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Background
Hip fractures are a common and costly health problem, resulting in significant morbidity and mortality, as well as high costs for healthcare systems, especially for the elderly. Implementing surgical preventive strategies has the potential to improve the quality of life and reduce the burden on healthcare resources, particularly in the long term. However, there are currently limited guidelines for standardizing hip fracture prophylaxis practices.
Methods
This study used a cost-effectiveness analysis with a finite-state Markov model and cohort simulation to evaluate the primary and secondary surgical prevention of hip fractures in the elderly. Patients aged 60 to 90 years were simulated in two different models (A and B) to assess prevention at different levels. Model A assumed prophylaxis was performed during the fracture operation on the contralateral side, while Model B included individuals with high fracture risk factors. Costs were obtained from the Centers for Medicare & Medicaid Services, and transition probabilities and health state utilities were derived from available literature. The baseline assumption was a 10% reduction in fracture risk after prophylaxis. A sensitivity analysis was also conducted to assess the reliability and variability of the results.
Results
With a 10% fracture risk reduction, model A costs between $8,850 and $46,940 per quality-adjusted life-year ($/QALY). Additionally, it proved most cost-effective in the age range between 61 and 81 years. The sensitivity analysis established that a reduction of ≥ 2.8% is needed for prophylaxis to be definitely cost-effective. The cost-effectiveness at the secondary prevention level was most sensitive to the cost of the contralateral side’s prophylaxis, the patient’s age, and fracture treatment cost. For high-risk patients with no fracture history, the cost-effectiveness of a preventive strategy depends on their risk profile. In the baseline analysis, the incremental cost-effectiveness ratio at the primary prevention level varied between $11,000/QALY and $74,000/QALY, which is below the defined willingness to pay threshold.
Conclusion
Due to the high cost of hip fracture treatment and its increased morbidity, surgical prophylaxis strategies have demonstrated that they can significantly relieve the healthcare system. Various key assumptions facilitated the modeling, allowing for adequate room for uncertainty. Further research is needed to evaluate health-state-associated risks.
Background
Post-COVID-19 syndrome (PCS) is a lingering disease with ongoing symptoms such as fatigue and cognitive impairment resulting in a high impact on the daily life of patients. Understanding the pathophysiology of PCS is a public health priority, as it still poses a diagnostic and treatment challenge for physicians.
Methods
In this prospective observational cohort study, we analyzed the retinal microcirculation using Retinal Vessel Analysis (RVA) in a cohort of patients with PCS and compared it to an age- and gender-matched healthy cohort (n = 41, matched out of n = 204).
Measurements and main results
PCS patients exhibit persistent endothelial dysfunction (ED), as indicated by significantly lower venular flicker-induced dilation (vFID; 3.42% ± 1.77% vs. 4.64% ± 2.59%; p = 0.02), narrower central retinal artery equivalent (CRAE; 178.1 [167.5–190.2] vs. 189.1 [179.4–197.2], p = 0.01) and lower arteriolar-venular ratio (AVR; (0.84 [0.8–0.9] vs. 0.88 [0.8–0.9], p = 0.007). When combining AVR and vFID, predicted scores reached good ability to discriminate groups (area under the curve: 0.75). Higher PCS severity scores correlated with lower AVR (R = − 0.37 p = 0.017). The association of microvascular changes with PCS severity were amplified in PCS patients exhibiting higher levels of inflammatory parameters.
Conclusion
Our results demonstrate that prolonged endothelial dysfunction is a hallmark of PCS, and impairments of the microcirculation seem to explain ongoing symptoms in patients. As potential therapies for PCS emerge, RVA parameters may become relevant as clinical biomarkers for diagnosis and therapy management.
Environmental emissions, global warming, and energy-related concerns have accelerated the advancements in conventional vehicles that primarily use internal combustion engines. Among the existing technologies, hydrogen fuel cell electric vehicles and fuel cell hybrid electric vehicles may have minimal contributions to greenhouse gas emissions and thus are the prime choices for environmental concerns. However, energy management in fuel cell electric vehicles and fuel cell hybrid electric vehicles is a major challenge. Appropriate control strategies should be used for effective energy management in these vehicles. On the other hand, there has been significant progress in artificial intelligence, machine learning, and designing data-driven intelligent controllers. These techniques have found much attention within the community, and state-of-the-art energy management technologies have been developed based on them. This manuscript reviews the application of machine learning and intelligent controllers for prediction, control, energy management, and vehicle to everything (V2X) in hydrogen fuel cell vehicles. The effectiveness of data-driven control and optimization systems are investigated to evolve, classify, and compare, and future trends and directions for sustainability are discussed.
The steel prefabricated family house ›Quelle-Fertighaus‹ designed and constructed by the German company Quelle, is an innovative modular system commercialised in 1962. All aspects of the Quelle-Fertighaus are planned on the principle of minimal effort for maximal flexibility. The clever design of the ground plan based on a 4 m × 7 m module offers the flexibility for either one to three additional modules.
The steel construction is innovative and unique, consisting of load-bearing portal frames acting as braces. The house design is furthermore characterised by a simple metrical grid layout and the practical placement of the foundation and basement, which allowed the very cost-effective production and the lowest price for a prefabricated family house in Germany during the postwar era. Nowadays its portal-frame-construction offers an interesting approach for its renovation and transformation according to present building demands.
The eVTOL industry is a rapidly growing mass market expected to start in 2024. eVTOL compete, caused by their predicted missions, with ground-based transportation modes, including mainly passenger cars. Therefore, the automotive and classical aircraft design process is reviewed and compared to highlight advantages for eVTOL development. A special focus is on ergonomic comfort and safety. The need for further investigation of eVTOL’s crashworthiness is outlined by, first, specifying the relevance of passive safety via accident statistics and customer perception analysis; second, comparing the current state of regulation and certification; and third, discussing the advantages of integral safety and applying the automotive safety approach for eVTOL development. Integral safety links active and passive safety, while the automotive safety approach means implementing standardized mandatory full-vehicle crash tests for future eVTOL. Subsequently, possible crash impact conditions are analyzed, and three full-vehicle crash load cases are presented.
Next-generation aircraft designs often incorporate multiple large propellers attached along the wingspan. These highly flexible dynamic systems can exhibit uncommon aeroelastic instabilities, which should be carefully investigated to ensure safe operation. The interaction between the propeller and the wing is of particular importance. It is known that whirl flutter is stabilized by wing motion and wing aerodynamics. This paper investigates the effect of a propeller onto wing flutter as a function of span position and mounting stiffness between the propeller and wing. The analysis of a comparison between a tractor and pusher configuration has shown that the coupled system is more stable than the standalone wing for propeller positions near the wing tip for both configurations. The wing fluttermechanism is mostly affected by the mass of the propeller and the resulting change in eigenfrequencies of the wing. For very weak mounting stiffnesses, whirl flutter occurs, which was shown to be stabilized compared to a standalone propeller due to wing motion. On the other hand, the pusher configuration is, as to be expected, the more critical configuration due to the attached mass behind the elastic axis.
This work proposes a hybrid algorithm combining an Artificial Neural Network (ANN) with a conventional local path planner to navigate UAVs efficiently in various unknown urban environments. The proposed method of a Hybrid Artificial Neural Network Avoidance System is called HANNAS. The ANN analyses a video stream and classifies the current environment. This information about the current Environment is used to set several control parameters of a conventional local path planner, the 3DVFH*. The local path planner then plans the path toward a specific goal point based on distance data from a depth camera. We trained and tested a state-of-the-art image segmentation algorithm, PP-LiteSeg. The proposed HANNAS method reaches a failure probability of 17%, which is less than half the failure probability of the baseline and around half the failure probability of an improved, bio-inspired version of the 3DVFH*. The proposed HANNAS method does not show any disadvantages regarding flight time or flight distance.
The management of knowledge in organizations considers both established long-term processes and cooperation in agile project teams. Since knowledge can be both tacit and explicit, its transfer from the individual to the organizational knowledge base poses a challenge in organizations. This challenge increases when the fluctuation of knowledge carriers is exceptionally high. Especially in large projects in which external consultants are involved, there is a risk that critical, company-relevant knowledge generated in the project will leave the company with the external knowledge carrier and thus be lost. In this paper, we show the advantages of an early warning system for knowledge management to avoid this loss. In particular, the potential of visual analytics in the context of knowledge management systems is presented and discussed. We present a project for the development of a business-critical software system and discuss the first implementations and results.