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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.
There is a growing demand for more flexibility in manufacturing to counter the volatility and unpredictability of the markets and provide more individualization for customers. However, the design and implementation of flexibility within manufacturing systems are costly and only economically viable if applicable to actual demand fluctuations. To this end, companies are considering additive manufacturing (AM) to make production more flexible. This paper develops a conceptual model for the impact quantification of AM on volume and mix flexibility within production systems in the early stages of the factory-planning process. Together with the model, an application guideline is presented to help planners with the flexibility quantification and the factory design process. Following the development of the model and guideline, a case study is presented to indicate the potential impact additive technologies can have on manufacturing flexibility Within the case study, various scenarios with different production system configurations and production programs are analyzed, and the impact of the additive technologies on volume and mix flexibility is calculated. This work will allow factory planners to determine the potential impacts of AM on manufacturing flexibility in an early planning stage and design their production systems accordingly.
Traditional vulcanization mold manufacturing is complex, costly, and under pressure due to shorter product lifecycles and diverse variations. Additive manufacturing using Fused Filament Fabrication and high-performance polymers like PEEK offer a promising future in this industry. This study assesses the compressive strength of various infill structures (honeycomb, grid, triangle, cubic, and gyroid) when considering two distinct build directions (Z, XY) to enhance PEEK’s economic and resource efficiency in rapid tooling. A comparison with PETG samples shows the behavior of the infill strategies. Additionally, a proof of concept illustrates the application of a PEEK mold in vulcanization. A peak compressive strength of 135.6 MPa was attained in specimens that were 100% solid and subjected to thermal post-treatment. This corresponds to a 20% strength improvement in the Z direction. In terms of time and mechanical properties, the anisotropic grid and isotropic cubic infill have emerged for use in rapid tooling. Furthermore, the study highlights that reducing the layer thickness from 0.15 mm to 0.1 mm can result in a 15% strength increase. The study unveils the successful utilization of a room-temperature FFF-printed PEEK mold in vulcanization injection molding. The parameters and infill strategies identified in this research enable the resource-efficient FFF printing of PEEK without compromising its strength properties. Using PEEK in rapid tooling allows a cost reduction of up to 70% in tool production.