Rock Fragmentation Evaluation towards Blast-To-Mill Concept of Blast Optimization in Hard Rock Mines

Traditional blast optimisation studies ensure efficient mining operation but ignore potential impact of blasting on primary crushing. The performance of the primary crusher is key to the ore beneficiation process. Optimisation studies conducted through the mining operations to the comminution circuit is vital to the mine-to-mill concepts in the mining industry. In this approach, an innovative approach to the assessment of in-situ blasting is proposed and evaluated. This approach focuses on the acceptability of rock fragments on the Run-of-Mine (ROM) pad as opposed to the pits. Fragmentation analysis was conducted in the pit and on the ROM pad. A correlation efficiency of 0.92 was realized between the measured rock fragments in the pit and that on the ROM pad. About 10% of the rock fragments in the pit were classified as boulders while about 30% of the same rock fragments deposited on the ROM pad were classified as boulders. However, about 30% of the rockpile on the ROM pad was estimated to be lower than the Close Side Setting (CSS) of the primary crusher. It is recommended that future research evaluates the energy consumption and its related cost at the primary crusher in comparison to in-pit fragmentation and mucking cost performance.

Prevalence and direct costs of patients with neuromyelitis optica: data from Campania region in southern Italy

Aim: The study aimed to estimate the prevalence and direct costs of neuromyelitis optica (NMO) patients in Campania, Italy. Materials & methods: We retrospectively evaluated 53 NMO patients (mean age: 50.9 ± 16.5 years; 34% men) from the Campania Region administrative databases identified through disease exemption codes in 2018 and analyzed the incidence of NMO among the Campania region population and the disease-related cost. Results: The prevalence of NMO was 0.91 per 100,000 individuals. The average regional cost per NMO patient was 10,836.2 euros. The highest cost was related to drugs (60.6%), followed by hospitalizations (32.7%), diagnostics (4.8%) and laboratory tests (1.0%). Conclusion: NMO is an extremely rare disease with an annual disease-related cost of 0.005% of public health expenditure.

Detecting Vicious Cycles in Urban Problem Knowledge Graph using Inference Rules

Urban areas have many problems, including homelessness, graffiti, and littering. These problems are influenced by various factors and are linked to each other; thus, an understanding of the problem structure is required in order to detect and solve the root problems that generate vicious cycles. Moreover, before implementing action plans to solve these problems, local governments need to estimate cost-effectiveness when the plans are carried out. Therefore, this paper proposes constructing an urban problem knowledge graph that would include urban problems' causality and the related cost information in budget sheets. In addition, this paper proposes a method for detecting vicious cycles of urban problems using SPARQL queries with inference rules from the knowledge graph. Finally, several root problems that led to vicious cycles were detected. Urban-problem experts evaluated the extracted causal relations.

A Field Experiment on Business Opposition to the U.S.-China Trade War

The United States's trade war with China proved to be detrimental to a wide swath of U.S. companies, but only a handful of well-connected firms pursued vigorous political action to oppose it. To better understand the constraints to corporate political action, we implemented a field experiment targeted at managers of U.S.-based firms in which we randomly provided original estimates of the costs of the trade war to their industry and company and then measured their willingness to take actions either opposing or supporting the trade war. We find that on the whole, U.S. companies that receive information about the rise in input costs from tariffs are less likely to take political action opposing the trade war, though this effect is highly conditional on respondents' pre-existing beliefs and on the number of tariffs affecting their industries. The information treatment caused the greatest opposition to the trade war among subjects who believed the trade war was harmful and whose companies' industries were affected by the largest array of tariffs. On the other side, subjects who previously believed they were helped by the trade war, and thus for whom the treatment provided contrasting evidence of trade-war harm from many tariffs, grew significantly less likely to support the trade war. Subjects with intermediate beliefs about the benefits or costs of the trade war showed the strongest negative effects from treatment. Finally, we find that partisan affiliation of the company's managers was as strong a predictor of support for or against the trade war as was the company's own vulnerability to tariff-related cost increases, suggesting that partisanship strongly shaped pre-existing beliefs.

Evaluation of CPAP mask performance during 3 years of mask usage: time for reconsideration of renewal policies?

BackgroundContinuous positive airway pressure (CPAP) mask renewal policies vary inside and between countries. There are no independent studies on the optimal mask renewal frequency. We aimed to evaluate CPAP mask function over time in a real-life clinical setting, and to compare the results against current renewal policies.MethodsDaily performance data of 1846 CPAP masks (65% nasal, 22% nasal pillows, 12% oronasal) were recorded from 450 participants (68% male, mean age 59 years) with obstructive sleep apnoea. The unintentional leak, Apnoea-Hypopnoea Index (CPAP-AHI) and usage data were exported from the CPAP device.ResultsOf 656 324 nights of CPAP usage, the mean renewal time was 497 days (SD 327), mean leak 5.7 L/min (SD 8.1) and CPAP-AHI 3.8 events/h (SD 3.6). The difference in mean leak between one (5.2 L/min, SD 7.5), 12 (6.0 L/min, SD 10.2) and 24 months (5.8 L/min, SD 7.5) was minimal (p=0.59). Mean CPAP-AHI remained normal and unchanged in nasal masks and pillows up to 30 months, and was highest in oronasal masks. Different mask manufacturers performed similarly. Masks’ daily or total usage did not affect the results. Shifting the mask renewal policy to 24 months could reduce the mask-related cost up to 50%–88%.ConclusionsNasal masks and pillows could be used at least 2 years without significant changes in unintentional leak and CPAP-AHI. We suggest updating the mask renewal policies of nasal masks and pillows; results on oronasal masks and other manufacturers CPAP devices need further verification.

Financial toxicity and patient-provider communication about cancer-related cost among prostate cancer patients and survivors.

215 Background: With early screening and advances in treatment, prostate cancer (PC) patients are living longer and facing increasingly complex therapeutic decisions alongside significant financial burden related to care (e.g., copays, coinsurance, other out-of-pocket (OOP) costs). Conversations with providers about financial concerns can help patients navigate these decisions, thereby promoting delivery of quality care and improving quality of life. We characterized financial toxicity (FT) and patient-provider communication about cancer-related cost among PC patients and survivors. Methods: 107 PC patients and survivors enrolled in Cancer Support Community’s Cancer Experience Registry completed items assessing FT (11-item FACIT-COST measure; range = 0-44, lower scores indicate greater FT). Items include ability to meet monthly expenses, financial stress, and cancer/treatment influence on financial situation. Frequencies and correlations between FT, health care team (HCT) communication, and socio-demographics were examined. Results: Participants were 89% non-Hispanic White, 5% Black, 2% Hispanic; mean age was 68 years (SD = 7.5). Median time since diagnosis was 3 years; 19% reported experiencing symptoms of PC at the time of diagnosis. 21% were ever metastatic, 22% experienced a recurrence, and 48% reported currently receiving treatment. 29% were employed full- or part-time; 52% spent at least $100/month on all OOP PC costs, 30% spent $250 or more, 16% spent $500 or more. Mean FT score was 28 (SD = 11.9). 67% reported members of their HCT did not discuss cost of treatment, 55% did not discuss impact of PC and treatment on work, 77% did not discuss financial distress. While most participants were satisfied with their doctor’s explanation of benefits (89%) and risks/side effects (79%) for each treatment option, only 49% were satisfied with how much their HCT discussed financial costs of each option. Greater patient confidence in communicating with doctor about PC was significantly associated with less FT ( r= .19, p< .05), but experiencing more FT was not correlated with a greater likelihood of HCT discussing cost of treatment ( r= -.05, p= .63) or discussing impact of cancer and treatment on work ( r= .04, p= .67). Conclusions: Results indicate that patients with greater financial toxicity report less confidence in communicating with their doctor about PC, however providers are not frequently or systematically initiating discussions around cost and impact on work even among those experiencing the highest levels of financial burden. Findings underscore the critical value of transparency about health care costs and impact, as well as support for providers in communicating effectively with patients about costs and available resources, to improve patient quality of life and health outcomes.

Comparison of cost-effectiveness and postoperative outcomes following integration of a stiff shaft glidewire into percutaneous nephrolithotripsy

Aims: To analyze the cost effectiveness of integrating a stiff shaft glidewire (SSGW) in percutaneous nephrolithotripsy (PCNL) relative to standard technique (ST). This is prudent because healthcare providers are experiencing increased pressure to improve procedure-related cost containment. Methods: ST for PCNL at our institution involves a hydrophilic glidewire during initial percutaneous access and then two new stiff shaft wires. The SSGW is a hydrophilic wire used for initial access and the remainder of the procedure. We collected operating room (OR) costs for all primary, unilateral PCNL cases over a 5-month period during which ST for PCNL was used at a single institution with a single surgeon and compared with a 6-month period during which a SSGW was used. Mean costs for each period were then compared along with stone-free rates and complications. Results: We included 17 total cases in the ST group and 22 in the SSGW group. The average operating room supply cost for the ST group was $1937.32 and $1559.39 in the SSGW group. The net difference of $377.93 represents a nearly 20% decrease in cost. This difference was statistically significant ( p = 0.031). There was no difference in postoperative stone-free rates (82.4% versus 86.4%, p = 1.0, respectively) or complications (23.5% versus 13.6%, p = 0.677, respectively) between ST and SSGW groups. Conclusion: Transitioning to a SSGW has reduced OR supply cost by reducing the number of supplies required. The change in wire did not affect stone-free rates or complications.

Understanding Nursing Home Responses to Minnesota’s New Value Based Reimbursement System

Even though Value Based Reimbursement (VBR) systems for nursing homes (NH) continue to expand, we have little understanding of how NH respond to VBR. In 2016, Minnesota passed VBR legislation for NHs that increased care-related funding and tied increases to a facility’s composite quality score. While care-related expenditures increased with VBR, the incentive for quality did not work as intended. We investigated the differential responses of facilities in their care-related expenditures and quality scores. Data were derived from cost reports and quality measures for the years 2013-2017 from 300 free-standing Minnesota NHs. Latent Class Growth Analysis was used to cluster facilities by their joint care-related cost and quality score trajectories over the period. Three interpretable trajectory clusters emerged: medium-to-high cost and medium-to-high quality (n=172), low cost and medium-to-high quality (n=54), and low cost and low quality (n=74), all during the pre-VBR period. In all three clusters cost rose significantly with VBR, but only in the low cost and low quality cluster did quality also rise significantly. The quality improving cluster had the highest percentage of government-owned and rural facilities as well as the largest annual increase in care related spending. The medium-to-high cost and medium-to-high quality cluster had the highest concentration of urban facilities (Twin City Metro Area) and were the most likely to be non-profit and chain owned. Although the new VBR system appeared effective in achieving its goals for a subset of facilities with lowest cost and quality, the majority of facilities increased care-related costs without improved quality.