Hasil untuk "Costs"

M. Schultz, J. Bendick, E. R. Holm et al.

Christopher M. Cook, G. Cole, P. Asaria et al.

C. Hennessy, Toni M. Whited

C. Bommer, E. Heesemann, Vera Sagalova et al.

Gregor Andrade, Steven N. Kaplan

A. Venables

R. Sandler, J. Everhart, M. Donowitz et al.

Hamdani Abdulgani, Hadiyanto Hadiyanto, Sudarno Sudarno et al.

Wastewater treatment using traditional systems is considered expensive because it requires considerable energy and installation. The current study assessed the existence of a combination process that can reduce costs and is easy to operate. This study evaluates the performance of an anaerobic-aerobic biofilter system to treat industrial wastewater from cracker production. The combination of anaerobic and aerobic biofilters can significantly reduce Biochemical Oxygen Demand (BOD) and Chemical Oxygen Demand (COD), which are important parameters for wastewater quality. Sampling was carried out on the influent channel of the fish cracker industry. Sampling uses the SNI 6989.59:2008 regulation in the form of a wastewater test sampling method. The results showed that the biofilter achieved BOD removal of up to 84.90% and COD reduction of more than 89.02% when operated with an extended Hydraulic Retention Time (HRT) of up to 24 h. The results also showed that in wastewater treatment, HRT optimization should be considered for maximum pollutant removal, as shorter retention times proved less effective in reducing COD and BOD organic loads. These findings suggest that anaerobic-aerobic biofilter systems are viable and scalable solutions for industries seeking efficient and environmentally friendly wastewater treatment options.

Xinglan Li, Lu Ge, Yingying Zhang et al.

Ulcerative colitis (UC) is a chronic inflammatory bowel disease that significantly impacts patients’ quality of life and incurs substantial healthcare costs. Currently, the diagnosis of UC primarily relies on invasive examinations, highlighting the necessity for rapid, non-invasive, and low-cost diagnostic methods. This study aims to identify a biomarker that can diagnose and assess UC through bioinformatics analysis of databases. We identified 470 differentially expressed genes (DEGs) from the GSE169568 expression matrix, with 225 genes being up-regulated and 245 down-regulated. Functional analyses using Gene Ontology, Kyoto Encyclopedia of Genes and Genomes, and Gene Set Enrichment Analysis demonstrated the enrichment of immune response-related processes. Weighted Gene Co-expression Network Analysis identified a core module associated with UC, comprising 169 genes that exhibited a strong correlation coefficient. By overlapping the UC-related module genes with DEGs, we determined 34 genes. We then assessed the predictive value of UC using the LASSO-Cox method and found that only NDUFB3 and SLIRP were significant. Furthermore, a difference in immune infiltration was observed between the UC and control groups, with macrophages shown to potentially interact with the hub genes. A nomogram model for UC diagnosis was developed based on these two genes, achieving an area under the curve of 0.898. The hub gene model was validated using the GSE94648 dataset, demonstrating good discrimination of the nomogram. Finally, we confirmed that both molecules were expressed at elevated levels in UC patients through clinical peripheral blood specimens. According to our research, NDUFB3 and SLIRP are promising biomarkers for UC and could aid in UC risk prediction. Future research should focus on clinical validation and the exploration of therapeutic interventions targeting the identified pathways and gene modules.

Jose A. Cabello-Mendez, Abraham Lopez-Miguel, Jose T. Perez-Quiroz et al.

Concrete is the most important construction material, and improving its durability properties is a topic in constant development owing to the economic costs that the degradation of concrete implies. Different nanoparticles have been reported to improve concrete durability, although the positive results are not a generality. Among these nanomaterials, graphene oxide stands out as an option for improving concrete properties, such as its compressive strength, which could increase the useful life of concrete infrastructure. This study addresses the effects of graphene oxide on the durability properties of concrete, with the aim of obtaining data on the viability of graphene oxide as an additive in concrete. The incorporation of graphene oxide into concrete was carried out through graphene oxide suspensions that were incorporated into concrete mixtures with a high water/cement ratio. The characterization of concrete was done using non-destructive testing such as ultrasonic pulse velocity, electrical resistivity, porosity, capillary absorption, chloride ion permeability, and other characterization methods such as compressive strength, XPS, SEM, and EDS. Together, these tests provided an overview of the concrete durability properties that are improved, affected, or unchanged by the presence of graphene oxide. In this study, a chemical analysis was also carried out on concrete modified with graphene oxide. The results show that graphene oxide improves the compressive strength of concrete, but the effect on durability properties is negligible; however, there are indications that, in combination with other additives, improvements can be achieved, so it is advisable to continue with these studies.

Roderica Rui Ge Ng, Charlene Xian Wen Kwa, Yuhe Ke et al.

Background: Diabetes mellitus (DM) is a critical risk factor associated with postoperative complications. Preoperative glycemic control, commonly assessed by glycated hemoglobin (HbA1c), may help stratify patients with DM. However, association between DM, HbA1c levels and perioperative outcomes in multi-ethnic Asian populations with distinct cardiometabolic profiles remains underexplored. Objectives: This study aimed to study the association between pre-existing DM, suboptimal glycemic control (HbA1c ≥ 7%), and postoperative complications in elective non-cardiac surgical patients, focusing on the role of HbA1c as a risk stratification tool. Methods: This secondary analysis included 688 patients from a prospective cohort at Singapore’s largest tertiary hospital. Postoperative complication(s) were assessed using the Comprehensive Complication Index. Patients were categorized into 2 groups—DM (regardless of HbA1c) and no DM (HbA1c ≤ 6%). We used multivariable logistic regression to explore associations within the entire cohort and DM subgroup. The relationship between preoperative HbA1c levels and postoperative complication(s) was also explored. Results: The overall incidence of postoperative complication(s) was 20.78%. DM was independently associated with increased postoperative complication(s) (adjusted OR 2.57, 95% CI 1.20-5.50, P = .015). A trend toward a higher likelihood of postoperative complication(s) was observed in patients with DM and suboptimal glycemic control (adjusted OR 1.39, 95% CI 0.56-3.45, P = .482) though this did not reach statistical significance. A noteworthy U-shaped relationship was identified between preoperative HbA1c levels and postoperative complication(s), with increased complications at both low and high HbA1c levels. Conclusion: This study highlights a significant association between DM and increased postoperative complications. The observed U-shaped relationship between HbA1c levels and complications underscores the need for comprehensive risk assessment across the full glycemic spectrum. Routine HbA1c screening and tailored perioperative strategies in multi-ethnic Asian populations could enhance surgical outcomes, reduce healthcare costs, and support broader public health goals in DM management.

José Glauber Cavalcante dos Santos, Alessandra Carvalho de Vasconcelos, Márcia Martins Mendes De Luca

ABSTRACT The objective of this article is to evaluate the effect of financial slack on the value relevance of environmental expenditures in Brazilian capital market firms. The Brazilian literature, unlike the foreign literature, has neglected to investigate the value relevance of environmental performance information. The study addresses the combination of environmental information with the financial condition of firms within the scope of value relevance, obtaining evidence not yet contemplated in the literature on the Brazilian capital market. It is noteworthy that the financial perspective strongly influences the valuation of firms in terms of the environmental dimension. Companies that engage in environmental spending and are in a better financial position are better valued and considered economically interesting. The same is not true for firms in a worse financial position. The study shows how the environmental dimension, which is not a priority from the shareholder's point of view, can be the object of investor attention if the financial condition requirement is met. The market monitors environmental expenditures in order to assess much more the extent of the effects of these expenditures on the generation of future cash flows rather than the company's environmental commitment. The sample includes 52 companies whose shares were traded on the B3 S.A. in the period 2009-2018, totaling 252 observations. The model proposed by Ohlson was used, adapted according to the literature, and operationalized in POLS models. In addition, analyses were reproduced considering the possible moderating effect of financial slack measures on the environmental spending proxy. The results indicate that environmental spending contributes to reducing the valuation of firms, signaling to investors only future economic costs. Financial slack was found to be an important element in the valuation of firms with environmental expenditures, and companies with environmental expenditures and greater financial slack had higher valuations than those with less financial slack.

Hasehni Vampere, Ebenezer Dassah, Rebecca Tawiah et al.

Background: Early rehabilitation interventions can significantly mitigate the effects of disabilities in children as they grow older. However, families of children with disabilities (CWDs) in resource-deprived settings face limited opportunities to access rehabilitation services for their children resulting in largely unmet rehabilitation needs. Aim: This study assessed knowledge of families of CWDs on rehabilitation services and accessibility to services for their children. Setting: The study was carried out in the selected districts in the Upper West Region, Ghana. Methods: Families that knew about rehabilitation services and acknowledged their child’s need for one were the subjects of this cross-sectional, quantitative study, using a researcher-administered questionnaire. STATA software was utilised for analysis. Results: Over half of the participants, 113 (54.85%), attempted to access rehabilitation services for their children, but only 31 (27.18%) were successful. The barriers to access included financial problems (n = 197 [95.63%]), shyness (n = 167 [81.07%]), transportation issues (n = 155 [75.24%]), community discouragement (n = 145 [70.39%]) and the attitudes of healthcare providers (n = 145 [70.39%]). Among those who accessed rehabilitation services, over half reported dissatisfaction with travel distance and associated costs (n = 18 [58.06%]), as well as travel time and wait time for services (n = 15 [48.39%]). Participants with no formal education (adjusted odds ratio [AOR] = 0.22; 95% confidence interval [CI]: 0.07, 0.59) and those who agreed that negative attitudes from health personnel were a barrier to access (AOR = 0.08, 95% CI: 0.00–1.01) were less likely to access rehabilitation services for their children. Conclusion: The low access to rehabilitation services suggests that many CWDs may miss relevant rehabilitation services that could improve their health outcomes and functioning. Policy interventions are required to facilitate families’ access to rehabilitation services for their children. Contribution: This study contributes to the literature on rehabilitation care in Ghana and provides a foundation for further research in rehabilitation care in the Upper West Region, as it is the first of its kind conducted in the region.

Julie Bruce, Bruno Mazuquin, Pankaj Mistry et al.

Background: Upper limb problems are common after breast cancer treatment. Objectives: To investigate the clinical effectiveness and cost-effectiveness of a structured exercise programme compared with usual care on upper limb function, health-related outcomes and costs in women undergoing breast cancer surgery. Design: This was a two-arm, pragmatic, randomised controlled trial with embedded qualitative research, process evaluation and parallel economic analysis; the unit of randomisation was the individual (allocated ratio 1 : 1). Setting: Breast cancer centres, secondary care. Participants: Women aged ≥ 18 years who had been diagnosed with breast cancer and were at higher risk of developing shoulder problems. Women were screened to identify their risk status. Interventions: All participants received usual-care information leaflets. Those randomised to exercise were referred to physiotherapy for an early, structured exercise programme (three to six face-to-face appointments that included strengthening, physical activity and behavioural change strategies). Main outcome measures: The primary outcome was upper limb function at 12 months as assessed using the Disabilities of Arm, Hand and Shoulder questionnaire. Secondary outcomes were function (Disabilities of Arm, Hand and Shoulder questionnaire subscales), pain, complications (e.g. wound-related complications, lymphoedema), health-related quality of life (e.g. EuroQol-5 Dimensions, five-level version; Short Form questionnaire-12 items), physical activity and health service resource use. The economic evaluation was expressed in terms of incremental cost per quality-adjusted life-year and incremental net monetary benefit gained from an NHS and Personal Social Services perspective. Participants and physiotherapists were not blinded to group assignment, but data collectors were blinded. Results: Between 2016 and 2017, we randomised 392 participants from 17 breast cancer centres across England: 196 (50%) to the usual-care group and 196 (50%) to the exercise group. Ten participants (10/392; 3%) were withdrawn at randomisation and 32 (8%) did not provide complete baseline data. A total of 175 participants (89%) from each treatment group provided baseline data. Participants’ mean age was 58.1 years (standard deviation 12.1 years; range 28–88 years). Most participants had undergone axillary node clearance surgery (327/392; 83%) and 317 (81%) had received radiotherapy. Uptake of the exercise treatment was high, with 181 out of 196 (92%) participants attending at least one physiotherapy appointment. Compliance with exercise was good: 143 out of 196 (73%) participants completed three or more physiotherapy sessions. At 12 months, 274 out of 392 (70%) participants returned questionnaires. Improvement in arm function was greater in the exercise group [mean Disabilities of Arm, Hand and Shoulder questionnaire score of 16.3 (standard deviation 17.6)] than in the usual-care group [mean Disabilities of Arm, Hand and Shoulder questionnaire score of 23.7 (standard deviation 22.9)] at 12 months for intention-to-treat (adjusted mean difference Disabilities of Arm, Hand and Shoulder questionnaire score of –7.81, 95% confidence interval –12.44 to –3.17; p = 0.001) and complier-average causal effect analyses (adjusted mean difference –8.74, 95% confidence interval –13.71 to –3.77; p ≤ 0.001). At 12 months, pain scores were lower and physical health-related quality of life was higher in the exercise group than in the usual-care group (Short Form questionnaire-12 items, mean difference 4.39, 95% confidence interval 1.74 to 7.04; p = 0.001). We found no differences in the rate of adverse events or lymphoedema over 12 months. The qualitative findings suggested that women found the exercise programme beneficial and enjoyable. Exercise accrued lower costs (–£387, 95% CI –£2491 to £1718) and generated more quality-adjusted life years (0.029, 95% CI 0.001 to 0.056) than usual care over 12 months. The cost-effectiveness analysis indicated that exercise was more cost-effective and that the results were robust to sensitivity analyses. Exercise was relatively cheap to implement (£129 per participant) and associated with lower health-care costs than usual care and improved health-related quality of life. Benefits may accrue beyond the end of the trial. Limitations: Postal follow-up was lower than estimated; however, the study was adequately powered. No serious adverse events directly related to the intervention were reported. Conclusions: This trial provided robust evidence that referral for early, supported exercise after breast cancer surgery improved shoulder function in those at risk of shoulder problems and was associated with lower health-care costs than usual care and improved health-related quality of life. Future work: Future work should focus on the implementation of exercise programmes in clinical practice for those at highest risk of shoulder problems. Trial registration: This trial is registered as ISRCTN35358984. Funding: This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 26, No. 15. See the NIHR Journals Library website for further project information.

Anna Francke, Joanna Majkowska-Gadomska, Zdzisław Kaliniewicz et al.

Shallots (<i>Allium cepa</i> L. <i>Aggregatum</i> group) are cultivated on small areas, mostly to harvest mature bulbs with dry scales. Due to their exceptional taste and nutritional value, and a short growing season, they can also be grown for early bunch harvest. New shallot cultivation strategies are being sought to meet consumers’ growing expectations regarding the quality of vegetables, and their increasing awareness of global food safety. Therefore, the aim of this study was to evaluate the effect of selected biostimulants on the biometric parameters, yield and nutritional value of shallot bulbs and leaves. The experimental factors were as follows: two biostimulant types—Effective Microorganisms (EM) and Goëmar Goteo (GG), two shallot cultivars—Bonilla F1 and Matador F1, grown for bunch harvest, and year of the study. Shallot leaves had a higher content of L-ascorbic acid, reducing sugars and nitrates than bulbs. Young bulbs had a higher content of DM and total sugars than leaves. The leaves and bulbs of shallot plants treated with EM accumulated the highest amounts of minerals. Macronutrient ratios were closer to optimal in shallot leaves than bulbs. The nitrate content of bulbs was inversely proportional to the nitrate content of leaves. Therefore, an increase in the nitrate content of leaves by around 330% led to an approximately 40% decrease in the nitrate content of bulbs. The correlations between the parameters of the chemical composition of shallots and shallot leaves show that the increase in the dry matter content of the bulbs (by approx. 60%) was accompanied by an increase in the L-ascorbic acid content in the leaves (by approx. 240%). The use of biostimulants in the cultivation of <i>A. cepa</i> L. <i>Aggregatum</i> group contributed to the reduction of L-ascorbic acid content in bulbs and had no positive effect on the leaves. Moreover, no positive effect of biostimulants on the reduction of nitrate content in shallot leaves and bulbs was observed, which is undesirable from the consumer’s point of view. After the use of biopreparations, the yield of shallots was lower than that of the control—by approx. 14% (EM) and approx. 4% (GG). Therefore, the measurable benefits of biostimulants in the cultivation of shallots grown for early bunch harvest do not balance the costs of their purchase and use.

Suzely Adas Saliba Moimaz, Jorge Abou Rejaili, Tânia Adas Saliba

Introduction: Dentists are at high risk of contamination by COVID-19 due to the proximity to the patients' oral cavity and airways. Objective: To elucidate the behaviors and adversities experienced by dentists because of the COVID-19 pandemic. Methods: This descriptive study invited 1.811 dentists affiliated with professional associations, dental cooperatives, and health insurance providers from São Paulo State, Brazil, in 2020 of which 473 agreed to participate. The data collection, using Google Forms, included the variables: sociodemographic conditions; characteristics of dental work; level of healthcare and sources of information about the pandemic; changes in the work process, financial impact with personal protective equipment (PPE) and biosafety measures; and consequences of the pandemic in the professional practice. Results: The 473 dentists (40.36±13.44 years), were mostly women (52.22%), had a specialty (55.60%), and were self-employed professionals (73.36%). It was observed that 78.01% of professionals had a reduction in their monthly income. The average of patients treated daily decreased by 35.48%. It was found that 30.44% of professionals had difficulty with the use of PPE, 3.59% contracted COVID-19, and 53.03% decided to postpone the appointment if the patient with suspected or confirmed COVID-19 sought treatment, even in emergencies. The use of high-speed handpieces was reported by most professionals (n=428; 90.48%). Conclusion: Behaviors: dentists used PPE and assigned very high or high levels of precaution about COVID-19. Adversities: dentists reported an increase in operating costs, changes in the work process, a decrease in appointments, and a reduction in the monthly income.

R. Shine

Sagyndykova Zhadyra, Nekrashevich Vladimir, Khazimov Kanat et al.

The research purpose was to develop the basics for silage preparation by vacuuming with the use of flexible polymer containers and estimating silage quality. The analysis of modern systems used for silage preparation and storage showed that the main disadvantages include the high storage and preparation costs, and losses of silage weight and nutrients by 3–25% after opening of storage facilities. To eliminate these disadvantages, the basics for preparing the silage by vacuuming in flexible polymer containers that can be transported and stored with optimum volume have been studied and developed. The study pursuits its goals by observing the changes in density and degree of silage compaction caused by the vacuum pressure and deadweight. A comparative estimation of silage quality indices was conducted by means of chemical analysis of silage specimens. The results show graphical dependencies of changes in silage volume and density at vacuum pressure up to 60 kPa. Moreover, a comparative assessment of quality indices of silage specimens prepared by vacuuming in soft containers, and traditional method using trenches was conducted. The reliability of results for silage storing quality in a vacuum container was achieved by fivefold test repetition within 2 years. Comparison of silage quality indices obtained using vacuum technology and traditional method showed improvement in favour of the proposed method: dry matter by 2.05%; protein by a factor of 1.47; nitrogenous substances by 1.37; starch by 1.56; calcium by 1.83; phosphorus by 2; digestible protein by 1.24; feed unit by 1.31; exchange energy by 1.16, which was achieved thanks to the elimination of succus leakage.

Noe Brasier, Michael Osthoff, Fiorangelo De Ieso et al.

The internet of health care things enables a remote connection between health care professionals and patients wearing smart biosensors. Wearable smart devices are potentially affordable, sensitive, specific, user-friendly, rapid, robust, lab-independent, and deliverable to the end user for point-of-care testing. The datasets derived from these devices are known as digital biomarkers. They represent a novel patient-centered approach to collecting longitudinal, context-derived health insights. Adding automated, analytical smartphone applications will enable their use in high-, middle-, and low-income countries. So far, digital biomarkers have been focused primarily on accelerometer data and heart rate due to well-established sensors originating from the consumer market. Novel emerging smart biosensors will detect biomarkers (or compounds) independent of a lab and noninvasively in sweat, saliva, and exhaled breath. These molecular digital biomarkers are a promising novel approach to reduce the burden from 2 major infectious diseases with urgent unmet needs: tuberculosis and infections with multidrug resistant pathogens. Active tuberculosis (aTbc) is one of the deadliest diseases from an infectious agent. However, a simple and reliable test for its detection is still missing. Furthermore, inappropriate antimicrobial use leads to the development of antimicrobial resistance, which is associated with high mortality and health care costs. From this perspective, we discuss the innovative approach of a noninvasive and lab-independent collection of novel biomarkers to detect aTbc, which at the same time may additionally serve as a scalable therapeutic drug monitoring approach for antibiotics. These molecular digital biomarkers are next-generation digital biomarkers and have the potential to shape the future of infectious diseases.

L. Burns, R. Hall, D. Blumenfeld et al.