We aimed to determine the surgical output for patients from Nunavik undergoing transfer to an urban centre for hysteroscopy, and associated costs. We performed a retrospective chart review of all patients from the 14 villages of Nunavik transferred for hysteroscopic surgery from 2016 to 2021. Diagnoses, surgical intervention, and nature of the procedure were all extracted from the patient charts, and costs/length of stay obtained from logisticians and administrators servicing the Nunavik region. Over a 5-year period, 22 patients were transferred from Nunavik for hysteroscopy, of which all were elective save one. The most common diagnosis was endometrial or cervical polyp and the most common procedure was diagnostic hysteroscopy. The average cost for patient transfer and lodging to undergo hysteroscopy in Montreal ranged from $6,000 to $15,000 CDN. On average, 4-5 patient transfers occur annually for hysteroscopy, most commonly for management of endometrial polyps, at a cost of $6,000 to $15,000 CDN, suggesting the need to investigate local capacity building in Nunavik and assess cost-effectiveness.

In this work, a one-stage dual internal circulation airlift anaerobic/anoxic/aerobic (DCAL-A2O) bioreactor was continuously operated for concurrent removal of nutrients and organics from milk processing wastewater (MPW). Special configuration of the airlift A2O bioreactor created possibility of the formation of desired anaerobic, anoxic and aerobic zones in a single unit. The process functionality of the bioreactor was examined under three influential operating variables i.e. hydraulic retention time (HRT; 7-15 h), air flow rate (AFR; 1-3 L/min) and aerobic volume ratio (AVR; 0.324-0.464). The optimum region was identified at HRT of 13h, AFR of 2L/min and AVR of 0.437, leading to TCOD, TN and TP removal efficiency of 94.5 %, 59.6 %, and 62.2 %, respectively, and effluent turbidity of 8 NTU. The impact of feed biodegradability on the process performance of the bioreactor treating the MPW, soft drink wastewater (SDW) and soybean oil plant wastewater (SOW) was also assessed. From the results, the feed characteristics affected significantly the nutrients removal. Moreover, the feeding location played an effective role in the nutrient removal while treating the MPW at optimum operating conditions. In this study, the change in residual organic matters as soluble microbial products (SMP) was monitored at various operating conditions. In addition, the impact of SMP extracted from sludge, extracellular polymeric substances (EPS) comprising of loosely bound EPS (LB-EPS) and tightly bound EPS (TB-EPS) was analyzed on sludge characteristics as bio-flocculation and settleability properties. According to the obtained data, the increase in operating variables led to the reduction in contents of effluent SMP, sludge SMP, LB-EPS, turbidity, and SVI, thereby, the enhancement in the sludge characteristics. Meanwhile, analysis of microbial communities verified the presence of various functional bacterial species. The cost operating evaluation confirmed the cost effectiveness of the airlift A2O bioreactor in reduction of energy consumption for the MPW treatment.

OBJECTIVE: To investigate the assumption that day-case cochlear implantation is associated with lower costs, compared to inpatient cochlear implantation, while maintaining equal quality of life (QoL) and hearing outcomes, for the Dutch healthcare setting.
METHODS: A single-center, non-blinded, randomized controlled trial in a tertiary referral center.
METHODS: Thirty adult patients with post-lingual bilateral sensorineural hearing loss eligible for unilateral cochlear implantation surgery were randomly assigned to either the day-case or inpatient treatment group (i.e., one night admission). We performed an intention-to-treat evaluation of the difference of the total health care-related costs, hospital and out of hospital costs, between day-case and inpatient cochlear implantation, from a hospital and patient perspective over the course of one year. Audiometric outcomes, assessed using CVC scores, and QoL, assessed using the EQ-5D and HUI3 questionnaires, were taken into account.
RESULTS: There were two drop-outs. The total health care-related costs were €41,828 in the inpatient group (n = 14) and €42,710 in the day-case group (n = 14). The mean postoperative hospital stay was 1.2 days (mean costs of €1,069) in the inpatient group and 0.7 days (mean costs of €701) for the day-case group. There were no statistically significant differences in postoperative hospital and out of hospital costs. The QoL at 2 months and 1 year postoperative, measured by the EQ-5D index value and HUI3 showed no statistically significant difference. The EQ-5D VAS score measured at 1 year postoperatively was statistically significantly higher in the inpatient group (84/100) than in the day-case group (65/100). There were no differences in postoperative complications, objective hearing outcomes, and number of postoperative hospital and out of hospital visits.
CONCLUSIONS: A day-case approach to cochlear implant surgery does not result in a statistically significant reduction of health care-related costs compared to an inpatient approach and does not affect the surgical outcome (complications and objective hearing measurements), QoL, and postoperative course (number of postoperative hospital and out of hospital visits).
METHODS:

OBJECTIVE: Persons who inject drugs (PWID) are at risk for severe gram-positive infections and may require prolonged hospitalization and intravenous (IV) antibiotic therapy. Dalbavancin (DBV) is a long-acting lipoglycopeptide that may reduce costs and provide effective treatment in this population.
METHODS: This was a retrospective review of PWID with severe gram-positive infections. Patients admitted from January 1, 2017, to November 1, 2019 (standard-of-care [SOC] group) and from November 15, 2019, to March 31, 2022 (DBV group) were included. The primary outcome was the total cost to the healthcare system. Secondary outcomes included hospital days saved and treatment failure.
RESULTS: A total of 87 patients were included (37 in the DBV group and 50 in the SOC group). Patients were a median of 34 years old and were predominantly Caucasian (82%). Staphylococcus aureus (82%) was the most common organism, and bacteremia (71%) was the most common type of infection. Compared to the SOC group, the DBV group would have had a median of 14 additional days of hospitalization if they had stayed to complete their therapy (P = 0.014). The median total cost to the healthcare system was significantly lower in the DBV group than in the SOC group ($31,698.00 vs $45,093.50; P = 0.035). The rate of treatment failure was similar between the groups (32.4% in the DBV group vs 36% in the SOC group; P = 0.729).
CONCLUSIONS: DBV is a cost-saving alternative to SOC IV antibiotics for severe gram-positive infections in PWID, with similar treatment outcomes. Larger prospective studies, including other patient populations, may demonstrate additional benefit.

BACKGROUND: The current shortage of radiology staff in healthcare provides a challenge for departments all over the world. This leads to more evaluation of how the radiology resources are used and a demand to use them in the most efficient way. Intraoperative MRI is one of many recent advancements in radiological practice. If radiology staff is performing intraoperative MRI at the operation ward, they may be impeded from performing other examinations at the radiology department, creating costs in terms of exams not being performed. Since this is a kind of cost whose importance is likely to increase, we have studied the practice of intraoperative MRI in Sweden.
METHODS: The study includes data from the first four hospitals in Sweden that installed MRI scanners adjacent to the operating theaters. In addition, we included data from Karolinska University Hospital in Solna where intraoperative MRI is carried out at the radiology department.
RESULTS: Scanners that were moved into the operation theater and doing no or few other scans were used 11-12% of the days. Stationary scanners adjacent to the operation room were used 35-41% of the days. For scanners situated at the radiology department doing intraoperative scans interspersed among all other scans, the proportion was 92%.
CONCLUSIONS: Our study suggests that performing exams at the radiology department rather than at several locations throughout the hospital may be an efficient approach to tackle the simultaneous trends of increasing demands for imaging and increasing staff shortages at radiology departments.

BACKGROUND: Blunt chest injury is associated with significant adverse health outcomes. A chest injury care bundle (ChIP) was developed for patients with blunt chest injury presenting to the emergency department. ChIP implementation resulted in increased health service use, decreased unplanned Intensive Care Unit admissions and non-invasive ventilation use. In this paper, we report on the financial implications of implementing ChIP and quantify costs/savings.
METHODS: This was a controlled pre-and post-test study with two intervention and two non-intervention sites. The primary outcome measure was the treatment cost of hospital admission. Costs are reported in Australian dollars (AUD). A generalised linear model (GLM) estimated patient episode treatment costs at ChIP intervention and non-intervention sites. Because healthcare cost data were positive-skewed, a gamma distribution and log-link function were applied.
RESULTS: A total of 1705 patients were included in the cost analysis. The interaction (Phase x Treatment) was positive but insignificant (p = 0.45). The incremental cost per patient episode at ChIP intervention sites was estimated at $964 (95 % CI, -966 - 2895). The very wide confidence intervals reflect substantial differences in cost changes between individual sites Conclusions: The point estimate of the cost of the ChIP care bundle indicated an appreciable increase compared to standard care, but there is considerable variability between sites, rendering the finding statistically non-significant. The impact on short- and longer-term costs requires further quantification.

Hemodialysis wastewater contains high concentrations of ammonia nitrogen and phosphorus. Recovery of these nutrients as soil fertilizers represents an interesting opportunity to ensure a sustainable fertilizer supply.
In this paper, a simple method for recovering phosphorous and nitrogen as crystalline struvite [MgNH4PO4·6H2O] is presented. An integrated cost model is also presented in order to create a positive business case.
Recovery rates in form of struvite of 95% of PO43--P and 23% of NH4+-N were achieved with a profit.
To the best of our knowledge, this paper is the first to study the recovery of these naturally occurring minerals from hemodialysis wastewater. This offers great potential for the valorization of this type of wastewater.

Perfluorooctanoic acid (PFOA) is a toxic and recalcitrant perfluoroalkyl substance commonly detected in the environment. Its low concentration challenges the development of effective degradation techniques, which demands intensive chemical and energy consumption. The recent stringent health advisories and the upgrowth and advances in photocatalytic technologies claim the need to evaluate and compare the state-of-the-art. Among these systems, chemical-free photocatalysis emerges as a cost-effective and sustainable solution for PFOA degradation and potentially other perfluorinated carboxylic acids. This review (I) classifies the state-of-the-art of chemical-free photocatalysts for PFOA degradation in families of materials (Ti, Fe, In, Ga, Bi, Si, and BN), (II) describes the evolution of catalysts, identifies and discusses the strategies to enhance their performance, (III) proposes a simplified cost evaluation tool for simple techno-economical analysis of the materials; (IV) compares the features of the catalysts expanding the classic degradation focus to other essential parameters, and (V) identifies current research gaps and future research opportunities to enhance the photocatalyst performance. We aim that this critical review will assist researchers and practitioners to develop rational photocatalyst designs and identify research gaps for green and effective PFAS degradation.

The study presented in this paper investigates the application of asphalt bitumen modification using a fast-reacting SBS polymer at a low modifier percentage. The hypothesis is that a fast-reacting styrene-butadiene-styrene (SBS) polymer that composes only 2% to 3% of the weight of the bitumen modification could extend the life of the pavement surfacing and pavement performance at relatively low input costs, increasing the net present value produced by the pavement during its life cycle. To confirm or refute this hypothesis, two types of road bitumens CA 35/50 and 50/70 were modified with low amounts of fast-reacting SBS polymer with the expectation of attaining properties similar to a 10/40-65 modified bitumen. For each type of unmodified bitumen, bitumen modification and comparative 10/40-65 modified bitumen, the following tests were conducted: needle penetration, softening point-ring and ball test method, and ductility test. The second part of the article focuses on a comparison of asphalt mixtures with different compositions of coarse-grain curves. For each mixture, complex modulus with varying temperatures and fatigue resistances are represented by the Wöhler diagram and compared. Based on in labo testing, the impact of the modification on pavement performance is evaluated. Life cycle changes for each type of modified and unmodified mixtures are quantified as road user costs, and attained benefits are compared with increased construction costs.

We aimed to estimate the total health care costs attributable to prostate cancer (PCa) during care phases by age, cancer stage, tumor grade, and primary treatment in the first year in British Columbia (BC), Canada. Using linked administrative health data, we followed a cohort of men aged ≥ 50 years at diagnosis with PCa between 2010 and 2017 (Cohort 1) from the diagnosis date until the date of death, the last date of observation, or 31 December 2019. Patients who died from PCa after 1 January 2010, were selected for Cohort 2. PCa attributable costs were estimated by comparing costs in patients to matched controls. Cohort 1 (n = 22,672) had a mean age of 69.9 years (SD = 8.9) and a median follow-up time of 5.2 years. Cohort 2 included 6942 patients. Mean PCa attributable costs were the highest during the first year after diagnosis ($14,307.9 [95% CI: $13,970.0, $14,645.8]) and the year before death ($9959.7 [$8738.8, $11,181.0]). Primary treatment with radiation therapy had significantly higher costs each year after diagnosis than a radical prostatectomy or other surgeries in advanced-stage PCa. Androgen deprivation therapy (and/or chemotherapy) had the highest cost for high-grade and early-stage cancer during the three years after diagnosis. No treatment group had the lowest cost. Updated cost estimates could inform economic evaluations and decision-making.