Effects of the size and cost reduction on a discounted payback period and levelized cost of energy of a zero-export photovoltaic system with green hydrogen storage.

Zero-export photovoltaic systems are an option to transition to Smart Grids. They decarbonize the sector without affecting third parties. This paper proposes the analysis of a zero-export PVS with a green hydrogen generation and storage system. This configuration is feasible to apply by any self-generation entity; it allows the user to increase their resilience and independence from the electrical network. The technical issue is simplified because the grid supplies no power. The main challenge is finding an economic balance between the savings in electricity billing, proportional to the local electricity rate, and the complete system's investment, operation, and maintenance expenses. This manuscript presents the effects of the power sizing on the efficacy of economic savings in billing (ηSaving) and the effects of the cost reduction on the levelized cost of energy (LCOE) and a discounted payback period (DPP) based on net present value. In addition, this study established an analytical relationship between LCOE and DPP. The designed methodology proposes to size and selects systems to use and store green hydrogen from the zero-export photovoltaic system. The input data in the case study are obtained experimentally from the Autonomous University of the State of Quintana Roo, located on Mexico's southern border. The maximum power of the load is LPmax = 500 kW, and the average power is LPmean = 250 kW; the tariff of the electricity network operator has hourly conditions for a medium voltage demand. A suggested semi-empirical equation allows for determining the efficiency of the fuel cell and electrolyzer as a function of the local operating conditions and the nominal power of the components. The analytical strategy, the energy balance equations, and the identity functions that delimit the operating conditions are detailed to be generalized to other case studies. The results are obtained by a computer code programmed in C++ language. According to our boundary conditions, results show no significant savings generated by the installation of the hydrogen system when the zero-export photovoltaic system Power ≤ LPmax and DPP ≤ 20 years is possible only with LCOE ≤ 0.1 $/kWh. Specifically for the Mexico University case study, zero-export photovoltaic system cost must be less than 310 $/kW, fuel cell cost less than 395 $/kW, and electrolyzer cost less than 460 $/kW.

Cost-effectiveness of Prophylactic Laser Peripheral Iridotomy in Primary Angle-Closure Suspects.

PURPOSE: To investigate the cost-effectiveness (CE) of prophylactic laser peripheral iridotomy (LPI) in primary angle-closure (PAC) suspects (PACSs). DESIGN: Cost-effectiveness analysis utilizing Markov models. SUBJECTS: Patients with narrow angles (PACSs). METHODS: Progression from PACSs through 4 states (PAC, PAC glaucoma, blindness, and death) was simulated using Markov cycles. The cohort entered at 50 years and received either LPI or no treatment. Transition probabilities were calculated from published models, and risk reduction of LPI was calculated from the Zhongshan Angle Closure Prevention trial. We estimated costs of Medicare rates, and previously published utility values were used to calculate quality-adjusted life year (QALY). Incremental CE ratios (ICER) were evaluated at $50 000. Probabilistic sensitivity analyses (PSAs) addressed uncertainty. MAIN OUTCOME MEASURES: Total cost, QALY, and ICER. RESULTS: Over 2 years, the ICER for the LPI cohort was > $50 000. At 6 years, the LPI cohort was less expensive with more accrued QALY. In PSA, the LPI arm was cost-effective in 24.65% of iterations over 2 years and 92.69% over 6 years. The most sensitive parameters were probability of progressing to PAC and cost and number of annual office visits. CONCLUSIONS: By 6 years, prophylactic LPI was cost-effective. The rate of progressing to PAC and differing practice patterns most impacted CE. With uncertainty of management of narrow angles, cost may be a decision management tool for providers. FINANCIAL DISCLOSURE(S): The authors have no proprietary or commercial interest in any materials discussed in this article.

Barriers and Facilitators to Father's Engagement in a Depression and Alcohol Use Intervention in Kenya: Father, Family, and Community Factors.

In Kenya, there is a treatment gap for depression and alcohol use that is especially large for fathers, which has consequences for families. While treatments exist, there are challenges to implementation. This study aimed to understand barriers and facilitators to implementing a treatment for fathers' depression and alcohol use in Eldoret, Kenya. Guided by the Consolidated Framework for Implementation Research and the Integrated Sustainability Framework, we conducted 18 key informant interviews and 7 focus group discussions (31 total participants) with stakeholders in Eldoret (hospital leaders, policy makers, mental health providers, community leaders, fathers, lay providers, and patients previously engaged in treatment). Interviews were analyzed using the framework method; themes were matrixed by framework domains. Participants identified barriers and facilitators, and opportunities for implementation, in the following domains: innovation, outer setting, inner setting, individual, sustainability, and characteristics of systems. Barriers included a lack of resources, stigma, masculine norms, cost of services, and alcohol dependence. Facilitators included community buy-in, family support, providers with lived experience, government support, and relevant treatment content. Findings will inform implementation strategy development for an intervention for fathers with depression and alcohol use, and family problems with local relevance and scalable potential.

Income inequality and entrepreneurship: Lessons from the 2020 COVID-19 recession.

We study entry into entrepreneurship during the COVID-19 recession of 2020 using new data from an extensive survey of more than 24,000 Spanish households, conducted between June and November 2020. We find that while the overall decline in the startup rate in 2020 was large, and of a similar magnitude as that during the Great Recession, the differential impact depending on ex ante income was starkly different. During 2020, the drop in firm entry was entirely concentrated among low- and medium-income households. We show that the entrepreneurship gap between these households and their high-income counterparts is not directly explained by social distancing, since it is mostly driven by the sectors not directly affected by lockdown measures, and it is larger among households that did not suffer a negative income shock during the pandemic. Our results instead indicate that high-income households performed relatively better during the COVID-19 recession because they had the means to exploit new business opportunities, thanks to their larger wealth and better access to external finance.

Cost-Effectiveness Analysis of Minimally Invasive Trabecular Meshwork Stents with Phacoemulsification.

PURPOSE: To investigate the costs and effects of implanting trabecular meshwork bypass stents during cataract surgery from a societal perspective in the United States. DESIGN: Cost-utility analysis using Markov models and efficacy/safety data from published pivotal or randomized control trials (RCTs) of devices investigated. PARTICIPANTS: Patients aged 65 years and older with mild to moderate primary open-angle glaucoma with or without visually significant cataract. METHODS: With the use of Markov models, glaucoma progression through 4 glaucoma states (mild, moderate, advanced, severe/blind) and death were simulated over 35 years. The cohort with cataract entered the model and received cataract surgery with or without device implantation. We included a medication management only reference group to calculate total costs and outcomes for those without cataract. Intraocular pressure (IOP) reductions from RCTs were converted to glaucoma state transition probabilities using visual field (VF) mean deviation (MD) decline rates from the Early Manifest Glaucoma Trial. Progressive thinning of the retinal nerve fiber layer (RNFL) on OCT imaging related to IOP control warranted further intervention, including adding medication, selective laser trabeculoplasty (SLT), or incisional glaucoma surgery. We estimated whole costs at Medicare rates and obtained utility values for glaucoma states from previous studies. Incremental costs per quality-adjusted life-year (QALY) gained were evaluated at a QALY threshold of $50 000. One-way deterministic sensitivity analysis, scenario analyses, and probabilistic sensitivity analyses addressed parameter uncertainty and demonstrated model robustness. MAIN OUTCOME MEASURES: Total costs, QALY, and incremental cost-effectiveness ratio (ICER). RESULTS: Over 35 years in the base case, the Hydrus (Ivantis, Inc.) implanted with cataract surgery arm cost $48 026.13 and gained 12.26 QALYs. The iStent inject (Glaukos Corp.) implanted with cataract surgery arm cost $49 599.86 and gained 12.21 QALYs. Cataract surgery alone cost $54 409.25 and gained 12.04 QALYs. Initial nonsurgical management cost $57 931.22 and gained 11.74 QALY. The device arms dominated or were cost-effective compared with cataract surgery alone within 5 years and throughout sensitivity analyses. The iStent inject arm was cost-effective in 94.19% of iterations in probabilistic sensitivity analyses, whereas the Hydrus arm was cost-effective in 94.69% of iterations. CONCLUSIONS: Implanting the Hydrus Microstent or iStent inject during cataract surgery is cost-effective at a conservative QALY threshold.

Examining the Research Evolution on the Socio-Economic and Environmental Dimensions on University Social Responsibility.

Responsible higher education institutions have an impact on society and economic, environmental, and social development. These effects define the axes of the socially responsible management of the universities. The concept of university social responsibility (USR) manages these relationships to produce a positive impact on society through higher education, research, and the transfer of knowledge and technology, as well as education for sustainability. For this study, worldwide research into this subject was studied for the period 1970-2019. A bibliometric analysis of 870 articles was made, obtaining results for the scientific productivity of the journals, authors, institutions, and countries contributing to this research. The main category is business, management, and accounting. The most productive journal is the Business and Society Review, while the California Management Review is the most cited. The authors with the most articles are Stavnezer, Luo, and Lanero. The most productive institution is Wuhan University. The United States is the country with the most publications and citations, and the same country, together with the United Kingdom, make the most international contributions. Evidence shows growing worldwide interest in the economic and environmental impacts of USR. Future research should focus on analysing the links between the responsible and sustainable consumption of universities and their short-term financial, economic, and sustainable impacts.

Mental Health Interventions during the COVID-19 Pandemic: A Conceptual Framework by Early Career Psychiatrists.

The emergence of mental health (MH) problems during a pandemic is extremely common, though difficult to address due to the complexities of pandemics and the scarcity of evidence about the epidemiology of pandemic-related MH problems and the potential interventions to tackle them. Little attention has been devoted so far to this topic from policymakers, stakeholders and researchers, resulting in a lack of replicable, scalable and applicable frameworks to help plan, develop and deliver MH care during pandemics. As a response, we have attempted to develop a conceptual framework (CF) that could guide the development, implementation, and evaluation of MH interventions during the ongoing COVID-19 pandemic. This CF was developed by early career psychiatrists from 16 countries that cover all the WHO regions. Their opinions were elicited via a semi-structured questionnaire. They were asked to provide their views about the current MH situation in their countries and to elaborate on existing 'myths' and misinformation. They were also asked to name the resources available and to propose solutions and approaches to provide accessible and affordable care. The CF was prepared based on the extant literature and the views discussed in this group; it illustrates the epidemiology of MH problems, preparedness plans, stage-specific plans or innovative solutions, opportunities to integrate those plans and possible outcomes at policy level. This CF can serve as a technical guide for future research regarding pandemics. It can be used to monitor trends and to optimize efforts, and to develop evidence based MH interventions. Still, further research focusing on the individual components of this framework is needed.

Fast 1.5 T chest MRI for the assessment of interstitial lung disease extent secondary to systemic sclerosis.

This study aims to evaluate the utility of magnetic resonance imaging (MRI) to assess interstitial lung disease (ILD) extent in patients with systemic sclerosis (SSc). Patients with SSc and varying degrees of ILD with a high-resolution computed tomography (HRCT), pulmonary function tests (PFTs), and a chest MRI containing an ultrafast SE sequence performed less than 1 year apart were included in the study. Wells global disease extent and Goh's staging algorithm were used to measure and categorize ILD both for MRI and HRCT. Correlation and diagnostic performance of MRI compared with HRCT and PFTs were calculated. Eighteen SSc patients were studied. MRI showed a good performance to detect ILD (AUC = 0.96) and was correlated with forced vital capacity (r = -0.60, p = 0.01), diffusing capacity of the lung for carbon monoxide (r = -0.79, p = 0.04), and also with HRCT (r = 0.85, p < 0.001), but MRI extent values were consistently lower than HRCT and, thus, not directly comparable. Goh's algorithm using HRCT and transformed to be used with MRI showed a good agreement (kappa = 0.73, p < 0.001) and MRI-measured ILD extent presented good intra-observer (ICC = 0.86) and inter-observer (ICC = 0.90) reliability. In SSc patients, MRI proved to be a good technique to detect and categorize ILD extent compared with HRCT, suggesting that it may be a valuable x-ray sparing technique for selected cases.

Cost-effectiveness of the 21-gene breast cancer assay in Mexico.

INTRODUCTION: The 21-gene breast cancer assay (Oncotype DX(®); Genomic Health, Inc.) is a validated diagnostic test that predicts the likelihood of adjuvant chemotherapy benefit and 10-year risk of distant recurrence in patients with hormone-receptor-positive, human epidermal growth receptor 2-negative, early-stage breast cancer. The aim of this analysis was to evaluate the cost-effectiveness of using the assay to inform adjuvant chemotherapy decisions in Mexico. METHODS: A Markov model was developed to make long-term projections of distant recurrence, survival, and direct costs in scenarios using conventional diagnostic procedures or the 21-gene assay to inform adjuvant chemotherapy recommendations. Transition probabilities and risk adjustment were taken from published landmark trials. Costs [2011 Mexican Pesos (MXN)] were estimated from an Instituto Mexicano del Seguro Social perspective. Costs and clinical benefits were discounted at 5% annually. RESULTS: Following assay testing, approximately 66% of patients previously receiving chemotherapy were recommended to receive hormone therapy only after consideration of assay results. Furthermore, approximately 10% of those previously allocated hormone therapy alone had their recommendation changed to add chemotherapy. This optimized therapy allocation led to improved mean life expectancy by 0.068 years per patient and increased direct costs by MXN 1707 [2011 United States Dollars (USD) 129] per patient versus usual care. This is equated to an incremental cost-effectiveness ratio (ICER) of MXN 25,244 (USD 1914) per life-year gained. CONCLUSION: In early-stage breast cancer patients in Mexico, guiding decision making on adjuvant therapy using the 21-gene assay was projected to improve life expectancy in comparison with the current standard of care, with an ICER of MXN 25,244 (USD 1914) per life-year gained, which is within the range generally considered cost-effective.

[Evaluation of breast cancer treatment at a tertiary-level institution with Popular Health Insurance in Mexico]. / Evaluación del tratamiento del cáncer de mama en una institución del tercer nivel con el Seguro Popular, México.

BACKGROUND: In our country breast cancer represents a major health problem. Only 45% of all population has access to health services, the consequence is delay in diagnosis and treatment. In Mexico, 66% of all new cases of breast cancer are diagnosed in locally advanced stages. From May 2007 the Health System Protection Against Catastrophic Expenses, called Seguro Popular (SP), breast cancer was included in covering the treatment of this neoplasm in any patient without access to social security. OBJECTIVE: To evaluate the results and impact of SP in the adjuvant and neoadjuvant treatment of a group of patients diagnosed with breast cancer at an institution of national reference. MATERIAL AND METHODS: We analyzed a group of 259 patients in stages (I-IIIC). The clinical stages I and II (55 patients) were treated with adjuvant chemotherapy FAC -T (fluorouracil 500 mg/m2, adriamycin 50 mg/m2 and cyclophosphamide 500 mg/m2 (FAC) followed by 12 weeks of paclitaxel 80 mg/m2 +/- trastuzumab loading dose of 4 mg/kg followed by 2 mg/kg); 204 patients in locally advanced stages (IIB-IIIC) received FAC-T +/- trastuzumab followed by surgery. Adjuvant treatment consisted of endocrine therapy for hormone-sensitive patients and radiotherapy 50 cGy according to international standards. RESULTS: The age at diagnosis was 47 years (range 23-68). 80% of them were locally advanced stages (IIB-IIIC) and were treated in a neoadjuvant setting, 20% was in early stages, treated with surgery and adjuvant chemotherapy The disease-free survival and overall survival at 30 months was 85.7 and 90% respectively. Overall pathologic complete response was obtained in 15% of cases. In the subgroup analysis showed that 41% of patients HER2 (+), 29% of triple-negative patients and 9% of hormone-sensitive tumors achieved complete pathological response (p = 0.0001). CONCLUSION: This is the first analysis of efficacy of adjuvant and neoadjuvant treatment in breast cancer since the introduction of popular secure non-entitled population. It is clear that treatment efficacy is similar to that reported in the literature, with 15% of pRC and survival to 30 months in 94-80%. The coverage of health expenditures treats a larger number of patients optimally. Along with this, efforts should be made to reduce the high frequency of diagnosis at advanced stage.

Correlación clínica radiológica de las consultas realizada en unidades de la Subdelegación Lázaro Cárdenas del IMSS / Clinic-radiological corelation of X-Ray examinations

El objetivo de este estudio es analizar la correlación clínica-radiológica en los diagnósticos establecidos, en las unidades médicas de primero y segundo nivel, del Instituto Mexicano del Seguro Social en Lázaro Cardenas, Mich. Se trata de un estudio de correlación, diagnóstica y radiológica con base en el expediente clínico, desde el punto de vista de un segundo observador, bajo la concordancia de un criterio de verdad aceptado. Se analizaron 407 expedientes. La correlación diagnóstica se estableció con un porcentaje de concordancia de 89 por ciento con un coeficiente de Kappa de .78, la pertinencia del apoyo radiológico solicitado se estableció con un porcentaje de concordancia de 85 por ciento, y un coeficiente de Kappa de .71. Los resultados de la correlación del estudio radiológico se presento con un porcentaje de 71.49 con un coeficiente de 45. Los dos primeros valores presentan una fuerza sustancial, consideramos que éstos se pueden incrementar, mediante la consistencia de la información y recopilación clínica en forma adecuada. El tercer valor presenta una fuerza moderada, que se puede modificar mediante la implementación y difusión de cuadros de eficacia de los procedimientos de apoyo diagnóstico de radiología

Evaluación de un proceso de andragogía / Evaluation of a rpocess of adult education

El objetivo del presente estudio es evaluar el proceso de diseminación selectiva de la información, mediante el conocimiento de los niveles cognoscitivos alcanzados. En una muestra seleccionada al azar del personal médico y paramédico (87 personas), de la Subdelegación en Ciudad Lázaro Cárdenas, Mich., del Instituto Mexicano del Seguro Social, mediante el método pretest-postest, con un periodo de intervalo de un mes, se realizó diseminación selectiva de la información. Encontrando un incremento porcentual en el test de 13 por ciento, por lo que la diseminación selectiva de la información aumenta la probabilidad de lograr mejores calificaciones con una p=<0.05, con un coeficiente de contingencia de 0.34, estadísticamente significativo. Estos niveles pueden ser mejorados en cuanto aumente la motivación intrínseca del trabajador y se realice una lectura crítica

Impacto de la educación antiparasitaria en la demanda de educación médica / Impact of antiparasitary education upon medical attention demand

Para evaluar el impacto de una estrategia de ducación antiparasitaria en la tasa de demanda de servicios por parasitosis intestinal, se midieron las consultas otorgadas en medicina familiar por parasitosis y las dosis de albendazol, un año antes y un año después de la eduación específica antiparasitaria. Se dieron 496 pláticas educativas dirigidas a escolares y madres. Asistieron en total 8945 personas. La tasa de consultas por parasitosis se redujo de 53 a 12 por 1000 derechohabientes (DH); y por ascaridiasis se redujo de 3.1 a 1.8 por 1000. Las dosis de albendazol se redujeron de 8503 a 3412. Se concluye que la educación específica antiparasitaria reduce la demanda de atención médica y la utilizació de albendazol. Se requiere en otro estudio comprobar el impacto sobr el resultado coproparasitoscópico