Hyperglycemia is associated with increased length of stay and total cost in patients hospitalized for congestive heart failure

Objectives: Hyperglycemia is a well-known marker of poor clinical outcomes in acute myocardial infarction and critical illness;however, its effect in congestive heart failure (CHF) is controversial. We hypothesized that persistent hyperglycemia is associated with increased length of stay (LOS) and increased total cost in patients admitted with CHF. Methods: We studied 203 consecutive patients admitted with a primary diagnosis of CHF. Patient characteristics, admission glucose, mean blood glucose (MBG) during the entire hospital stay, length of stay, total cost, and readmission rates were assessed. Persistent hyperglycemia was defined as a MBG level ≥140 mg/dl. Results:Patients with persistent hyperglycemia had longer mean LOS (8.1 vs 5.2 days, p = 0.001) and higher total hospital costs (median $8940 vs $6892, p = 0.01) independent of diabetes status. Similarly, prolonged hospital stay >7 days (38% vs 21%;p = 0.01) and total cost >$10,000/patient (46% vs 29%;p = 0.01) were seen more commonly in patients with poor glucometrics. Neither admission glucose >140 mg/ dL or diabetes status was predictive of total costs or LOS. In multivariate linear regression, only MBG ≥ 140 mg/dl was associated with increased LOS and total cost. Patients with persistent hyperglycemia also had higher 6 months all-cause readmission rates (51% vs 37%;p = 0.03). Conclusion: Persistent hyperglycemia (MBG > 140 mg/dL), but not admission glucose, was associated with increased LOS, total cost and readmission rates independent of diabetes status. Our study emphasizes the need to further examine the role of glycemic control in patients admitted with CHF.

Reducing costly falls after total knee arthroplasty

AIM To investigate whether adductor canal nerve block(ACB) reduces patient falls when compared to femoral nerve block(FNB) after total knee arthroplasty(TKA). METHODS We conducted an institutional review of all-cause falls after TKA from January 2013 to August 2016 using a quality improvement database. Our inclusion criteria were patients with diagnosis of primary knee osteoarthritis who underwent primary unilateral TKA with either a FNB or an ACB and sustained a fall during their hospitalization. We excluded patients who had revision TKA and extensor mechanism reconstruction. We also excluded patients with a history of post-traumatic arthritis, prior history of lower extremity fracture, history of neurological disease, or cerebrovascular disease. RESULTS A total of 834 patients had TKA with femoral nerve block and knee immobilizer(FNB + KI). Of those patients, 11(1.3%) experienced a fall during their hospital stay. In contrast, 791 patients had TKA with ACB. Of those patients, only one(0.13%) patient fall was recorded within this group. We used the Fisher's exact test to compare the differences between the two groups. The difference between the two groups achieves statistical significance(P = 0.006). We also found that 11 out of the 12 patients that fell had a right TKA procedure while one patient had a left TKA procedure. Nine out of twelve patients that fell were female, while only three patients were male.CONCLUSION Given the reduction in the number of falls with ACB, it is recommended that ACB be considered the preferred analgesia for patients undergoing a TKA procedure.

Charging Ahead with E-Buses: Benefits, Costs, and Transition Roadmap

This paper reaches a recommendation for the 10-year e-bus transition roadmap for New York City. The lifecycle model of emission reduction demonstrates the ecological and financial impacts of a complete transition from the current diesel bus fleet to an all-electric bus fleet in New York City by 2033. This study focuses on the NOx pollution, which is the highest among all major cities by Environmental Protection Agency (EPA) and greenhouse gases (GHG) with annual emissions of over five million tons. Our model predicts that switching to an all-electric bus fleet will cut GHG emissions by over 390,000 tons and NOx emissions by over 1300 tons annually, in addition to other pollutants such as VOCs and PM 2.5. yielding an annual economic benefit of over 75.94 million USD. This aligns with the city mayor office’s initiative of achieving total carbon neutrality. We further model an optimized transition roadmap that balances ecological and long-term benefits against the costs of the transition, emphasizing feasibility and alignment with the natural replacement cycle of existing buses, ensuring a steady budgeting pattern to minimize interruptions and resistance. Finally, we advocate for collaboration between government agencies, public transportation authorities, and private sectors, including electric buses and charging facility manufacturers, which is essential for fostering innovation and reducing the costs associated with the transition to e-buses.

Artificial Intelligence Integration with Energy Sources (Renewable and Non-renewable)

In the past decade or so,AI(artificial intelligence)technology has been growing with such a mesmerizing speed that today its presence in almost any industry that deals with any huge sheer volume of data is taking advantage of AI by integrating it into their day-to-day operation.Meanwhile,seven billion people worldwide shape the world’s energy system and directly impact the fundamental drivers of energy,both renewable and non-renewable sources,to meet the demand for electricity from them.These energy sources can be reached from nature such as solar,wind,etc.,and human-made such as NPPs(nuclear power plants)in the form of either fission as an old technology since the Manhattan project and in the near future as fusion in the form of magnetic or inertial confinements.Meanwhile,AI controlling nuclear reactors are about to happen.The basic idea is to apply AI with its two subset components as ML(machine learning),and DL(deep learning)techniques to go through the mountains of data that come from a reactor,spot patterns in it,and calling them to the unit’s human attention operators is not invadable either.Designers of such nuclear reactors will combine simulation and real-world data,comparing scenarios from each to develop“confidence[in]what they can predict and what is the range of uncertainty of their prediction”.Adding that,in the end,the operator will make the final decisions in order to keep these power plants safe while they are in operation and how to secure them against cyber-attack natural or human-made disasters.In this short communication article,we would like to see how we can prove some of these concepts;then a NPP manufacturer can pick it up and use it in their designs of a new generation of these reactors.

Use of antibiotic-loaded cement in total knee arthroplasty

Bone cement has the capacity to release antibiotic molecules if any antibiotic is included in it, and these elution properties are improved as cement porosity is increased. In vitro studies have shown high local antibiotic concentration for many hours or few days after its use. Antibiotic loaded bone cement(ALBC) is helpful when treating an infection in total knee arthroplasty(TKA) revision surgery. The purpose of this paper was to review the evidence for the routine use of ALBC in TKA in the literature, its pros and cons. Many authors have recommended the use of ALBC also in primary TKA for infection prophylaxis, but the evidence based on data from National Registries, randomized clinical trials and meta-analysis suggest a protective effect of ALBC against infection when used in hips, but not(or only mild) in knees. A possible explanation to this finding is that the duration and quantity of locally elevated antibiotic levels after surgery are smaller in TKA, due to the smaller amount of cement used for fixation in TKA-only a layer in the bone surface. There are some concerns about the routine use of ALBC in primary TKA as prophylaxis against infection: Firstly, there is a risk of hypersensivity or toxicity even when the chance is highly improbable. Secondly, there is a reduction in the mechanical properties of the cement, but this can be probably neglected if the antibiotic is used in low doses, not more than 1 g per 40 g cement package. Another significant concern is the increased economic cost, which could be overlooked if there were enough savings in treating fewer prosthetic infections. Finally, there is also a risk of selection of antibiotic-resistant strains of bacteria and this could be the main concern. If used, the choice of the antibiotic mixed in ALBC should consider microbiological aspects(broad antimicrobial spectrum and low rate of resistant bacteria), physical and chemical aspects(thermal stability, high water solubility), pharmacological characteristics(low risk to allergic reactions or toxicity) and economic aspects(not too expensive). The most commonly used antibiotics in ALBC are gentamicin, tobramycin and vancomycin. In conclusion, there is a paucity of randomized clinical trials in the use of ALBC in primary TKAs and the actual evidence of the effect of ALBC in reducing the risk of infection is insufficient. This, in addition to concerns about patient safety, risks of increase in the antibiotic resistance of microorganisms and the increase in costs in the procedure, lead us to recommend a cautious use of ALBC, perhaps only in high-risk patients(immunocompromised, morbidly obese, diabetic and patients with previous history of fracture or infection around the knee) unless the benefits of ALBC use were fully proven. Meanwhile, the rigorous use of peri-operative prophylactic systemic antibiotics and adoption of efficient antiseptic procedures and improved surgical techniques must be considered the gold standard in infection prevention in TKA surgery.

Variable and Invariable,Explore the Value-Creation Techniques of Management Accounting by Benchmarking the Financial Management of Large Enterprises

With the development of information technology such as ChatGPT,artificial intelligence,5G,and so on,technological innovation brings about a qualitative change in the economic business.This change is embodied in breakthroughs in the field of science and technology and the iterative upgrading process of products.The traditional business model undoubtedly fails to adapt to the management needs of modern enterprises,while traditional financial practices and knowledge reserves cannot meet these needs.Faced with sudden technological changes and the emergence of financial sharing,financial robots,etc.,there is an urgent need for financial practitioners to transform from traditional financial accounting to value-creating management accounting.In the future,financial professionals with the ability to embrace uncertainty,adapt to environmental changes,and find breakthroughs in uncertain environments will be the most sought-after by enterprises.This paper aims to benchmark the excellent financial management models of large enterprises and conduct thematic research on financial management in large enterprises.It seeks to explore,in the era of big data management accounting,the road and art of creating value in enterprises.The objective is to provide references for colleagues in the financial field and to explore effective ways to generate value for enterprise management ideas,thus serving as a reference point in the financial transformation journey.

Research on Property Rights, Revenue Transparency and Equity Financing Costs ——Based on the Perspective of CEO Overconfidence

This paper takes the Chinese listed company with the equity refinancing qualification from 2012 to 2013 as the research object, and uses the residual revenue model to calculate the equity financing cost. This paper discusses the impact of the overconfidence of executives on the equity financing cost and its impact mechanism. The unique institutional background examines the differences in property rights characteristics. The research found that:(1) executive overconfidence has a negative impact on the cost of equity financing, executives tend to be overconfident, the higher the equity financing cost of the company;(2) the overconfidence of executives to state-owned enterprises compared to private enterprises The negative impact of financing costs is more significant;(3) in addition, this paper also examines the potential impact mechanism of executive overconfidence on the cost of equity financing. The quality of information disclosure and the risk of investor prediction have a mediating effect on the impact of executive overconfidence on equity financing costs.

Financial Statement Valuations in Italian Accounting Thought Between the 19th and the 20th Century： From ＂Exchange Value＂ to ＂Historical Cost＂

The main subject of this paper is the theory of financial statement valuations observed in its historical development. More notably, regarding the subject, the research is concerned with some theoretical concepts developed by the Italian doctrine in a very specific age, namely, between the 19th and the 20th century, which in fact, devoid of any accounting regulation. This paper analyzes in particular the shift from the exchange value rule to the historical cost method and tries to explain the reasons of such a development. In the second half of the 19th century, some of the best Italian scholars, who were faced with the need to properly develop the problem of accounting valuations, thought that it was appropriate to rely on concepts that belonged to similar sciences, such as economics and real estate appraisal, by blindly borrowing the theory of value from the former and the theory of valuations from the latter. During that age, everything hinged around the concept of exchange value. At the dawn of the 20th century, the Italian accounting doctrine began to wonder about a subject that was crucial to the financial statement theory： the informative purposes underlying the financial statements. At the same time, the first principle took shape, which might be called as the ＂finalistic principle of value＂. It is still the basis of the theory of financial accounting measurements, for which different evaluative criteria must be applied to different informative purposes. Thus, an alternative criterion to that of the exchange value makes its appearance on the scene of the accounting valuations, notably the historical cost. The introduction of the historical cost criteria and above all the relinquishment of the combination of the ＂economic cost＂ in favor of that of the ＂manufacturing cost＂ allow the Italian accounting to get rid of the theories of economics and real estate appraisal, thus, becoming independent regarding the financial statement valuations.

Socio-demographic factors impact time to discharge following total knee arthroplasty

AIM To determine social, logistical and demographic factors that influence time to discharge in a short stay pathway(SSP) by following total knee arthroplasty(TKA). METHODS The study included primary TKA's performed in a highvolume arthroplasty center from January 2016 through December 2016. Potential variables associated with increased hospital length of stay(LOS) were obtained from patient medical records. These included age, gender, race, zip code, body mass index(BMI), number of pre-operative medications used, number of narcotic medications used, number of patient reported allergies(PRA), simultaneous bilateral surgery, tobacco use, marital status, living arrangements, distance traveled for surgery, employment history, surgical day of the week, procedure end time and whether the surgery was performed during a major holiday week. Multivariate step-wise regression determined the impact of social, logistical and demographic factors on LOS. RESULTS Eight hundred and six consecutive primary SSP TKA's were included in this study. Patients were discharged at a median of 49 h(post-operative day two). The following factors increased LOS: Simultaneous bilateral TKA [46.1 h longer(P < 0.001)], female gender [4.3 h longer(P = 0.012)], age [3.5 h longer per ten-year increase in age(P < 0.001)], patient-reported allergies [1.1 h longer per allergy reported(P = 0.005)], later procedure endtimes [0.8 h longer per hour increase in end-time(P = 0.004)] and Black or African American patients [6.1 h longer(P = 0.047)]. Decreased LOS was found in married patients [4.8 h shorter(P = 0.011)] and TKA's performed during holiday weeks [9.4 h shorter(P = 0.011)]. Non-significant factors included: BMI, median income, patient's living arrangement, smoking status, number of medications taken, use of pre-operative pain medications, distance traveled to hospital, and the day of surgery. CONCLUSION The cost of TKA is dependent upon LOS, which is affected by multiple factors. The clinical care team should acknowledge socio-demographic factors to optimize LOS.

Management Accounting Problems and Perspectives in the Local Government of Estonia： An Analysis From the Viewpoint of Parsons＇ Paradigm

This case study focuses on the current and future needs of the management accounting within the Tallinn city government and their potential relationships with the sustainability reporting. This analysis is based on the study carried out within the city organizations in 2011. The questionnaire drawn up by the authors includes several questions about the current management accounting tools of the city and their development and support needs. The authors also add some questions related to the sustainability reporting, which is obligatory for the city as one of the members of the Aalborg Charter. The quantitative methodology was used. The authors＇ conclusion is that the level of the managerial accountability of the Estonian municipality is increasing and its sole economic focus is changing to a broader perspective. According to the findings of the study, the authors argue that both management accounting principles and sustainability principles are coming closer together. By using Talcott Parsons＇ adaptation, goal attainment, integration, and latency （AGIL） paradigm, the authors point out four critical components for implementing the sustainability reporting into a management accounting system. The results of this study highlight the role of values in the management accounting development, which is in harmony with the AGIL paradigm.

企业数字技术创新对全要素生产率的影响——基于要素结构优化和管理效率提升的双路径

企业进行数字技术创新,不仅能够通过技术进步直接提高全要素生产率,而且可以通过赋能其他生产要素并改善要素配置来间接提高全要素生产率。采用沪深A股上市公司2011—2022年的数据分析发现:企业的数字专利增加对全要素生产率具有显著的正向影响,表明企业进行技术创新能够显著提升其全要素生产率;数字技术创新能够提高企业员工中高学历人员和技术人员的比例以及技术资产占比,同时还能降低企业的信息不对称程度、管理费用和代理成本,表明数字技术创新可以通过优化要素结构和提升管理效率来促进企业全要素生产率提升;数字技术创新对国有企业、大型企业、成长性较高企业、西部地区企业的全要素生产率具有更强的提升作用;企业数字技术创新的全要素生产率提升效应在技术密集型行业、资本密集型行业、劳动密集型行业中依次减弱。因此,应将数字技术创新作为提高企业全要素生产率的着力点,政府、企业与高校三方联合共建数字技术人才高地,依托数字技术拓展企业的治理边界,并将企业家精神融入公司治理及技术创新的全过程。

企业数字化转型对可持续经营能力的影响研究

在数字经济迅猛发展的时代背景下,企业数字化转型是否会影响可持续经营是一个值得探讨的重要问题。本文以2011~2022年中国A股非金融类上市企业为研究对象,实证检验数字化转型对可持续经营能力的影响和作用机制。研究发现,企业数字化转型有助于提升可持续经营能力,且投资者关注发挥了明显的正向调节作用。进一步研究发现,企业数字化转型通过提高会计信息质量和全要素生产率两条路径来提升可持续经营能力。异质性检验发现,在国有企业和制度环境水平较高的地区中,数字化转型对可持续经营能力的提升作用更为明显。据此,不仅丰富了企业数字化转型经济后果的研究领域,也为企业如何提高可持续经营能力以实现高质量发展目标提供了合理可行的建议。

基于生命周期碳排放和总拥有成本的公交车队更新优化

为探索电能和氢能源作为常规公交替代燃料的优势和潜力,确定公交车队更新时序的优化方案,从生命周期的角度综合考虑碳排放和总拥有成本的影响,提出了一种混合整数规划模型.基于柴油、天然气、油电混合、纯电动和氢燃料电池5种动力类型公交的运营数据,分析了电力结构、制氢方式、车辆购置成本和氢能源使用成本的不确定性对车队更新方案的影响.结果表明:电动公交车是当前公交车队更新的最佳选择;在现有的车辆技术水平和制氢方式情景下,不宜选择氢燃料电池公交;在蓝氢或绿氢得到大规模商业化之前,不建议通过财政补贴的方式全面推广氢燃料电池公交;采用该方法可以在不同情景和预期目标下确定公交车队的更新优化方案,促进绿色可持续发展.

Comparison of implant related complications amongst patients with opioid use disorder and non-users following total knee arthroplasty

BACKGROUND The influence of opioid use disorder on implant related complications, infection and readmission rates, and total global episode-of-care costs following primary total knee arthroplasty(TKA) is limited.AIM To examine whether opioid abuse in patients undergoing primary TKA.METHODS A retrospective analysis of the Medicare dataset, using the PearlDiver database,from 2005-2014 comparing outcomes in patients with opioid abusers(OUD) to non-opioid abusers(NOU) undergoing primary TKA was performed. Patient outcomes were analyzed including implant complications, readmission rates, and day-of-surgery and 90-d cost. Statistical analysis was performed with R(University of Auckland, New Zealand) calculating odds-ratio(OR) along with their respective 95% confidence interval(95%CI) and P-values.RESULTS The OUD group was at greater odds of having implant related complications overall(20.84% vs 11.25%; OR: 2.07; 95%CI: 1.93-2.23; P < 0.001). Revision(OR:2.07; 95%CI: 1.11-3.84; P < 0.001), infection(OR: 1.92; 95%CI: 1.72–2.18; P < 0.001),periprosthetic fractures(OR: 1.83; 95%CI: 1.16-4.79; P < 0.001), and 90-dreadmission rates(OR: 1.47, 95%CI: 1.35-1.61, P < 0.001) were also significantly increased. OUD patients also incurred in higher day-of-surgery and total global 90-d episode-of-care costs compared to NOU.CONCLUSION Patients with OUD show an increased risk of complications compared to the nonopioid users group. Appropriate recognition, pre-surgical optimization, and patient education are essential to mitigate these complications and improve patient outcome.

Human Resource Accounting： Costs and Benefits Analysis

Human resource accounting is related with intellectual capital in literature. This study adds another dimension for human resource accounting field. It is costs, human resource management related costs. Research topic is intellectual capital and human resource costs in human resource accounting. Research question is that human resource accounting is technic of management accounting. Research methodology is the case study approaches. Main result of study is that human resource costs are recorded in financial accounting and this information might be used by human resource leaders and other executives. Further, human resource of company may be recorded as intellectual capital in balanced sheet. Quantity of record might become total compensation of firms. In conclusion, HR accounting is management accounting technic with its support for information role and decision-making role.

The development and change study of cost accounting in the IT environment

Relative to costs of computerized accounting, the cost accounting information further to get rid of the shackles of artificial accounting, reflecting a pure information management thinking, which contains a richer content, and traditional cost accounting theory a profound impact on the system. Clear understanding of the environment in the IT development process cost accounting will help us actively to promote cost accounting change, innovation and development.

Financial Modeling of Accounting Costs Acquisition of Arms

In case of restrictive defense budget financing, efficient and effective use of funds is now more than ever becoming a crucial question in functioning of the Ministry of Defense and Serbian Armed Forces （MoD and SAF）. Any investment in acquisition of arms and military equipment （AME） due to financial significance does not allow mistakes in decision making. Qualitative analysis of cost of assets through the entire programmed lifecycle is a complex multi-disciplinary and multi-criteria problem whose solving requires application of the model multi-criteria optimization. In our operational practice thus far, solving the said problems there wasn＇t enough the model multi-criteria optimization so the optimal results were lacking. In this paper investment process of AME in the MoD and SAF was analyzed, from the point of cost treatment in the process, its flaws have been pointed out and a more comprehensive - integrated approach has been suggested.

对抗性话语的底层概念及研究方法

国际地缘政治场域中错综复杂的矛盾与利益冲突已投射、产生一种新的频繁显现的话语方式——对抗性话语。本文从梳理哲学中的“矛盾”概念开始,然后系统讨论对抗性话语的界定特征及实证研究方法。研究揭示,毛泽东论述的对抗性矛盾是现今对抗性话语最重要和最直接的哲学概念基础,而维特根斯坦的语言游戏论可为对抗性话语研究提供分析工具。文章继而从话语动因、目标受众、话语方式与策略、评价标准等向度讨论话语对抗双方的攻防、博弈和较量特征。方法论上,本文主张采用基于语料库与人工智能技术相结合的路径,强调数据整体解释性与局部语境下意义识解的协同要义。

多主体外部监管合力可以助力企业提升全要素生产率吗?——基于多源监管大数据的视角

基于沪深A股上市公司2017—2022年数据,借助深度学习和大数据分析技术综合描述多主体外部监管大数据,验证外部监管合力对企业全要素生产率的驱动作用及具体驱动路径。研究发现,外部监管合力具有“信息效应”和“治理效应”,通过提高会计信息披露质量、降低双重代理成本、提升技术创新水平、优化资本配置效率,进而提升全要素生产率,助力企业打造新质生产力。进一步研究发现,由于企业成长性和外部制度环境不同,外部监管合力的监管驱动效应存在差异。研究丰富了多主体外部监管合力共促企业高质量发展的理论分析,为进一步推进企业加快形成新质生产力提供了政策参考依据。