Estimation of the Direct Cost of Management of Venous Thromboembolism in Three Reference Hospitals in the City of Yaoundé: A Retrospective Study over a Three-Year Period

Background: Venous thromboembolism (VTE) is a major public health problem due to its increasing frequency, mortality and management cost. This cost may require major financial efforts from patients, especially in developing countries like ours where less than 7% of the population has health insurance. This study aimed to estimate the direct cost of managing VTE in three reference hospitals in Yaoundé. Methods: This was a cross-sectional retrospective study over a three-year period (from January 1st 2018 to December 31 2020) carried out in the Cardiology departments of the Central and General Hospitals, and the Emergency Centre of the city of Yaoundé. All patients managed during the study period for deep vein thrombosis and pulmonary embolism confirmed by venous ultrasound coupled with Doppler and computed tomography pulmonary angiography respectively were included. For each patient, we collected sociodemographic and clinical data as well as data on the cost of consultation, hospital stay, workups and medications. These data were analysed using SPSS version 23.0. Results: A total of 92 patient’s records were analysed. The median age was 60 years [48 - 68] with a sex ratio of 0.53. The median direct cost of management of venous thromboembolism was 766,375 CFAF [536,455 - 1,029,745] or $1415 USD. Management of pulmonary embolism associated with deep vein thrombosis was more costly than isolated pulmonary embolism or deep vein thrombosis. Factors influencing the direct cost of management of venous thromboembolism were: hospital structure (p = 0.015), health insurance (p 0.001), type of pulmonary embolism (p = 0.021), and length of hospital stay (p = 0.001). Conclusion: Management of VTE is a major financial burden for our patients and this burden is influenced by the hospital structure, health insurance, type of pulmonary embolism and length of hospital stay.

A Hybrid Model for Improving Software Cost Estimation in Global Software Development

Accurate software cost estimation in Global Software Development(GSD)remains challenging due to reliance on historical data and expert judgments.Traditional models,such as the Constructive Cost Model(COCOMO II),rely heavily on historical and accurate data.In addition,expert judgment is required to set many input parameters,which can introduce subjectivity and variability in the estimation process.Consequently,there is a need to improve the current GSD models to mitigate reliance on historical data,subjectivity in expert judgment,inadequate consideration of GSD-based cost drivers and limited integration of modern technologies with cost overruns.This study introduces a novel hybrid model that synergizes the COCOMO II with Artificial Neural Networks(ANN)to address these challenges.The proposed hybrid model integrates additional GSD-based cost drivers identified through a systematic literature review and further vetted by industry experts.This article compares the effectiveness of the proposedmodelwith state-of-the-artmachine learning-basedmodels for software cost estimation.Evaluating the NASA 93 dataset by adopting twenty-six GSD-based cost drivers reveals that our hybrid model achieves superior accuracy,outperforming existing state-of-the-artmodels.The findings indicate the potential of combining COCOMO II,ANN,and additional GSD-based cost drivers to transform cost estimation in GSD.

Assessment of the Indirect Cost of Drug Resistant Tuberculosis Treatment to Patients in a High Burden, Low Income Setting in Mozambique

Introduction: Tuberculosis is closely linked to poverty, with patients facing significant indirect treatment costs. Treating drug-resistant tuberculosis further increases these expenses. Notably, there is a lack of published data on the indirect costs incurred by patients with drug-resistant tuberculosis in Mozambique. Objective: To assess the indirect costs, income reduction, and work productivity incurred by patients undergoing diagnosis and treatment for Drug-Resistant Tuberculosis (DRTB) in Mozambique during their TB treatment. Methods: As part of a comprehensive mixed-methods study conducted from January 2021 to April 2023, this research utilized a descriptive cross-sectional approach, incorporating both quantitative and qualitative methods. The primary goal was to evaluate the costs incurred by the national health system due to drug-resistant TB. Additionally, to explore the indirect costs experienced by patients and their families during treatment, semi-structured interviews were conducted with 27 individuals who had been undergoing treatment for over six months. Results: All survey participants unanimously reported a significant decline in labour productivity, with 70.3% experiencing a reduction in their monthly income. Before falling ill, the majority of respondents (33.3%) earned up to $76.92 monthly, representing the minimum earnings range, while 29.2% had a monthly income above $230.77, the maximum earnings range. Among those who experienced income loss, the majority (22.2%) reported a decrease of up to $76.92 per month, and 18.5% cited a loss exceeding $230.77 per month. Notably, patients with Drug-Resistant Tuberculosis (DRTB) have not incurred the direct costs of the disease, as these are covered by the government. Conclusion: The financial burden of treating Drug-Resistant Tuberculosis (DRTB), along with the income reduction it causes, is substantial. Implementing a patient-centred, multidisciplinary, and multisector approach, coupled with strong psychosocial support, can significantly reduce the catastrophic costs DRTB patients incur.

Numerical simulation for the initial state of avalanche in polydisperse particle systems

Numerical simulation is employed to investigate the initial state of avalanche in polydisperse particle systems.Nucleation and propagation processes are illustrated for pentadisperse and triadisperse particle systems,respectively.In these processes,particles involved in the avalanche grow slowly in the early stage and explosively in the later stage,which is clearly different from the continuous and steady growth trend in the monodisperse system.By examining the avalanche propagation,the number growth of particles involved in the avalanche and the slope of the number growth,the initial state can be divided into three stages:T1(nucleation stage),T2(propagation stage),T3(overall avalanche stage).We focus on the characteristics of the avalanche in the T2 stage,and find that propagation distances increase almost linearly in both axial and radial directions in polydisperse systems.We also consider the distribution characteristics of the average coordination number and average velocity for the moving particles.The results support that the polydisperse particle systems are more stable in the T2 stage.

Resistance development,cross-resistance,and fitness costs associated with Aphis gossypii resistance towards sulfoxaflor and acetamiprid in different geographical regions

Aphis gossypii has become increasingly difficult to manage due to its strong insecticide resistance.In the laboratory,we established sulfoxaflor-resistant and acetamiprid-resistant strains in two A.gossypii populations with different basal insecticide resistance levels,and evaluated the effects of basal insecticide resistance on the resistance development and cross-resistance,as well as differences in fitness.Under the same selection pressure,Yarkant A.gossypii(with low basal insecticide resistance)evolved resistance to sulfoxaflor and acetamiprid more quickly than Jinghe A.gossypii(with high basal insecticide resistance),and the evolution of A.gossypii resistance to sulfoxaflor developed faster than acetamiprid in both Yarkant and Jinghe,Xingjiang,China.The sulfoxaflor-resistant strains selected from Yarkant and Jinghe developed significant cross-resistance to acetamiprid,imidacloprid,thiamethoxam and pymetrozine;while the acetamiprid-resistant strains developed significant cross-resistance to sulfoxaflor,imidacloprid,thiamethoxam,pymetrozine,and chlorpyrifos.The relative fitness of A.gossypii decreased as the resistance to sulfoxaflor and acetamiprid developed.The relative fitness levels of the sulfoxaflor-resistant strains(Yarkant-SulR and Jinghe-SulR)were lower than those of the acetamipridresistant strains(Yarkant-AceR and Jinghe-AceR).In addition,the relative fitness levels of sulfoxaflor-and acetamiprid-resistant strains were lower in Jinghe than in Yarkant.In summary,basal insecticide resistance of A.gossypii and insecticide type affected the evolution of resistance to insecticides in A.gossypii,as well as cross-resistance to other insecticides.The sulfoxaflor-and acetamiprid-resistant A.gossypii strains had obvious fitness costs.The results of this work will contribute to the insecticide resistance management and integrated management of A.gossypii.

Impact of initial fluctuations and nuclear deformations in isobar collisions

Relativistic isobar^(96)_(44)Ru+^(96)_(44)Ru and^(96)_(40)Zr+^(96)_(40)Zrcollisions have revealed intricate differences in their nuclear size and shape,inspiring unconventional studies of nuclear structure using relativistic heavy ion collisions.In this study,we investigate the relative differences in the mean multiplicityR_(<Nch>)and the secondR_(ε2)and third-order eccentricityR_(ε3)between isobar collisions using initial state Glauber models.It is found that initial fluctuations and nuclear deformations have negligible effects on R_(<Nch>)in most central collisions,while both are important for the R_(ε2)and R_(ε3),the degree of which is sensitive to the underlying nucleonic or sub-nucleonic degree of freedom.These features,compared to real data,may probe the particle production mechanism and the physics underlying nuclear structure.

Mg-doped,carbon-coated,and prelithiated SiO_(x) as anode materials with improved initial Coulombic efficiency for lithium-ion batteries

Silicon suboxide(SiO_(x),x≈1)is promising in serving as an anode material for lithium-ion batteries with high capacity,but it has a low initial Coulombic efficiency(ICE)due to the irreversible formation of lithium silicates during the first cycle.In this work,we modify SiO_(x) by solid-phase Mg doping reaction using low-cost Mg powder as a reducing agent.We show that Mg reduces SiO_(2) in SiO_(x) to Si and forms MgSiO_(3) or Mg_(2)SiO_(4).The MgSiO_(3) or Mg_(2)SiO_(4) are mainly distributed on the surface of SiO_(x),which suppresses the irreversible lithium-ion loss and enhances the ICE of SiO_(x).However,the formation of MgSiO_(3) or Mg_(2)SiO_(4) also sacrifices the capacity of SiO_(x).Therefore,by controlling the reaction process between Mg and SiO_(x),we can tune the phase composition,proportion,and morphology of the Mg-doped SiO_(x) and manipulate the performance.We obtain samples with a capacity of 1226 mAh g^(–1) and an ICE of 84.12%,which show significant improvement over carbon-coated SiO_(x) without Mg doping.By the synergistical modification of both Mg doping and prelithiation,the capacity of SiO_(x) is further increased to 1477 mAh g^(–1) with a minimal compromise in the ICE(83.77%).

An Initial Perturbation Method for the Multiscale Singular Vector in Global Ensemble Prediction

Ensemble prediction is widely used to represent the uncertainty of single deterministic Numerical Weather Prediction(NWP) caused by errors in initial conditions(ICs). The traditional Singular Vector(SV) initial perturbation method tends only to capture synoptic scale initial uncertainty rather than mesoscale uncertainty in global ensemble prediction. To address this issue, a multiscale SV initial perturbation method based on the China Meteorological Administration Global Ensemble Prediction System(CMA-GEPS) is proposed to quantify multiscale initial uncertainty. The multiscale SV initial perturbation approach entails calculating multiscale SVs at different resolutions with multiple linearized physical processes to capture fast-growing perturbations from mesoscale to synoptic scale in target areas and combining these SVs by using a Gaussian sampling method with amplitude coefficients to generate initial perturbations. Following that, the energy norm,energy spectrum, and structure of multiscale SVs and their impact on GEPS are analyzed based on a batch experiment in different seasons. The results show that the multiscale SV initial perturbations can possess more energy and capture more mesoscale uncertainties than the traditional single-SV method. Meanwhile, multiscale SV initial perturbations can reflect the strongest dynamical instability in target areas. Their performances in global ensemble prediction when compared to single-scale SVs are shown to(i) improve the relationship between the ensemble spread and the root-mean-square error and(ii) provide a better probability forecast skill for atmospheric circulation during the late forecast period and for short-to medium-range precipitation. This study provides scientific evidence and application foundations for the design and development of a multiscale SV initial perturbation method for the GEPS.

An Analysis of the Accounting Costs Associated with 20-Month DR TB Regimens in Maputo City, Mozambique

Introduction: Socioeconomic and demographic conditions in a country can influence tuberculosis incidence and mortality, with nearly 95% of tuberculosis-related deaths occurring in poorer countries. Mozambique is among the 30 countries with the highest TB burden. Objective: The study aimed to estimate the average direct medical cost of treating drug-resistant tuberculosis in 19 health centers in Maputo City, Mozambique. Methods: A retrospective analysis of direct medical costs was conducted on patients aged 18 and older who completed 20-month drug-resistant tuberculosis treatment regimens in Maputo City in 2019. Results: This analysis covered 140 patients who completed a 20-month treatment regimen, with 64.3% (78) being male and 35.7% (62) female. Approximately 50% of the participants were aged between 29 and 47. The average direct medical cost of DRTB treatment was $4789.43, reaching up to $6568.00, with a standard deviation of $753.26, including clinical interventions and treatment. Conclusion: The direct medical costs for a basic treatment package for a patient with drug-resistant TB in Mozambique equal 36 minimum wages. Developing alternative and innovative funding mechanisms and identifying ways to mitigate costs through the use of generic medicines would be beneficial.

Multi-Level Image Segmentation Combining Chaotic Initialized Chimp Optimization Algorithm and Cauchy Mutation

To enhance the diversity and distribution uniformity of initial population,as well as to avoid local extrema in the Chimp Optimization Algorithm(CHOA),this paper improves the CHOA based on chaos initialization and Cauchy mutation.First,Sin chaos is introduced to improve the random population initialization scheme of the CHOA,which not only guarantees the diversity of the population,but also enhances the distribution uniformity of the initial population.Next,Cauchy mutation is added to optimize the global search ability of the CHOA in the process of position(threshold)updating to avoid the CHOA falling into local optima.Finally,an improved CHOA was formed through the combination of chaos initialization and Cauchy mutation(CICMCHOA),then taking fuzzy Kapur as the objective function,this paper applied CICMCHOA to natural and medical image segmentation,and compared it with four algorithms,including the improved Satin Bowerbird optimizer(ISBO),Cuckoo Search(ICS),etc.The experimental results deriving from visual and specific indicators demonstrate that CICMCHOA delivers superior segmentation effects in image segmentation.

Costs of Schizophrenia at Psychiatric Hospital of Bingerville (Ivory Coast)

Schizophrenia is classified as a priority mental disorder by the World Health Organization (WHO) and accounts for around 35% of diagnoses at the Bingerville Psychiatric Hospital (HPB). The aims of the study were to identify the cost drivers for hospitalization and to calculate the costs of managing schizophrenia in hospital, with a view to planning household expenditure on care. This pilot cross-sectional study involved 31 patients with schizophrenia who had been hospitalized in the various third-category wards at the HPB between 1st January 2019 and 31st May 2020. Sampling was accidental. The methods used to estimate costs were based on the actual costs of drugs, hospitalization and additional examinations which prices were known, and on patients’ estimations for certain expenses such as food and transport. Results: The sex ratio was 3.42, the mean age was 29.52 years. The mean length of stay was 46.19 days, and the most frequent clinical forms were paranoid schizophrenia (41.9%) and schizoaffective disorder (29%). The combination of haloperidol and chlorpromazine was the most common medications for initial treatment (67.8%) and maintenance treatment (41.9%). The average cost of hospitalization at HPB for schizophrenia was XOF 164,412 (€249.90). The average direct medical cost was XOF 105,412 (€160.226) and the average direct non-medical cost was XOF 59,000 (€89.68). The average daily cost of antipsychotic treatment was XOF 795/day (€1.2084). The high cost of drugs as a proportion of hospitalization costs suggested the need of a reflection on the simplification of prescribing practices, assistance in psychiatric emergencies and the development of other alternatives to psychiatric hospitalization in Côte d’Ivoire.

Irregular initial solidification by mold thermal monitoring in the continuous casting of steels:A review

Occasional irregular initial solidification phenomena,including stickers,deep oscillation marks,depressions,and surface cracks of strand shells in continuous casting molds,are important limitations for developing the high-efficiency continuous casting of steels.The application of mold thermal monitoring(MTM) systems,which use thermocouples to detect and respond to temperature variations in molds,has become an effective method to address irregular initial solidification phenomena.Such systems are widely applied in numerous steel companies for sticker breakout prediction.However,monitoring the surface defects of strands remains immature.Hence,indepth research is necessary to utilize the potential advantages and comprehensive monitoring of MTM systems.This paper summarizes what is included in the irregular initial solidification phenomena and systematically reviews the current state of research on these phenomena by the MTM systems.Furthermore,the influences of mold slag behavior on monitoring these phenomena are analyzed.Finally,the remaining problems of the formation mechanisms and investigations of irregular initial solidification phenomena are discussed,and future research directions are proposed.

An improved initial rotor position estimation method using high-frequency pulsating voltage injection for PMSM

High frequency pulsating voltage injection method is a good candidate for detecting the initial rotor position of permanent magnet synchronous motor.However,traditional methods require a large number of filters,which leads to the deterioration of system stability and dynamic performance.In order to solve these problems,a new signal demodulation method is proposed in this paper.The proposed new method can directly obtain the amplitude of high-frequency current,thus eliminating the use of filters,improving system stability and dynamic performance and saving the work of adjusting filter parameters.In addition,a new magnetic polarity detection method is proposed,which is robust to current measurement noise.Finally,experiments verify the effectiveness of the method.

Cost of Medical Treatment for Primary Open-Angle Glaucoma in Relation to Patients’ Income and Its Impact on the Prognosis of the Disease, in Bouaké University Hospital

Introduction: Medical treatment for POAG is continuous and lifelong treatment. The aim of this study was to evaluate the relationship between the cost of this treatment and patients’ income and the impact of this relationship on treatment compliance. Materials and Methods: Prospective cross-sectional study with a descriptive aim covering sociodemographic data, average incomes, and direct and indirect costs of treatment of 57 patients followed for POAG during the period from January 1, 2012, to December 31, 2016 (5 years). Results: The patients were aged 25 to 77 years (mean = 54.4 years) with a male predominance (sex ratio = 1.5). Retirees were the most represented (26.32%), followed by workers in the informal sector (14.04%) and housewives (12.28%). Patients who had an annual income less than or equal to 900,000 CFA francs (€1370.83) per year represented 56.14% and those who did not have health coverage represented 57.89%. The treatment was monotherapy (64.91%), dual therapy (31.58%) or triple therapy (3.05%) and the average ratio of “annual cost of treatment to annual income” was 0.56 with for maximum 2.23 and 0.02 as minimum. Patients who considered the cost of treatment unbearable for their income represented 78.95%. Conclusion: Prevention of blindness due to glaucoma requires early detection but also the establishment of health coverage mechanisms to improve compliance with medical treatment. In addition, consideration should be given to the development of glaucoma surgery in our country, the indication of which could be the first intention in certain patients, considering for those patients, the geographical and financial accessibility of medical treatment. .

A digital twin model-based approach to cost optimization of residential community microgrids

This paper presents a peer-to-peer community cost optimization approach based on a single-prosumer energy management system.Its objective is to optimize energy costs for prosumers in the community by enhancing the consumption efficiency.This study was conducted along two main axes.The first axis focuses on designing a digital twin for a residential community microgrid platform.This phase involves data collection,cleaning,exploration,and interpretation.Moreover,it includes replicating the functionality of the real platform and validating the results.The second axis involves the development of a novel approach that incorporates two distinct prosumer behaviors within the same community microgrid,while maintaining the concept of peer-to-peer energy trading.Prosumers without storage utilize their individual PV systems to fulfill their energy requirements and inject excess energy into a local microgrid.Meanwhile,a single prosumer with a storage system actively engages in energy exchange to maximize the community’s profit.This is achieved by optimizing battery usage using a cost optimization solution.The proposed solution is validated using the developed digital twin.

The potential impact of increased whole grain consumption among Chinese adults on reducing healthcare costs and carbon footprint

Excessive consumption of refined grains harms human health and ecosystem viability.Whole grains,as a healthy and sustainable alternative to refined grains,can benefit individual health by providing dietary fiber,B vitamins,and bioactive substances.Additionally,they aid in improving the environment due to their higher extraction rate and lower carbon emission during the processing stage.However,few studies have attempted to evaluate the economic and social benefits of increasing the amount of whole grain in grain intake.This paper estimates the potential savings in healthcare costs and reduced food carbon footprints(CFs)that could result from a shift toward whole grain consumption following the Chinese Dietary Guidelines(CDG).We investigate hypothetical scenarios where a certain proportion(5–100%)of Chinese adults could increase their whole grain intakes as proposed by CDG to meet the average shortfall of 30.2 g.In that case,the healthcare costs for associated diseases(e.g.,type2 diabetes mellitus(T2DM),cardiovascular disease(CVD),and colorectal cancer(CRC))are expected to reduce by a substantial amount,from USD 2.82 to 56.37 billion;the carbon emission levels are also projected to decrease by0.24–5.72 million tons.This study provides compelling evidence that advocating for the transition towards greater consumption of whole grain products could benefit individual health,the environment,and society,by reducing both healthcare costs and carbon emissions.

Impact of carbon disclosure on debt financing costs

Creditors,such as banks,often use disclosed environmental information to assess a company’s environmental risk and ensure the safety of debt funds.Consequently,carbon disclosures have become an important consideration for creditors when making investments.This study explores the relationship between carbon disclosure and debt financing costs using data on listed companies from 2008 to 2019.The results show that carbon disclosure can reduce the debt financing costs of enterprises,and that this influence is more significant for private companies than for state-owned enterprises.Instrumental variables and Propensity Score Matching(PSM)were used to evaluate the robustness of negative relationships.Furthermore,carbon disclosure has a more significant impact on debt costs with less environmental supervision pressure,weak residents’environmental awareness,and weak product market competition.These findings provide guidance for companies’carbon information disclosure and support the establishment of official carbon disclosure standards.

Impact of Initial Soil Conditions on Soil Hydrothermal and Surface Energy Fluxes in the Permafrost Region of the Tibetan Plateau

Accurate initial soil conditions play a crucial role in simulating soil hydrothermal and surface energy fluxes in land surface process modeling.This study emphasized the influence of the initial soil temperature(ST)and soil moisture(SM)conditions on a land surface energy and water simulation in the permafrost region in the Tibetan Plateau(TP)using the Community Land Model version 5.0(CLM5.0).The results indicate that the default initial schemes for ST and SM in CLM5.0 were simplistic,and inaccurately represented the soil characteristics of permafrost in the TP which led to underestimating ST during the freezing period while overestimating ST and underestimating SLW during the thawing period at the XDT site.Applying the long-term spin-up method to obtain initial soil conditions has only led to limited improvement in simulating soil hydrothermal and surface energy fluxes.The modified initial soil schemes proposed in this study comprehensively incorporate the characteristics of permafrost,which coexists with soil liquid water(SLW),and soil ice(SI)when the ST is below freezing temperature,effectively enhancing the accuracy of the simulated soil hydrothermal and surface energy fluxes.Consequently,the modified initial soil schemes greatly improved upon the results achieved through the long-term spin-up method.Three modified initial soil schemes experiments resulted in a 64%,88%,and 77%reduction in the average mean bias error(MBE)of ST,and a 13%,21%,and 19%reduction in the average root-mean-square error(RMSE)of SLW compared to the default simulation results.Also,the average MBE of net radiation was reduced by 7%,22%,and 21%.

TRADE DEPENDENCIES AND TRANSACTION COSTS: THE OC-CUPATION OF DECELEA HIGHLIGHTS BOTH THE BENEFITS AND THE DRAWBACKS OF A MARITIME ECONOMY

Thucydides asserts that the occupation of Decelea by the Spartans in 413 BC made the grain supply for Athens costly by forcing the transport from land onto the sea.This calls into question the well-established consensus that sea transport was far cheaper than land transport.This paper contends that the cost of protecting supply lines-specifically the expenses associated with the warships which escorted the supply ships-rendered the grain transported on the new route exceptionally costly.In this paper,the benefits and drawbacks of a maritime economy,including transaction costs,trade dependencies,and the capabilities of warships and supply ships are discussed.

Reliability-based life-cycle cost seismic design optimization of coastal bridge piers with nonuniform corrosion using different materials

Reinforcement corrosion is the main cause of performance deterioration of reinforced concrete(RC)structures.Limited research has been performed to investigate the life-cycle cost(LCC)of coastal bridge piers with nonuniform corrosion using different materials.In this study,a reliability-based design optimization(RBDO)procedure is improved for the design of coastal bridge piers using six groups of commonly used materials,i.e.,normal performance concrete(NPC)with black steel(BS)rebar,high strength steel(HSS)rebar,epoxy coated(EC)rebar,and stainless steel(SS)rebar(named NPC-BS,NPC-HSS,NPC-EC,and NPC-SS,respectively),NPC with BS with silane soakage on the pier surface(named NPC-Silane),and high-performance concrete(HPC)with BS rebar(named HPC-BS).First,the RBDO procedure is improved for the design optimization of coastal bridge piers,and a bridge is selected to illustrate the procedure.Then,reliability analysis of the pier designed with each group of materials is carried out to obtain the time-dependent reliability in terms of the ultimate and serviceability performances.Next,the repair time of the pier is predicted based on the time-dependent reliability indices.Finally,the time-dependent LCCs for the pier are obtained for the selection of the optimal design.