources, consumers have difficulties in assessing relevant benefits and risks. Targeted communication that could explicitly and efficiently reveal benefits and risks is highly recommended to enhance consumer awareness and trust. This may especially be needed to reach middle-aged consumers who showed less confidence in NTP, compared to young consumers. Consumers from Spain, Denmark, and the Netherlands appeared more interested in consuming NTP F&V, compared to Italy, Serbia, and Germany. These findings are expected to provide recommendations to better communicate non-thermally processed F&V with consumers in the EU.
Three-dimensional (3-D) imaging sonar systems require large planar arrays, which incur hardware costs. In contrast, a cross array consisting of two perpendicular linear arrays can also support 3-D imaging while dramatically reducing the number of sensors. Moreover, the use of an aperiodic sparse array can further reduce the number of sensors efficiently. In this paper, an optimized method for sparse cross array synthesis is proposed. First, the beamforming of a cross array based on a multi-frequency algorithm is simplified for both near-field and far-field. Next, a perturbed convex optimization algorithm is proposed for sparse cross array synthesis. The method based on convex optimization utilizes a first-order Taylor expansion to create position perturbations that can optimize the beam pattern and minimize the number of active sensors. Finally, a cross array with 100 + 100 sensors is employed from which a sparse cross array with 45 + 45 sensors is obtained via the proposed method. The experimental results show that the proposed method is more effective than existing methods for obtaining optimum results for sparse cross array synthesis in both the near-field and far-field.
The regular replacement of lubricating oil plays a key role in improving machine reliability and reducing unexpected failures of an oil lubricated system. This paper proposes a condition-based maintenance problem with selected oil field data to determine the optimal time of the lubricating oil replacement. The selected oil field data contain health information about the lubricating oil, so the degradation state of the oil can be predicted and the future health condition can be evaluated. The proposed lubricating oil replacement problem is modeled with the evaluated oil health condition in a Markov decision process framework and then, a method for constructing a health index for the lubricating oil is proposed based on information theory to fuse the multiple oil field data and build a degradation progression prediction model. Finally, the proposed method for condition-based lubricating oil replacement is illustrated in a practical case study. The possible applications of an optimal policy for lubricating oil replacement are much wider. For instance, the method can be used as an input to optimize an operational plan and further reduce the maintenance costs.
Abstract The recovery factor from tight gas reservoirs is typically less than 15%, even with multistage hydraulic fracturing stimulation. Such low recovery is exacerbated in tight gas condensate reservoirs, where the depletion of gas leaves the valuable condensate behind. In this paper, three enhanced gas recovery (EGR) methods including produced gas injection, CO2 injection and water injection are investigated to increase the well productivity for a tight gas condensate reservoir in the Montney Formation, Canada. The production performance of the three EGR methods is compared and their economic feasibility is evaluated. Sensitivity analysis of the key factors such as primary production duration, bottom-hole pressures, and fracture conductivity is conducted and their effects on the well production performance are analyzed. Results show that, compared with the simple depletion method, both the cumulative gas and condensate production increase with fluids injected. Produced gas injection leads to both a higher gas and condensate production compared with those of the CO2 injection, while waterflooding suffers from injection difficulty and the corresponding low sweep efficiency. Meanwhile, the injection cost is lower for the produced gas injection due to the on-site available gas source and minimal transport costs, gaining more economic benefits than the other EGR methods.
Background. The main problems that arise when using equipment for cultivation are to ensure the heat and mass transfer processes in devices, presence of turbulent and stagnant zones, high-energy consumption, low heat transfer coefficients when working with viscous fluids.
Objective. The aim of the paper is the experimental determination of the remote control heat transfer advantages in production line bioreactors using ultrasonic beam compared to contact methods.
Methods. An experimental study of the heat and mass transfer process in a bioreactor on the stand with UZP-6-1 immersion unit of the ultrasonic radiator with radiation frequency 42 kHz is carried out.
Results. Sound waves emitted into a liquid form a concentration zone of passable sound energy in the confocal vessel form of a cylindrical surface and force the liquid to move along the inner surface of the glass along the ascending cylindrical spiral, forming a motive flow throughout the volume, causing peripheral layers of liquid and bottom layers to move in a horizontal and vertical planes, without leaving stagnant zones. The closer to the coincidence angle is the directed ultrasonic beam the greater is the effectiveness of the driving flow.
Conclusions. The use of sound waves allows obtaining a high-quality product in technological lines based on bioreactors with minimal risk for the technological process. Radiation parameters and working volume physic-mechanical properties change allow fully using the properties of resonant manifestations of the sound wave influence on the working liquid with minimal costs.
This paper assesses the operational and design aspects of coagulation and flocculation in upflow gravel filters (CF-UGF) in a multi-stage filtration (MSF) plant. This study shows that CF-UGF units improve the performance of MSF considerably, when the system operates with turbidity above 30 NTU. It strongly reduces the load of particulate material before the water enters in the slow sand filters (SSF) and therewith avoids short filter runs and prevents early interruption in SSF operations. The removal efficiency of turbidity in the CF-UGF with coagulant was between 85 and 96%, whereas the average efficiency without coagulant dosing was 46% (range: 21&ndash;76%). Operating with coagulant also improves the removal efficiency for total coliforms, <i>E-coli</i> and HPC. No reduction was observed in the microbial activity of the SSF, no obstruction of the SSF bed was demonstrated and SSF runs were maintained between 50 and 70 days for a maximum head loss of 0.70 m. The most important advantage is the flexibility of the system to operate with and without coagulant according to the influent turbidity. It was only necessary for 20% of the time to operate with the coagulant. The CF-UGF unit represented 7% of total construction costs and the O&M cost for the use of coagulant represented only 0.3%.