Hasil untuk "Costs"

Stanton Heister, Felix Kin Peng Hui, David Ian Wilson et al.

The 2015 Paris Agreement paved the way for the carbon trade economy, which has since evolved but has not attained a substantial magnitude. While carbon credit exchange is a critical mechanism for achieving global climate targets, it faces persistent challenges related to transparency, double-counting, and verification. This paper examines how Distributed Ledger Technology (DLT) can address these limitations by providing immutable transaction records, automated verification through digitally encoded smart contracts, and increased market efficiency. To assess DLT’s strategic potential for leveraging the carbon markets and, more explicitly, whether its implementation can reduce transaction costs and enhance market integrity, three alternative approaches that apply DLT for carbon trading were taken as case studies. By comparing key elements in these DLT-based carbon credit platforms, it is elucidated that these proposed frameworks may be developed for a scalable global platform. The integration of existing compliance markets in the EU (case study 1), Australia (case study 2), and China (case study 3) can act as a standard for a global carbon trade establishment. The findings from these case studies suggest that while DLT offers a promising path toward more sustainable carbon markets, regulatory harmonization, standardization, and data transfer across platforms remain significant challenges.

Yang Liu, Wenbin Liu, Ying Wu et al.

High permeability distributed photovoltaic (PV) access to the distribution network makes it easy to cause frequent overvoltage of the system. However, the traditional centralized optimization scheduling method is difficult to meet the real-time voltage regulation requirements due to high communication costs. In this regard, this paper proposes a distributed fast voltage regulation method for energy storage systems (ESSs) in distribution networks. Firstly, to reduce the communication burden, the distribution network cluster is divided according to the electrical distance modularity index. Secondly, the distributed control model of active distribution network with the goal of voltage recovery and ESS power balance is established, and a distributed controller is designed. The feedback-control gains are optimized to improve the convergence rate. Finally, the IEEE33 bus system and IEEE69 bus system are applied for simulation. The results show that the proposed distributed optimal control method can effectively improve the voltage level of the distribution network under the condition of ensuring the ESS power balance.

Leonova Yu.Yu., Negadaev V.A.

The increase in the cost of energy resources makes it necessary to take into account measures to reduce non-production losses of electricity when building an electricity supply network. It is possible to reduce power losses by increasing the power factor. Despite a significant amount of research on the optimization of methods for selecting reactive power compensation devices, their placement and management, the installation costs of such devices are often determined approximately, without taking into account the nature of the dependencies between cost and their parameters. This article presents the results of research on the dependence of the cost of reactive power compensation devices on their parameters: reactive power, permissible current and capacitance. To clarify the nature of the relationship between the cost of capacitor banks and the value of reactive power, regression equations describing this relationship (in prices of 2023) are defined. The method of correlation analysis is used to find the regression equations. Based on the value of the Fisher criterion, a regression equation was chosen that best describes the relationship between the specified parameters of capacitor banks. The use of a deflator index to predict the cost of capacitor banks is proposed. To determine the values of the reactive power of a capacitor bank, at which it is advisable to turn on capacitors through a step-up transformer, the cost of reactive power compensation methods at reactive power values of 50 kVAr and above and a comparison of reactive power compensation methods using a step-up transformer and without its use was carried out. Based on the results of the study, conclusions were drawn: on the existence of a relationship between the cost of capacitor banks and reactive power, described by a polynomial regression equation; on the influence of voltage values on the cost of a unit of capacitance of capacitor banks. It is noted that if the required reactive power exceeds the value of 300 kVAr, it is advisable to consider switching on static capacitors using a step-up transformer.

Pablo N. Refolio-Samperi, Elena Adaschewski, Dieter Hanelt et al.

The present study evaluated a two-stage process of Haematococcus sp. to enhance the nutritional value by astaxanthin and fatty acid accumulation. Initial screening of different growth media during the green stage, focusing on enhanced biomass yield, showed the maximum growth using flory medium with a biomass yield of 0.991 g L−1 at the 30th day. Bold’s basal medium (BBM) exhibited the second highest biomass yield of 0.856 g L−1 at the 21th day. Due to faster growth, BBM presented the highest recorded biomass productivity of 0.040 g L−1 day−1, an increase of 21.2 % higher than flory and 207.7 % higher than the standard WHM medium. In the red stage, focused on maximizing astaxanthin yield, high-temperature stress was found to be the most effective stressor, leading to a significant increase in astaxanthin production by 217 % in comparison to the control. Interestingly, this stress condition also enhanced the total cellular fatty acids accumulation by 82.4 % over the control. However, a reduction in stearic acid (18:0) and alpha-linolenic acid (18:3n3) proportions under stress conditions was observed, suggesting the induction of metabolic shifts which involve reallocation of resources towards astaxanthin biosynthesis. These findings demonstrate a successful optimization strategy for Haematococcus sp. cultivation, which could be applied in industrial settings to enhance astaxanthin yield while reducing the production costs by avoiding vitamin supplementation, thereby helping in sustainable bio-based economy development.

Guoyu Zhang, Ye Tian, Wenhan Yin et al.

The use of automation technology in agriculture has become particularly important as global agriculture is challenged by labor shortages and efficiency gains. The automated process for harvesting apples, an important agricultural product, relies on efficient and accurate detection and localization technology to ensure the quality and quantity of production. Adverse lighting conditions can significantly reduce the accuracy of fruit detection and localization in automated apple harvesting. Based on deep-learning techniques, this study aims to develop an accurate fruit detection and localization method under adverse light conditions. This paper explores the LE-YOLO model for accurate and robust apple detection and localization. The traditional YOLOv5 network was enhanced by adding an image enhancement module and an attention mechanism. Additionally, the loss function was improved to enhance detection performance. Secondly, the enhanced network was integrated with a binocular camera to achieve precise apple localization even under adverse lighting conditions. This was accomplished by calculating the 3D coordinates of feature points using the binocular localization principle. Finally, detection and localization experiments were conducted on the established dataset of apples under adverse lighting conditions. The experimental results indicate that LE-YOLO achieves higher accuracy in detection and localization compared to other target detection models. This demonstrates that LE-YOLO is more competitive in apple detection and localization under adverse light conditions. Compared to traditional manual and general automated harvesting, our method enables automated work under various adverse light conditions, significantly improving harvesting efficiency, reducing labor costs, and providing a feasible solution for automation in the field of apple harvesting.

Jaime E. Ordóñez, Victor M. Huertas

Abstract Aim Palivizumab has proven effective in reducing hospitalizations, preventing severe illness, improving health outcomes, and reducing healthcare costs for infants at risk of respiratory syncytial virus (RSV) infection. We aim to assess the value of palivizumab in preventing RSV infection in high-risk infants in Colombia, where RSV poses a significant threat, causing severe respiratory illness and hospitalizations. Methods We conducted a decision tree analysis to compare five doses of palivizumab with no palivizumab. The study considered three population groups: preterm neonates (≤ 35 weeks gestational age), infants with bronchopulmonary dysplasia (BPD), and infants with hemodynamically significant congenital heart disease (CHD). We obtained clinical efficacy data from IMpact-RSV and Cardiac Synagis trials, while we derived neonatal hospitalization risks from the SENTINEL-1 study. We based hospitalization and recurrent wheezing management costs on Colombian analyses and validated them by experts. We estimated incremental cost-effectiveness ratios and performed 1,000 Monte Carlo simulations for probabilistic sensitivity analyses. Results Palivizumab is a dominant strategy for preventing RSV infection in preterm neonates and infants with BPD and CHD. Its high efficacy (78% in preventing RSV in preterm infants), the substantial risk of illness and hospitalization, and the high costs associated with hospitalization, particularly in neonatal intensive care settings, support this finding. The scatter plots and willingness-to-pay curves align with these results. Conclusion Palivizumab is a cost-saving strategy in Colombia, effectively preventing RSV infection in preterm neonates and infants with BPD and CHD by reducing hospitalizations and lowering healthcare costs.

Fabiana Sofia Ricci, Alain Boldini, Xinda Ma et al.

Visual impairment represents a significant health and economic burden affecting 596 million globally. The incidence of visual impairment is expected to double by 2050 as our population ages. Independent navigation is challenging for persons with visual impairment, as they often rely on non-visual sensory signals to find the optimal route. In this context, electronic travel aids are promising solutions that can be used for obstacle detection and/or route guidance. However, electronic travel aids have limitations such as low uptake and limited training that restrict their widespread use. Here, we present a virtual reality platform for testing, refining, and training with electronic travel aids. We demonstrate the viability on an electronic travel aid developed in-house, consist of a wearable haptic feedback device. We designed an experiment in which participants donned the electronic travel aid and performed a virtual task while experiencing a simulation of three different visual impairments: age-related macular degeneration, diabetic retinopathy, and glaucoma. Our experiments indicate that our electronic travel aid significantly improves the completion time for all the three visual impairments and reduces the number of collisions for diabetic retinopathy and glaucoma. Overall, the combination of virtual reality and electronic travel aid may have a beneficial role on mobility rehabilitation of persons with visual impairment, by allowing early-phase testing of electronic travel aid prototypes in safe, realistic, and controllable settings. Author summary Testing electronic travel aids under development is an outstanding research area, due to the rapid growth in the number of people with visual impairment. For decades, different technologies have been employed to improve the mobility of persons with visual impairment, but suitable and easy-to-use solutions have not yet been established. In this study, we propose the use of virtual reality for early-phase testing of electronic travel aids in safe, realistic, and controllable settings. We demonstrate the approach using an haptic feedback device developed in-house in the form of a belt. Our device can be simply wear by a user, providing free hands and real-time operation. The approach offers the combined possibility of designing highly realistic, urban environments and of simulating different forms of visual impairment on healthy subjects. Our integrated wearable electronic travel aid/virtual reality system establishes a novel assistive framework to mitigate the consequences of visual impairment. We envision this framework could improve training, reduce rehabilitation, and abate societal costs, while creating an engaging and compelling experience for persons with visual impairment.

Tetsuya Tachibana, Hiroki Katagiri, Hideyuki Koga et al.

Purpose: The advantage of total hip arthroplasty (THA) in an anterior approach compared with a posterior approach in terms of early postoperative pain and function and lowering dislocation risks is controversial. This study aimed to identify whether THA using the anterior approach lowers costs compared with the posterior approach. Methods: We identified 294 patients who underwent primary THA and compared the cost of total inpatient stay, inpatient length of stay (LOS), cost of operating room, and the rates of discharged patients, complications, and reoperation between the anterior and posterior approaches using propensity score matching analysis. Results: One-to-one matching resulted in 135 pairs of patients who underwent THA using both approaches. The cost of total inpatient stay was significantly lower in the anterior approach (anterior vs. posterior [1,322,800 vs. 1,445,219 yen]; p ​= ​0.04). Furthermore, in the anterior approach, the inpatient LOS was shorter (anterior vs. posterior [19.9 vs. 25.0 days]; p ​< ​0.001). However, there was no significant difference in the cost of the operating room and the rates of patients discharged home, total complications (anterior vs. posterior [5.2 vs. 11.1 ​%]; p ​= ​0.08), or revisions between the two approaches. Conclusions: Using propensity score matching, the current study demonstrated that THA in the anterior approach shortened inpatient LOS and rendered an 8 ​% reduction in the total inpatient cost compared with the posterior approach.

Emily Eisner, Shôn Lewis, Charlotte Stockton-Powdrell et al.

Abstract Background Depression during the postnatal year is prevalent in mothers (17%) and fathers (9%), and suicide is the leading cause of maternal death in this period. Lifelong costs and consequences of untreated postnatal depression (PND) are high due to impacts on infants as well as parents. We aimed to improve access to PND treatment using digital screening. We developed a smartphone app (ClinTouch DAWN-P) that allows parents to monitor their mood daily with the Edinburgh Postnatal Depression Scale (EPDS), uploading responses in real-time to a secure server. We evaluated the app’s feasibility, acceptability, validity and safety in a proof-of-concept study. Methods Pregnant women (≥ 36 weeks gestation) and partners were recruited from antenatal services and invited to complete daily EPDS assessments via the ClinTouch DAWN-P app until 6 weeks postpartum. Participants completed standard paper-based EPDS at two time points for validity comparisons. We examined app acceptability and usability at 6 weeks postpartum with qualitative interviews, examined using framework analysis, and the abridged Mobile App Rating Scale (convergent mixed methods design). Results Most (96%) eligible pregnant women approached were keen to try the app. Participating mothers (n = 15) and partners/fathers (n = 8) found the app easy to use, and 91% continued to use it for the full study period. Overall, 67% of daily app-based assessments were completed, with a history of depression predicting lower app usage. Participants suggested modifications to the app and its deployment to improve usability (e.g., extending the response window and including feedback and parenting advice). The validity of app-based responses was confirmed by high agreement with standard EPDS. App-based and paper-based ratings showed perfect agreement in identifying cases of likely PND. There were no serious adverse events relating to app use. Conclusions Digital PND screening appears feasible, acceptable, valid and safe. It also benefits from being remotely delivered: we enrolled all participants remotely during the first COVID-19 lockdown. Use of digital screening could address known shortcomings of conventional health visitor-delivered screening such as limited staff time, parental unwillingness to disclose difficulties to a professional, lack of partner/father screening, and language barriers. Trial registration The study was prospectively registered (Clinicaltrials.gov: NCT04279093 ).

Jiu-Lin Li, Li-Min Chen, Hao Xu

Building information modeling (BIM) is a data-based tool for engineering, design, and building management, which is used to parameterize and model various types of information. This information may then be shared and introduced throughout the building life-cycle phases (planning, design, construction and operation, and maintenance (O&M)). Therefore, BIM allows engineers to correctly understand and efficiently respond to varying types of building information as well as serves as a foundation for cooperation between the design and construction teams. Hence, BIM plays an important role in increasing productivity, minimizing costs, and shortening construction times. In this article, we present a case example where BIM was used for intelligent construction of a large wastewater-treatment plant (WTP). The process involved intelligent design and simulation techniques, management and simulation of construction works, digital delivery solutions, BIM-based Internet of things O&M, and environmental monitoring. BIM was used to digitalize the construction, delivery, and O&M processes of the WTP. According to this case example, we also offer suggestions on how deep learning and intelligent control techniques can be used to enhance intelligent O&M in WTPs.

Ilnitsky O.A., Plugatar Y.V., Pashtetsky A.V. et al.

The objective of the research is to determine the optimal zones and thresholds of soil moisture, temperature, illumination, limiting photosynthesis and transpiration of Quércus pubéscens Willd. and allowing the introduction of the species to other regions. The dependences of the net photosynthesis rate (Pn) and the transpiration rate (E) on stomatal conductivity (gs), leaf temperature (Tl), and soil moisture (Ws) are shown. The ratio of the processes of photosynthesis and respiration, under the influence of soil drought, allowed us to define their optimal values: Ws = 26 – 28%, Pn = 16 –18 μmol/m2c, Rt = 2 – 4 μmol/m2c. The relationship between the net photosynthesis rate, total respiration, and leaf temperature allowed us to determine the temperature maximum of net photosynthesis (the thermal compensation point): Pn = Rt = 2.0 μmol/m2c at Tl = 37ºC. It was found that in the absence of soil drought, the proportion of respiratory costs (Rt/Pg) from true photosynthesis is 20 – 23%, and with soil moisture of 8 – 10% increases to 55 – 58%.

Rezwan F. Munshi, James R. Pellegrini Jr, Pranavi Patel et al.

We aim to study the impact of pulmonary hypertension on acutely exacerbated chronic obstructive pulmonary disease (AECOPD). We used the 2016 and 2017 National Readmission Database with an inclusion criterion of AECOPD as a primary and pulmonary hypertension as a secondary diagnosis using ICD 10‐CM codes. Exclusion criteria were age under 18 years, non‐elective admission, and discharge in December. The primary outcome was in‐hospital mortality during the index admission. Secondary outcomes were 30‐day readmission rate, resource utilization, and instrument utilization including intubation, prolonged invasive mechanical ventilation >96 h (PIMV), tracheostomy, chest tube placement, and bronchoscopy during the index admission. A total of 627,848 patients with AECOPD were included in the study, and 68,429 (10.90%) patients had a diagnosis of pulmonary hypertension. Pulmonary hypertension was more common among females (61.14%) with a mean age of 71 ± 11.66, Medicare recipients (79.5%), higher Charlson comorbidity index, and treatment in an urban teaching hospital. Pulmonary hypertension was associated with greater mortality (adjusted odds ratio (aOR) 1.89, p < 0.001), higher 30‐day readmission (aOR 1.24, p < 0.001), higher cost (adjusted mean difference (aMD) $2785, p < 0.01), length of stay (aMD 1.09, p < 0.001), and higher instrument utilization including intubation (aOR 199, p < 0.001), PIMV (aOR 2.12, p < 0.001), tracheostomy (aOR 2.1, p < 0.001), bronchoscopy (aOR 1.46, p = 0.007), and chest tube placement (aOR 1.39 p < 0.004). We found that pulmonary hypertension is related to higher in‐hospital mortality, length of stay, increased instrument utilization, readmission, and costs. Our study aims to shed light on the impact of pulmonary hypertension on AECOPD in hopes to improve future management.

Laura-Selin Harding, Georg Fieg

The reactive dividing wall column (RDWC) is a highly integrated apparatus, which combines a reactive distillation and a dividing wall column in one single shell. Thus, high savings in investment as well as operational costs can be achieved compared to conventional process alternatives. Due to the high grade of integration the process behavior of the RDWC is strongly nonlinear and extremely complex. Hence, it is not trivial to understand how the process performs in detail and to predict the advantageousness of the RDWC for a given task during conceptual design. Still, for a safe and energy efficient design as well as a steady operation in the industrial praxis it is essential to know, how the process performances and for which tasks the RDWC is more advantageous than less integrated process alternatives. Therefore, the aim of this research is to generate a profound process understanding and identify process applications for the RDWC. The investigations carried out focus on the influence of non-ideal reaction system properties, such as azeotropic phase equilibria. To determine the best process integration level, the energy optimal designs of the RWDC and less integrated process alternatives are determined and compared. By applying this procedure suitable reaction system characteristics can be identified and so, process applications for the RDWC can be derived. Moreover, heuristics regarding the optimal level of process integration can be deduced. This leads to an easier determination of the optimal process integration level and an acceleration of the conceptual design phase.

Dirk Heider, Herbert Matschinger, Andreas D Meid et al.

<h4>Background</h4>In the growing population of the elderly, drug-related problems are considered an important health care safety issue. One aspect of this is the prescription of potentially inappropriate medication (PIM) which is considered to increase health care costs.<h4>Objective</h4>Using data from the Health Economics of Potentially Inappropriate Medication (HEPIME) study, we aimed to analyze how the number of prescribed substances moderates the association of PIM use as defined by the German PRISCUS list and health care costs applying a longitudinal perspective.<h4>Methods</h4>An initial number of 6,849,622 insurants aged 65+ of a large German health insurance company were included in a retrospective matched cohort study. Based on longitudinal claims data from the four separate quarters of a 12-month pre-period, 3,860,842 individuals with no exposure to PIM in 2011 were matched to 508,212 exposed individuals. Exposure effects of PIM use on health care costs and the number of prescribed substances were measured based on longitudinal claims data from the four separate quarters of the 12-month post-period.<h4>Results</h4>After successful balancing for the development of numerous matching variables during the four quarters of the pre-period, exposed individuals consumed 2.1 additional prescribed substances and had higher total health care costs of 1,237 € when compared to non-exposed individuals in the 1st quarter of the post-period. Controlling for the number of prescribed substances, the difference in total health care costs between both study groups was 401 €. The average effect of one additionally prescribed substance (other than PIM) on total health care costs was increased by an amount of 137 € for those being exposed to a PIM. In quarters 2-4 of the post-period, the differences between both study groups tended to decrease sequentially.<h4>Conclusions</h4>PIM use has an increasing effect on the development of health care costs. This cost-increasing effect of PIM use is moderated by the number of prescribed substances.

Tomasz Famulski

The aim of this article is to identify the relation between transaction costs and the law, both on theoretical and practical grounds. In literature various approaches on the issue of transaction costs are presented, but it was Ronald H. Coase’s discovery and explanation that turned out to be one of the most crucial determinants of the development of Law & Economics. Thereby, the findings of economics on the issue of transaction costs are interfuses L&E as a jurisprudential movement. Detailed analysis of selected current Polish legal regulations lead to a conclusion that some of those regulations generate transaction costs, while other limit the ability to transact. Concurrently, legal regulations that foster reduction of the level of transaction costs are indentified. In general conclusion it can be asserted that the previous assumption – legal regulations can affect transaction costs in both positive and negative way – is true.

Cezary Mik, Ewa Wojtaszek-Mik

Combating Late Payment in Commercial Transactions in the Light of the Directive 2000/35/EC and in the Polish Law Summary The European Community has recognized late payments as one of important obstacles to a good functioning of the internal market. The preparatory works of the EC in this field prove that a long way has been come from the European Parliament’s initiative to the directive 2000/35/E C of the European Parliament and the Council dated 29 June 2000 on combating late payment in commercial transactions. A rather limited scope of the directive is a result of extensive modifications introduced by the Council to the initial proposals. The directive concentrates on the interests in case of late payment, reasonable compensation for recovery costs, retention of title and recovery procedures for unchallenged claims. The above study presents the substance of the directive and its transposition rules. The first attempt to implement the EC directive in Poland was the law of 6 September 2001. As it was not satisfactory, a new law on payment terms in commercial transactions was issued on 12 June 2003. It will enter into force on 1 January 2004. This new law is limited to interests and procedural aspects. The above study presents the results of the directive’s transposition within this law. The act of law from 2003 certainly sets new limits on the freedom of contracts, but it is an interesting and rare example of a protection of weaker parts to the contract, which are not consumers, but enterprises. W hat should be reproached is that a typical civil matter is regulated in an act of law separate from the Polish Civil Code. A breach of the rule of the integrity of the Polish Civil Code is again a price for the fast implementation of the EC law in Poland.

Hans-Joerg eFugel, Mark eNuijten, Maarten Jacobus Postma et al.

Background: Stratified Medicine (SM) is becoming a practical reality with the targeting of medicines by using a biomarker or genetic-based diagnostic to identify the eligible patient sub-population. Like any healthcare intervention, SM interventions have costs and consequences that must be considered by reimbursement authorities with limited resources. Methodological standards and guidelines exist for economic evaluations in clinical pharmacology and are an important component for health technology assessments (HTAs) in many countries. However, these guidelines have initially been developed for traditional pharmaceuticals and not for complex interventions with multiple components. This raises the issue as to whether these guidelines are adequate to SM interventions or whether new specific guidance and methodology is needed to avoid inconsistencies and contradictory findings when assessing economic value in SM.Objective: This article describes specific methodological challenges when conducting health economic (HE) evaluations for SM interventions and outlines potential modifications necessary to existing evaluation guidelines /principles that would promote consistent economic evaluations for SM.Results/Conclusions: Specific methodological aspects for SM comprise considerations on the choice of comparator, measuring effectiveness and outcomes, appropriate modelling structure and the scope of sensitivity analyses. Although current HE methodology can be applied for SM, greater complexity requires further methodology development and modifications in the guidelines.

V. L. Denisenko, Yu. M. Gain

A medical trend which is currently gaining strength includes the complex treatment based on the concept of «fast-track» recovery in oncology. An application of modern high-tech approaches allowed minimizing the terms of treatment, shortening economic costs and getting the highest final results. It provides a high quality treatment. Given method could exclude an interim treatment stages, sufficiently reduces terms of general treatment and rehabilitation of patients and could succeed in high quality of life for the patients in short- and long-term period. The authors present the results of successful clinical surgery of 78 patients using this method in public health.

Dias Zanoni, Dias Ulisses, Setubal João C

<p>Abstract</p> <p>Background</p> <p>Decreasing costs of DNA sequencing have made prokaryotic draft genome sequences increasingly common. A contig scaffold is an ordering of contigs in the correct orientation. A scaffold can help genome comparisons and guide gap closure efforts. One popular technique for obtaining contig scaffolds is to map contigs onto a reference genome. However, rearrangements that may exist between the query and reference genomes may result in incorrect scaffolds, if these rearrangements are not taken into account. Large-scale inversions are common rearrangement events in prokaryotic genomes. Even in draft genomes it is possible to detect the presence of inversions given sufficient sequencing coverage and a sufficiently close reference genome.</p> <p>Results</p> <p>We present a linear-time algorithm that can generate a set of contig scaffolds for a draft genome sequence represented in contigs given a reference genome. The algorithm is aimed at prokaryotic genomes and relies on the presence of matching sequence patterns between the query and reference genomes that can be interpreted as the result of large-scale inversions; we call these patterns inversion signatures. Our algorithm is capable of correctly generating a scaffold if at least one member of every inversion signature pair is present in contigs and no inversion signatures have been overwritten in evolution. The algorithm is also capable of generating scaffolds in the presence of any kind of inversion, even though in this general case there is no guarantee that all scaffolds in the scaffold set will be correct. We compare the performance of <smcaps>sis</smcaps>, the program that implements the algorithm, to seven other scaffold-generating programs. The results of our tests show that <smcaps>sis</smcaps> has overall better performance.</p> <p>Conclusions</p> <p><smcaps>sis</smcaps> is a new easy-to-use tool to generate contig scaffolds, available both as stand-alone and as a web server. The good performance of <smcaps>sis</smcaps> in our tests adds evidence that large-scale inversions are widespread in prokaryotic genomes.</p>

Philip M Clarke, Paul Glasziou, Anushka Patel et al.

Diabetes imposes a substantial burden globally in terms of premature mortality, morbidity, and health care costs. Estimates of economic outcomes associated with diabetes are essential inputs to policy analyses aimed at prevention and treatment of diabetes. Our objective was to estimate and compare event rates, hospital utilization, and costs associated with major diabetes-related complications in high-, middle-, and low-income countries.Incidence and history of diabetes-related complications, hospital admissions, and length of stay were recorded in 11,140 patients with type 2 diabetes participating in the Action in Diabetes and Vascular Disease (ADVANCE) study (mean age at entry 66 y). The probability of hospital utilization and number of days in hospital for major events associated with coronary disease, cerebrovascular disease, congestive heart failure, peripheral vascular disease, and nephropathy were estimated for three regions (Asia, Eastern Europe, and Established Market Economies) using multiple regression analysis. The resulting estimates of days spent in hospital were multiplied by regional estimates of the costs per hospital bed-day from the World Health Organization to compute annual acute and long-term costs associated with the different types of complications. To assist, comparability, costs are reported in international dollars (Int$), which represent a hypothetical currency that allows for the same quantities of goods or services to be purchased regardless of country, standardized on purchasing power in the United States. A cost calculator accompanying this paper enables the estimation of costs for individual countries and translation of these costs into local currency units. The probability of attending a hospital following an event was highest for heart failure (93%-96% across regions) and lowest for nephropathy (15%-26%). The average numbers of days in hospital given at least one admission were greatest for stroke (17-32 d across region) and heart failure (16-31 d) and lowest for nephropathy (12-23 d). Considering regional differences, probabilities of hospitalization were lowest in Asia and highest in Established Market Economies; on the other hand, lengths of stay were highest in Asia and lowest in Established Market Economies. Overall estimated annual hospital costs for patients with none of the specified events or event histories ranged from Int$76 in Asia to Int$296 in Established Market Economies. All complications included in this analysis led to significant increases in hospital costs; coronary events, cerebrovascular events, and heart failure were the most costly, at more than Int$1,800, Int$3,000, and Int$4,000 in Asia, Eastern Europe, and Established Market Economies, respectively.Major complications of diabetes significantly increase hospital use and costs across various settings and are likely to impose a high economic burden on health care systems.