In-Hospital Costs Associated With an Expanded Endonasal Approach to Anterior Skull Base Tumors

Objective: To determine in-hospital costs associated with performing an EEA to anterior skull base pathology and to identify drivers of cost variability for patients undergoing endoscopic anterior skull base surgery. Methods: All endoscopic anterior skull base surgeries performed over a period from January 1st, 2015 to October 24th, 2017 were evaluated. The electronic medical record was reviewed for patient factors, tumor characteristics, and cost variables associated with each hospital stay and univariate analysis was performed using Stata software. Results: An EEA was associated with an average total in-hospital cost of $44 545. Compared to patients undergoing a transsphenoidal approach to pituitary tumor resection, EEA patients incurred higher in-hospital costs across all variables including a total cost increase of $15 921 (95% confidence interval $5720-26 122, P = .002). Univariate analysis of all endoscopic anterior skull base surgery patients showed a cost increase of $30 616 associated with post-operative cerebrospinal fluid (CSF) leak ($10 420-50 811, P = .004), $14 610 with post-operative diabetes insipidus (DI) ($4610-24 609, P = .004), and $11 522 with African-American patients relative to Caucasian patients ($3049-19 995, P = .008). Conclusions: Patients who undergo endoscopic EEA for resection of anterior skull base tumors typically incur greater in-hospital costs than patients undergoing a standard TSA. Post-operative complications such as CSF leak and DI, as well as ethnicity, are significant drivers of cost-variability.

PREDICTING THE SCHEDULE AND COST PERFORMANCE IN PUBLIC SCHOOL BUILDING PROJECTS IN TAIWAN

The Ministry of Education (MOE) of Taiwan invests about NTD 30 billion a year in Public School Building Projects (PSBPs). However, 95% of the PSBPs have been extended and have incurred increased costs. A PSBP performance evaluation and prediction system was established by using the Fuzzy Delphi Method (FDM), association rules and an Artificial Neural Network (ANN). Sixty-two Taiwanese PSBPs were used as the samples, while eleven high correlation factors that influence the project performance of PSBPs were defined, and the reasons leading to the poor project performance were discussed in this study. Moreover, the results of the test cases operated by ANN showed that the accuracy rate for schedule and cost variability predictions can reach 84%. The high accuracy rate indicated the reliability of priority control for high-risk projects in the future. The proposed approach can be provided to clients, design and construction firms, and project managers to understand the project performance in real time and to establish a dynamic tracking review and response measures for improving the overall project satisfaction.

Healthcare System-to-System Cost Variability in the Care of Pediatric Abdominal Pain-Associated Functional Gastrointestinal Disorders

The purpose of this study was to assess cost variability in the care of abdominal pain-associated functional gastrointestinal disorders (AP-FGIDS) in youth across health systems, races, and specific AP-FGID diagnoses. Patients, aged 8–17 years, with a priority 1 diagnosis corresponding to a Rome IV defined AP-FGID were identified within the Health Facts® database. Total costs were obtained across the continuum of care including outpatient clinics, emergency department, and inpatient or observation units. Cost variability was described comparing different health systems, races, and diagnoses. Thirteen thousand two hundred and fourteen patients were identified accounting for 17,287 encounters. Total costs were available for 38.7% of the encounters. There was considerable variability in costs within and, especially, across health systems. Costs also varied across race, urban vs. rural site of care, and AP-FGID diagnoses. In conclusion, there was considerable variability in the costs for care of AP-FGIDs which is sufficient to support multi-site studies to understand the value of specific tests and treatments. Significant differences in costs by race merit further investigation to understand key drivers.

Adaptive functions of neurobehavioral plasticity in language learning and processing

This article presents a large scope of issues on early and late language plasticity that increase our understanding of the neurobehavioral dynamics of change, the main property of the learning brain. In their pioneering work, Bates and Kuhl have convincingly demonstrated that plasticity is intrinsic to development. Bates has provided new data on the impressive recovery of language in children with focal brain injury, highlighting that both hemispheres support the early phases of this change, contrary to previous assumptions. The fundamental reorganization of the early phonemic system around the age of 8 months proposed by Kuhl, combining neural commitment and social abilities, has powerful cascading effects for subsequent word learning. Our developmental crosslinguistic research on online sentence processing in monolinguals and simultaneous bilinguals has revealed distinctive linguistic patterns of “cue cost”, a multifactorial concept relevant for capturing the microplasticity of the processing system. Whatever the language, the shift around the age of 9 towards the canonical adult pattern indicates an efficient adaptive processing occurring with a small delay in bilinguals. Most salient, from childhood, bilinguals exhibit specific cue cost patterns with interactions. In older French adults, cue cost variability is mediated by processing speed which preserves online syntactic abilities but reveals plasticity limits in Alzheimer’s patients.

Prospective Observational Study on Prescribing Pattern of Antifungal Drugs in the 400 Out-Patient Department of Dermatology in a Tertiary Care Hospital

Introduction: Fungal infections have been a serious disease over a few decades. Superficial fungal infections not only cause life-threatening illnesses but slowly reduce the Quality of life of patients. Objective: To study the prescribing pattern of antifungal drugs, distribution of fungal disease, and cost variability between different antifungal drugs prescribed. Materials and methods: Prospective observational study was carried out at Justice K.S. Hegde Charitable Hospital from August 2018 to April 2019. Outpatient departments patient satisfying the inclusion criteria were included in the study. Factors like age, gender, diagnosis, and type of prescribed antifungal drugs along with Price variability among different brands of the drug were considered. Antifungal drug prescriptions of patients were analyzed. Results: More than 50% of the patients were from age 21-40 yrs. Males (51.8%) were more than females (48%). The majority of the drugs prescribed were topically (64%). Tine a corpor is was the most prevalent fungal disease. The Azoles group of Antifungal was most prescribed. And the percentage variability between different brands was high. Conclusion: The study concluded the extensive use of antifungal agents. The highly prescribed drug was found to be luliconazole. The study also concluded that the use of generic prescriptions might reduce the cost of illness and enhance the rational use of the drug.

Reviewing Locally Available Chicken Feed Resources at Different Agro-Ecologies (High, Mid and Low Land), Formulating According To Growth Stage (Growers and Layers) Of Chicken and Its Average Price in SNNPR

As discussed at the result part, this study has done by reviewing different research papers conducted in southern region peoples nations and nationalities regional state, research institute on poultry feed resource availabilities at different agro-ecologies with its’ average cost variability and formulated based on growers and layers feed by considering nutrient content of it. Accordingly, most common feed types identified at highland areas were Kocho, Taro root and Barley midland areas Kocho, Taro root, Barley, maize and sorghum, sweat potato and lowland area maize, Sweat potato. Not only the locally available feed but also concentrated feeds (noug cake, wheat bran, premixes, salt and minerals) were investigated depending on their accessibility/availability. Therefore, considering these all conditions formulation was done with 100% supplementation of feed to overcome with the feed shortage problems of chicken and to enhance production and productivity of them by using those feed types that available at three different agro ecologies (highland, midland and lowland) in the region.

Variability in hospital treatment costs: a time-driven activity-based costing approach for early-stage invasive breast cancer patients

ObjectivesUsing a standardised diagnostic and generic treatment path for breast cancer, and the molecular subtype perspective, we aim to measure the impact of several patient and disease characteristics on the overall treatment cost for patients. Additionally, we aim to generate insights into the drivers of cost variability within one medical domain.Design, setting and participantsWe conducted a retrospective study at a breast clinic in Belgium. We used 14 anonymous patient files for conducting our analysis.ResultsSignificant cost variations within each molecular subtype and across molecular subtypes were found. For the luminal A classification, the cost differential amounts to roughly 166%, with the greatest treatment cost amounting to US$29 780 relative to US$11 208 for a patient requiring fewer medical activities. The major driver for these cost variations relates to disease characteristics. For the luminal B classification, a cost difference of roughly 242% exists due to both disease-related and patient-related factors. The average treatment cost for triple negative patients amounted to US$26 923, this is considered to be a more aggressive type of cancer. The overall cost for HER2-enriched is driven by the inclusion of Herceptin, thus this subtype is impacted by disease characteristics. Cost variability across molecular classifications is impacted by the severity of the disease, thus disease-related factors are the major drivers of cost.ConclusionsGiven the cost challenge in healthcare, the need for greater cost transparency has become imperative. Through our analysis, we generate initial insights into the drivers of cost variability for breast cancer. We found evidence that disease characteristics such as severity and more aggressive cancer forms such as HER2-enriched and triple negative have a significant impact on treatment cost across the different subtypes. Similarly, patient factors such as age and presence of gene mutation contribute to differences in treatment cost variability within molecular subtypes.

Reliability-Based Optimization for Energy Refurbishment of a Social Housing Building

This paper investigates the influence of a stochastic variation of both energy and economic parameters in an optimization loop applied to a refurbished social housing building. Usually, energy and economic optimization procedures rely on the results of an underlying numerical deterministic model which influences both energy gains and economic figures. However, an analyst must always face the random variation of input and parameter data. The unknown data can represent poor initial information or data that can change in a long time; this is the case of fuel cost and economic indexes in particular. This paper deals with both problems for building refurbishment optimization, the former related to the initial state of a building, and the latter to the energy cost variability. Reliability analysis considers a stochastic variation of parameters looking for solutions that incorporate a risk level; in this case, it deals with optimization objectives related to different impacts on economic, environmental and health aspects. The considered building represents a social house, and the energy reduction measures involve the application of internal insulation layers to the walls and the replacement of existing windows with more efficient ones.