Hasil untuk "Costs"

James A. Brickley, J. Coles, G. Jarrell

Shareholder activists and regulators are pressuring U.S. firms to separate the titles of CEO and Chairman of the Board. They argue that separating the titles will reduce agency costs in corporations and improve performance. The existing empirical evidence appears to support this view. We argue that this separation has potential costs, as well as potential benefits. In contrast to most of the previous empirical work, our evidence suggests that the costs of separation are larger than the benefits for most large firms.

W. Stewart, J. Ricci, E. Chee et al.

Simon Woodruff, Alicia Durham, Alex Higginbottom et al.

This paper documents the work of the Clean Air Task Force (CATF) International Working Group (IWG) on Fusion Cost Analysis in 2024-2025, and the methodological extensions implemented in the CATF-supported branch of the pyFECONs fusion power-plant costing framework. Using the standards-aligned chart-of-accounts and physics-to-economics workflow established by ARPA-E. The IWG development reorganizes and deepens the framework around three architecture-defining cost-driver tracks for Magnetic Fusion Energy (MFE), Inertial Fusion Energy (IFE), and Magneto-Inertial Fusion Energy (MIFE). In particular, the generic driver placeholder in Account 22.1.3 is treated as a controlled swap-point and replaced by a full cost-account development for the dominant driver in each class, enabling auditable traceability from requirements and geometry to rolled-up plant costs. On top of this driver-centric foundation, we introduce a probabilistic costing layer that compounds materials price uncertainty, TRL-based maturity uncertainty, and learning-curve uncertainty into cost distributions. We then describe safety-informed costing that enumerates fusion-relevant hazards and maps mitigating systems, structures, and provisions into standardized accounts, together with scenario-parameterized regulatory and financial adders. Finally, we document expanded macroeconomic and finance parameterization and a value-metrics module that complements LCOE with investment and planning measures (NPV, IRR MIRR, revenue requirements, WACC-based annualization, and residual and follow-on value), all computed from the same COA-mapped outputs. Collectively, these additions convert a deterministic, standards-aligned costing backbone into an extensible analysis environment suitable for transparent sensitivity studies, uncertainty propagation, and safety- and finance-coupled interpretation of fusion pilot-plant and NOAK scenarios.

Rossella Berni, Nedka Dechkova Nikiforova, Federico Mattia Stefanini

In this study, a procedure to build Bayesian optimal designs using utility functions and exploiting existing data is proposed. The procedure is illustrated through a case study in the field of reliability, by applying a hierarchical Bayesian model and performing Markov Chain Monte Carlo simulations. Two innovative contributions are introduced: (i) the definition of specific utility functions that involve several key issues and (ii) the use of observational data. The use of observational data makes it possible to build the optimal design without additional costs for the company, while the definition of the utility functions accounts for the specific characteristics of the reliability study. Features like model residuals, i.e., discrepancies between observed and predicted response values, and the costs of the electronic component are addressed. Costs are also weighted considering the environmental impact. Satisfactory results are obtained and subsequently validated through an in-depth sensitivity analysis.

Binbin Han, Binbin Han, Xiaofang Chen

BackgroundLung cancer places a substantial burden on hospital inpatient care, particularly in tertiary cancer centers. Evidence remains limited on how hospital performance-based management reforms are associated with inpatient efficiency and costs among patients with lung cancer.MethodsWe conducted a retrospective, real-world study using inpatient administrative data from a tertiary cancer hospital in China between 2016 and 2020. Hospitalizations (admissions) of patients with lung cancer were identified, and patient records were linked to enable secondary patient-level analyses. Length of stay (LOS) and daily hospitalization costs were evaluated as complementary indicators of inpatient efficiency and resource utilization intensity. A hospital performance reform implemented in April 2018 was examined by comparing pre-reform (2016–2017) and post-reform (2019–2020) periods. An interrupted time series analysis (ITSA) was conducted using segmented regression on monthly geometric means of log-transformed outcomes at the hospitalization level. Multivariable patient-level regression analyses were conducted as secondary analyses.ResultsA total of 25,331 patients hospitalized with lung cancer were included. After April 2018, LOS declined by approximately 1.6% per month (p < 0.001) relative to the pre-reform trend, while daily hospitalization costs increased by approximately 2.1% per month (p < 0.001) relative to the pre-reform trend. Patient-level analyses were directionally consistent, with the post-reform period associated with a 16.0% shorter LOS and a 31.9% higher daily cost. Sensitivity analyses excluding 2020 and restricting to index admissions yielded similar results.ConclusionsAmong patients hospitalized with lung cancer, the hospital performance reform implemented in 2018 was associated with shorter hospitalization duration and higher daily costs. These findings suggest concurrent changes in inpatient efficiency and resource utilization intensity and highlight the importance of using complementary indicators when evaluating hospital management reforms in oncology care.

Saba Javanpour, A. Radman, Sarow Saeedi et al.

Transportation plays a critical role in supply chain networks, directly impacting cost efficiency, delivery reliability, and environmental sustainability. This study provides an enhanced optimization model for transportation planning, emphasizing environmental sustainability and cost-efficiency. An Integer Linear Programming (ILP) model was developed to minimize the total transportation costs by considering organizational and third-party vehicles' operational and rental costs while incorporating constraints on carbon emissions. The model incorporates multi-modal transportation routing and emission caps to select the optimized number of organizational and rental vehicles of different modes in each route to ensure adherence to sustainability goals. Key innovations include adding carbon emission constraints and optimizing route selection to reduce overall emissions. The model was implemented using the Gurobi solver, and numerical analysis reveals a trade-off between cost minimization and carbon footprint reduction. The results indicate that adopting tight environmental policies increases the costs by around 8% on average while more than 95% of the vehicles utilized will be rented. These insights provide actionable guidance for industries aiming to enhance both economic performance and environmental responsibility.

Heather O’Mahen, Louise Howard, Helen Sharp et al.

Background Perinatal mental health disorders affect one in five mothers during pregnancy or within 2 years post childbirth. These disorders can lead to poor pregnancy and childbirth outcomes and maternal deaths. Additionally, they negatively affect a child’s cognitive, social and emotional development. Stigma and a lack of specialised services have limited access to mental health care. National Health Service England invested £365M in community perinatal mental health teams, but their impact on women and infants’ outcomes are not known. Objectives Develop a taxonomy of community perinatal mental health teams (work package 1). Compare and validate two assessments of quality of mother–infant interaction for use by community perinatal mental health teams (work package 2). Evaluate the effectiveness and cost-effectiveness of community perinatal mental health teams (work packages 3 and 4). Design Mixed-methods study. Setting Community perinatal mental health teams in England. Participants Women who were pregnant or within 2 years postnatal. Methods and outcome measures Work package 1: Typology of community perinatal mental health teams in England. Work package 2: Reliability and validity of two observational assessments of parent–infant interaction. Work package 3: Realist evaluation interviews with women, partners/close others, and staff to determine effective community perinatal mental health team components. Work package 4: Analysis of linked data: Association of community perinatal mental health teams with access to secondary care mental health services. Risk of acute relapse and improved obstetric and neonate outcomes for women with pre-existing severe disorders in areas with community perinatal mental health teams compared to generic services. Economic analysis of cost of community perinatal mental health teams. Results Objective 1: Community perinatal mental health team typologies revealed in 2020, 84% had basic staffing levels and 63% had more multi-professionals. Objective 2: The ‘Parent Infant Interaction Observation Scale’ and ‘National Institute of Child Health and Human Development’ assessments of mother–infant interaction were reliable and valid; the National Institute of Child Health and Human Development is more suitable for community perinatal mental health teams. Objective 3: Work package 3: Interviews with 139 women, 55 partners/close others and 80 health workers highlighted the importance of specialist perinatal knowledge, responding in a warm and non-judgemental way, working closely with other healthcare providers, optimising medication, supporting mothers to reduce conflict and improve social support, helping mother–infant bonding, and teaching emotional management. Work package 4: Analysis of linked health data revealed higher risks for obstetric and neonate problems in women with severe mental health disorders, particularly recent or very serious episodes. Work package 4: Areas with community perinatal mental health teams saw increased mental health access among perinatal women and reduced need for acute care, albeit at a higher cost and with greater neonatal risks. Limitations High levels of missing data on diagnosis and mental health outcomes in existing health and service data. Lack of data on child outcomes. Evaluation occurred during community perinatal mental health team changes and the coronavirus disease discovered in 2019 pandemic limiting a full assessment of the impact of community perinatal mental health teams on maternal and child outcomes. Conclusions Community perinatal mental health teams can support perinatal women with complex, moderate/severe mental health disorders, but further attention to women’s physical needs is essential. The use of observational assessments of parent–infant relationships will enhance the evaluation of community perinatal mental health teams’ impact on infant outcomes. Future work Research should focus on prospective studies that gather mental health and child outcomes from community perinatal mental health teams and primary care mental health, to assess broader impacts of perinatal-specific treatment across care pathways. Study registration This study is registered on Research Registry as researchregistry5463. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: 17/49/38) and is published in full in Health and Social Care Delivery Research; Vol. 13, No. 38. See the NIHR Funding and Awards website for further award information. Plain language summary We evaluated how well community perinatal mental health teams were working. The study had four work packages. Work package 1 created community perinatal mental health team categories in England. In 2020, 84% had basic staffing, and 63% had more multi-professionals involved in mother and baby care. Work package 2 evaluated two assessments of mother–baby interaction. ‘Parent Infant Interaction Observation Scale’ was better at predicting how babies would be developmentally at age 2, though is best used for babies 2–8 months old. ‘National Institute of Child Health and Human Development-3’ could be better for community perinatal mental health teams, because it can be used for babies 3–24 months old, is simpler to use and takes less staff training time. Work package 3 used interviews to look at what aspects of community perinatal mental health team care helped women. We interviewed 139 women, 55 family members and 80 health workers in 10 community perinatal mental health teams throughout England. Good community perinatal mental health teams were comprehensive and had staff who were relational, approachable and non-judgemental. They understood what new mothers needed. Mothers and babies were greatly helped by: community perinatal mental health teams working closely with other health providers perinatal-specific medication advice helping mothers connect with other mothers supporting mothers to reduce conflict and get more support helping mother–infant bonding teaching mums how to manage their emotions. Work package 4 evaluated National Health Service maternity and mental health data. We found women with serious mental health problems had a higher chance of having childbirth and newborn difficulties. The risk was greatest for women with very recent or serious mental health problems. In areas with community perinatal mental health teams, more perinatal women accessed earlier help with their mental health, with fewer women having highest levels of care. Areas with community perinatal mental health teams cost more money and newborns had greater health risks. Community perinatal mental health teams are good at helping perinatal women with mental health problems, but further work is needed to understand how to help their newborn baby’s health. Scientific summary Background Perinatal mental health (PMH) disorders (mental disorders occurring in pregnancy or 2 years after childbirth) are widely prevalent, affecting one in five mothers. Women with PMH have distressing symptoms and poor functioning that can affect their relationships with their families and infant. There is growing evidence that PMH disorders are associated with pregnancy complications, poor childbirth outcomes, maternal deaths in the first postnatal year and long-term negative effects on child cognitive, social and emotional development. Stigma, lack of specialist services and trained staff, and lack of clinically feasible assessments, particularly for the parent–infant relationship, have meant access to mental health care has been poor. In the ‘Five Year Forward’ and ‘Long Term Plans’, NHS England invested over £365M to improve access to community perinatal mental health teams (CPMHTs), but the effectiveness of these services on women and children’s health and well-being is not known. Objectives Develop a taxonomy of variations characterising CPMHTs [work package (WP) 1]. Compare and validate two observational assessments of quality of mother–infant interaction for use by CPMHTs (WP2). Evaluate the effectiveness and cost-effectiveness of CPMHTs (WPs 3 and 4). WP3: Which CPMHT components promote access to treatment and which components work, for whom, in what circumstances, how and why to reduce PMH problems? WP4: In women with pre-existing severe disorders are CPMHTs (compared with generic services) associated with: higher levels of access to secondary care mental health services (generic and CPMHTs)? lower risk of relapse? improved birth outcomes? greater cost-effectiveness? Methods (2020–3) Work package 1/RQ1 To characterise service variations [research questions (RQ1)], we created a taxonomy classifying CPMHT elements. Using published data, expert and patient consensus, we created a programme theory on optimal service provision. A programme theory explains how, when and why a programme is expected to work. We used service-level data gathered from CPMHT annual reports to NHS England (2020), NHS Benchmarking (2015–8), Royal College of Psychiatry Perinatal Quality Network, and National Maternity and Perinatal Audit (2017 and 2019) to develop the taxonomy relative to the programme theory. Work package 2/RQ2 We assessed the reliability and predictive validity of two observational assessments of the parent–infant relationship. Observational assessments of the parent–infant relationship are considered superior to self-report, but there is a lack of consensus on which assessments have the best predictive validity to later child outcomes. We used video archive material from a prospective, longitudinal Medical Research Council-funded study from pregnancy to school age (The Wirral Child Health and Development Study) to evaluate the Parent–Infant Interaction Observation Scale (PIIOS; for use with infants 2–8 months) and the National Institute for Child Health and Human Development (NICHD; for use with infants) system. Using 250 mother–infant interactions recorded at 6–8 months of age, 2 research assistants coded 3-, 5- and 7-minute clips from the 7-minute recorded observation available using each system. Inter-rater reliability and intrarater reliability were assessed. Predictive validity was determined in relation to (1) attachment security from the Strange-Situation Paradigm and (2) child internalising (emotional) and externalising (behavioural) problem scores from the Brief Infant Toddler Socio-Emotional Assessment (age 1 and 2) and Pre-school Child Behaviour Checklist at school entry. We tested whether we could identify a briefer reliable and valid form of either assessment for use in routine clinical practice. Work package 3/RQ3 We carried out a realist evaluation assessing components of CPMHTs that promoted treatment access and perceived outcomes (RQ3). Using WP1 typology and programme theory, we selected 10 CPMHTs for variations on service components and configurations (e.g. level of mother–infant/psychological interventions, integration with other services). We employed a purposive sampling approach (with maximum variation in characteristics), to identify and interview at least 10 women, their (consenting) partners or close other (CO), and up to 10 staff from each service to help us refine and test aspects of our programme theory, which identified how programme activities were associated with outcomes. Women were eligible if they were near the end of their care with the CPMHT or had finished care within the past 2 years. Interviews, up to 60 minutes in duration, assessed domains from our programme theory (e.g. experiences/acceptability of care, service components they believed made a difference to their care and outcomes and how this made an impact on their mental health and functioning with their family, including their infant). Where individuals had ‘less successful’ outcomes, we asked them for their opinions on what might have helped. We asked partners/CO related questions about impact of care received and how/if the CPMHT involved the CO. We asked staff how teams operate, which service components improve mother and baby outcomes, and which populations CPMHTs work best for. We also gathered service-level data on monthly referral numbers, referral source, ethnicity of women on the service and staffing breakdown. A realist logic of analysis was used. Work package 4/RQ4 We used linked NHS routinely collected data from the Maternity Services Data Set, the Mental Health Services Data Set and the Hospital Episode Statistics between 2016 and 2019. Using an initial data set from 2016, we firstly examined associations between women who had a history of severe and complex mental health problems and obstetric and neonatal outcomes. We investigated whether there was a relationship between severity, as indicated by an acute hospitalisation, and recency of the mental health problem and these outcomes. For RQ4, we used data between 2016 and 2019 and we compared areas with a CPMHT to those without on women’s access to secondary mental health care, acute post partum relapse (defined as admission to either inpatient or crisis team care), duration of admissions and associated costs. We also examined obstetric and neonatal outcomes (including birthweight, prematurity and infant death and stillbirth) for perinatal women with a history of severe and complex mental health problems in areas with CPMHTs compared to those without. Results Work package 1/RQ1 In 2020, there were 55 CPMHTs. This represented coverage across 94.8% of mental health trusts in the country. Using staff configurations that captured variations in service provision relative to the programme theory, we created a hierarchical taxonomy consisting of a basic, foundational classification of services based on presence of a psychiatrist, nurse and psychologist (84% of CPMHTs), and a secondary, comprehensive level with greater service differentiation in line with key domains in the long-term plan (63% of CPMHTs). These included the basic classification as well as occupational therapists and nursery nurses. Work package 2/RQ2 We found evidence for the reliability and predictive validity of the total-score PIIOS and a three-item form of the NICHD (NICHD-3; parental sensitivity, intrusiveness and positive regard/warmth), and the total-score PIIOS. No shorter form of PIIOS was identified with sufficient predictive validity. Filming for a 5-minute period achieved optimal reliability and predictive (discriminative) validity to age 2 mental health outcomes for both NICHD-3 and PIIOS total score, although PIIOS had broader predictive validity to age 2 internalising and externalising mental health outcomes. Neither observational tool predicted longer-term mental health outcomes at school entry, consistent with the high number of intervening events in this time period. Work package 3/RQ3 Across 10 different CPMHTs, we interviewed 139 women, 55 partners/CO and 80 health and social care practitioners to determine effective CPMHT components. As predicted, comprehensive CPMHTs resulted in improvements in the experiences and mental health outcomes of women and infants, with some women stating CPMHTs were a ‘transformative’ experience. These improvements were grounded in the collaborative, integrative care provided between comprehensive CPMHTs and other health providers. Integration across care pathways was greatest with maternity, mother and baby hospitals, obstetrics, and crisis teams and was lowest with general practitioners and adult mental health. Perinatal women with mental health disorders strongly preferred treatment from health professionals with specialist PMH knowledge as they felt these individuals were best placed to understand their complex family-related needs. Women described style of treatment delivery as critical to their perceived outcomes, including compassionate, open, non-judgemental care. These factors were associated with their perceptions that they got the ‘right’ treatments and their descriptions of their level of treatment engagement. The value of adaptable treatment catering to changing schedules and locations (home, clinic, remote, etc.) was emphasised. A holistic approach, typically combining pharmacological and relational treatments, yielded positive perceived results. Women appreciated the CPMHTs’ expertise optimising their medication by providing comprehensive, up-to-date information on the risks and benefits of medications during the perinatal period. This was especially important for women with severe mental illness (SMI). Women described how CPMHTs reduced isolation and stigma by improving social connectedness among parents, enhanced social support and reduced family conflicts, facilitated better bonding between mothers and their infants, and equipped women with emotional management skills while supporting their engagement in meaningful activities. Expansion of CPMHTs to meet the long-term plan was ongoing during the evaluation, with varying provision across different teams. While SMI care pathways were robust in most teams, disparities in referral pathways and interventions for other mental health problems were apparent. For example, some CPMHTs lacked psychological support, with negative effects on women with post-traumatic stress disorder, obsessive–compulsive disorder, anxiety and depression. Treatments that directly intervened with the parent–infant or couple’s relationship were not yet widely available. This especially affected women who had experienced acute or complex trauma, and those who described experiencing problems bonding with their baby and/or heightened conflict in their relationships. Numbers of ethnically diverse women seen in CPMHTs were lower than expected based on local prevalence estimates. Work package 4/RQ4 We found that depending on definition, between 7% and 9% of women had histories of secondary mental healthcare contact, indicating presence of a severe and complex mental health disorder. We found a significant increased risk for negative obstetric and neonatal outcomes in women who had a history of severe and complex mental health disorders, as indicated by previous contact with secondary mental health care. These risks were greatest for women with the most severe mental health problems, as indicated by a history of hospitalisation, and those who had contact in the last year with secondary mental health care. When comparing mental health treatment access and related costs in areas with and without CPMHTs (RQ4), we found greater access to higher overall use of community mental health treatment and lower risk of acute relapse (lower rates of hospitalisation or crisis resolution teams). When examining acute care components separately, there were more acute hospitalisations and longer durations of stay and less use of crisis resolution teams in areas with CPMHTs compared to those without. These differences resulted in overall higher costs in areas with CPMHTs [mean £651, standard deviation (SD) 4634] compared to areas without (mean £414, SD 4196) which were statistically significant [fully adjusted mean difference £111, 95% confidence interval (CI) £29 to £192, p = 0.008]. There were higher risks of neonatal death and stillbirth and the birth of a baby small for gestational age in areas with CPMHTs versus those without, but lower risks of premature births. Conclusion Between 7% and 9% of women had a history of serious and complex PMH problems and they were at increased risks for negative obstetric and neonatal outcomes. The availability of CPMHTs, relative to areas without CPMHTs, increased overall use of specialist mental healthcare services and reduced postnatal risk of acute relapse. This was associated with overall higher costs in areas with CPMHTs. Our results also suggest the risks of stillbirth/neonatal death and babies born small for gestational age may increase with a CPMHT. There was considerable variation in CPMHT configurations. Those with comprehensive provision provided greater access to a wider range of evidence-based care across mental health problems but many still lacked parent–infant and family treatment offers. CPMHTs were often not serving expected numbers from diverse communities. Feasible parent–infant assessments are available and may help to highlight need and ensure parent–infant dyads get appropriate care. We found both the PIIOS and NICHD-3 were valid and reliable assessments of the parent–infant relationship, but the NICHD-3 may have greater clinical utility due to its brevity to train (2 days vs. 3 days) and code (~15 minutes vs. 20–30 minutes), its predictive validity to attachment security and externalising problems, and application from 3 to 24 months of age. Implications for health care WP2 showed that the PIIOS mother–infant assessment had broader predictive validity to child outcomes at age 2 but should only be used with infants between 2 and 8 months. The NICHD-3 had good predictive validity, is shorter to train and code and can be used with a broader age range between 3 and 24 months, so may be more appropriate for CPMHTs. WP3 demonstrated CPMHT staff need perinatal specific training and supervision to ensure they have the perinatal specialist skills women want and benefit from. WP3 found staff’s ‘soft skills’, being warm, non-judgemental, reliable and offering outreach, made a key difference to women’s engagement and outcomes. Despite their importance, ‘soft skills’ often go unmeasured and undervalued in mental health services. A culture shift is needed to prioritise, support and value ‘soft skills’. This should include training, job planning to include time for these skills, measurement, performance management and assessing staff attitudes. In WP3, women and COs benefitted when family was included in treatment (with woman’s permission). Our results highlighted reducing conflict and improving support, approaches aligned with recommendations from NHS England’s guide on good practices for partners and family members. WP4 showed CPMHTs are effective at improving access to needed and effective treatments, but pregnancy/neonate outcomes are an area of concern. Further research into the causes of this relationships is urgently needed, but several steps may help to promote positive outcomes. First, CPMHTs should encourage collaboration between mental health services and maternity/neonate services to ensure equitable attention to both health and mental health concerns. Second, treatment burden may affect women/birthing people (bp) ability to attend both health and mental health appointments. Colocated services and joint clinic sessions could reduce treatment burden. Lastly, training mental health practitioners on the physical health needs of women could support improved potential for timely communication with maternity for health concerns. Research recommendations We need to know the biological, social and healthcare determinants of increased neonate risk in areas with CPMHTs. Routine mental health data have very high levels of missing data on diagnosis and mental health outcomes. CPMHTs have also had limited time to fully embed themselves into practice, making it difficult to retrospectively assess their impact on women and their babies. Prospective studies that recruit women from case identification and follow them through the perinatal period and with longer-term follow-up assessing mental health, service use, health and linked child outcomes are needed to reliably assess the effectiveness and cost-effectiveness of CPMHTs. Research should focus on the development, evaluation and implementation of interventions tailored for underserved and diverse perinatal populations. WP4 data were based solely on secondary care data. A broader approach, using primary care data sets, data on talking therapies and aspects of different characteristics of CPMHTs could include women with a wider range of problems and severity and provide a better understanding of treatment components that work across the care pathway. Future research needs to evaluate the NICHD and PIIOS measures’ sensitivity to change following parent–infant intervention. Study registration This study is registered on Research Registry as researchregistry5463. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: 17/49/38) and is published in full in Health and Social Care Delivery Research; Vol. 13, No. 38. See the NIHR Funding and Awards website for further award information.

Anatoliy S. Sudnitsyn, Alexander L. Shastov, Nikolay M. Klushin et al.

Introduction The most common approach to the treatment of osteomyelitic cavities (Cierny – Mader type III) is a two-stage approach proposed by Masquelet, the main shortcoming of which is the need to perform a second surgical intervention which results in a longer rehabilitation period, increased economic costs and additional emotional distress of the patient. In electronic databases, we found 17 publications devoted to the use of partially bioresorbable materials for filling in uncomplicated bone defects. The experience of treatment of chronic osteomyelitis (Cierny – Mader type III) using such materials has not been described. Purpose Demonstration of the first use of a partially bioresorbable osteosubstituting material in a one‑stage treatment of a patient with a long-term osteomyelitic process after failures of conventional surgical treatment methods. Materials and methods We present a case of a 54-year old patient with a diagnosis of chronic post-traumatic osteomyelitis of the right leg, fistulous form, associated with contracture of the right ankle joint, 2-cm shortening of the right lower limb. A one-stage treatment technique was used using a partially bioresorbable osteosubstituting material for the first time in combination with antibacterial drugs, preselected in accordance with the patient's microbial cultures. Results The study evaluated the use of a partially bioresorbable material impregnated with antibacterial drugs in the treatment of a patient with osteomyelitic cavity Cierny – Mader type III that achieved stable arrest of purulent and inflammatory process. Discussion The mandatory two-stage Masquelet approach increases the surgical aggression, requires collection of an autologous bone graft, thus the risk of possible complications becomes higher. The obvious advantages of bioresorbable materials impregnated with antibacterial drugs to fill in bone defects are: no need to collect an autograft, a reduction in the number of surgical interventions to one, the possibility of gradual natural degradation of the implant from the patient's body due to bioresorption. Conclusion The study demonstrates the potential use of partially bioresorbable materials in a one-stage technology for treating patients with Cierny – Mader type III osteomyelitic cavities.

Bartosz Jan Barzak

Stroke remains one of the leading causes of disability and death worldwide, resulting in significant social and economic costs. Effective post-stroke rehabilitation, including physiotherapy, occupational therapy, speech therapy and psychological support, is crucial for improving motor and cognitive functions and quality of life in patients. In recent decades, there has been dynamic development of multimedia therapeutic tools, such as virtual reality (VR), robotics, mobile applications and telemedicine. These technologies allow for the personalisation of exercises, greater patient engagement and monitoring of therapy progress. The introduction of VR systems, computer games and motion controllers has revolutionised motor and cognitive rehabilitation, and the use of gamification elements increases motivation and the number of repetitions of exercises performed. A review of studies confirms the effectiveness of VR and other multimedia tools in improving upper limb function, gait, balance and cognitive function and reducing the symptoms of depression after a stroke, as well as strengthening motivation for rehabilitation. Modern technologies also facilitate performing exercises at home, which is particularly important for maintaining long-term therapeutic activity. Multimedia tools are a valuable complement to traditional methods, contributing to the intensity, effectiveness and attractiveness of the post-stroke rehabilitation process.

Marta Jaskulak, Malwina Zimowska, Marta Rolbiecka et al.

The prevalence of obesity has reached epidemic proportions worldwide, posing a significant public health concern due to its association with various chronic diseases and healthcare costs. In addition to traditional risk factors such as diet and physical activity, emerging evidence suggests that environmental pollutants, termed obesogens, may contribute to the obesity epidemic. Obesogens are endocrine-disrupting chemicals (EDCs) that can alter lipid homeostasis, promote adipogenesis, and disrupt metabolic regulation, leading to increased adiposity and obesity risk. This review explores available data from human studies published in the last decade, along with the mechanisms underlying obesogenic action, including their effects on adipocyte differentiation, adipose tissue development, and metabolic regulation. Overall, 75 studies were analyzed. Early-life exposure during critical developmental windows has been shown to increase obesity risk later in life, potentially through epigenetic modifications and transgenerational effects. Epidemiological studies provide evidence of associations between prenatal or early-life exposure and increased obesity risk in offspring. Additionally, study found more consistent associations between exposure to some EDCs (including phthalates, parabens, and bisphenols) and obesity or metabolic outcomes in children and women, while results for other chemicals (i.e. PFAS and organochlorine pesticides) were more heterogeneous, especially in adolescents and adults. Key findings indicate consistent associations between phthalate exposure and obesity in children, with mixed results for adults. Future research should focus on elucidating the full spectrum of obesogens, their mechanisms of action, and their implications for obesity risk across generations. This knowledge will inform preventive strategies and public health interventions aimed at addressing the obesity epidemic and its associated health burden.

Xiaoling Zhang, Yanan Li, Kang Wang et al.

Riboflavin, an important vitamin utilized in pharmaceutical products and as a feed additive, is mainly produced by metabolically engineered bacterial fermentation. However, the reliance on antibiotics in the production process leads to increased costs and safety risks. To address these challenges, an antibiotic-free Escherichia coli riboflavin producer was constructed using metabolic engineering approaches coupled with a novel plasmid stabilization system. Initially, competitive pathways and feedback inhibition were attenuated to enhance the metabolic flux towards riboflavin. Key genes in the purine pathway were overexpressed to boost the availability of riboflavin precursors. Subsequently, a plasmid stabilization system based on toxin was screened and characterized, achieving a plasmid retention rate of 84.9% after 10 days of passaging. Finally, transcriptomic analysis at the genome-wide level revealed several rate-limiting genes, including pgl, gnd, and yigB, which were subsequently upregulated, leading to a 26% improvement in riboflavin production. With optimization of the culture medium, the final strain allowed the production of 11.5 g/L of riboflavin with a yield of 90.4 mg/g glucose in 5 L bioreactors without antibiotics. These strategies can be extended to other plasmid-based riboflavin derivative production systems.

MASTAC LAVINIA , FILIP COSMIN , TRANDAFIR RALUCA ANDREEA

The realm of construction is presently experiencing a remarkable metamorphosis, propelled by advancements in technology, economic imperatives, and a growing insistence on sustainability. This study examines the central themes of construction research through a bibliometric approach. The VOSviewer software was used to identify relationships and trends between concepts such as digitalization, innovation, sustainability and cost management. The results indicate an increasing focus on the integration of advanced technologies such as Building Information Modeling (BIM), automation and resource management. The geographical distribution of the research highlights the dominance of countries such as China, the United States and the United Kingdom, alongside emerging contributions from regions such as Malaysia and Hong Kong. Nevertheless, considerable disparities endure, particularly within rising economies. The insufficient allocation of resources towards research and development for small and medium enterprises serves as a significant impediment to the broad embrace of advanced technologies. The study highlights the need for an interdisciplinary approach, where collaboration with fields such as economics, management, ecology and human resources is necessary to maximize the potential of the industry. The study underscores the significance of bespoke public policies and efficacious international collaborations to foster the extensive embrace of innovative technologies and sustainable solutions.

Persis E Mathew, Archa Susan Cherian, Rakshith S et al.

Background Post-operative pain is experienced by the majority of patients and can be managed using a single analgesic agent or through multimodal analgesia.Objective To evaluate the prescription patterns of analgesics and assess pain management among post-operative patients.Method This was a prospective observational study conducted on 400 patients over a six months period. Data collected included patient demographics age gender chief complaints diagnosis laboratory test results and details of the drugs prescribed such as genericbrand name dose frequency route of administration and duration of treatment. Assessment of pain was done using the Numerical Rating Scale.Result Out of 400 patients 243 were male 60.75 and 167 were female 39.25. The largest proportion of subjects belonged to the 46-60 years age group 33.75. Majority of subjects reported mild pain 52.75. Most drugs were prescribed by brand name 88.1. Intravenous administration was the most common route 97.14. Tramadol was the frequently prescribed monotherapy on the day of surgery 16.25 whereas paracetamol was the most commonly prescribed monotherapy on postoperative days 1 42.96 2 61.61 and 3 69.37. The combination of tramadol and paracetamol was the most commonly prescribed combination therapy on postoperative day 0 40.25 day 1 26.04 day 2 15.16 and day 3 7.5.Conclusion This study highlights the need to curb irrational prescribing to reduce morbidity and ease the public health burden. Promoting the judicious use of all medications including analgesics can lower costs limit adverse effects and improve care delivery.

Marcin K. Dziuba, Kristina M. McIntire, Kensuke Seto et al.

ABSTRACT The impacts of microsporidia on host individuals are frequently subtle and can be context dependent. A key example of the latter comes from a recently discovered microsporidian symbiont of Daphnia, the net impact of which was found to shift from negative to positive based on environmental context. Given this, we hypothesized low baseline virulence of the microsporidian; here, we investigated the impact of infection on hosts in controlled conditions and the absence of other stressors. We also investigated its phylogenetic position, ecology, and host range. The genetic data indicate that the symbiont is Ordospora pajunii, a newly described microsporidian parasite of Daphnia. We show that O. pajunii infection damages the gut, causing infected epithelial cells to lose microvilli and then rupture. The prevalence of this microsporidian could be high (up to 100% in the lab and 77% of adults in the field). Its overall virulence was low in most cases, but some genotypes suffered reduced survival and/or reproduction. Susceptibility and virulence were strongly host-genotype dependent. We found that North American O. pajunii were able to infect multiple Daphnia species, including the European species Daphnia longispina, as well as Ceriodaphnia spp. Given the low, often undetectable virulence of this microsporidian and potentially far-reaching consequences of infections for the host when interacting with other pathogens or food, this Daphnia–O. pajunii symbiosis emerges as a valuable system for studying the mechanisms of context-dependent shifts between mutualism and parasitism, as well as for understanding how symbionts might alter host interactions with resources.IMPORTANCEThe net outcome of symbiosis depends on the costs and benefits to each partner. Those can be context dependent, driving the potential for an interaction to change between parasitism and mutualism. Understanding the baseline fitness impact in an interaction can help us understand those shifts; for an organism that is generally parasitic, it should be easier for it to become a mutualist if its baseline virulence is relatively low. Recently, a microsporidian was found to become beneficial to its Daphnia hosts in certain ecological contexts, but little was known about the symbiont (including its species identity). Here, we identify it as the microsporidium Ordospora pajunii. Despite the parasitic nature of microsporidia, we found O. pajunii to be, at most, mildly virulent; this helps explain why it can shift toward mutualism in certain ecological contexts and helps establish O. pajunii is a valuable model for investigating shifts along the mutualism-parasitism continuum.

Gaguk Suprianto

  Di Indonesia, tumbuhan rimpang dikenal sebagai sumber bahan pengobatan tradisional. Bahan-bahan tersebut dapat dijadikan minuman herbal dalam bentuk serbuk. Salah satu pengolahan produk tersebut berupa pengeringan yang merupakan proses penting dalam industri herbal dan memiliki implikasi langsung terhadap kualitas akhir produk. Penelitian ini bertujuan untuk meningkatkan efisiensi pengeringan rimpang, menjaga konsistensi kualitas produk dan optimasi proses produksi. Sehingga industri akan memperoleh manfaat mulai dari peningkatan kualitas rimpang, waktu pengeringan yang lebih singkat, peningkatan kapasitas produksi dan pengurangan biaya produksi. Teknologi Internet of Things dapat dimanfaatkan untuk proses pengeringan rimpang sebagai sistem otomatisasi, kendali dan pemantauan yang dapat dilakukan secara jarak jauh melalui aplikasi mobile. Lebih dari itu, dengan IoT data sensor yang diperoleh terkelola di database untuk keperluan analisa. Hasil uji lapangan untuk pengujian error diperoleh rata-rata persentase error 1,5% dan pengujian akurasi diperoleh rata-rata persentase akurasi sebesar 98,49%. Merujuk pada hasil tersebut menunjukkan bahwa sensor thermocouple dapat diandalkan. Untuk pengukuran kadar air kunyit dengan berat awal 30 Kg memerlukan waktu selama 7 jam untuk mencapai kadar air 9-10%. Hal ini karena batas atas suhu yang diatur sebesar 50ºC untuk menjaga kandungan nutrisi pada rimpang. Pemanfaatan Internet of Things terbukti dapat digunakan untuk membantu proses pengeringan rimpang baik dari pemantauan dan pengendalian perangkat melalui aplikasi mobile. Diharapkan penelitian ini menjadi suatu rujukan untuk industri herbal yang ingin meningkatkan kualitas produk dengan biaya yang produksi yang minimum.   Abstract In Indonesia, rhizome plants are known as a source of traditional medicinal ingredients. These ingredients can be made into herbal drinks in powder form. One of the product processes is drying, which is an important process in the herbal industry and has direct implications for the final quality of the product. This research aims to increase the efficiency of rhizome drying, maintain consistent product quality and optimize the production process. So the industry will gain benefits starting from improving rhizome quality, shorter drying time, increasing production capacity and reducing production costs. Internet of Things technology can be used for the rhizome drying process as an automation, control and monitoring system that can be done remotely via a mobile application. Moreover, with IoT the sensor data obtained is managed in a database for analysis purposes. Field test results for error testing obtained an average error percentage of 1.5% and accuracy testing obtained an average accuracy percentage of 98.49%. Referring to these results shows that the thermocouple sensor is reliable. To measure the water content of turmeric with an initial weight of 30 kg, it takes 7 hours to reach a water content of 9-10%. This is because the upper temperature limit is set at 50ºC to maintain the nutritional content of the rhizomes. It has been proven that the use of the Internet of Things can be used to assist the rhizome drying process by monitoring and controlling devices via mobile applications. It is hoped that this research will become a reference for the herbal industry that wants to improve product quality with minimum production costs.

Quentin Hillebrand, Vorapong Suppakitpaisarn, Tetsuo Shibuya

We suggest the use of hash functions to cut down the communication costs when counting subgraphs under edge local differential privacy. While various algorithms exist for computing graph statistics, including the count of subgraphs, under the edge local differential privacy, many suffer with high communication costs, making them less efficient for large graphs. Though data compression is a typical approach in differential privacy, its application in local differential privacy requires a form of compression that every node can reproduce. In our study, we introduce linear congruence hashing. With a sampling rate of $s$, our method can cut communication costs by a factor of $s^2$, albeit at the cost of increasing variance in the published graph statistic by a factor of $s$. The experimental results indicate that, when matched for communication costs, our method achieves a reduction in the $\ell_2$-error for triangle counts by up to 1000 times compared to the performance of leading algorithms.

Elham Mashayekhi, Javad Damirchi, Ahmad Reza Yazdanian

For valuing European options, a straightforward model is the well-known Black-Scholes formula. Contrary to market reality, this model assumed that interest rate and volatility are constant. To modify the Black-Scholes model, Heston and Cox-Ingersoll-Ross (CIR) offered the stochastic volatility and the stochastic interest rate models, respectively. The combination of the Heston, and the CIR models is called the Heston-Cox-Ingersoll-Ross (HCIR) model. Another essential issue that arises when purchasing or selling a good or service is the consideration of transaction costs which was ignored in the Black-Scholes technique. Leland improved the simplistic Black-Scholes strategy to take transaction costs into account. The main purpose of this paper is to apply the alternating direction implicit (ADI) method at a uniform grid for solving the HCIR model with transaction costs in the European style and comparing it with the explicit finite difference (EFD) scheme. Also, as evidence for numerical convergence, we convert the HCIR model with transaction costs to a linear PDE (HCIR) by ignoring transaction costs, then we estimate the solution of HCIR PDE using the ADI method which is a class of finite difference schemes, and compare it with analytical solution and EFD scheme. For multi-dimensional Black-Scholes equations, the ADI method, which is a category of finite difference techniques, is appropriate. When the dimensionality of the space increases, finite difference techniques frequently become more complex to perform, comprehend, and apply. Consequently, we employ the ADI approach to divide a multi-dimensional problem into several simpler, quite manageable sub-problems to overcome the dimensionality curse.

Easun Arunachalam, William Ireland, Xingbo Yang et al.

Life is a nonequilibrium phenomenon: metabolism provides a continuous supply of energy that drives nearly all cellular processes. However, very little is known about how much energy different cellular processes use, i.e. their energetic costs. The most direct experimental measurements of these costs involve modulating the activity of cellular processes and determining the resulting changes in energetic fluxes. In this review, we present a flux balance framework to aid in the design and interpretation of such experiments, and discuss the challenges associated with measuring the relevant metabolic fluxes. We then describe selected techniques that enable measurement of these fluxes. Finally, we review prior experimental and theoretical work that has employed techniques from biochemistry and nonequilibrium physics to determine the energetic costs of cellular processes.

Giorgio Severi, Will Pearce, Alina Oprea

Recent work by Jia et al., showed the possibility of effectively computing pairwise model distances in weight space, using a model explanation technique known as LIME. This method requires query-only access to the two models under examination. We argue this insight can be leveraged by an adversary to reduce the net cost (number of queries) of launching an evasion campaign against a deployed model. We show that there is a strong negative correlation between the success rate of adversarial transfer and the distance between the victim model and the surrogate used to generate the evasive samples. Thus, we propose and evaluate a method to reduce adversarial costs by finding the closest surrogate model for adversarial transfer.

Nathalie Paul, Tim Wirtz, Stefan Wrobel et al.

We interpret solving the multi-vehicle routing problem as a team Markov game with partially observable costs. For a given set of customers to serve, the playing agents (vehicles) have the common goal to determine the team-optimal agent routes with minimal total cost. Each agent thereby observes only its own cost. Our multi-agent reinforcement learning approach, the so-called multi-agent Neural Rewriter, builds on the single-agent Neural Rewriter to solve the problem by iteratively rewriting solutions. Parallel agent action execution and partial observability require new rewriting rules for the game. We propose the introduction of a so-called pool in the system which serves as a collection point for unvisited nodes. It enables agents to act simultaneously and exchange nodes in a conflict-free manner. We realize limited disclosure of agent-specific costs by only sharing them during learning. During inference, each agents acts decentrally, solely based on its own cost. First empirical results on small problem sizes demonstrate that we reach a performance close to the employed OR-Tools benchmark which operates in the perfect cost information setting.