Search Results (823)

The commitment to the Sustainable Development Goals and the need for increasing the circularity of industrial processes call for the exploitation of byproducts to generate value-added chemicals in cost- and energy-advantageous processes. In this process simulation-based research, two technologies were evaluated for the synthesis of isoamyl acetate from fusel oil: (A) an indirect process, and (B) a direct process using reactive distillation. Aspen Hysys v14.0 was used for simulation. A sensitivity analysis was performed to identify the influence of operating parameters on product purity, isoamyl acetate recovery and productivity, and energy consumption. Technology B was found to be the most favorable, obtaining 22.27 kg/h of isoamyl acetate with a purity of 98%. The total consumption values of cooling water and heating were 24.33 kW and 24.50 kW, respectively. Based on the best conditions, a technical–economic analysis was performed that demonstrated the viability of the process, obtaining a net present value (NPV) of US$3,587,110/year, an internal rate of return (IRR) of 38.95% and a payback period (PP) of 5.05 years. If acid recirculation is considered in the process, an NPV of US$7,232,950, an IRR of 56.34%, and a PP of 3.56 years are obtained. Full article

Background: The high prevalence of overweight and obesity in Singapore necessitates scalable primary prevention strategies. This study evaluated the short-term effectiveness of FitterLife, a 12-week, digitally delivered, group-based behavioural weight management programme targeting at-risk adults without diabetes or hypertension in the community. Methods: In a retrospective matched cohort study, we compared 306 FitterLife participants (enrolled from October 2021 to January 2025) with 5087 controls identified from a population health data mart, matched on age, sex, ethnicity, and baseline body mass index (BMI). The primary outcome was achieving ≥5% weight loss or a ≥1 kg/m² BMI reduction at 12 weeks. Programme effectiveness was analysed using propensity score matching (1:1) and inverse probability weighted regression. Mixed-effects models assessed weight/BMI trajectories and modified Poisson regression identified behavioural factors associated with success. Results: After matching, FitterLife participants were more likely to achieve the weight loss target than controls (45.7% vs. 13.7%, coefficient = 0.32, 95% confidence interval [CI]: 0.26–0.38) and were over three times as likely to succeed (Adjusted incidence rate ratio [aIRR] = 3.37, 95% CI: 2.87–3.93). The programme group showed significant reductions in weight (−2.23 kg, 95% CI: −2.57 to −1.90) and BMI (−0.86 kg/m², 95% CI: −0.95 to −0.73) at the end of programme. Higher session attendance and improved behavioural factors were associated with success. Conclusions: FitterLife was effective in achieving clinically significant short-term weight loss in a real-world setting. The findings demonstrate the potential of a scalable, behavioural theory-informed, virtual group model as a viable primary prevention strategy within national chronic disease management efforts. Full article

Background/Objectives: Digitalization of intensive care units (ICUs) aims to enhance patient safety and efficiency through standardized documentation, real-time data integration, and clinical decision support. This study evaluated whether the implementation of a patient data management system (PDMS) was associated with improvements in quality of care, infection prevention, and patient outcomes in a trauma ICU. Methods: We conducted a single-center, retrospective, before–after cohort study comparing a pre-digitalization period (2021–2022) with a post-digitalization period (2025). Consecutive adult trauma ICU admissions were analyzed. The exposure was unit-wide adoption of a PDMS implemented in 2024. The primary outcome was ICU length of stay (LOS); secondary outcomes included ICU mortality, nosocomial infection rates (episodes per 1000 ICU-days), ventilation- and antibiotic-days, device utilization, and infection epidemiology. Prespecified sensitivity analyses were performed. Results: A total of 108 patients were included (43 pre- and 65 post-digitalization). Baseline characteristics were comparable between groups. Median ICU LOS decreased from 13.0 to 6.0 days (p = 0.02). Mortality declined from 18.6% to 6.2% (p = 0.06), and crude infection rates decreased from 42.2 to 30.8 per 1000 ICU-days (rate ratio 0.73; p = 0.28). Adjusted analyses showed no statistically significant differences for mortality (aOR 0.40; p = 0.45), infection rates (aIRR 0.88; p = 0.68), LOS (aRR 1.04; p = 0.87), ventilation-days (aRR 0.86; p = 0.65), or antibiotic-days (aRR 0.70; p = 0.30). Per-patient rates of ventilator-associated pneumonia and bloodstream infection were significantly lower after digitalization (both p = 0.04), and Acinetobacter spp. infections decreased markedly (7 to 0 cases; p = 0.001). Findings were consistent after exclusion of ICU stays < 24 h. Conclusions: ICU digitalization was associated with shorter unadjusted ICU stays and favorable trends in infection and mortality outcomes, though adjusted analyses were neutral. Larger multicenter studies incorporating device-day denominators and time-to-event analyses are needed to confirm the causal impact of digital transformation on ICU quality of care. Full article

Background: Serum albumin is a well-known marker of nutritional and inflammatory status and has been associated with adverse outcomes in heart failure (HF). However, its predictive value for length of hospital-stay and short-term mortality in elderly HF patients remains underexplored. Objectives: To investigate the association between serum albumin levels at hospital admission and length of stay, as well as post-admission mortality, in a cohort of elderly patients hospitalized for HF. Methods: We conducted a retrospective analysis of 56 consecutive patients aged ≥65 years admitted for HF. Comorbidities were assessed using the Cumulative Illness Rating Scale for Geriatrics (CIRS-G), and inflammatory status was measured via C-reactive protein (CRP). Negative binomial regression with robust confidence intervals was employed to evaluate the relationship between serum albumin and length of hospital-stay, adjusting for age, comorbidity burden, and CRP. Cox proportional hazards models were used to assess mortality at 6 months and 1 year, adjusting for age, comorbidity, CRP, and HF subtype, with Kaplan–Meier curves illustrating unadjusted survival differences according to albumin levels and HF subtype. Results: Mean age was 78.6 ± 7.5 years, with 69.6% female patients. Mean serum albumin at admission was 3.58 ± 0.60 g/dL, and mean length of stay was 14.8 ± 10.1 days. Each 1 g/dL increase in albumin was associated with a 32% reduction in length of stay (adjusted IRR = 0.68; 95% CI: 0.54–0.85; p = 0.01), independently by age, inflammatory status and comorbidity. Serum albumin was independently associated with reduced risk of death at 6 months (HR 0.30; 95% CI: 0.11–0.82; p = 0.019) and 1 year (HR = 0.41; 95% CI: 0.17–0.96; p = 0.041). Conclusions: Serum albumin at hospital admission independently predicts length of stay and short-term mortality in elderly patients with HF. Albumin measurement, simple, cheap and universally available biomarker, is helpful for early risk stratification and may guide clinical management in this vulnerable population. Full article

Objective: This study aimed to investigate annual and seasonal trends, as well as regional differences, in female breast cancer mortality in Hungary between 2004 and 2023. Methods: Data on cancer mortality were obtained from the publicly available nationwide population register. Poisson and quasi-Poisson regression models were applied to investigate the annual trend in breast cancer mortality rates. Cyclic trends in mortality were analysed using the Walter–Elwood method, and regional differences in age-standardised mortality rates (ASMRs) were evaluated across Hungarian regions. Results: Over the two decades studied, a total of 42,779 deaths from breast cancer were recorded. A significant declining trend in annual ASMRs for female breast cancer was observed during the study period (IRR = 0.996; 95% CI [0.993–0.998]; p = 0.002). Seasonal analysis revealed a significant cyclic pattern, with the highest number of deaths occurring during the winter months, peaking in December. The highest age-standardised breast cancer mortality rate (43.9 ± 0.2 per 100,000 female persons per year) was observed in the Capital region (Budapest), while the lowest ASMR (36.2 ± 0.25 per 100,000 female persons per year) was found in the Northern Great Plain region (p = 0.028). Conclusions: Although Hungary has implemented a free national breast cancer screening programme, this study demonstrates that breast cancer mortality remains high in the country. Additionally, breast cancer mortality exhibits significant regional and seasonal variation. These findings underscore the need for targeted public health interventions and optimised resource allocation to improve outcomes. Full article

This study examines the economic performance of residential photovoltaic systems combined with battery storage (PV-BESS) under Poland’s net-billing regime for a single-family household without subsidy support in 10-year operational horizon. These insights extend existing European evidence by demonstrating how net-billing fundamentally alters investment incentives. The analysis incorporates real production data from selected locations and realistic household consumption profiles. Results demonstrate that optimal system configuration (6 kWp PV with 15 kWh storage) achieves 64.3% reduction in grid electricity consumption and positive economic performance with NPV of EUR 599, IRR of 5.32%, B/C ratio of 1.124 and discounted payback period of 9.0 years. The optimized system can cover electricity demand in the summer half-year by over 90% and reduce local network stress by shifting surplus solar generation away from midday peaks. Residential PV-BESS systems can achieve economic efficiency in Polish conditions when properly optimized, though marginal profitability requires careful risk assessment regarding component costs, durability and electricity market conditions. For Polish energy policy, the findings indicate that net-billing creates strong incentives for regulatory instruments that promote higher self-consumption, which would enhance the economic role of residential storage. Full article

Background: Drug-resistant tuberculosis (DR-TB) constitutes a serious threat to global public health due to the increase in strains resistant to multiple drugs, especially isoniazid and rifampicin. This resistance increases mortality, estimated at 25.6% globally, and complicates treatments due to its high toxicity and cost. Materials and Methods: A quantitative ecological study was carried out with data on drug-resistant tuberculosis reported in Sivigila in the years (2020–2023) SIVIGILA database. 1694 cases were analyzed, considering sociodemographic variables such as age, sex, nationality and prioritized population groups. Departmental rates per 100,000 inhabitants were calculated with DANE projection, from these choropleth maps were developed. Applying a Kulldorff spatial scan under a Poisson model using the SMERC package of R (version 4.5.1), with windows centered on each department and Monte Carlo simulation contrast to identify high-risk clusters (RR > 1). Results: (DR-TB) Predominantly in men aged 30–44 years, with a progressive increase until 2023 (IRR = 2.11). Three high-risk clusters were detected in the southwest and center of the country. Discussion: Drug-resistant tuberculosis in Colombia showed a sustained increase in the years of study, with a cumulative increase of 110% compared to 2020, associated with economically active people more exposed due to occupational and social factors. The greatest burden was observed in the general population. Cases also increased in groups with social and health vulnerability conditions. Conclusions: The departments of Risaralda, Meta, and Valle del Cauca presented the highest drug resistance rates in Colombia. Full article

Background: Mozambique introduced the 10-valent pneumococcal conjugate vaccine (PCV10) in 2013 using a three-dose primary series with no booster dose (3p+0) and later switched to the PCV13 using a schedule of two primary doses with one booster (2p+1). We aimed to describe the burden and serotype distribution of pneumococcal meningitis in children under 5 years of age in Mozambique over an eleven-year period starting with the year of PCV10 introduction, and assess the impact of the PCV vaccine and schedule changes. Methods: We analysed meningitis surveillance data in Mozambique from March 2013 through to December 2023. Cerebrospinal fluid (CSF) samples were collected from eligible children in three referral hospitals (Maputo Central Hospital [south], Beira Central Hospital [central], and Nampula Central Hospital [north]). Culture and polymerase chain reaction assay (qPCR) were performed on each sample. S. pneumoniae-positive samples were subsequently serotyped using multiplex assay. We estimated annual incidence rates for pneumococcal meningitis in children under 5 years old following the PCVs’ introduction (2013–2023). The impact of the product switch and schedule change from PCV10/3p+0 to PCV13/2p+1 on the burden and serotype distribution of pneumococcal meningitis was assessed. Results: Of the 4075 CSF samples tested, 7.4% (301/4075) were positive for S. pneumoniae, 2.5% (103/4075) for H. influenzae, and 1.0% (42/4075) for N. meningitidis. Pneumococcal meningitis incidence in children under five reduced from 44.7 cases per 100,000 in 2013 to 4.6 cases per 100,000 in 2023, an 89.7% reduction. In the PCV13/2p+1 period (2020–2023), pneumococcal meningitis incidence was 51.2% lower than the PCV10/3p+0 period (2013–2017) (IRR 0.49, 95% CI 0.4–0.6; p < 0.001). PCV10-serotype pneumococcal meningitis incidence among children under five decreased by 65.6% in the PCV13/2p+1 period (IRR 0.34, 95% CI 0.2–0.6; p < 0.001). We detected zero cases of pneumococcal meningitis due to the PCV13-serotype in 2020–2023, whereas non-PCV10/13-serotypes increased by 76% (IRR 1.76, 95% CI 1.2–2.6; p = 0.004). The case–fatality proportion decreased by 71.9% (95% CI 62.9–84.8%) in the PCV13/2p+1 period. Conclusions: Since the introduction of PCVs in Mozambique, the burden of pneumococcal meningitis and deaths in children under 5 years of age has substantially decreased, as well as the prevalence of PCV13-serotypes. Higher valency PCVs are needed due to the increased prevalence of non-PCV10/13-serotypes. Funding: Gavi, The Vaccine Alliance, reference number: MOZ-HSS-2-INS; WHO Reference: 2014405143-0, creation DFC to support HIB & Surveillance System. Full article

To address petroleum security concerns and improve its energy structure, China continues to expand its utilization of coal-to-liquid (CTL) technology. While integrating carbon capture and storage (CCS) is essential to reduce the CO₂ emissions from CTL, the high CO₂ abatement cost remains one major barrier to its large-scale implementation. Carbon pricing could improve the cost-effectiveness and competitiveness of CTL-CCS. The impacts of the upstream carbon tax and the downstream carbon price are discussed, considering two indirect coal liquefaction routes: a once-through synthesis process with electricity generation from unreacted syngas and a process with recycling unreacted syngas. The financial performance, with or without CCS, was evaluated using process simulation in Aspen Plus 11.1 and a cost estimation model. First, the product cost of recycling synthesis is consistently lower than of once-through synthesis, indicating better economic efficiency. Second, adopting CCS without a carbon price significantly undermines economic performance. To keep the product cost increase below 10%, the upstream carbon tax and the downstream carbon price should be less than 100 and 120 RMB/tCO₂, respectively. Third, the upstream carbon tax can quickly increase product costs and reduces NPV and IRR, but fails to incentivize actual emissions reduction. Fourth, the downstream carbon price can effectively drive actual emissions reduction, particularly at a higher carbon price. Finally, without a sufficiently high carbon price, enterprises lack necessary incentive to implement CCS. When the carbon price reaches 196 RMB/tCO₂ (approximately 30 USD/tCO₂), CCS becomes a cost-effective option for the CTL process. Full article

We conducted a techno-economic feasibility study and assessed the FP²O resilience of an industrial plant producing magnetized hydrogels from Peruvian Amarilla Reyna potato starch. The process includes alkaline pretreatment, grafting with acrylic acid, crosslinking with N, N′-methylenebisacrylamide, and in situ magnetization via Fe₃O₄ coprecipitation. A total of 12 techno-economic and three financial indicators were analyzed. At the base scale, the total capital investment was 49.78 MMUSD, with raw materials accounting for 92.4% of costs. The economic analysis indicates a payback period of 2.13 years, an IRR of 34.52%, and an NPV of 25.38 MMUSD. The break-even point is at 4760.84 USD/t, with 32.15% capacity utilization, demonstrating operational flexibility to handle demand variations or planned shutdowns. Compared to published techno-economic assessments of lignin- and chitosan-based hydrogels, which involve total capital investments of 236–1248 MMUSD and payback periods in the 6–30-year range, this scheme requires less capital investment and a payback period three to ten times shorter, underscoring its economic competitiveness on an industrial scale. Full article

To examine travel distance and its impact on wait time for positron emission tomography–computed tomography (PET/CT) in patients with lung and prostate cancers and lymphoma in Alberta. We used the Alberta cancer registry and diagnostic imaging database to identify patients with lung and prostate cancers and lymphoma who had a PET/CT scan during April 2017 and March 2023. The Alberta Facilities Distance/Time Look Up Table was used to calculate travel distance from the patient’s residence to the PET/CT facility. Negative binomial regression was used to assess the association between travel distance and wait time for PET/CT. The study included 9503 patients. Lung cancer accounted for 43.4% of the patients, followed by lymphoma (37.1%) and prostate (19.5%) cancer. There were more female patients with lung cancer (55.5%) than lymphoma (42.9%; p < 0.001). The mean (SD) age was 66.8 (13.8) years and lymphoma patients were younger (59.6 years) than lung (70.3 years; p < 0.001) or prostate (72.7 years; p < 0.001) cancer patients. Diabetes (14.2%) was the most prevalent comorbidity. The median (IQR) travel distance was 21 (12–121) km and this was shorter for urban (16 km) than rural (148 km; p < 0.001) patients, but the wait time was similar (median = 20 vs. 21 days; p = 0.378). There were no significant associations between travel distance and wait time (IRR = 1.00; p = 0.108). The results were robust in subgroup analyses by type of cancer and scan priority. There were no associations between travel distance and wait time for PET/CT. Additional research is warranted to examine the potential impact of longer travel distances on overall access to care and patient outcomes. Full article

Background/Objectives: Hip fracture is a condition with increasing hospital demand, and the determinants of hospital stay are crucial for improving clinical outcomes and costs in this vulnerable population. To establish the determinants of the length of hospital stay (HS) of older adult patients with hip fractures in a hospital in the Lambayeque region of Peru during 2017–2019. Methods: We conducted an observational study based on a secondary data analysis. The outcome variable was HS, measured in terms of days from admission to the hospitalization unit until discharge. The main independent variables were age, functional ambulation category scale, cognitive status index (Mental Red Cross scale), Barthel index, comorbidities, geriatric syndromes, trauma diagnosis, reason for surgical delay, preoperative time and preoperative complications. We performed a Poisson or negative binomial regression through crude and adjusted models. Results: Of 399 patients, the average age was 82.25 years, with 63.7% being female. A Poisson and negative binomial regression analysis were conducted for the variables that were significant in the crude model, which were sex, multimorbidity, mental Red Cross scale, Barthel index, functional ambulation, number of geriatric syndromes, traumatic diagnosis, reason for delay in the first model, preoperative complications in the first model, emergency stay, and preoperative time in the second model. According to the adjusted model, the analysis found that in the first model, advanced dementia as measured by the Mental Red Cross (MRC) scale was associated with an increase in hospital length of stay (IRR = 1.82, 95% CI = 1.03–3.23, p < 0.04); similarly, having preoperative complications increased hospital length of stay (IRR = 1.56, 95% CI = 1.30–1.86, p < 0.001), adjusted for clinical variables; in the second model, preoperative time was associated with an increase in hospital length of stay (IRR = 7.44, 95% CI = 6.96–7.96, p < 0.001), adjusted for emergency department stay. A third global model was developed, finding that advanced dementia as measured by the MRC (IRR = 1.82, 95% CI = 1.02–3.23, p < 0.04) and the presence of preoperative complications (IRR = 1.56, 95% CI = 1.30–1.86, p < 0.04) were associated with increased hospital length of stay, adjusted for clinical and hospital variables. Conclusions: The average HS of older adult hip fracture patients treated at a tertiary hospital in the Lambayeque region of Peru was 17 days. The main determinants of HS duration were advanced dementia and presence of preoperative complications. Full article

Objectives: To study the associations of central retinal vein occlusion (CRVO) with glaucoma and cataract before and after the onset of CRVO. Methods: This study included 439 fundus photographically verified CRVO cases and a 5:1 set of 2195 registry-based age- and sex-matched control subjects without a record of CRVO. The study assessed rates of cataract and glaucoma before and after CRVO based on diagnoses, procedures, and prescriptions and analyzed their association with CRVO. Odds ratio (OR) and incidence rate ratio (IRR) estimates for 10 years prior to a subject’s first CRVO and incident comorbidity after CRVO were compared. Results: The median age at the time of presentation of 439 eligible patients with CRVO was 71 years (interquartile range 11 years). In the 10 years leading up to the incidence of CRVO, the ORs for glaucoma and cataract were 6.01 (95% confidence interval (CI95) 4.05 to 8.94) and 2.13 (CI95 1.45 to 3.12), respectively. During a mean follow-up of 5.7 years after CRVO, the incidence rate ratios for glaucoma and cataract were 16.7 (CI95 9.32–30.1) and 1.99 (CI95 1.39–2.84), respectively. Conclusions: Glaucoma and cataract occurred at elevated rates compared with the background population, both before and after the clinical presentation of CRVO. The results fit a disease model where retinal perfusion is compromised by chronic venous congestion, leading to glaucomatous retinal degeneration. Chronic venous congestion may subsequently convert to clinically manifest CRVO when retinal capillaries have been sufficiently weakened to produce hemorrhage, edema and vision loss. Full article

Background and Objectives: Ward-level risk in pulmonary tuberculosis (TB) is often estimated from static admission data. This study evaluated a pragmatic composite—TRIAD-TB—integrating physiology (SpO₂, respiratory rate), inflammation (systemic immune-inflammation index [SII], C-reactive protein [CRP]), and nutrition (BMI, albumin), augmented by 72 h changes in CRP and albumin, to predict 30-day mortality and hospital length of stay (LOS). Methods: A pooled prospective cohort of 126 HIV-negative adults without chronic systemic immunosuppression hospitalized with culture-confirmed pulmonary TB at two Romanian tertiary centers was analyzed. TRIAD-TB combined z-scored admission markers and 72 h deltas. The primary outcome was 30-day all-cause mortality; secondary outcomes included LOS. Associations were estimated using Firth logistic regression (mortality) and quasi-Poisson regression (LOS). Discrimination and overall performance were summarized by AUC and Brier score; internal performance used bootstrap optimism-correction. Results: Across TRIAD-TB tertiles, 30-day mortality increased from 2.4% to 16.7%, and mean LOS rose from 24.7 ± 5.8 to 32.1 ± 7.3 days. Each SD increase in TRIAD-TB was associated with higher odds of death (adjusted OR 2.4, 95% CI 1.3–4.8; p = 0.006) and longer hospitalization (adjusted IRR 1.19, 95% CI 1.09–1.30; p < 0.001). The full model discriminated mortality well (AUC 0.84; Brier 0.067) and explained 21.8% of LOS deviance. Early dynamics were informative: higher CRP ratio (72 h/0 h) and albumin decline tracked with adverse outcomes. An admission-only “mini-TRIAD” retained strong discrimination (AUC 0.79). Conclusions: A dynamic composite leveraging routine vitals and laboratory tests—plus 72 h trajectories—accurately stratified short-term risk in hospitalized pulmonary TB, while an admission-only “mini-TRIAD” retained strong discrimination. Together, these tools may support early escalation, targeted monitoring, and capacity planning. TRIAD-TB may support early escalation, targeted monitoring, and capacity planning; however, because it was derived in HIV-negative, non-immunosuppressed adults in an Eastern European setting, TRIAD-TB and the admission-only “mini-TRIAD” require external validation, including in cohorts with substantial HIV co-infection and different comorbidity profiles, before any broader implementation. Full article

Background: Agricultural production plays a vital role in the global economy by integrating different sectors and promoting capital circulation across industries. In this context, the dairy sector emerges as a promising avenue for investment. This study aims to assess the economic feasibility of establishing a dairy plant for the production of parmesan and mozzarella cheeses in Lavras, MG, considering both deterministic and probabilistic scenarios. Methods: The analysis was conducted in three stages: data collection, deterministic economic feasibility analysis using traditional financial indicators (NPV, IRR, profitability rate, and payback), and a probabilistic assessment using the Monte Carlo simulation with 100,000 iterations to incorporate uncertainty into the model. Results: The deterministic results indicated a positive Net Present Value (NPV), Internal Rate of Return (IRR) exceeding the Minimum Attractiveness Rate (MAR), and a profitability rate above 1.5, validating the investment’s viability. The probabilistic analysis reinforced these findings, with over 80% of simulated scenarios resulting in a positive NPV and over 77% showing IRR above the MAR. Key variables influencing profitability included market share, Class AB cheese consumer percentage, parmesan markup, operational costs, and per capita cheese consumption. Conclusions: The study confirms the economic feasibility of implementing the proposed dairy plant. The integration of Monte Carlo Simulation enhanced the robustness of the analysis by accounting for uncertainty, providing valuable insights for strategic decision-making. The project presents strong potential for regional development, job creation, and income generation. Full article