Return on Investment after Implementation of a Centralized Automated Storage System in a Hospital Pharmacy

An ADS （automated dispensing system） was implemented in our hospital pharmacy in 2008 to optimize and secure the medication process. The main objective of this study was to compare the projected and the real ROI （return on investment）, after seven years of use. ROI was calculated annually （from 2008 to 2015）, by deducting the cost of investment （ADS buying and implementation, maintenance, repairs and ADS upgrade） from the cost saving （drugs stock reduction and decrease of pharmacy staff dedicated to global dispensing）. In 2015, total costs saving （＋$1,141,987） were divided between decreasing drug stock value and reduction of pharmacy staff. Total costs of investment （-$978,656） were acquisition, maintenance, repairs and an unplanned upgrade costs. Finally, the real ROI was ＋$163,331 after seven years of use. In 2008, projected ROI was ＋$410,786. The real payback period has been increased by approximately two years （six years of use, instead of four years as expected）. Despite their cost, ADSs are a worthwhile investment, leading to a ROI within a few years. These economic considerations should be put into perspective with optimization of drugs stock management, greater efficiency of the global dispensing process, securitization of medication process and redeployment of pharmacy staff.

Ratio K: a New Way of Metering and Evaluating the Risk and Return of Stock Investment

Although widely used, both the Markowitz model and VAR (Value at Risk) model have some limitations in evaluating the risk and return of stock investment. By the analysis of the conceptions of risk and return, together with the three hypotheses of technological analysis, a novelty model of metering and evaluating the risk and return of stock investment is established. The major indicator of this model , risk-return ratio K, combines the characteristic indicators of risk and return. Regardless of the form of the risk-return probability density functions, this indicator K can always reflect the risk-return performances of the invested stocks clearly and accurately. How to use the model to make optimum investment and how to make portfolio combined with clustering analysis is also explained.

Determination of the Financing Scale,Time Limit and Returns from the Investment in BOT Projects

The key aspect to the successful implementation of BOT concept is the raising of finance by project sponsor,so financial engineering techniques and capital structuring skills are required to find the proper mix of debt and equity.The capital structure and present a model to determine the equity level from the aspects of financing scale,construction time and return on investment are analyzed.The resulting model can help the sponsor to avoid the capital risk,and offer the government a criterion to evaluate management ability of the sponsor.To show the application and availability of this model,a case study is conducted.Thus,this paper is concern with the determination of financing scale,construction time,and return on investment which would assist the sponsor to ensure that the equity level for optimal capital structure is available prior to the implementation stage in BOT project operation.

Increasing our return on investment in science:Start with better behavior

In August of 2022,I gave the opening keynote address at the 5th North American Congress on Biomechanics,in Ottawa,Canada.The topic of my talk was about whether the research ecosystem was getting a reasonable return on its investment in biomedical research.I provided several examples as to why I posed this question.

Straw return increases crop production by improving soil organic carbon sequestration and soil aggregation in a long-term wheat-cotton cropping system

Straw return is a promising strategy for managing soil organic carbon(SOC)and improving yield stability.However,the optimal straw return strategy for sustainable crop production in the wheat(Triticum aestivum L.)-cotton(Gossypium hirsutum L.)cropping system remains uncertain.The objective of this study was to quantify the long-term(10 years)impact of carbon(C)input on SOC sequestration,soil aggregation and crop yields in a wheat-cotton cropping system in the Yangtze River Valley,China.Five treatments were arranged with a single-factor randomized design as follows:no straw return(Control),return of wheat straw only(Wt),return of cotton straw only(Ct),return of 50%wheat and 50%cotton straw(Wh-Ch)and return of 100%wheat and 100%cotton straw(Wt-Ct).In comparison to the Control,the SOC content increased by 8.4 to 20.2%under straw return.A significant linear positive correlation between SOC sequestration and C input(1.42-7.19 Mg ha^(−1)yr^(−1))(P<0.05)was detected.The percentages of aggregates of sizes>2 and 1-2 mm at the 0-20 cm soil depth were also significantly elevated under straw return,with the greatest increase of the aggregate stability in the Wt-Ct treatment(28.1%).The average wheat yields increased by 12.4-36.0%and cotton yields increased by 29.4-73.7%,and significantly linear positive correlations were also detected between C input and the yields of wheat and cotton.The average sustainable yield index(SYI)reached a maximum value of 0.69 when the C input was 7.08 Mg ha^(−1)yr^(−1),which was close to the maximum value(SYI of 0.69,C input of 7.19 Mg ha^(−1)yr^(-1))in the Wt-Ct treatment.Overall,the return of both wheat and cotton straw was the best strategy for improving SOC sequestration,soil aggregation,yields and their sustainability in the wheat-cotton rotation system.

A Study on Equivalence of Return-risk and Risk-return Models for Investment Strategies

1 Introduction It is known that the Capital Asset Pricing Model was first proposed by Markowitz and he was awarded the Nobel Prize

LEAPS IN G.D.-H.K. COOPERATION FOLLOWING RETURN——Report on Guangdong High New Technology Projects Investment Symposium '97

Hongkong’s smooth return creates vast prospect and numerous opportunities for Guangdong-Hongkong economic cooperation. Over the past decade the cooperation has gone a long way, from non-governmental to governmental, from processing trade to high technology. Presently, it has become a highprofile activity which covers various areas.More than 20,000 representatives from 5,063 corporations participated the symposium. And 1,559 agreements, involving $ 13.159 billion, were signed. Of the investment, $8.7851 billion, or 66.8 per cent is from overseas investors. Of the agreements, 810 or 65 per cent, are high new

Risk assessment of oil and gas investment environment in countries along the Belt and Road Initiative

With the implementation of the Belt and Road Initiative, China is deepening its cooperation in oil and gas resources with countries along the Initiative. In order to better mitigate risks and enhance the safety of investments, it is of significant importance to research the oil and gas investment environment in these countries for China's overseas investment macro-layout. This paper proposes an indicator system including 27 indicators from 6 dimensions. On this basis, game theory models combined with global entropy method and analytic hierarchy process are applied to determine the combined weights, and the TOPSIS-GRA model is utilized to assess the risks of oil and gas investment in 76 countries along the Initiative from 2014 to 2021. Finally, the GM(1,1) model is employed to predict risk values for 2022-2025. In conclusion, oil and gas resources and political factors have the greatest impact on investment environment risk, and 12 countries with greater investment potential are selected through cluster analysis in conjunction with the predicted results. The research findings may provide scientific decisionmaking recommendations for the Chinese government and oil enterprises to strengthen oil and gas investment cooperation with countries along the Belt and Road Initiative.

Fast solution to the free return orbit's reachable domain of the manned lunar mission by deep neural network

It is important to calculate the reachable domain(RD)of the manned lunar mission to evaluate whether a lunar landing site could be reached by the spacecraft. In this paper, the RD of free return orbits is quickly evaluated and calculated via the classification and regression neural networks. An efficient databasegeneration method is developed for obtaining eight types of free return orbits and then the RD is defined by the orbit’s inclination and right ascension of ascending node(RAAN) at the perilune. A classify neural network and a regression network are trained respectively. The former is built for classifying the type of the RD, and the latter is built for calculating the inclination and RAAN of the RD. The simulation results show that two neural networks are well trained. The classification model has an accuracy of more than 99% and the mean square error of the regression model is less than 0.01°on the test set. Moreover, a serial strategy is proposed to combine the two surrogate models and a recognition tool is built to evaluate whether a lunar site could be reached. The proposed deep learning method shows the superiority in computation efficiency compared with the traditional double two-body model.

Early endotracheal intubation is not associated with the rate of return of spontaneous circulation following cardiac arrest at the emergency department:an exploratory analysis

Cardiac arrest poses a significant global public health challenge,manifesting in approximately 550,000 cases annually within the United States.[1]In-hospital cardiac arrest(IHCA)is commonly attributed to airways and respiratory issues.[2]Recommendations emphasize the expertise of responders in airway management.[3]Various options exist,such as chest compression-only cardiopulmonary resuscitation(CPR),bag-mask ventilation(BMV),and advanced airways.The BMV and advanced airways are not deemed equivalent or superior based on previous evidence.[4]Achieving consistency in choosing and timing the optimal airway approach during IHCA is crucial.The current American Heart Association guidelines suggest an advanced airway strategy when endotracheal intubation(ETI)success rates are high,but the optimal time for advanced airway management remains unclear.[5]Wong et al[6]revealed that survival improved by less than 5 min with advanced airway management.According to a subgroup analysis of IHCA patients in emergency departments(EDs),early intubation was associated with a 1.5-fold greater rate of return of spontaneous circulation(ROSC)than in other locations.[7]ED patients’constant monitoring and immediate management,with readily available intubation equipment,enhance early intubation and survival rates.[6]Nonetheless,IHCA patients intubated within the first 15 min had a lower ROSC rate.

Eight of ten patients return to daily activities, work, and sports after total knee arthroplasty

BACKGROUND Besides return to work(RTW)and return to sports(RTS),patients also prefer to return to daily activities(RTA)such as walking,sleeping,grocery shopping,and domestic work following total knee arthroplasty(TKA).However,evidence on the timelines and probability of patients’RTA is sparse.AIM To assess the percentage of patients able to RTA,RTW,and RTS after TKA,as well as the timeframe and influencing factors of this return.METHODS A retrospective cohort study with prospectively collected data was conducted at a medium-sized Dutch orthopedic hospital.Assessments of RTA,RTW,and RTS were performed at 3 mo and/or 6 mo following TKA.Investigated factors en-compassed patient characteristics,surgical characteristics,and preoperative patient-reported outcomes.RESULTS TKA patients[n=2063;66 years old(interquartile range[IQR]:7 years);47%male;28 kg/m2(IQR:4 kg/m2)]showed RTA ranging from 28%for kneeling to 94%for grocery shopping,with 20 d(IQR:27 d)spent for putting on shoes to 74 d(IQR:57 d)for kneeling.RTW rates varied from 62%for medium-impact work to 87%for low-impact work,taking 33 d(IQR:29 d)to 78 d(IQR:55 d).RTS ranged from 48%for medium-impact sports to 90%for low-impact sports,occurring within 43 d(IQR:24 d)to 90 d(IQR:60 d).One or more of the investigated factors influenced the return to each of the 14 activities examined,with R²values ranging from 0.013 to 0.127.CONCLUSION Approximately 80%of patients can RTA,RTW,and RTS within 6 mo after TKA.Return is not consistently in-fluenced by predictive factors.Results help set realistic pre-and postoperative expectations.

Dynamic convergent shock compression initiated by return current in high-intensity laser-solid interactions

We investigate the dynamics of convergent shock compression in solid cylindrical targets irradiated by an ultrafast relativistic laser pulse.Our particle-in-cell simulations and coupled hydrodynamic simulations reveal that the compression process is initiated by both magnetic pressure and surface ablation associated with a strong transient surface return current with density of the order of 10^(17) A/m^(2) and lifetime of 100 fs.The results show that the dominant compression mechanism is governed by the plasma β,i.e.,the ratio of thermal pressure to magnetic pressure.For targets with small radius and low atomic number Z,the magnetic pressure is the dominant shock compression mechanism.According to a scaling law,as the target radius and Z increase,the surface ablation pressure becomes the main mechanism generating convergent shocks.Furthermore,an indirect experimental indication of shocked hydrogen compression is provided by optical shadowgraphy measurements of the evolution of the plasma expansion diameter.The results presented here provide a novel basis for the generation of extremely high pressures exceeding Gbar(100 TPa)to enable the investigation of high-pressure physics using femtosecond J-level laser pulses,offering an alternative to nanosecond kJ-laser pulse-driven and pulsed power Z-pinch compression methods.

Increased number of symptoms during the acute phase of SARS-CoV-2 infection in athletes is associated with prolonged time to return to full sports performance—AWAREⅧ

Purpose The aim of the study was to identify factors associated with prolonged time to return to full performance(RTFP)in athletes with recent severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)infection.Methods Prospective cohort study with cross sectional analysis.A total of 84 athletes with confirmed SARS-CoV-2 infection assessed at a coronavirus disease 2019 recovery clinic gave a history of age,sex,type/level of sport,co-morbidities,pre-infection training hours,and 26 acute SARS-CoV-2 symptoms from 3 categories(“nose and throat”,“chest and neck”,and“whole body”/systemic).Data on days to RTFP were obtained by structured interviews.Factors associated with RTFP were demographics,sport participation,history of co-morbidities,pre-infection training history,and acute symptoms(type,number).Outcomes were:(a)days to RTFP(median,interquartile range(IQR))in asymptomatic(n=7)and symptomatic athletes(n=77),and(b)hazard ratios(HRs;95%confidence interval)for symptomatic athletes with vs.without a factor(univariate,multiple models).HR<1 was predictive of higher percentage chance of prolonged RTFP.Significance was p<0.05.Results Days to RTFP were 30 days(IQR:23–40)for asymptomatic and 64 days(IQR:42–91)for symptomatic participants(p>0.05).Factors associated with prolonged RTFP(univariate models)were:females(HR=0.57;p=0.014),endurance athletes(HR=0.41;p<0.0001),co-morbidity number(HR=0.75;p=0.001),and respiratory disease history(HR=0.54;p=0.026).In symptomatic athletes,prolonged RTFP(multiple models)was significantly associated with increased“chest and neck”(HR=0.85;p=0.017)and“nose and throat”(HR=0.84;p=0.013)symptoms,but the association was more profound between prolonged RFTP and increased total number of“all symptoms”(HR=0.91;p=0.001)and“whole body”/systemic(HR=0.82;p=0.007)symptoms.Conclusion A larger number of total symptoms and specifically“whole body”/systemic symptoms during the acute phase of SARS-CoV-2 infection in athletes is associated with prolonged RTFP.

MODELING THE PRIVATE FINANCIAL RETURNS FROM GREEN BUILDING INVESTMENTS

INTRODUCTION We analyze the financial returns to a green building renovation project for a small commercial office building in the urban Midwest.Compared with a comparable conventional renovation,the LEED renovation required additional building costs of approximately$7.41 per square foot.

Gut microbiota affects the estrus return of sows by regulating the metabolism of sex steroid hormones

Background Sex hormones play important roles in the estrus return of post-weaning sows.Previous studies have demonstrated a complex and bi-directional regulation between sex hormones and gut microbiota.However,the extent to which the gut microbiota affects estrus return of post-weaning sows is largely unknown.Results In this study,we first screened 207 fecal samples from well-phenotyped sows by 16S rRNA gene sequencing and identified significant associations between microbes and estrus return of post-weaning sows.Using metagenomic sequencing data from 85 fecal samples,we identified 37 bacterial species that were significantly associated with estrus return.Normally returning sows were characterized by increased abundances of L.reuteri and P.copri and decreased abundances of B.fragilis,S.suis,and B.pseudolongum.The changes in gut microbial composition significantly altered the functional capacity of steroid hormone biosynthesis in the gut microbiome.The results were confirmed in a validation cohort.Significant changes in sex steroid hormones and related compounds were found between normal and non-return sows via metabolome analysis.An integrated analysis of differential bacterial species,metagenome,and fecal metabolome provided evidence that normal return-associated bacterial species L.reuteri and Prevotella spp.participated in the degradation of pregnenolone,progesterone,and testosterone,thereby promoting estrogen biosynthesis.Furthermore,the microbial metabolites related to sow energy and nutrient supply or metabolic disorders also showed relationships with sow estrus return.Conclusions An integrated analysis of differentially abundant bacterial species,metagenome,and fecal metabolome revealed the involvement of L.reuteri and Prevotella spp.in sow estrus return.These findings provide deep insight into the role of gut microbiota in the estrus return of post-weaning sows and the complex cross-talk between gut microbiota and sex hormones,suggesting that the manipulation of the gut microbiota could be an effective strategy to improve sow estrus return after weaning.

Exploring the Factors Associated with 12-Month Non-Return to Work among Motorcyclists Involved in Road Accidents

Introduction: Motorcyclists bear a disproportionate burden of morbidity and mortality from road accidents. In addition, the consequences of these accidents affect the ability of victims to return to work. This study aimed to determine the prevalence and factors associated with non-return to work among surviving motorcyclists involved in road accidents 12 months after the event. Materials and Methods: It was a cross-sectional study conducted using data from a cohort of motorcyclists involved in accidents and recruited in five hospitals in Benin from July 2019 to January 2020. The dependent variable was non-return to work 12 months after the accident (yes vs no). The independent variables were categorized into two groups: baseline and 12-month follow-up variables. Logistic regression was used to determine the factors associated with non-return to work at 12 months among the participants. Results: Among the 362 participants, 55 (15.19%, 95% CI = 11.84 - 19.29) had not returned to work 12 months after the accident. Risk factors for non-return to work identified were: smoking (aOR = 4.41, 95% CI = 1.44 - 13.56, p = 0.010), hospitalization (aOR = 2.87, 95% CI = 1.14 - 7.24, p Conclusion: The prevalence of non-return to work at 12 months was high among surviving motorcyclists involved in road accidents in Benin. Integrated support for patients based on identified risk factors should effectively improve their return to work.

Symptom presentation and evolution in the first 48 hours after injury are associated with return to play after concussion in elite Rugby Union

Background:Return to play(RTP)in elite rugby is managed using a 6-stage graduated RTP protocol,which can result in clearance to play within 1 week of injury.We aimed to explore how symptom,cognitive,and balance presentation and evolution during concussion screens 2 h(head injury assessment(HIA2)and 48 h(HIA3)after injury were associated with time to RTP)to identify whether a more conservative graduated RTP may be appropriate.Methods:A retrospective cohort study was conducted in 380 concussed rugby players from elite men’s rugby over 3 consecutive seasons.Players were classified as shorter or longer returns,depending on whether RTP occurred within 7 days(allowing them to be considered to play the match 1 week after injury)or longer than 8 days,respectively.Symptom,cognitive,and balance performance during screens was assessed relative to baseline(normal or abnormal)and to the preceding screen(improving or worsening).Associations between sub-test abnormalities and RTP time were explored using odds ratios(OR,longer vs.shorter).Median day absence was compared between players with abnormal or worsening results and those whose results were normal or improving.Results:Abnormal symptom results during screens 2 h and 48 h after concussion were associated with longer return time(HIA2:OR=2.21,95%confidence interval(95%CI):1.39-3.50;HIA3:OR=3.30,95%CI:1.89-5.75).Worsening symptom number or severity from the time of injury to 2 h and 48 h post-injury was associated with longer return(HIA2:OR=2.49,95%CI:1.36-4.58;HIA3:OR=3.34,95%CI:1.10-10.15).Median days absence was greater in players with abnormal symptom results at both HIA2 and HIA3.Cognitive and balance performance were not associated with longer return and did not affect median days absence.Conclusion:Symptom presentation and evolution within 48 h of concussion were associated with longer RTP times.This may guide a more conservative approach to RTP,while still adhering to individualized concussion management principles.

A novel predictor of unsustained return of spontaneous circulation in cardiac arrest patients through a combination of capnography and pulse oximetry: a multicenter observational study

BACKGROUND:Unsustained return of spontaneous circulation(ROSC)is a critical barrier to survival in cardiac arrest patients.This study examined whether end-tidal carbon dioxide(ETCO_(2))and pulse oximetry photoplethysmogram(POP)parameters can be used to identify unsustained ROSC.METHODS:We conducted a multicenter observational prospective cohort study of consecutive patients with cardiac arrest from 2013 to 2014.Patients’general information,ETCO_(2),and POP parameters were collected and statistically analyzed.RESULTS:The included 105 ROSC episodes(from 80 cardiac arrest patients)comprised 51 sustained ROSC episodes and 54 unsustained ROSC episodes.The 24-hour survival rate was significantly higher in the sustained ROSC group than in the unsustained ROSC group(29.2%vs.9.4%,P<0.05).The logistic regression analysis showed that the difference between after and before ROSC in ETCO_(2)(ΔETCO_(2))and the difference between after and before ROCS in area under the curve of POP(ΔAUCp)were independently associated with sustained ROSC(odds ratio[OR]=0.931,95%confi dence interval[95%CI]0.881-0.984,P=0.011 and OR=0.998,95%CI 0.997-0.999,P<0.001).The area under the receiver operating characteristic curve ofΔETCO_(2),ΔAUCp,and the combination of both to predict unsustained ROSC were 0.752(95%CI 0.660-0.844),0.883(95%CI 0.818-0.948),and 0.902(95%CI 0.842-0.962),respectively.CONCLUSION:Patients with unsustained ROSC have a poor prognosis.The combination ofΔETCO_(2) andΔAUCp showed signifi cant predictive value for unsustained ROSC.

Microstructure and mechanical properties of Co-28Cr-6Mo-0.22C investment castings by current solution treatment

This study examined the impact of current solution treatment on the microstructure and mechanical properties of the Co-28Cr-6Mo-0.22C alloy investment castings.The findings reveal that the current solution treatment significantly promotes the dissolution of carbides at a lower temperature.The optimal conditions for solution treatment are determined as a solution temperature of 1,125°C and a holding time of 5.0 min.Under these parameters,the size and volume fraction of precipitated phases in the investment castings are measured as6.2μm and 1.1vol.%.The yield strength,ultimate tensile strength,and total elongation of the Co-28Cr-6Mo-0.22C investment castings are 535 MPa,760 MPa,and 12.6%,respectively.These values exceed those obtained with the conventional solution treatment at 1,200°C for 4.0 h.The findings suggest a phase transformation of M_(23)C_(6)→σ+C following the current solution treatment at 1,125°C for 5.0 min.In comparison,the traditional solution treatment at 1,200°C for 4.0 h leads to the formation of M_(23)C_(6)and M_(6)C carbides.It is noteworthy that the non-thermal effect of the current during the solution treatment modifies the free energy of both the matrix and precipitation phase.This modification lowers the phase transition temperature of the M_(23)C_(6)→σ+C reaction,thereby facilitating the dissolution of carbides.As a result,the current solution treatment approach achieves carbide dissolution at a lower temperature and within a significantly shorter time when compared to the traditional solution treatment methods.

Impact of the carbon market on investment benefits of power-grid enterprises in China: a system dynamics analysis

The power grid,as the hub connecting the power supply and consumption sides,plays an important role in achieving carbon neutrality in China.In emerging carbon markets,assessing the investment benefits of power-grid enterprises is essential.Thus,studying the impact of the carbon market on the investment and operation of powergrid enterprises is key to ensuring their efficient operation.Notably,few studies have examined the interaction between the carbon and electricity markets using system dynamics models,highlighting a research gap in this area.This study investigates the impact of the carbon market on the investment of power-grid enterprises using a novel evaluation system based on a system dynamics model that considers carbon-emissions from an established carbon-emission accounting model.First,an index system for benefit evaluation was constructed from six aspects:financing ability,economic benefit,reliability,social responsibility,user satisfaction,and carbon-emissions.A system dynamics model was then developed to reflect the causal feedback relationship between the impact of the carbon market on the investment and operation of power-grid enterprises.The simulation results of a provincial power-grid enterprise analyze comprehensive investment evaluation benefits over a 10-year period and the impact of carbon emissions on the investment and operation of power-grid enterprises.This study provides guidelines for the benign development of power-grid enterprises within the context of the carbon market.