Automated medical diagnosis is one of the important machine learning applications in the domain of healthcare. In this regard, most of the approaches primarily focus on optimizing the accuracy of classification models. In this research, we argue that unlike general-purpose classification problems, medical applications, such as chronic kidney disease (CKD) diagnosis, require special treatment. In the case of CKD, apart from model performance, other factors such as the cost of data acquisition may also be taken into account to enhance the applicability of the automated diagnosis system. In this research, we have proposed two techniques for cost-sensitive feature ranking. An ensemble of decision tree models is employed in both the techniques for computing the worth of a feature in the CKD dataset. An automatic threshold selection heuristic is also introduced which is based on the intersection of features’ worth and their accumulated cost. A set of experiments are conducted to evaluate the efficacy of the proposed techniques on both tree-based and non-tree based classification models. The proposed approaches are also evaluated against several comparative techniques. Furthermore, it is demonstrated that the proposed techniques select around 1/4^th of the original CKD features while reducing the cost by a factor of 7.42 of the original feature set. Based on the extensive experimentation it is concluded that the proposed techniques employing feature-cost interaction heuristic tend to select feature subsets that are both useful and cost-effective.

Classification predictive modeling involves the accurate assignment of observations in a dataset to target classes or categories. There is an increasing growth of real-world classification problems with severely imbalanced class distributions. In this case, minority classes have much fewer observations to learn from than those from majority classes. Despite this sparsity, a minority class is often considered the more interesting class yet developing a scientific learning algorithm suitable for the observations presents countless challenges. In this article, we suggest a novel multi-class classification algorithm specialized to handle severely imbalanced classes based on the method we refer to as SAMME.C2. It blends the flexible mechanics of the boosting techniques from SAMME algorithm, a multi-class classifier, and Ada.C2 algorithm, a cost-sensitive binary classifier designed to address highly class imbalances. Not only do we provide the resulting algorithm but we also establish scientific and statistical formulation of our proposed SAMME.C2 algorithm. Through numerical experiments examining various degrees of classifier difficulty, we demonstrate consistent superior performance of our proposed model.

Currently, skin cancer is the most commonly diagnosed form of cancer in humans and is one of the leading causes of death in patients with cancer. Biopsy methods are an invasive research method and are not always available for primary diagnosis. Imaging methods have low accuracy and depend on the experience of the dermatologist. Artificial intelligence technologies can match and surpass visual analysis methods in accuracy, but they have the risk of a false negative response when a malignant pigmented lesion can be recognized as benign. One possible way to improve accuracy and reduce the risk of false negatives is to analyze heterogeneous data, combine different preprocessing methods, and use modified loss functions to eliminate the negative impact of unbalanced dermatological data. The paper proposes a multimodal neural network system with a modified cross-entropy loss function that is sensitive to unbalanced heterogeneous dermatological data. The accuracy of recognition in 10 diagnostically significant categories for the proposed system was 85.19%. The novelty of the proposed system lies in the use of cross-entropy loss when training the modified function with the help of weight coefficients. The introduction of weighting factors has reduced the number of false negative forecasts, as well as improved accuracy by 1.02-4.03 percentage points compared to the original multimodal systems. The introduction of the proposed multimodal system as an auxiliary diagnostic tool can reduce the consumption of financial and labor resources involved in the medical industry, as well as increase the chance of early detection of skin cancer.

This paper presents a detailed description of three methodologies to electrify the rural households of small loads with reliable and economical method using solar energy as input source of power. It is observed that high DC voltage is better and economical solution rather than AC based solar systems and low voltage DC systems. In this paper, three methodologies were analysed to select the right combination of portable converters with low prices, which may further enhance the energy access and affordability to common people. The proposed three methodologies were tested through action research in collaboration with a team of scientists and technical experts of National Institute of Solar Energy. The comparative analysis is carried out on three different converters, various kind of house loads and types of power supply i.e. AC/DC. The performance, quality and economic evaluation has been carried out with the help of MATLAB SIMULINK and other measuring instruments specific for solar photovoltaic systems. The derived results were analysed and inferences made for use in village household loads and their income groups. Further, a three-step analytical framework on village-level power energy efficient power at affordable power preposition was presented. This study will help in the designing as well as in the performance and economic evaluation of converters based on solar photovoltaic systems of different technologies.

Mexico is currently facing important water management challenges. Cities in the country are facing water scarcity and at the same time, they struggle with floods during the raining season. The water sensitive urban design (WSUD) approach has proved to be helpful in tackling urban water challenges such as floods and water scarcity and it is being implemented in cities around the world. The WSUD approach highlights the role of both the water cycle and the water utilities systems, when transitioning towards a water sensitive stage. Therefore, the objective of this research is to analyse the current situation of the water cycle and the water utility (SIAPA). To do so, we have selected the Metropolitan Area of Guadalajara (MAG) and proposes a case study approach. Within our case of study, we answer two questions: 1) What are the causes of water scarcity and flooding in the MAG? and 2) What are the proposals to solve these problems under a WSUD approach? By answering these questions, we identified that the water management in the MAG corresponds to a single purpose infrastructure. This type of management does not contribute to solve the problems of water scarcity and floods. The water supply policy is based only on the construction of large dams disregarding the storage and use of rainwater, and reuse of greywater, and water-conservation devices. In order to transition towards a water sensitive stage, a WSUD approach that includes multi-purpose infrastructure should be considered. Such as green roofs, swales, rainwater gardens, infiltration trenches, etc.

Today’s purchasing companies demand an advanced buyer equal of enactment from their supplier while the two parties maintain a respectful connection. Although the supplier selection (SC) product life cycle cost (SCPLCC) is an important consideration among corporations, SCPLCC problem has become associated with deciding how one supplier should be selected from possible alternatives. In this study, we applied two types of goal programming, multiobjective linear programming and revised multichoice goal programming to develop a PLCC-based concept to solve the SCPLCC problem and construct a decision-making tool for application to a case of supply chain management in a Taiwanese light-emitting diode company in the high-tech industry. Our study main contribution Company managers can easily use the two approaches of the SCPLCC model with different parameters to solve SCPLCC model problems. Finally, we comparing five models found RMCGP with weighted linear goal programming had an adequate effect for application to the PLCC concept for high-technology comapny; this cloud make company decision–makers focus on low PLCC and select better supplier.

Supplier selection (SC) product life cycle cost (SCPLCC) is an important consideration among corporations, SCPLCC problem has become associated with deciding how one supplier should be selected from possible alternatives. In this study, we applied two types of goal programming, multiobjective linear programming and revised multichoice goal programming to develop a PLCC-based concept to solve the SCPLCC problem and construct a decision-making tool for application to a case of supply chain management in a Taiwanese light-emitting diode company in the high-tech industry. Our study main contribution Company managers can easily use the two approaches of the SCPLCC model with different parameters to solve SCPLCC model problems. Finally, we comparing five models found RMCGP with weighted linear goal programming had an adequate effect for application to the PLCC concept for high-technology company; this cloud makes company decision–makers focus on low PLCC and select a better supplier in sustainable supply chains goal.

Using the PLCC advantages generates revenue and lowers costs more than might be anticipated. It ensures better decisions by using a more perfect and practical assessment of revenues and costs. Although the supplier selection (SC) product life cycle cost (SCPLCC) is an important consideration among corporations, SCPLCC problem has become associated with deciding how one supplier should be selected from possible alternatives. In this study, we applied two types of goal programming, multiobjective linear programming and revised multichoice goal programming to develop a PLCC-based concept to solve the SCPLCC problem and construct a decision-making tool for application to a case of supply chain management in a Taiwanese light-emitting diode company in the high-tech industry. Our study main contribution Company managers can easily use the two approaches of the SCPLCC model with different parameters to solve SCPLCC model problems. Finally, we comparing five models found RMCGP with weighted linear goal programming had an adequate effect for application to the PLCC concept for high-technology company; this cloud make company decision–makers focus on low PLCC and select better supplier.

Supplier selection (SC) continues to be a crucial component in manufacturing procurement. Using the PLCC advantages generates revenue and lowers costs more than might be anticipated. Supplier selection (SC) product life cycle cost (SCPLCC) is an important consideration among corporations, SCPLCC problem has become associated with deciding how one supplier should be selected from possible alternatives. Past literature on this topic is limited. We try to close this gap in knowledge. In this study, we attempt to apply two types of goal programming, multiobjective linear programming and revised multichoice goal programming to develop a PLCC-based concept to solve the SCPLCC problem and construct a decision-making tool for application to a case of supply chain management in a Taiwanese light-emitting diode company in the high-tech industry. Our study main contribution Company managers can easily use the two approaches of the SCPLCC model with different parameters to solve SCPLCC model problems. Finally, we are comparing five models found RMCGP with weighted linear goal programming had an adequate effect for application to the PLCC concept for high-technology Company; this cloud makes company decision–makers focus on low PLCC and select a better supplier in sustainable supply chains development.

Glucose-sensitive films were prepared by the layer-by-layer (LbL) deposition of poly(ethyleneimine) (H-PEI) solution and DNA solution (containing glucose oxidase (GOx)). H-PEI/DNA+GOx multilayer films were constructed using electrostatic interactions. The (H-PEI/DNA+GOx)5 film was then partially decomposed by hydrogen peroxide (H2O2). The mechanism for the decomposition of the LbL film was considered to involve a more reactive oxygen species (ROS) that was formed by the reaction of hemin and H2O2, which then caused nonspecific DNA cleavage. GOx present in the LbL films reacts with glucose to generate hydrogen peroxide. Therefore, decomposition of the H-PEI/DNA+GOx)5 film was observed when the thin film was immersed in a glucose solution. A (H-PEI/DNA+GOx)5 film exposed to a glucose solution for periods of 24, 48 72, and 96 h indicated decomposition of the film increased with the time. The rate of LbL film decomposition increased with the glucose concentration. At pH and ionic strength close to physiological conditions, it was possible to slowly decompose the LbL film at a sub-millimolar glucose concentration.

Aim of the presented research was to develop an optical sensing system to investigate the demineralization process of the bones. Optical measurement techniques are widely used and increasingly adapted in biological and biomedical applications due to their non-destructive nature and safety. Optical examination of the bone condition could facilitate clinical trials and improve the safety of patients. The authors used a set of complementary methods: polarization-sensitive optical coherence tomography (PS-OCT) and Raman spectroscopy. To stimulate the process of demineralization and gradual removal of the hydroxyapatite, the test samples of chicken bones were placed into 10% acetic acid. Measurements were carried out in two series. The first one took two weeks with data acquired every day. In the second series, the measurements were made during one day at an hourly interval (after 1, 2, 3, 5, 7, 10, and 24 hours). Raman spectroscopy was used to evaluate the disappearance of the hydroxyapatite. The relation between the content of hydroxyapatite and images recorded using OCT was analyzed and discussed. Moreover, the polarization properties of the bones have been evaluated. Based on OCT images, the retardation angles of the bones have been calculated. This work presents a preliminary study on the mechanism of bone demineralization and confirms the potential of the applied optical methods.

The absence of highly effective delivery systems is a major challenge for gene therapy. Our work was aimed at the development of novel cationic liposomes possessing high transfection efficiency. For this purpose, a novel disulfide polycationic amphiphile 2S4 was synthesized. Cationic liposomes based on 2S4 and a helper lipid DOPE were formed by the thin film hydration method and exhibited effective pDNA delivery into the HEK293 cells, with a maximal transfection activity superior to that of the commercial agent Lipofectamine^® 2000. Our results suggest that the polycationic amphiphile 2S4 is a promising candidate for in vitro nucleic acid delivery.

Supplier selection/replacement strategies and optimized purchasing policies play a key role in efficient supply chain management in today’s dynamic market. Here we study supplier replacement in a one-level assembly system (OLAS) producing one type of finished product. To assemble the product, we need to provide multi-type components, but assembly will be interrupted if any single component is missing, and incoming units will get hoarded until the missing component arrives. The assembly process can be interrupted by various sources of uncertainty, including delays in component deliveries. There is consequently a non-negligible risk that the assembly process may get stopped any moment. This brings inventory-related costs, which should be minimized. Here we consider discrete lead-time distributions to mimic industry-world reality. We present a model that takes into account not only optimal assignment of component order release dates but also replacement of a critical supplier. For a given unit, we model several alternative suppliers with alternative pricing and lead-time uncertainties, and we evaluate the impact on the total assembly system. For a more general case where several suppliers may be replaced, we propose a genetic algorithm.

Smart materials represent an elegant class of (macro)-molecules endowed with the ability to react to chemical/physical changes in the environment. Herein, we prepared new photo responsive azobenzenes possessing halogen bond donor groups. The X-ray structures of two molecules highlight supramolecular organizations governed by unusual noncovalent bonds. In azo dye I-azo-NO2, the nitro group is engaged in orthogonal H···O···I halogen and hydrogen bonding, linking the units in parallel undulating chains. As far as compound I-azo-NH-MMA is concerned, a non-centrosymmetric pattern is formed due to a very rare I···π interaction involving the alkene group supplemented by hydrogen bonds. The Cambridge Structural Database contains only four structures showing the same I···CH₂=C contact. For all compounds, an ¹⁹F NMR spectroscopic analysis confirms the formation of halogen bonds in solution through a recognition process with chloride anion, and the reversible photo-responsiveness is demonstrated upon exposing a solution to UV light irradiation. Finally, the intermediate I-azo-NH2 also shows a pronounced color change due to pH variation. These azobenzenes are thereby attractive building blocks to design future multi-stimuli responsive materials for highly functional devices.

In this work, fluorinated graphene nanoscrolls (FGN) were synthesized via facile chemical methods under simple and mild conditions. Interestingly, the formation of the featured FGN was significantly solvent sensitive. Experimental results indicated that in the presence of aprotic solvent, for example, N,N dimethylformamide (DMF), the reaction system inclined to form the interesting FGN nanostructures. The structure and morphology of the prepared FGN were detailed characterized by atomic force microscopy (AFM), transmission electron microscopy (TEM), scanning electron microscopy (SEM) and X-ray diffraction (XRD) etc. The obtained FGN was used as a cathode material for primary lithium ion batteries with superior discharge specific capacity (eg. 979.3 mAhg-1), stable discharge platform and high energy density (eg. 2287.9 Wh kg-1), which fosters it a high density, low cost and durable candidate for cathode material for lithium ion batteries..

Despite multiple classical outcomes arising from the quantum Rayleigh conversions of photons underlying the propagation of optical waves through dielectric media and the ensuing light-matter interactions, this quantum process has been largely ignored. Several of its outcomes are considered in this article from a physical perspective, e.g., inter-quadrature coupling of photons, phase-dependent amplification in optical directional couplers and related polarization rotation, phase-shifting of weak signals in the optically linear regime, location-dependent coupling coefficient for refractive index gratings, etc. A correct identification of these effects will enable useful design and operation of integrated photonic functional devices.

Sensory Processing Sensitivity (SPS) is a trait describing inter-individual differences in sensitivity to environments, both positive and negative ones. SPS has attracted growing societal interest. However, (neuro)scientific evidence is lagging behind. We critically discuss how to measure SPS, how it relates to other theories of Environmental Sensitivity and other temperament and personality traits, how SPS interacts with environments to influence (a)typical development, what the underlying aetiologies and mechanisms are, and its relation to mental disorders involving sensory sensitivities. Drawing on the diverse expertise of the authors, we set an agenda for future research to stimulate the field. We conclude that SPS is a heritable, evolutionarily conserved trait, linked to increased risk for psychopathology and stress-related problems in response to negative environments, as well as to greater benefits (e.g., intervention responsivity, positive mood) in positive environments. We need advances in objective assessment of SPS, understanding mechanisms, differentiating it from (seemingly) related mental disorders, to exploit the potential of SPS to improve mental health, preserve human capital, and prevent adverse effects.

In order to evaluate the economy of superhighway, on the basis of the analysis of the cost of the ordinary expressway and high speed railway, the cost of superhighway is estimated. On this basis, the standard of the toll of superhighway at all levels is determined by reference to the standard of the construction cost and the toll collection standard of the ordinary expressway. According to the toll collection standard of superhighway and the fuel consumption cost of superhighway at all levels, the cost of single car and the single person cost of superhighway are calculated. Based on the analysis of highway passenger transport, railway passenger transport and civil aviation ticket price, the single person cost per kilometer of the above travel modes is calculated and compared with the single person travel cost per kilometer of superhighway. The results show that the single person cost of superhighway is between 0.29 and 0.47 yuan /km, which is 0.28 yuan /km higher than the highway bus, 0.18 yuan /km higher than the ordinary expressway self driving and 0.23 yuan /km higher than the express train, but 0.78 yuan/km lower than that of the first class seat of high-speed train, and is 0.92 yuan/km far lower than that of civil aviation flight economy class and 2.42 yuan/km lower than the business class. Therefore, the superhighway trip has certain advantages in economy.

In this study, the influence of graphene oxide nanoparticles on the bond-slip behavior of fiber and fly ash based geopolymer paste was examined. Geopolymer paste incorporating graphene oxide nanoparticles solution was cast in half briquetted specimens and embedded with a fiber. Three types of fibers were used: steel, polypropylene, and basalt. The pullout test was performed at two distinct speeds: 1 mm/second and 3 mm/second. Results showed that the addition of graphene oxide increased the compressive strength of geopolymer by about 7%. The bond-slip responses of fibers embedded in geopolymer mixed with graphene oxide exhibited higher peak stress and toughness as compared to those embedded in normal geopolymer. Each fiber type also showed different mode of failure. Both steel and polypropylene fibers showed full bond-slip responses due to their high ductility. Basalt fiber, on the other hand, because of its brittleness, failed by fiber fracture mode which showed no-slip in pull out responses. Both bond strength and toughness were found to be rate sensitive. The sensitivity was higher in graphene oxide/geopolymer than in conventional geopolymer.

Directional modulation (DM), as an emerging promising physical layer security (PLS) technique at the transmitter side with the help of an antenna array, has developed rapidly over decades. In this study, a DM technique using a polarization sensitive array (PSA) to produce the modulation with different polarization states (PSs) at different directions is investigated. A PSA, as a vector sensor, can be employed for more effective DM for an additional degree of freedom (DOF) provided in the polarization domain. The polarization information can be exploited to transmit different data streams simultaneously at the same directions, same frequency, but with different PSs in the desired directions to increase the channel capacity, and with random PSs off the desired directions to enhance PLS. The proposed method has the capability of concurrently projecting independent signals into different specified spatial directions while simultaneously distorting signal constellation in all other directions. The symbol error rate (SER), secrecy rate, and the robustness of the proposed DM scheme are analyzed. Design examples for single- and multi-beam DM systems are also presented. Simulations corroborate that 1) the proposed method is more effective for PLS; 2) the proposed DM scheme is more power-efficient than the traditional artificial noise aided DM schemes; and 3) the channel capacity is significantly improved compared with conventional scalar antenna arrays.

For the majority of the contractual arrangements used in construction projects, the owner is not responsible for the cost deviations due to the variability of labor productivity or material price, amongst many other aspects. Consequently, the cost performance of a project may be entirely distinct for the owner and the contractor. Since the majority of the quantitative research on cost estimation and deviation found in the literature adopts the owners’ perspective, this research provides a contribution towards modelling costs and cost deviation from a contractors’ perspective. From an initial sample of 13 residential building and 10 office building projects, it was possible to develop models for cost estimation at the early stage of development including both endogenous and exogenous variables. Although the sample is relatively small, the authors were able to fully analyze all the cost data, using no secondary sources of data (very frequent in cost modelling studies). The statistically significant variables in the cost estimation models were the areas above and below ground and the years following the 2008 financial crisis, including the international bailout (2011-2014) period. For estimating the unit cost, a nonlinear model was obtained with the number of underground and total floor, the floor ratio and the years following the 2008 financial crisis, including the international bailout (2011-2014) period as predictors. For the office buildings, it was also found a statistically significant correlation between the cost deviation and the number of underground floors.

The main aspects of material research: material synthesis, material structure, and material properties, are interrelated. Acquiring atomic structure information of electron beam sensitive materials by electron microscope, such as porous zeolites, organic-inorganic hybrid perovskites, metal-organic frameworks, is an important and challenging task. The difficulties in characterization of the structures will inevitably limit the optimization of their synthesis methods and further improve their performance. The emergence of integrated differential phase contrast scanning transmission electron microscopy (iDPC-STEM), a STEM characterization technique capable of obtaining images with high signal-to-noise ratio under lower doses, has made great breakthroughs in the atomic structure characterization of these materials. This article reviews the developments and applications of iDPC-STEM in electron beam sensitive materials, and provides an outlook on its capabilities and development.

El Niño Southern Oscillation (ENSO) is an important of mode of climatic variability that through altering climate patterns exerts a discernible impact on ecosystems and society. For this reason, ENSO has attracted much interest in the climate and health science community with many analysts investigating ENSO health links through considering the degree of dependency of the incidence of a range of climate diseases on the occurrence of El Niño events. Because of the mounting interest in the relationship between ENSO as a major mode of climatic variability and health this paper presents an overview of the basic characteristics of the ENSO phenomenon and its climate impacts, discusses the use of ENSO indices in climate and health research and outlines the present understanding of ENSO health associations. Also touched upon are ENSO-based seasonal health forecasting and the possible impacts of climate change on ENSO and the implications this holds for future assessments of ENSO health associations. The review concludes that there is still some way to go before a thorough understanding of the association between ENSO and health is achieved with a need to move beyond analyses undertaken through a purely statistical lens with due acknowledgement that ENSO as a complex non-canonical phenomenon and that simple ENSO health associations should not be expected.

Nasopharyngeal carcinoma (NPC) has not been thoroughly studied, and the pathogenesis of NPC is unclear. Scientists have neither discovered effective therapies nor achieved a desirable prognosis. Some studies have found that the regulation of intra- and extracellular ion channels hinges directly on cell apoptosis, and treatment with Gambogenic acid (GNA) brings changes to the volume-sensitive outwardly rectifying chloride (VSOR Cl-) current of CNE-2Z cells recorded by the patch clamp method. Nevertheless, rarely have any researchers probed into the relevance between this variation and the anti-tumor mechanism of GNA. This paper is suggested that GNA activates the VSOR Cl- current on the CNE-2Z cell membrane, and the activation of VSOR Cl- currents by GNA in CNE-2Z cells is blocked by the chloride channel blockers DIDS and DCPIB. GNA induces the down-regulation of GRP78 and up-regulation of ATF4 as well as chop proteins, which is evidence for the induction of CNE-2Z cell apoptosis, and this correlates with ER stress. GNA can activate the VSOR Cl- channel and lead to the occurrence of ER stress, thus inducing the apoptosis of CNE-2Z cells and inhibiting the proliferation of CNE-2Z cells.

Stimuli-responsive polymeric materials have attracted significant attentions in a variety of high-value-added and industrial applications during the past decade. Among various stimuli, light is of particular interest as a stimulus due to its unique advantages such as precisely spatiotemporal control, mild conditions, ease of use, and tunability. In recent years, a lot of effort toward synthesis of biocompatible and biodegradable polypeptide has resulted in many examples of photo-responsive nanoparticles. Depending on the specific photochemistry, those polypeptide derived nano-assemblies are capable of crosslinking, disassembling, or morphing into other shapes upon light irradiation. In this mini-review, we aim to assess the current state of photo-responsive polypeptide based nanomaterials. First, those “smart” nanomaterials will be categorized by their photo-triggered events (i.e., crosslinking, degradation, and isomerization) which are inherently governed by photo-sensitive functionalities including o-nitrobenzyl, coumarin, azobenzene, cinnamyl, and spiropyran. In addition, the properties and applications of those polypeptide nanomaterials will be highlighted as well. Finally, the current challenges and future directions of this subject will be evaluated.

The purpose of this research is to determine if the tradeoffs that Kissick proposed among cost containment, quality, and access remain as rigidly interconnected as originally conceived in the contemporary health care context. Although many have relied on the Kissick model to advocate for health policy decisions, to our knowledge, the model has never been empirically tested. Some have called for policy makers to come to terms with the premise of the Kissick model tradeoffs, others have questioned the model given the proliferation of quality enhancing initiatives, automation, and information technology in the health care industry. One wonders whether these evolutionary changes alter or disrupt the originality of the Kissick paradigms themselves. Methods: Structural Equation Modeling (SEM) was used to evaluate the Kissick hypothetical relationships among the unobserved constructs of cost, quality, and access in hospitals for the year 2018. Hospital data were obtained from Definitive Healthcare a subscription site which contains Medicare data as well as non-Medicare data for networks, hospitals, and clinics (final n= 2,766). Results: Reporting significant net effects as defined by our chosen study variables, we find that as quality increases costs increase, as access increases quality increases, and as access increases, costs increase. Policy and Practice Implications: Our findings lend continued relevance to a balanced approach to health care policy reform efforts. Simultaneously bending the health care cost curve, increasing access to care, and advancing quality of care is as challenging now as it was when the Kissick model was originally conceived.

The paper presents a new conception of quasi-distributed sensor for simultaneous measurement of several physical fields and the results of an experimental study of this sensor. A distinctive feature of the sensor defined by the sensitive RC elements connected in the original tree-like structure. The proposed is the structure of the sensor and measurement system as well as corresponding measurement algorithm. The high accuracy demonstrated by the sensor’s prototype gives possibility to effective use the proposed sensors in many technical and scientific applications.

Fiber distributed optical fiber acoustic sensor (DAS) is generally used in distributed long-distance acoustic/vibration measurement. We found that DAS with excellent performance of low self-noise and anti-fading in combination with the plastic structure in daily life as an acoustic transducer can achieve high-sensitivity acoustic measurement at a single point rather than designing a state-of-the-art acoustic transducer or using special enhanced scattering fiber. The simple acoustic transducer we proposed for DAS can reach the sensitivity level of -106.5dB re. 1rad/μPa at a sensing range of 5.1 km, which can meet many demands on the industrial site.

In California, an average of 41,900 patients are diagnosed annually with Staphylococcus bacterial infection; out of these, 24,090 patients have methicillin-resistant Staphylococcus aureus (MRSA) infection and 17,810 patients have methicillin-sensitive Staphylococcus aureus (MSSA) infection. The aim of this paper is to find out whether there is a significant difference in strain dominancy and in what direction. The paper gathered and analyzed data for period of five years of infection rate due to Staphylococcus aureus. This study indicates that a significant difference in dominancy exists, the MRSA infection rate (an average of five years period) is 1.35 times higher than the MSSA infection rate (P-value < 0.05, CI: 95%), but the gap between the two infection rates is decreasing. The infection rate of both MRSA and MSSA is in a path of decline.

Legacy risks from infrastructures and industrial installations often reveal themselves when a potential for failure has been discovered much later than at the stage of the design and construction of a structure. In which case, there might already be a problem with the legacy installation, or even a crisis, without having had an accident. When the hazard cannot be taken away, the question arises as to how much effort, if any, should be spent on improving the situation. The usefulness of the three archetypical approaches to this problem: setting a standard, the As Low As Reasonably Practicable approach and a case-by-case discourse approach are discussed for their applicability for these legacy risks. Although it would be desirable to retrofit legacy risks to previously set legal requirements as is the case when acceptability limits are set in law or demonstration of ALARP is demanded, it may be impossible to reduce the residual risk to an otherwise acceptable level without taking away or replacing the infrastructure, which is not acceptable either. Therefor in conclusion the only available solution to persistent legacy risk problems seems to be to have a thorough discussion with all relevant stakeholders until an agreement is in some way found.

Estimation of the worth of continuity of electricity supply is of interest of industry, authorities and research society. There are numerous methods to calculate the Customer Interruption Costs (CICs). Each method has its advantages and disadvantages. This paper approaches the problem from Distribution System Operators’ (DSOs) point of view and adopts two existing analytical models. One model is used by the Finnish Energy Market Authority and the second one was proposed by the authors at a previous study. The model suggested by the authors as an alternative to the one used by the Finnish Energy Market Authority proposes a simple and straightforward methodology which will provide credible and objective estimations by only utilizing publicly available analytical data. We made use of cost and reliability indices data of 78 DSOs in Finland from the year 2016. In addition to cost estimations, this paper highlights regional differences in CIC estimations in different parts of Finland and critically overviews the existing standard customer compensation scheme in Finland.

The objective of this paper was to give an overview of the expressed preference (EP) techniques of environmental valuation. These methods offer estimation of the value of a resource not necessarily willingness to pay (WTP) or willingness to Accept (WTA) compensation rather upper and lower values. The method of measuring individuals’ willingness to pay is usually based on contingent valuation method (CVM). This research focuses on defining, categorizing, and applicability of various environmental valuation techniques that have been and can be applied in attaching value to a given resource using expressed/Revealed preference methods. The study serves as a supplementary synthesis and discussion to the board of knowledge of resource valuation methods. More specifically, selected methods to discussed herein include; contingent valuation method, hedonic pricing model, travel cost method, trade-off game method, the costless-choice method, Delphi method, Replacement Cost Method, Relocation Cost Method, Opportunity cost method, and Cost-benefit Method. In the last part, applicability of the methods is fully illustrated to support future studies on resource valuation.

Fluorescent carbon dots (C-dots) were synthesized by one pot hydrothermal treatment of garlic juice at 180 °C for 7h. The as-prepared C-dots with an average diameter of 2.13±0.71 nm can be well dispersed, and show absinthe fluorescence with a quantum yield of 8.9% in water. The C-dots were fully characterized by TEM, XPS, XRD, and FTIR, respectively. Additionally, the as-prepared C-dots reveal nearly nontoxic to SW480 cells and can be used for cell imaging. The water solution of C-dots show sensitivity to pH values and metal ions, and also have a high selectivity to the Hg²⁺ ion among other transition metal ions, and achieve a high sensitive detection with the detection limit of 0.45 μM. The fluorescent C-dots are expected to be useful for the evaluation of mercury ions in environmental water system.

Flash flood is one of the most significant natural disasters in China, particularly in mountainous area, causing heavy economic damage and casualties of life. Accurate risk assessment is critical to an efficient flash flood management. There are more than 530,000 small watersheds in 2058 counties in China where flash flood should be prevented. In practice, with limited fund and different risk levels, the priorities of each small watershed for flash flood prevention and control are also needed for an efficient flash flood management. This paper, take Licheng county in China as an example, aims to give out these priorities for management. First, sensitive indexes are identified among index system, which includes 9 indexes based on underlying surface characteristics of small watershed in hilly region. Second, the range of each index and the rank division of each index for evaluation are determined. Based on the rank divisions for evaluation, the flash flood risk grade eigenvalue (H) is calculated by Variable Fuzzy Method (VFM ) using 1000 samplings generated by Latin hypercube sampling method. Third, the key sensitivity factors that affect flash flood risk grade eigenvalue (H) are assessed by two different global sensitivity analysis methods -- stepwise regression analysis and mutual entropy. Both results indicate that watershed slope (S) is the most sensitive factor; the second is antecedent precipitation index (CN); while other factors are slightly different sensitive in sequence. This study shows that stepwise regression analysis and mutual information analysis are appropriate for the sensitivity analysis of mountain flash flood risk. Finally, based on watershed slope (S), the priorities of flash flood prevention and control of 119 small watersheds in Licheng county are given out.

We review some semantical aspects of probability bounds from Boole’s “conditions on possible experience” violated by quantum mechanics. We also speculate about emerging space-time categories as an epiphenomenon of quantization and the resulting breakdown of relativity theory by non-unitary and non-linear processes.

OBJETIVES: During the COVID-19 pandemic, the risk of collapse of the health system created great difficulties. We will demonstrate that Intermediate Respiratory Care Units (IRCU) provide adequate management of patients with non-invasive respiratory support, which is particularly important in patients with SARS-CoV-2 pneumonia. METHODS: A prospective observational study of patients with COVID-19 admitted to the ICU of a tertiary hospital. Sociodemographic data, comorbidities, pharmacological, respiratory support, laboratory and blood gas variables were collected. The overall cost of the unit was subsequently analyzed. RESULTS: 991 patients were admitted, 56 to the IRCU (of the 81 a critical care unit). Mean age was 65 years (SD 12.8), Barthel Index 75 (SD 8.3), Charlson 3.1 (SD 2.2), HTN 27%, COPD 89% and obesity 24%. Significant relationship (p <0.05) with higher mortality of the following: fever greater than or equal to 39oC [OR 5.6; 95% CI (1.2-2.7); p = 0.020], protocolized pharmacological treatment [OR 0.3; 95% CI (0.1-0.9); p = 0.023] and IOI [OR 3.7; 95% CI (1.1-12.3); p = 0.025]. NIMV showed less of a negative impact [OR 1.8; 95% CI (0.4-8.4); p = 0.423] than IOI. The total cost of the IRCUs amounted to €66,233. The cost per day of stay in the IRCU was €164 per patient. The total cost avoided was €214,865. CONCLUSION: The pandemic has highlighted the importance of IRCUs in facilitating the management of a high patient volume. The treatment carried out in IRCUs is effective and efficient, reducing both admissions to and stays in the ICU.

Information and Communication Technology (ICT) education has attracted attention in recent years. But there are many issues specific to ICT education such as monetary cost, time, environment, teacher education system, motivation, curriculum, and health problems. In this paper, we investigated and considered the issues in ICT education in Japan from 10 viewpoints.

The aim of this article is to propose a core game theory model of transaction costs wherein it is indicated how direct costs determine the probability of loss and subsequent transaction costs. The existence of optimum is proven, and the way in which exposure influences the location of the optimum is demonstrated. The decisions are described as a two-player game and it is discussed how the transaction cost sharing rule determines whether the optimum point of transaction costs is the same as the equilibrium of the game. The dispute between actors regarding changing the share of transaction costs to be paid by each party is modeled by a non-cooperative bargaining game. Requirements of efficient transaction cost sharing rules are defined, and it is posited that solution exists which is not unique. Policy conclusions are also devised based on principles of design of institutions to influence the nature of transaction costs.

The present work studies the concept of productivity in shipbuilding and how it should be measured. The existing metrics, shipbuilding process and shipyard organization were studies in order to choose the most adequate metrics which would allow the measuring of a shipyard productivity in a systematic and holistic way. This is achieved by gathering the man-hours spent in each ship organized by cost centre and using Compensated Gross Tonnages as the measure of output from the shipyard. Data was gathered for thirty ships built in the same European yard organized by cost centre. From the data collected it was found that the ratio of hours spent in outfitting to the hours spent in structures is proportional to the complexity of the ship. There was also opportunity to study the work reduction resulting from building ships in series and the shares of labour for ships series and across ship types.

The present work aimed to validate a low-cost passive monitoring procedure. For its validation, the monitoring of atmospheric organic pollutants - polycyclic aromatic hydrocarbons (PAH) was carried out in a capital of the central-western region of Brazil. The sensors were fixed on poles intended for electrification during the dry season. After 15 days, samples were extracted by solvent extraction and analysed by High-Resolution Gas Chromatography with Flame Ionization Detector (HRGC-FID). For the validation of the procedure, PAHs monitored and standardised by the American Environmental Agency (EPA), a benchmark for environmental monitoring of air quality by several countries, were analysed. The results demonstrated that the low-cost passive monitoring method was effective in the quantification of PAH in the environment-air, capable of being used by countries that do not have many resources for monitoring air quality.

A disaster wrecks those affected. It spares many in the affected areas, yet those spared may be indirectly impacted. Specific risks are often inherent within a social system or physical location, but they can also be created due to unavoidable natural or technological hazards. The consequences, however, can be similar in that they wreak havoc in communities and destroy economic systems. The analytical framework of deterrence and coping has ascertained beneficial in many circumstances, but a cost benefit calculation is a must to infer the feasibility of planning strategy and resource allocation. This study points to the Cost-Benefit Analysis (CBA) of flood management by District Disaster Management Kulgam. The assessment is established on secondary pooled data collected from administration offices, NGOs, published Journals, and local and national newspapers. It also characterised the strategy, the technique adopted, and the sources of flood damage cost information. The totalled benefits report for 78686.18 lakh of rupees, and that of total costs account for 2218.75lakh of rupees. The Benefit-Cost ratio greater than one (>1) indicates that Flood Management in District Kulgam was economically feasible and successfully governed. The State of Jammu and Kashmir put up with necessary prevention and administration measures to break the spell of devastation due to floods to significant status.

The object of this work is to report some preliminary results on the mechanical harvesting of blueberry fruits of cv. Cargo® in the Piedmont region, one of the most productive areas of Italy that is specialized for fresh blueberry production. The automatization of harvesting operations could represent a competitive advantage for the investigated area’s blueberries supply chain, but could act as a limitation to maintaining the quality of fresh berries. A prototype machine and a commercial harvester (Easy Harvester®) were compared to manual picking, considering harvest efficiency (share of loss), labor productivity and harvesting cost. In the indicated context, the cost of labor exceeds 2.00 euros per kg of sellable product. The use of the prototype allowed a 37% re-duction of this cost, and the use of the Easy Harvester® allowed a reduction of about two thirds. It should be emphasized that these positive performances do not consider two other aspects: the re-duction in the marketable volume (attributable to losses in the harvest and post-harvest phase), and the reduction in the net sale price by 0.30 euros due to the sorting/selection costs in the ware-house. In this study, we highlight how the transition to mechanical harvesting requires the trans-formation of several farming and warehouse operations, such as new crop varieties, new field configurations, and new packaging processes. However, a possible technical improvement of the Easy Harvester® machine could represent an opportunity for Italian companies in the planning of the production and marketing of berries, involving all actors of the supply chain. Further research on the use of mechanization in the sector must still be continued and supported.

Three Dimensional Variational data assimilation or analysis (3DVAR) is one of most classical methods for providing the initial values for numerical models. In this method, the dimensions of the background error covariance and the observational error covariance matrices are large. Therefore, it is difficult to get the inverse of the covariance matrices and to reduce the orders of these matrices without information loss. With the use of the Sylvester Equation, on the basis of a new linear regression, a new cost function for 3DVAR was given. For the first-guess m×n field, there is an approximate 1−(m²+n²)/(mn×mn) reduction with m>1 & n>1 by using the cost function. The results of the numerical experiments show that the effect of this algorithm is no worse than that of the old cost function for 3DVAR.

Background: Chronic lower limb ulcers (CLLU) have an important burden to the individual and the healthcare system. However, there is a lack of information about the cost of CLLU in Argentina.Objective: To determinate the number and cost of consultation and hospitalization associated to CLLU in a public hospital in Argentina. Methods: Retrospective observational study. Cost estimation were calculated based on days of stay, treatments and laboratory tests in a inpatient population and the number of consultations, treatments and laboratory tests, in a outpatient population. Results: In 2013 and 2014, the overall number of consultation with ICD-10 codes was 7,224 and the number of inpatient was 359. The mean age for male and female outpatient consultations was 59.53(±13.06) years and 59.04(±10.93), respectively. For CLLU male and female inpatient, the mean age was 63.9(±10.4) years and 54.5(±8.6) years, respectively. The length of stay was 22.88 days. There was a mean of 0.41 surgeries per patient where 25% were amputations. The mean annual cost in a single public hospital was US$4,053.65 per inpatient and US$3,589.24 per outpatient. Conclusion: Cost information allows new public health policies to reduce socioeconomic burden due to CLLU.

Despite the success of recent efforts to increase access to improved water, sanitation, and hygiene (WASH) globally, approximately one-third of schools around the world still lack adequate WASH services. A lack of WASH in schools can lead to the spread of preventable disease and increase school absences, especially among women. Inadequate financing and budgeting has been named as a key barrier for integrating successful and sustainable WASH programs into school settings. For this reason, the purpose of this review is to describe the current knowledge around the costs of WASH components as well as financing models that could be applied to WASH in schools. Results show a lack of information around WASH costing, particularly around software elements as well as there is a lack of data overall for WASH in school settings as compared to community WASH. This review also identifies several key considerations when designing WASH budgets or selecting financing mechanisms. Findings may be used to advise future WASH in school programs.

Construction project management and cost management is a difficult process that affects the overall success of construction projects. The success of a construction project can be assessed according to key performance indicators (KPIs). Cost savings and cost optimization over the life of a construction project is one of these KPIs. Cost management is largely performed through intelligent information technology in the construction industry. Information systems and information technologies have seen an increase in use in the management of construction projects. The same goes for cost management. Several studies mentioned in the paper point to this increase in use in recent years also in the management of costs at various stages. Many studies point to the use of information technology and software applications in the field of cost management. Still, to a large extent, there are no surveys focused on the analysis of the impact and impact factor of information technology on cost savings or cost optimization in various phases of construction projects. The research discusses the issue of the impact of information technology on cost management in various phases of a construction project. The main goal of the research is to analyze the influence of information technology factors on cost savings and optimization in individual phases of a construction project. Several statistical methods were used in the research. The resulting model of information technology impact factor was created based on data processing and the use of the AHP method.

Accurate and reliable project cost estimates are fundamental to achieve successful municipal capital improvement (CIP) programs. Engineering cost estimates typically represent critical information for key decision makers to authorize and efficiently allocate the necessary funds for construction, budgeting, to generate a request for proposals, contract negotiations, scheduling, etc. for these reasons, cost estimators are using different estimating methods and approaches that allow for required levels of accuracy. As the project’s scope becomes more detailed and the potential risks are identified and/or the project design stage progresses these cost estimates are revised and updated. In this paper, the most common project cost estimation methods and approaches were collected and categorized into two main groups of (1) probabilistic and (2) deterministic methods. Under these groups overall ten different methods were identified and discussed addressing their requirements, advantages, and shortcomings, including the potential risk that can positively or negatively affect the project’s cost outcome. This paper will be a good resource for professionals who are in budget development and/or are seeking to a better understanding of different methods in determining an appropriate base cost margin and produce a meaningful and reliable project cost estimate.

Lettuce is a salt-sensitive crop and has a threshold electrical conductivity of 1.3–2.0 mS cm-1 and above that is considered detrimental. As there has been very little information on the physio-logical response of different critical stages of lettuce under different salt stress (SS), the current study is focused on investigating the effects of SS on the critical physiological traits influencing the carbon assimilation in different growth stages of lettuce. The experiment was conducted in deep-water culture hydroponic system in a greenhouse condition. Four levels of sodium chloride salt treatments (EC: 20, 16, 8, and 1.8 mS cm-1) were applied. During both growth stages (day 11 (GS1) and day 19 (GS2) after salt treatment), the leaf transpiration rate, stomatal conductance, and intercellular CO2 were severely decreased. However, the carbon assimilation rate remained unchanged under SS. Similarly, the water use efficiency increased under the SS. It is concluded that the increasing SS increased stomatal and non-stomatal limiting factors during GS1 suggesting the enhanced limitation in photosynthetic activity while no such trend was observed during GS2. The decreased gm with increased SS at GS1 and GS2 suggested that SS induced the irreversible decrease of gm, which in turn can be responsible for the transient reduction in the Vcmax and Jmax during GS2. Taken together, the evidence from this research recommends that varying the SS levels can significantly affect the physiological performance of lettuce at both growth stages.

Cannabidiol (CBD) is a non-intoxicating compound extracted from Cannabis sativa, showing antidepressant-like effects in different rodent models. However, inconsistent results have been described depending on the species and the strain used to assess depressive-like behaviour. Moreover, only a few studies have investigated the effect of CBD in female rodents. Therefore, we aimed to i) investigate the effects of CBD in two different strains of mice (Swiss and C57BL/6) and in a rat model of depression based on selective breeding (Flinders Sensitive and Resistant Lines, FSL and FRL) subjected to tests predictive of antidepressant-like effects; and ii) investigate the influence of sex in the effects of CBD in both mice and rats. CBD induced an antidepressant-like effect in male Swiss but not in female Swiss or C57BL/6 mice in the tail suspension test (TST). In male FSL rats, CBD produced an antidepressant-like effect one-hour post-injection. However, in female FSL, CBD induced a bimodal effect, increasing the immobility time at one hour and decreasing it at two hours. Ketamine produced an antidepressant-like effect in male and female FSL rats at different doses. In conclusion, strain, sex, and administration time affect CBD's behavioural response to rodents exposed to tests predictive of antidepressant effects.

The importance of this study may be defined by using the smart techniques to earned value indicators of residential buildings projects in Republic of Iraq, only one development intelligent forecasting model was presented to predict Schedule Performance Index (SPI), Cost Performance Index (CPI), and To Complete Cost Performance Indicator (TCPI) are defined as the dependent. The approach is principally influenced by the determining numerous factors which effect on the earned value management, that involves Iraqi historical data. In addition, six independent variables (F1: BAC, Budget at Completion., F2: AC, Actual Cost., F3, A%, Actual Percentage., F4: EV, Earned Value. F5: P%, Planning Percentage., and F6: PV, Planning Value) were arbitrarily designated and satisfactorily described for per construction project. It was found that ANN has the capability to envisage the dust storm with a great accuracy. The correlation coefficient (R) has been 90.00%, and typical accuracy percentage has been 89.00%.

The literature was scoped to help place mass spectrometric (MS) platforms in the spotlight of the life sciences, as a tool of OMICS and OMICS 2.0 technologies. Moreover, today’s appliances are so handy, that they literally place a whole lab on a single chip. Methods of OMICS (and the most recently developed term OMICS 2.0) are tackled, having in mind their aptness for educational purposes, as well as their feasibility. This same topic was highlighted in many reviews that have been periodically published. The author’s initial interest was the forensic application of MS, but since these interests changed, terms such as “biosensors” were also examined, so the review included means of discovery of efficient biomarkers and clinical therapeutic targets. Aside from simply reviewing the research status and the future perspectives, this article tackles terms such as Society 5.0 and OMICS 2.0. However, within the framework of this review, physical chemistry, bioinformatics, or specific software solutions were not specifically studied. Since the topic of generating permanent collections of digital content for retrospective analysis was also reviewed, the need for loads of data – cloud storage was discussed in the context of MS. These large quantities of data are easier to operate with if generated by MS, rather than by any other commercially available assay. In this manner, the review has strengthened an in-depth understanding of the applications of MS.

Background: Human epidermal growth factor receptor 2 (HER-2) overexpression can be found in 15-20% of breast cancers, and it strongly correlates with aggressive clinical behavior and adverse prognosis. The first-line treatment for HER-2 positive metastatic breast cancers is the combination of trastuzumab, pertuzumab, and taxane (PTH). ABP 980 is a biosimilar of the innovator trastuzumab and is characterized by highly comparable effectiveness. Methods: The group of 61 patients with HER-2 positive MBC received biosimilar ABP 980 plus pertuzumab and docetaxel from November, 18, 2018 to December, 24, 2019. The response to therapy, overall survival (OS), progression-free survival (PFS), metastases, and adverse effects among patients were determined and analyzed. Results: Initially, 42 women responded partially to the treatment and their median PFS was 27 months. Median PFS for the whole group was 18 months. Cardiotoxicity of treatment was noticed in all patients in the form of the reduction in left ventricular ejection fraction but only in 2 cases, it was the reason for withdrawing from therapy. Conclusion: Biosimilar ABP 980 is registered in the same indications as the innovator trastuzumab and their effectiveness, as well as side effects, are comparable. The costs of biosimilar make the therapy more accessible and thus more patients with MBC around the world can receive relevant treatment.

Based on the data of A-share listed companies in Shanghai and Shenzhen of China from 2011 to 2018 and the digital inclusive finance index of Peking University (2011-2018), this paper empirically tests the impact of digital finance development on corporate social responsibility in various provinces of China and its impact mechanism. The results show that: (1) the development of digital finance helps to promote the fulfillment of corporate social responsibility; (2) the influence mechanism of the development of digital finance to promote the fulfillment of corporate social responsibility lies in that it reduces the cost of debt financing and leads to the improvement of corporate social responsibility.(3) Further research shows that the positive relationship between digital finance and corporate social responsibility is more significant in private enterprises. At the same time, the impact is more significant in areas with poor market environment. The above research shows that the development of digital finance has a significant positive effect, which will improve the level of corporate social responsibility.

We report a very frugal microscope building method from easily realizable parts. We show a highly portable field ready compound type microscope with bright field, dark field and projection microscopy capabilities. It has good resolution and magnification for multiple aspects of education and diagnosis. We demonstrate that such a system can be built from simple lenses in laser pointers and camera modules with no specific 3d printed parts or costly lenses. We show all the parts of the system like stage, coarse and fine focussing system, microscope body, even slides can be built from commonly available materials like soda bottle and DVD disks. We list alternate, safer and easily available staining methods and chemicals. The microscope is developed with a target that it can be self-developed even in rural areas of the world with only resources at one’s disposal with very little education. This features a stable focussing and panning system for comfortable viewing through eyes and also easy imaging with a smartphone. We show its utility for microorganism analysis and potential for clinical diagnosis.

The Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has caused the Coronavirus Disease 2019 (COVID-19) worldwide pandemic in 2020. In response, most countries in the world implemented lockdowns, restricting their population’s movements, work, education, gatherings, and general activities in attempt to ‘flatten the curve’ of COVID-19 cases. The public health goal of lockdowns was to save the population from COVID-19 cases and deaths, and to prevent overwhelming health care systems with COVID-19 patients. In this narrative review I explain why I changed my mind about supporting lockdowns. First, I explain how the initial modeling predictions induced fear and crowd-effects [i.e., groupthink]. Second, I summarize important information that has emerged relevant to the modeling, including about infection fatality rate, high-risk groups, herd immunity thresholds, and exit strategies. Third, I describe how reality started sinking in, with information on significant collateral damage due to the response to the pandemic, and information placing the number of deaths in context and perspective. Fourth, I present a cost-benefit analysis of the response to COVID-19 that finds lockdowns are far more harmful to public health than COVID-19 can be. Controversies and objections about the main points made are considered and addressed. I close with some suggestions for moving forward.

The lean supply chain of construction engineering projects is to achieve the maximum satisfaction of the owners' needs in order to effectively achieve the goal of supply chain management. This paper explores an effective method of lean supply chain cost management for construction engineering projects with target cost management, so that each participating unit on the supply chain node can fully utilizes its core competencies to minimize internal consumption and waste, and achieve the optimal overall efficiency of the supply chain. According to the requirements of the goal planning theory of the construction project company, establish a lean supply chain cost planning system for the construction project, realize the basic model of the lean supply chain cost management of the construction project, and set the target cost from the lean project of the construction project. The technical decomposition is established by the process of cost decomposition and cost pressure transmission and sub-target cost planning.

Background: Trichomoniasis is the most common non-viral STI globally and yet is not a reportable disease. Trichomonas Vaginalis is an important source of reproductive morbidity and may increase risk of acquisition and transmission of HIV. WHO and CDC recommend various regimens of Nitro-Imidazoles for treatment. The common Nitro-Imidazoles used for Trichomoniasis are Metronidazole and Tinidazole, which vary in their cost, efficacy and side effect profile and it is relevant to study these factors, for better management of the patients. Objectives: This study aims to compare and study the efficacy, compliance of various treatment regimens, their outcomes and side-effects for Trichomoniasis, among STI clinic attendees in Trinidad. Methods: A clinical trial study was designed and after obtaining the informed consent a routine clinical examination was conducted and the swabs for Trichomoniasis tests were collected for diagnosis from the 692 participants. Out of 692 participants, Eighty two (82) patients with established diagnosis of Trichomonas infection were quasi-randomly treated using different regimens. Compliance to treatment, side effects and outcome were evaluated. Results: The prevalence of the Trichomoniasis in population attending our STI clinic is 11.9% and prevalence of HIV is 9%. Of the total 82 participants for the treatment, 80% were females; nearly 90% of the patients belonged to age group 15-45 years and over 60% were below 30 yrs. Among those diagnosed for Trichomonas vaginalis, 13.3% had associated HIV infection. The compliance with respect to single dose treatment was significantly better than the long duration oral regimen and has significant relation with side effects of the treatment. The outcome is generally better and comparable and shows no significant difference between different treatment regimens used in the study. Conclusions: Metronidazole and Tinidazole are commonly used drugs in various regimens. compliance is better with those treated with Tinidazole and Metronidazole stat, than with other groups. Outcome is comparable between these regimens, especially when combined with other important factors like abstinence and treatment of the partners. The treatment regimens mainly differ in the compliance and side effects profile, which suggests that to improve the compliance the drugs with less side effects, short course regimen would be a preferred choice.

One of the key areas of the International Renewable Energy Agency’s (IRENA) programme of work is the analysis of renewable technology costs and performance and the dissemination of these results to as wide an audience as possible. In addition to analysis, IRENA seeks to engage a broad range of stakeholders in the context of this work through the Renewable Costing Alliance. The Costing Alliance brings together companies, industry association, governments and researchers to share, confidentially, data for real-world renewable energy project cost and performance, helping to build further on IRENA’s costing work to date. In this context the authors analyse the current cost differentials and cost reduction potentials for solar PV in Japan compared to best practice levels and identify the reasons for higher costs in Japan and how to reduce them. This study analyses the current installed cost differentials for utility-scale, commercial and residential rooftop solar PV systems. In addition to identifying the reasons for the cost differentials, potential policy recommendations to reduce the cost differential are identified.

Intense physical efforts performed at maximal or near-maximal speeds and the ability to recover among sprint are important characteristics of soccer player. Considering that women's soccer is a markedly growing sport, the aim of the study was to analyse the performance (total time –TT-; fatigue index percentage -IF%) and physiological (aerobic and anaerobic) responses to Repeated Sprint Ability Test (RSA, 7×30 m sprints with 25 s of active recovery among sprints) in an elite female player (age: 30 yrs; BMI: 20.3 kg/m²). A repeated measure MANOVA over the 7 sprints time series was applied (p < 0.05). Results showed that TT was 58.71 s (Ideal Time: 56.98 s) with IF% of 3.0%. Energy contributions were given for 80.3% by aerobic, 19.2% by anaerobic lactid, and 0.5% by anaerobic alactid sources. Considering that 1) we have different kinetics in heart rate (HR) and maximum oxygen uptake with oxygen uptake that reach the peak when HR is still rising, and 2) the energy consumption during intermittent exercises requires different metabolism as a result of physiological stimuli proposed, the present findings substantiate the need to choose specific and adequate training methods for female soccer players that aim at increasing their RSA performances.

Carbon concrete PAN/lignin-based CF composites are a new promising material class for the building industry. The replacement of the traditional heavy and corroding steel reinforcement by carbon fiber (CF) based reinforcements offers many significant advantages: a higher protection of environmental resources because of lower CO2 consumption during cement production, a longer lifecycle and thus muss less damage in structural components and a higher degree of design freedom because lightweight solutions can be realized. However, due to cost pressure in civil engineering, completely new process chains are required to manufacture CF based reinforcement structures for concrete. The article describes the necessary process steps in order to develop CF reinforcement: (1) the production of cost-effective CF using novel carbon fiber lines, (2) the fabrication of CF rebars with different geometry profiles. It was found that PAN/lignin-based CF is currently the most promising material in order to meet the future market demands. However, significant research needs to be undertaken in order to improve the properties of lignin-based and PAN/lignin-based CF, respectively. The CF can be manufactured to CF-based rebars using different manufacturing technologies which have been developed on prototype level in this study.

Transport biofuels derived from biogenic material are used for substituting fossil fuels, thereby abating greenhouse gas (GHG) emissions. Numerous competing conversion options exist to produce biofuels, with differing GHG emissions and costs. In this paper analysis and modelling of the long-term development of GHG abatement and relative GHG abatement cost competitiveness between crop-based biofuels in Germany is carried out. Presently dominant conventional biofuels and advanced liquid biofuels were found not to be competitive compared to the substantially higher yielding options available: sugar beet based ethanol for the short to medium term least-cost option and Substitute Natural Gas (SNG) for the medium to long term. The competitiveness of SNG was found to depend highly on the emissions development of the power mix. Silage maize based biomethane was found competitive on a land area basis, but not on an energetic basis. Due to land limitations as well as cost and GHG uncertainty, a stronger focus on the land use of crop-based biofuels should be laid in policy.

This paper aimed to assess the technical efficiency of maize seed production and the major factors contributing on technical efficiency. Maize is the second most important staple crop in Nepal, but the average yield of maize is very low as compared to other countries having similar agro-climatic requirements. Inefficient use of resources had led to low yield in maize crop. The software Raosoft was used to determine the required sample size and total of 182 samples were selected using simple random technique in June, 2016. Stochastic production frontier model and Tobit model were used to derive the results. The average technical efficiency of maize seed production ranged from 0.25-0.92 with an average of 0.71which revealed the scope of increasing technical efficiency by 29 percent. The majority of the farmers (29.1%) were at higher technical efficiency level of 0.8-0.9 followed by 28.6 percent at 0.7-0.8 and 23.1 percent at 0.6-0.7. Age and schooling of household head, experience on maize seed production, area shared by maize crop and dummies variables such as livestock holding, source of seed and access to extension service had found significantly affecting on the technical efficiency level. For the least developed country like Nepal it would be better to use the available resources wisely and improvement of existing technologies would be more cost effective than that of discovering new technologies. The study recommended that the concerned organizations should focus on mixed agricultural farming system, access to better quality seed and provide technical knowledge which would help in improving technical efficiency.

Air pollution has created a lot of problems in the developed and developing countries. To avoid or reduce these problems, constant monitoring of the air should be ensured. The conventional techniques is costly because it requires a lot of money and time consuming. Biomonitoring has been the alternative method. Moss, lichens and plants are biomonitors available to entrap air pollutants. The aim of this paper is to discuss one of the ways of monitoring air pollution – Moss bag technique. To do this, types, choice, preparation, handling of bags after preparation of moss were discussed. From the literatures consulted, it was discovered that there were differences in the techniques used by the researchers. In all, the use of mosses with emphasis on the employment of moss bag have proved to be a powerful tool in airborne particulate and toxic elements. To conclude, developing countries should focus more on this technique because it will reduce cost of air monitoring.

A low-cost bio-mass-derived carbon substrate has been employed to synthesize MoS₂@carbon composites through a hydrothermal method. Carbon fibers derived from natural cotton provide a three-dimensional and open framework for the uniform growth of MoS₂ nanosheets, thus constructing hierarchically coaxial architecture. The unique structure could synergistically benefit fast Li-ion and electron transport from the conductive carbon scaffold and porous MoS₂ nanostructures. As a result, the MoS₂@carbon composites, when served as anodes for Li-ion batteries, exhibit a high reversible specific capacity of 820 mAh g^-1, high-rate capability (457 mAh g^-1 at 2 A g^-1), and excellent cycling stability. The superior electrochemical performance makes the MoS₂@carbon composites to be low-cost and promising anode materials for Li-ion batteries.

A techno-economic model was developed to investigate the influence of components on the system costs of redox flow batteries. Sensitivity analyses were carried out based on a example of a 10 kW/120 kWh vanadium redox flow battery system and the costs of the individual components were analyzed. Particular consideration was given to the influence of material costs and resistances of bipolar plates and energy storage media as well as voltages and electric currents. Based on the developed model it was possible to formulate statements about the targeted optimization of existing battery systems and general aspects for future developments of redox flow batteries.

Cement manufacturing is one of the most energy-intensive industries in the world. Most of the cost of producing cement is accounted by fuel consumption and power expenditures. Thermal power plants are the major source of electricity in Pakistan. But they are not efficient and environmentally friendly. This study simulates four different models for five cement plants of Pakistan on Homer Pro software and compares the optimal solutions based on the net present cost (NPC), levelized cost of electricity (LCOE) and greenhouse gas (GHG) emissions. Model-1 consists of solar panels, electrolyzer, hydrogen tank, hydrogen generator and converter. Model-2 has only a diesel generator and acts as a base case in this study. Model-3 has solar panels and a battery-converter system. In Model-4, diesel generators, solar panels and converters are considered. Based on NPC, the most optimal model is Model-4, having a 0.249 $/KWh LCOE in islanded systems. The NPC and operating costs are US$540 million and US$ 32.5 million per year, respectively, with a 29.80% reduction in CO2 emissions when compared to the base case. Based on GHG emissions, Model-1 and Model-3 are the best models with 0% GHG emissions. Sensitivity analyses is also performed using the parameters of load, inflation rate and discounted rate. The results prove that the proposed hybrid micropower systems (HMS) can sustainably provide electricity for 24 hours a day to the sites under consideration with minimum objectives.

Proteasome inhibitors, like bortezomib, play a key role in the treatment of multiple myeloma (MM); however, most patients eventually relapse and eventually show multiple drug resistance, and the molecular mechanisms of this resistance remain unclear. The present study examines the expression of previously-described genes that may influence resistance to bortezomib treatment at the mRNA level (ABCB1, CXCR4, MAF, MARCKS, POMP, PSMB5, RPL5, TXN and XBP1). mRNA expression was determined in 73 MM patients treated with bortezomib-based regimens (30 bortzomib-sensitive and 43 bortezomib-refractory patients) and 11 healthy controls. RPL5 was significantly down-regulated in multiple myeloma patients as compared with healthy controls. Moreover, POMP was significantly up-regulated in MM patients refractory to bortezomib-based treatment. In multivariate analysis, high expression of PSMB5 and CXCR and autologous stem cell transplantation were independent predictors of progression-free survival, and high expression of POMP and RPL5 was associated with shorter overall survival.

In the current context of worldwide honey bee colony losses, among which the varroa mite plays a major role, hope to improve honey bee health lies in part in the breeding of varroa resistant colonies. To do so, methods used to evaluate varroa resistance need better understanding. Repeatability and correlations between traits such as Mite Non-Reproduction (MNR), Varroa Sensitive Hygiene (VSH) and hygienic behaviour are poorly known, due to practical limitations and to their underlying complexity. We investigate (i) the variability, (ii) repeatability of the MNR score and (iii) its correlation with other resistance traits. To reduce the inherent variability of MNR scores, we propose to apply an Empirical Bayes correction. On the short-term (ten days) MNR had a modest repeatability of 0.4 whereas on the long- term (a month) it had a low repeatability of 0.2, similar to other resistance traits. Within our dataset there was no correlation between MNR and VSH. Although MNR is amongst the most popular varroa resistance estimates in field studies, its underlying complex mechanism is not fully understood. Its lack of correlation with better described resistance traits and low repeatability suggest that MNR need to be interpreted cautiously, especially when used for selection.

Background: Stoma closure is a widely performed surgical procedure, with 6295 undertaken in England in 2018 alone. This procedure is associated with significant complications; incisional hernias are the most severe, occurring in 30% of patients. Complications place considerable financial burden on the NHS; hernia costs are estimated at GBP 114 million annually. As recent evidence (ROCSS, 2020) found that prophylactic meshes significantly reduce rates of incisional hernias following stoma closure surgery, an evaluation of this intervention vs. standard procedure is essential. Methods: A cost-utility analysis (CUA) was conducted using data from the ROCSS prospective multi-centre trial, which followed 790 patients, randomly assigned to mesh closure (n=394) and standard closure (n=396). Quality of life was assessed using mean EQ-5D-5L scores from the trial, and costs in GBP using UK-based sources over a 2-year time horizon. Results: The CUA yielded an incremental cost-effectiveness ratio (ICER) of GBP 128,356.25 per QALY. Additionally, two univariate sensitivity analyses were performed to test the robustness of the model. Conclusion: The results demonstrate an increased benefit with mesh prophylaxis, but at an increased cost. Although the intervention is cost-ineffective and greater than the ICER threshold of GBP 30,000/QALY (NICE), further investigation into mesh prophylaxis for at risk population groups is needed.

Aircraft emissions represent a relevant amount of human induced CO2. Globally, up to 2.5 per cent of such emissions stem from the aviation industry. In order to investigate the effects within the atmosphere, realistic flight profiles are necessary to provide quantitatively tangible values of emissions. The flight profiles and the according fuel consumption can be calculated by using waypoints from flight plans and Base of Aircraft Data (BADA). This paper presents an approach to refine the fuel consumption by integrating the passenger load into the calculation. Since effects of emissions have to be assessed on a greater scale, such as on the European air traffic network, the presented approach provides cost functions for CO2 emissions for different aircraft types and load factors. The cost functions were derived by means of regression analyses of BADA based calculated flight profiles with a step size of one second. The calculations are based on real historic traffic scenarios of several days. The derived aircraft specific fuel burn coefficients enable a simple and efficient integration of CO2 estimations depending on the flight distance, load factor and aircraft type. This can be applied to large traffic scenarios to also study different set-ups such as travel restrictions, other disruptions or an alteration in the traffic system as a whole. In order to enable the assessment of further aspects of such changes to the European air traffic system at large and to foster reproducibility and comparability of related studies, we provide further general-purpose cost estimation functions for several important key characteristics. Besides fuel consumption, we develop cost estimations for air navigation fees and maintenance for conventional aircraft. Those functions are also provided for the design concept of a short-range all-electric aircraft. This propeller aircraft features game-changing technologies such as active laminar flow control, active load alleviation and advanced materials and structure concepts. The approaches discussed in this paper will focus on the generic aspects of aircraft related costs, which can be derived from general available data. For the sake of reproducibility, the results will be made publicly available.

Background: Simulation plays a crucial role in health studies, as it helps medical students apply their theoretical knowledge in real-life situations. Moulage is one of the techniques that helps in making simulation more realistic or high-fidelity. It uses special effects to emulate wounds for a better understanding of what the wound is like visually. Still, moulage is expensive, time-consuming, resource-intensive, and requires the training of staff, which is why we need to find low-cost substitutes for moulage materials. Method: When searching the database “PubMed” for the terms “Low-cost and Medical moulage”, we retrieved 222 studies, out of which when excluding results not related to low-cost, we obtained 62 studies, from which when removing studies that do not contain information regarding moulage, we found two papers, after referring to citations and cited articles of those papers, we ended up with six studies. Based on the selected articles and additional articles sourced from their reference list, a total of 11 studies were included in the review. Results: We understand that moulage is a technique that helps make simulations come alive, but the resources required to use it are at times, expensive, which is why we need to find methods to do low-cost moulage, and many studies address that it can be as simple as using homemade ingredients. Students from a previous study have talked about their opinions regarding the realistic component of moulage and whether if it is any different from other moulages. Most of the students agreed that the moulage ranked well in face and content validity. However, further innovations must be introduced in the field to be widely spread and lead to newer opportunities. Conclusion: Although the research done under moulage is limited, it is accepted that moulage is helpful for simulation-based studies and that low-cost moulage can help make medical studies a better experience for students studying it. Students have a favorable opinion on the realistic aspect of the low-cost moulage applied to them. Newer methods can be introduced to moulage, and it can be implemented in low-income countries.

Background: Simulations have historically aided training programs by providing a realistic and holistic replication of professional scenarios and procedures. Simulations have developed over the past 40 years to include varying fidelities and modalities of simulation. Learning in a simulation-centered environment has benefits, ranging from improved patient care to specific skills acquisition while catering to students’ numerous and varied learning approaches. Simulation is a multifaceted field that benefits all parties, the teachers, the learners, and the patients. The application of simulation to medical education and its amalgamation with other modes and substitutes allows for a more integrated learning and testing curriculum that advances the current trajectory of medical education. Such developments, however, are limited to resource rich areas, leaving behind low-middle income countries to use traditional, less evolved methodologies and practices. This review aimed to explore different aspects of simulation and focus specifically on low-cost task trainers and their accessibility. Method: The purpose of the study was to assess the accessibility of low-cost task trainers in terms of cost-effectiveness, distribution, validation, and frequency within specific specialties. To do so, 84 PubMed publications have been screened, and 39 filtered research studies have collected the necessary data. After analyzing the papers, we classified the following information – process, specialization, validation (y/n), costs, development location, and year of publication. Results: After carefully analyzing the accumulated data from the selected 39 publications, we found that most studies (i.e., 6 out of 39) were published in 2020. Emergency Medicine was the most common specialty for which low-cost trainers were developed (9 out of 39 procedural simulators); Otolaryngology followed this with 8 out of 39 trainers and general surgery with 7/39 of the task-trainers. The price ranges fluctuated and fell within the price bracket of USD 0 to USD 400 collectively. Our review also uncovered the concentration of development of such innovations solely in high income countries (HICs). Conclusion: Simulation is an invaluable tool applicable to a diverse range of phases of medical education. Future conjunction of simulation with low-cost substitutes along with increased encouragement and enthusiasm towards developing cost effective simulation-based learning environments (SBLEs) with the reserves and requirements of these areas in mind may prove to be a reliable option for low and middle resource settings

Background. Until now, cost of allergy treatment in insured public health care system and non-insured self-financing private health care system in Indonesia has not been well documented and published, as well as the cost of allergy treatment with subcutaneous immunotherapy. Objective. To evaluate the clinical and cost benefits of allergic rhinitis treatment in children with subcutaneous immunotherapy in non-insured self-financing private health care system. Methods. A retrospective cohort study conducted from 2015 until 2020, compared clinical improvement and health care costs over 18 months in newly diagnosed AR children who received SCIT versus matched AR control subjects who did not receive SCIT, with each group consisting of 1,098 subjects Results. Decrease of sp-HDM-IgE level (kU/ml) from 20.5 + 8.75 kU/ml to 12.1 + 3.07 kU/ml had been observed in the SCIT group. To reduce the symptom score of allergic rhinitis by 1.0 with SCIT it costs IDR 21,753,062.7 per child, for non SCIT it costs IDR 104,147,878.0 per child. Meanwhile, to reduce the medication score (MS) by 1.0 with SCIT it costs Rp. 17,024,138.8 while with non SCIT it costs Rp. 104,147,878.0. Meanwhile, to lower combination symptoms and medication score (CSMS) by 1.0, with SCIT it costs IDR 9,550,126.6, while with non SCIT it costs IDR 52,073,938.9. Conclusion. In conclusion, this first Indonesia-based study demonstrates substantial health care cost savings associated with SCIT for children with AR in an uninsured private health care system and provides strong evidence for the clinical benefits and cost-savings benefits of AR treatment in children.

It is often difficult to extract data on material and energy wates and related costs in the value chain of conventional production units. Many organizations are not fully aware of the actual cost of material and energy waste. For this purpose, advanced costing methods should be used. This study uses material and energy flow cost accounting to determine material costs, losses, and waste management. The case study of this research is the construction of turbine blades in Iran Power Plant Company. In this study, using the extracted data, the construction costs of turbine blades have been studied. The conventional method of making a turbine blade is the machining method, which we will see has a huge amount of wastes of materials and energy. By studying different methods, we will find that there is an alternative method called forging, which reduces losses and costs. Finally, the costs of the two methods are compared. Engineering economics techniques have also been used to compare two methods on a long-term planning horizon.

Introduction: Pharmaceutical products are inevitable for human health. Owing to the growing need for pharmaceuticals, pharmaceutical companies introduce drugs annually into the market in addition to the extensive collection of existing pharmaceutical products. Households, farms, health facilities, and pharmaceutical industries release pharmaceutical waste into the environment at low concentrations through routine pharmaceutical use, damage, and expiry. The effects of active pharmaceutical ingredients (API) on non-target species in the environment are not known. Over the years, pharmaceuticals such as diclofenac and ibuprofen in trace amounts have been detected in public water systems, ground and surface water. Unwanted medicines should be safely disposed of at a reduced financial cost to mitigate the public and environmental health risks. Lack of general knowledge of how to dispose of unused pharmaceuticals leads to improper disposal resulting in accidental toxicity, rising healthcare costs, landfills pilfering/scavenging, water supply pollution, anti-microbial resistance, and death. To mitigate such effects, pharmacists should raise public awareness about safe disposal practices. Objective: This review aims to examine the sources of pharmaceutical waste, disposal costs, secure disposal methods, the effects of inappropriate disposal, and the role of pharmacists in the disposal. Method: The information on the stated objectives was gathered from available sources through a comprehensive literature review. Conclusion: Many countries contain tons of pharmaceutical waste that are expensive to destroy. Because of improper disposal, pharmaceutical waste has been found at trace amounts in drinking and surface water. A practical, environmentally sustainable approach to pharmaceutical waste management, with policies and guidelines, and public awareness campaigns, are necessary to address the problem of safe waste disposal. The national drug regulatory bodies should conduct environmental risk assessment resulting from the disposal of unwanted pharmaceuticals. Pharmacists should facilitate extensive training on sustainable drug use and proper pharmaceutical waste disposal at all levels to reduce the risks associated with improper disposal. Reduction of pharmaceutical waste generation at each step of a drug’s lifecycle, implementing takeback options, collection at approved sites, and modern technology to treat wastewater are highly recommended to reduce the effects of unwanted pharmaceuticals on human health and the environment.

The Planning and implementation of construction projects are difficult processes and are burdened with many risk elements. The budget spread over time, which is developed on the basis of the schedule, presents the expected distribution of costs throughout the duration of the works, which during the implementation of the project is subject to constant changes resulting from time, cost and organizational factors. Managing construction contracts requires managers to be able to analyze on an ongoing basis the variances of production costs - from the values calculated in the offer cost estimate and assumed in the Budgeted Cost of Work Scheduled. The article attempts to analyze the emerging time and cost deviations using proprietary T/S and T/C monitoring, based on simple indicators of the EVM method. An example of construction of a multi-family housing development was used to study the variances of planned and incurred costs.

Planning and implementation of construction projects are difficult processes and are burdened with many risk elements. The budget spread over time, which is developed on the basis of the schedule, presents the expected distribution of costs throughout the duration of the works, which during the implementation of the project is subject to constant changes resulting from time, cost and organizational factors. Managing construction contracts requires managers to be able to analyze on an ongoing basis the variances of production costs - from the values calculated in the offer cost estimate and assumed in the Budgeted Cost of Work Scheduled. The article attempts to analyze the emerging time and cost variances using proprietary C-S and S-C monitoring, based on simple indicators of the EVM method. An example of construction of a multi-family housing development was used to study the variances of planned and incurred costs.

In the last years, the development of low-cost GNSS sensors allowed monitoring in a continuous way movement related to natural processes like landslides with increasing accuracy and limited efforts. In this work, we present the first results of an experimental low-cost GNSS continuous monitoring applied to the unstable slope affecting the Madonna del Sasso Sanctuary (NW Italy). The courtyard of Sanctuary is built of two unstable blocks delimited by high cliff. Previous studies and non-continuous monitoring showed that blocks suffer a seasonal cycle of thermal expansion and long-term trend to downslope of few millimeters per year. The presence of continuous monitoring solution, could be an essential help to better understand the kinematics of unstable slope and to recognize the beginning of a possible paroxysm phase that could end with a failure of the unstable area. We tested the accuracy of the instruments and the first year of experimental measurements are presented. We also propose a methodological approach that considers the use of automatized procedures for the identification of anomalous trends and a risk communication strategy based on monitoring data.

Project complexity is usually considered as one of main causes of cost overruns, resulting in poor performance and thus project failure. However, empirical studies focused on evaluating its effects on project cost remain lacking. Given this circumstance, this study attempts to develop the relationships between project cost and the multidimensional project complexity elements. We establish complexity as a multidimensional factor including the task, organization, market, legal, and environment complexities. This study uses an empirical evidence-based structural model to account for the relationships between project cost and project complexity. By doing so, a quantitative assessment of multi-dimensional project complexity has been developed. The findings suggest that task and organization complexities have direct effects on project cost, while market, legal and external environment complexities have indirect effects on project cost. The practical contribution is that the findings can improve the understanding of which dimension of complexity significantly influence project cost, and the need to focus efforts on strategically addressing that complexities.

Construction projects are usually operating in a complex and dynamic environment in which the accumulation of many interrelated factors causes high uncertainty. Construction projects are complex and frequently involve substantial uncertainties including process complicatedness, intricate organization structure, dynamic environment, and financial strain. The study aims to categorize the influencing factors into three groups, namely construction project system, economic-market climate, and external environment. It attempts to adopt a novel analysis tool to examine the relationship between the project cost and multiple influencing factors by using Bayesian SEM. While the Bayesian SEM method has been receiving increasing attention in exploring the relationship between latent variables, construction studies still heavily rely on the covariance-based SEM approach. This study introduces several advantages of Bayesian SEM that make it more flexible and powerful than covariance-based SEM and provides the foundation of Bayesian SEM estimation and inference by illustrating this method in a project cost application.

Construction projects are usually operating in a complex and dynamic environment in which the accumulation of many interrelated factors causes high uncertainty. Construction projects are complex and frequently involve substantial uncertainties including process complicatedness, intricate organization structure, dynamic environment, and financial strain. The study aims to categorize the influencing factors into three groups, namely construction project system, economic-market climate, and external environment. It attempts to adopt a novel analysis tool to examine the relationship between the project cost and multiple influencing factors by using Bayesian SEM. While the Bayesian SEM method has been receiving increasing attention in exploring the relationship between latent variables, construction studies still heavily rely on the covariance-based SEM approach. This study introduces several advantages of Bayesian SEM that make it more flexible and powerful than covariance-based SEM and provides the foundation of Bayesian SEM estimation and inference by illustrating this method in a project cost application.

The beginning of industrialization human being has observed a variety of environmental troubles in the world. This industrialization has not only brought growth and affluence but ultimately troubled the ecosystem. One of the crashes is visible, in form of water contamination. Here the current study heavy metal contamination of water body has been discussed. Effluents from a great number of industries viz., tannery, textile, pigment & dyes, paint, wood processing, petroleum refining, electroplating, leather etc., have a major amount of heavy metals in their wastewater. The conventional technique of handling heavy metal pollution includes chemical oxidation, chemical precipitation, ion exchange, reverse osmosis, membrane separation, electrodialysis etc. These processes are expensive, energy intensive and frequently related with generation of poisonous by-product. Therefore, the adsorption has been examined as a cost-efficient technique of elimination of heavy metals from wastewater. In the current study different low-cost adsorbent has been a review as an abatement of heavy metal contamination from wastewater. These adsorbent comprise materials of natural origin like peat moss, zeolites, clay, and chitin are found to be an effective agent for removal of deadly heavy metals like Pb, Cd, Zn, Cu, Ni, Hg, Cr etc. Separately from these, a variety of agricultural wastes like rice husk, waste tea, neem bark, black gram; Turkish coffee, walnut shell etc. were also known as a powerful adsorbent for heavy metal removal. at the side of that low-cost industrial byproduct like fly ash, lignin, iron (III) hydroxide and red mud, coffee husks, Areca waste, tea factory waste, sugar beet pulp, battery industry waste, blast furnace sludge, waste slurry, sea nodule remains and grape stalk wastes have been discovered for their technical possibility to eliminate toxic heavy metals from impure water.

Increasing distributed generation and intermittency, along with the increasing frequency of extreme weather events, impose a serious challenge for the electric power supply security. Understanding the costs of interruption is vital in terms of enhancing the power system infrastructure and planning the distribution grid. On the other hand, customer rights and demand response techniques are further reasons to study the worth of power reliability. In this paper, the authors make use of directional distance function and shadow pricing method for a case study from Finland. The aim is to calculate the cost of one minute of power interruption from the distribution network operator perspective. The sample consists of 78 distribution network operators from Finland with cost and network information between 2013 and 2015.

Widespread poverty is the most serious threat and social problem that Bangladesh faces. Regional vulnerability to climate change threatens to escalate the magnitude of this poverty. It is essential that projections of poverty be made while bearing in mind the effects of climate change. The main purpose of this paper is to investigate the agrarian sub-national regional analysis of climate change vulnerability in Bangladesh under various climate change scenarios and its potential impact on poverty. This study is relevant to socio-economic research on climate change vulnerability and agriculture risk management and has the potential to contribute new insights to the complex interactions in household income and climate change risks to agricultural communities in Bangladesh and South Asia. The current study uses analysis of variance, cluster analysis, decomposition of variance and log-normal distribution to estimate the parameters of income variability that ascertain vulnerability levels and help us to understand the poverty levels that climate change could potentially incur. It is found that the income share in income sources revealed that income category shares across the various regions of Bangladesh are far from uniform. The variance decomposition of income showed that agricultural income in Mymensingh and Rangpur is the main cause of income difference. Moreover, large variance of agricultural income in the regions is induced by gross income from rice production. Additionally, constant reduction of rice yield due to climate change in Bangladesh is not such a severe problem for farmers, however, the extreme events like flood, flash flood, drought, sea level rise, and greenhouse gas emission based on RCPs could increase the poverty rates in Mymensingh, Rajshahi, Barisal, and Khulna regions that would be highly affected by unexpected yield loss due to extreme climatic events. Therefore, research and development of adaptation measures to climate change for regions where farmers are largely dependent on agricultural income is important.

This research proposes a framework to assist wind energy developers to select the optimum deployment site of a wind farm by considering the Round 3 zones in the UK. The framework includes optimisation techniques, decision-making methods and experts’ input in order to help stakeholders with investment decisions. Techno-economic, Life Cycle Costs (LCC) and physical aspects for each location are considered along with experts’ opinions to provide deeper insight into the decision making process. A process on the criteria selections is also presented and seven conflicting criteria are being considered in TOPSIS methods in order to suggest the optimum location that was produced by the NSGAII algorithm. Seagreen Alpha was the most probable solution, followed by Moray Firth Eastern Development Area 1, which demonstrates by example the effectiveness of the newly introduced framework that is also transferable and generic. The outcomes are expected to help stakeholders and decision makers to make more informed and cost-effective decisions under uncertainty when investing in offshore wind energy in the UK.

Rifampicin is one of the most important chemotherapeutic agents used in the treatment of tuberculosis. M. tuberculosis clinical strains resistant to rifampicin harbor mainly mutation in an 81-base pair region of rpoB. These mutations mainly consist of single amino acid substitutions. However insertions also can be related with rifampicin resistance strains. Herein, we described an insertion of 12 nucleotides in clinical isolates of M. tuberculosis resistant to rifampicin, all obtained from inmates. To evaluate the importance this insertion in surviving and drug resistance, it were carried out fitness experimental assays as well as in silico studies of 3D structural models, molecular docking simulations and virtual screening. The medical records of the seven patients showed all were previously treated to tuberculosis. Growth curves shown that the insertion determines a biological cost when compared to wild type rpoB and katG; or the double mutated rpoB S531L and katG S315T. From docking and molecular dynamics simulations it can be inferred that the insertion does not affect the process of synthesis of RNA transcripts. On the other hand, in the mutant RNAP-RIF complex rifampicin confirmed a low affinity interaction for the mutant form. Interesting, virtual screening for potential inhibitors for wtRNAP and mRNAP using a library of 1446 compounds approved by the FDA showed that the best ligands were mainly compounds with antibiotic activity, although the targets involved in the pharmacological action are other than RNAP. In conclusion, seven strains of M. tuberculosis RIF resistant that present an insertion of four amino acids in RNA polymerase showed by growth curve assays, a biological cost. Further, bioinformatics tools had characterized the putative drug resistance dynamic as well as the maintenance of RNA polymerase activity.

The pollution of the bays in Abidjan is a major concern for the Ivorian policy makers. In fact, the pollution of the bays induce high costs to the society while impacting population health dramatically. As a result, pollution reduction management of production activities has been undertaken in the Cocody Bay area. To our knowledge, no study has yet proposed a model to evaluate the cost-effectiveness of these pollution management strategies. A cost-effectiveness model, based on Monte Carlo simulation, was developed to assess the economic and environmental impacts of various scenarios characterized by a set of production practices, both in the short term and in the long term. The authors discuss the steps and input parameters of the model presented. The proposed model may serve as the basis for identifying an optimal production scenario defined as the scenario with the best incremental cost-effectiveness ratio considering a willingness to pay (WTP) threshold. The WTP, to be estimated based on the gross domestic product of Côte d’Ivoire, represents the opportunity costs associated with selecting the optimal scenario. The current framework can also be applied to other settings facing similar challenge.

As argued by ‘Declaration of Concrete Environment (2010)’ of Korea and ‘Declaration of Asian Concrete Environment (2011)’ of six Asian countries, concrete as a single material has lately shown extremely large impact on environmental issues such as climate change. Assessment of environmental impact from concrete material and production has considerable importance. Concrete is a major material used in the construction industry that emits a large amount of substances with environmental impacts during its life cycle. Accordingly, technologies for the reduction in and assessment of the environmental impact of concrete from the perspective of Life Cycle Assessment must be developed. At present, the studies in relation to greenhouse gas emission from concrete are being carried out globally as a countermeasure against climate change. In this study, a sustainable concrete mix design algorithm was designed using correlation analyses, and its carbon emission and cost reduction performances were assessed. Using correlation analyses, the concrete strength, w/b and s/a ratios, and CO₂ emissions were identified as major variables of concrete mix design that influenced other variables. Also, this study aims to evaluate the CO₂ emission reduction performance of the algorithm-deduced sustainable concrete mix design, and therefore, the CO₂ emissions of the sustainable concrete mix design are compared with those of the actual concrete mix design applied to the construction of the office building A in South Korea.

The purpose of this study is to examine the relationship between the institutional investors which can affect financial performance for corporate sustainability on the income smoothing. Therefore, this study focus on the connection between the nature of stock rights and income smoothing in China. For this study, hypotheses were established on the relationship each state-controlled companies, income smoothing, and information equilibrium of individual investors, and empirical analysis was conducted through related variables. The analysis results are summarized in three categories as follows. First, this research finds that state-controlled firms (CONTs) prefer income smoothing activities compared to non-state-controlled firms for the long-term sustainable development of firms using data from 2011 to 2019. Second, this study found out that Institutional investors support the behavior of CONTs to smooth their earnings because this behavior is seen as an attempt by CONTs to convey valuable private information to other investors. Third, we was able to discover that institutional investors' monitoring effect is predominantly driven by pressure-resistant institutional investors. This research complements the lack of empirical research on income smoothing and enable to give a guideline that the type of stock rights is a critical key determinant of participation in income smoothing activities for stable growth and sustainability in the future.

Cement industry is one of the highest energy consuming industries. The quantity of fuel and energy needed accounts for most of the cost of cement manufacturing. Thermal power plants generate electricity but are harmful and ineffective by nature. As a backup mechanism to account for main grid failures, batteries can be utilized. In this paper the first ever investigation on battery’s depth of discharge (DOD) for four different kinds of battery technologies is carried out in the framework of cement industry. The intended battery technologies are the lead-acid battery (LA), lithium-ion battery (Li-ion), vana-dium redox battery (VR), and nickel–iron battery (Ni-Fe). Four hybrid energy generation models (HEGMs) for five cement plants of Pakistan using the HOMER pro software are proposed. Cement plants includes Askari Cement Plant, Wah (ACPW); Bestway Cement Plant, Kalar Kahar (BCPKK); Bestway Cement Plant, Farooqia (BCPF); Bestway Cement Plant, Hattar (BCPH); and DG Cement Plant, Chakwal (DGCPC). HEGM-1 comprises of a diesel generator (DGen), a photovoltaic system (PV), a converter, and a battery system. HEGM-2 comprises of a PV system, a converter, and a battery system. HEGM-3 is the grid-connected version of HEGM-1 and HEGM-4 is the grid-connected version of HEGM-2. A base-model consisting of grid only is used as a reference. A multi-criteria decision analysis (MCDA) is performed by formulating a cumulative objective function (COF) which includes net present cost (NPC), levelized cost of energy (LCOE), and greenhouse gas (GHG) emissions. The principal objective is the maximization of COF while simultaneously minimizing the objectives (NPC, LCOE and GHG emissions), based on optimal battery technology and DOD. The results reveal that VR is the most suitable battery technology with 10% DOD. It is achieved for DGCPC with HEGM-3 with 61.49% of NPC, 78.62% of LCOE and 84.00% of GHG emissions reduction as com-pared to the base model.

BACKGROUND: The National Lung Screening Trial (ILST) and the NELSON study showed that lung cancer-specific mortality can be reduced by 20-24% using low-dose computed tomography (LDCT) screening in high-risk populations, due to an increase in early-stage diagnoses. RESEARCH QUESTION: How much lung cancer-related direct costs may be reduced using a LDCT screening programme based on the ILST protocol in a public healthcare system?STUDY DESIGN AND METHODS: Cost analysis of lung cancer screening (LCS) vs. usual care in the framework of the retail price of the Catalan public healthcare system. The LCS group included costs of screening (ILST protocol), treatment cost according to weighted average distribution of TNM staging in the NLST and NELSON trials, lung cancer detection rate (CDR) and smoking cessation intervention. The usual care group included treatment costs based on distribution of TNM staging registered in the Spanish index hospital. RESULTS: In the usual care group, treatment costs were €91,959. In the 5-year duration of the LCS programme, the average expected costs per subject were €1,342 (range €1,054-1,832 depending on malignancy in detected nodules) for screening and €32,431 for treatment, with an expected reduction of €952 based on an average CDR of 1.6%. The decrease in cost resulting from stage shift offsets 70.6% of the costs of the screening programme. INTERPRETATION: Baseline 5-year LCS costs are low according to the ILST protocol. In the Catalan public healthcare system, the expense reduction from the stage shift due to the LCS programme compensates a substantial part of its costs.

As China put forward its “carbon emissions peak and carbon neutrality” goals, how to achieve carbon reduction had become a key for China’s goal. The manufacturing industry is an important source of carbon dioxide emissions. For a manufacturing country like China, adjustments in various aspects of the industry would have a huge impact on carbon emissions. As an important reform of contemporary production mode, the process of production automation in China will inevitably affect China's carbon emissions. Therefore, the analysis of the impact of production automation on carbon dioxide emissions was an important basis for judging the future carbon reduction in China. Refer to the traditional study of carbon Kuznets curve, this paper analyzed the impact of average wage on production automation and the role of production automation in the carbon Kuznets curve(CKC). This paper proposed that production automation plays a mediating role in the process of carbon emissions, and gives a verification model of the mediating role. By analyzing the relationship between average wage and production automation process, the U-shaped curve relationship between them was verified. By examining the relationship between carbon dioxide emission data and production automation industry in China, we verified that production automation plays a partial mediating role in the change of carbon Kuznets curve. Combined with the analysis of the two parts, this paper believed that with the continuous development of China's intelligent manufacturing industry, China's carbon reduction prospects were more optimistic, and there was a good industrial foundation to achieve the “carbon peaking and carbon neutrality” goals. Finally, this paper proposes policy suggestions as increase research investment in production automation, help promote the application of production automation, encourage the research and application development of low-carbon technology, especially encourage modular design, so as to give full play to the role of production automation in the process of carbon neutrality in China.

Primary and secondary cardiovascular prevention is less effective than expected due to the concern about polymedication by professionals and the lack of patient adherence to medications prescribed in the medium and long term. Polypills have been presented as a possible solution. A comprehensive bibliographic review is presented about polypills as mechanisms for facilitating adherence and a proposed guide for the use of polypills for the prevention of cardiovascular risk. 41 articles were included, showing options for the polypill as a method of primary and secondary cardiovascular prevention.The polypill increases therapeutic adherence in the medium and long term, also increasing the therapeutic results compared to the administration of the various drugs separately. Based on the evidence, a flow diagram is proposed for the prescription of a polypill.Polypills increase the effectiveness and adherence of patients to primary and secondary cardiovascular prevention programs, without increasing the cost of the intervention. The use of a polypill in cardiovascular prevention can be effective as a prescription tool.

River valley bottoms have hydrological, geomorphological, and ecological importance and are buffers for protecting the river from upland nutrient loading coming from agriculture and other sources. They are relatively flat, low-lying areas of the terrain that are adjacent to the river and bound by increasing slopes at the transition to the uplands. These areas have under natural conditions, a groundwater table close to the soil surface. The objective of this paper is to present a stepwise GIS approach for the delineation of river valley bottom within drainage basins and use it to perform a national delineation. We developed a tool that applies a concept called cost distance accumulation with spatial data inputs consisting a river network and slope derived from a digital elevation model. We then used wetlands adjacent to rivers as a guide finding the river valley bottom boundary from the cost distance accumulation. We present results from our tool for the whole country of Denmark carrying out a validation within three selected areas. The results reveal that the tool visually performs well and delineates both confined and unconfined river valleys within the same drainage basin. We use the most common forms of wetlands (meadow and marsh) in Denmark's river valleys known as Groundwater Dependent Ecosystems (GDE) to validate our river valley bottom delineated areas. Our delineation picks about half to two-thirds of these GDE. However, we expected this since farmers have reclaimed Denmark's low-lying areas during the last 200 years before the first map of GDE was created. Our tool can be used as a management tool, since it can delineate an area that has been the focus of management actions to protect waterways from upland nutrient pollution.

The residential sector in the United States is in need of comprehensive policy-making reforms that concurrently address housing affordability and environmental sustainability. This study investigates the feasibility of state-wide zero-energy affordable housing by analyzing historical data on climate, energy use, and solar system costs in the Commonwealth of Virginia. The hypothesis examined is that the net present cost of implementation of rooftop residential solar systems to achieve zero-energy Low-Income Housing Tax Credit (LIHTC) buildings is lower than the discounted present cost of energy of otherwise identical conventional buildings that run without renewable energy generation systems. The authors propose a generalizable framework for analyzing the feasibility of achieving region- or state-wide zero-energy LIHTC developments. To validate the framework, the authors employ a longitudinal sample of monthly energy use data from 2013-2016 obtained from 310 residential units of 15 LIHTC developments across the state. Based on statistical regression analysis, energy simulation, and simulation-based risk analysis, the authors find that the net present value of zero-energy LIHTC investments can be positive with a low risk. The investment value varies often depending on the zero-energy building definition, weather characteristics, retail price of electricity, and incentive rate. This study can help housing policymakers and industry professionals analyze and benchmark the feasibility of innovative zero-energy housing policies and projects.

Microsystems are key enabling technologies, with applications found in almost every industrial field, including in-vitro diagnostic, energy harvesting, automotive, telecommunication, drug screening, etc. Microsystems, such as microsensors and actuators, are typically made up of components below 1000 microns in size that can be manufactured at low-unit cost through mass-production. Yet, the development of microsystems for commercial or educational purposes, has typically been limited to upper income countries due to the initial investment costs associated with the microfabrication equipment and processes. However, recent technological advances have enabled the development of low-cost microfabrication tools. In this paper, we describe a range of low-cost approaches and equipment (below £1000), developed or adapted and implemented in our laboratories. We describe processes including photolithography, micromilling, 3D printing, xurography and screen-printing used for the microfabrication of structural and functional materials. The processes that can be used to shape a range of materials with sub-millimetre feature sizes are demonstrated here in the context of Lab-on-Chips, but they can be adapted for other applications. We anticipate that this paper, which will enable researchers to build a low-cost microfabrication toolbox in a wide range of settings, will spark a new interest in microsystems.

Face milling is a well known commercial process highly used in heavy industries that consumes high amount of power. Besides power issue, modern manufacturing industries are aiming for per part cost reduction keeping the product quality unimpaired. Unexpectedly if the part is rejected in any stage of manufacturing, the cost of manufacturing dramatically increases. Major cause of part rejection is excessive tool wear that imparts poor surface profile or catastrophic tool failure that causes adherence of broken tool debris onto machined surface. Furthermore, the tool wear is associated with sliding distance (frictional distance) and the tool life quantifies the cost of tools. As such, from the perspective of manufacturing industries it is imperative to optimize the surface quality parameter, cost of part, power consumption, and material removal – this is exactly what is accomplished here. By this work, it is possible to conserve power consumption, produce parts with lower cost, manufacture with uncompromising surface quality and enhanced material removal rate. Moreover, as intermediate factors of interest, the influences of sliding distance, tool life and tool flank wear on the overall machining performance are evaluated. The multi-objective optimization by Grey Relational Analysis (GRA) revealed that for improved product performance and fast manufacturing (case 1) optimum results are: feed per tooth fz = 0.25 mm/tooth, cutting speed vc = 392.6 m/min and cutting length l = 0.5 mm; for resource conservation (case 2) the optimum results are: feed per tooth fz = 0.125 mm/tooth, cutting speed vc = 392.6 m/min, cutting length l = 0.5 mm.

Information regarding the cost of a construction project is available to the investor and project participants in order to determine the subsequent success of a project, given that the information they collect has an impact on the decisions they make. Cost calculations, especially in the initial phase of a project, often generate large errors. This paper presents the new approach based on a combination of the Case Based Reasoning method (CBR) with the originally selected criteria for the description of a construction project (as a result of Pearson correlation coefficient and Spearman's rank correlation coefficient) and Building Information Modeling (BIM) technology. The CBR method fulfils expectations for a simple and fast system supporting the cost estimation process. It does not require any specialist knowledge, so it will be comprehensible to cost estimation practitioners. The BIM-based model gives the opportunity for the calculation of quantity take-offs and enables the use of the information contained in the BIM model in the cost estimation process. In order to prepare the model an appropriate relational database had to be developed. With extensive research, a database of 173 construction projects, including the construction of a sports field, was obtained. There were 14 variables defined originally by authors; however, only 10 (as a result of the correlation analysis) were used for the calculation. Data related to the project were collected in the BIM model. Results estimating the project’s unit price, using the CBR method, were presented and discussed. The Mean Absolute Estimate Error was used to evaluate the model.

In this study, the probabilistic exergoeconomic analysis was performed for four industrial gas turbine (GT) units comprising of two (GT16 and GT19) units of 100MW GE engine and two (GT8 and GT12) units of 25MW Hitachi engine at Transcorp Power Limited, Ughelli. These four industrial GT engine units were modelled and simulated using natural gas as fuel. The design point (DP) simulation results of the modelled GT engines were validated with the available DP thermodynamic data from original equipment manufacturer (OEM). This was done before the off-design point (ODP) simulation was carried out which represents the plant operations. The results obtained from exergy analysis at full load operation show that the turbine has the highest exergy efficiency followed by compressor and combustion having the least. For turbines these were 96.13% for GT8 unit, 98.02% for GT12 unit, 96.26% for GT16 unit, and 96.30% for GT19 unit. Moreover, the combustion chamber has the highest exergy destruction efficiency of 55.16% GT8 unit, 56.58% GT12 unit, 43.90% GT16 unit, and 43.30% GT19 unit respectively. The exergy analysis results obtained from the four units show that the combustion chamber (CC) is the most significant exergy destruction with lowest exergy efficiency and highest exergy destruction efficiency of plant components. The exergoeconomic analysis results from four units showed combustion chamber energy destruction cost of 531.08 $/h GT8 unit, 584.53 $/h GT12 unit, 2351.81$/h GT16, and 2315.93$/h GT19 unit. The probabilistic results analysis based on the input parameters distributions evaluated and discussed.

Background: Real-time remote monitoring of pulmonary artery pressures has previously shown to reduce heart failure (HF) related hospitalisations and to improve quality of life of selected HF patients. The value of CardioMEMS in Southern Europe, where healthcare costs are significantly lower, remains uncertain. Objective: To evaluate the cost-effectiveness of the CardioMEMS HF system in the Spanish healthcare setting. Methodology: This single-centre study included 35 HF patients with a CardioMEMS device (treatment group) and compared them with similar patients receiving standard HF treatment (control group). The Propensity Score Matching method was used and the comparators were found using the variables age, sex, New York Heart Association class, left ventricular ejection fraction, and diabetes mellitus. Cost-effectiveness was measured as the incremental cost per quality-adjusted life year gained. Results: The CardioMEMS HF system outperformed usual management with a net monetary value difference of 2,731€ per patient at 1 year. The incremental cost per quality-adjusted life year gained was 15,896€. Results were consistent in the sensitivity analyses performed. Conclusion: This analysis suggests that remote monitoring of pulmonary artery pressure with CardioMEMS HF system is a cost-effective strategy in the Spanish healthcare setting.