First Ever in Kuwait, Successful Application of CO2 Foam Acid Fracturing Enables Paradigm Shift in Stimulation Strategy of Kuwait Jurassic Depleted Reservoirs

The first ever CO2 foam fracturing new technology in Kuwait Oil Company (KOC) history was executed flawlessly in late 2021. Three treatments were executed. Co2 Foam Fracturing proved its significant added value of improving productivity in deep depleted tight carbonate Jurassic reservoirs, enhance flow back, reduce water consumption and carbon emission, and enable early production plus improving operation efficiency and cost saving. The stimulation operation has proven to be a huge success for all multidisciplinary teams involved as preliminary results showed over 50-70% production increase compared to offset wells. The main challenges of acid fracturing stimulation in depleted reservoirs are the need for extended formation cleanup to flow back the injected fluids via prolonging Nitrogen lift that add higher operational costs and intervention operations. Therefore, energetic high foam efficiency frac fluid becomes essential to assist flowback and retrieve pumped frac fluids from reservoir. To tackle these challenges, Carbon Dioxide CO2 is pumped in liquid phase as energetic fluid together with normal frac fluids. Due to CO2 liquid nature, high foam efficiency can be reached (40 – 50%) at much lower friction losses. So, it enables achieving pumping frac at high rates and high foam efficiency. The main benefits of CO2 Foam frac are better fracture cleanup due to expansion of the stored compressed gas in the liquid CO2, fluid loss control that is provided by foam, minimized fracture conductivity damage, and the increase in hydrostatic pressure while pumping that translates to lower surface pressures during injection. The selected pilot well is in depleted deep tight carbonate reservoir area of North Kuwait Jurassic gas fields. The executed acid fracturing operation required close planning starting from Q1-2021. Many challenges faced from logistical issues, lack of infrastructure and CO2 resources for the multi-faceted operation due to COVID-19 pandemic limitations. These challenges were tackled ahead with the integration of technical and operations teams to bridge the knowledge gap and to enable executing the operation safely. The pilot well's net incremental production gain is estimated at 50-70% compared to offset wells, with improved flowback and formation cleanup with less well intervention. The resulting time and cost savings as well as the incremental well productivity and better operation efficiency confirmed high perspectives for the implemented foam acid fracturing approach. Another two CO2 Foam acid fracturing wells were executed with good results too. This paper will demonstrate the value of CO2 foam fracturing in depleted reservoir and KOC experience post first application and its plans to expand CO2 Foam Fracturing application across KOC different fields. © Society of Petroleum Engineers - HFTC 2023. All rights reserved.

Use of trained scent dogs for detection of COVID-19 and evidence of cost-saving.

Background: One of the lessons learned from the coronavirus disease 2019 (COVID-19) pandemic is the importance of early, flexible, and rapidly deployable disease detection methods. Currently, diagnosis of COVID-19 requires the collection of oro/nasopharyngal swabs, nasal turbinate, anterior nares and saliva but as the pandemic continues, disease detection methods that can identify infected individuals earlier and more quickly will be crucial for slowing the spread of the virus. Previous studies have indicated that dogs can be trained to identify volatile organic compounds (VOCs) produced during respiratory infections. We sought to determine whether this approach could be applied for detection of COVID-19 in Rwanda and measured its cost-saving. Methods: Over a period of 5 months, four dogs were trained to detect VOCs in sweat samples collected from human subjects confirmed positive or negative for COVID-19 by reverse transcription polymerase chain reaction (RT-PCR) testing. Dogs were trained using a detection dog training system (DDTS) and in vivo diagnosis. Samples were collected from 5,253 participants using a cotton pad swiped in the underarm to collect sweat samples. Statistical analysis was conducted using R statistical software. Findings: From August to September 2021 during the Delta wave, the sensitivity of the dogs' COVID-19 detection ranged from 75.0 to 89.9% for the lowest- and highest-performing dogs, respectively. Specificity ranged from 96.1 to 98.4%, respectively. In the second phase coinciding with the Omicron wave (January-March 2022), the sensitivity decreased substantially from 36.6 to 41.5%, while specificity remained above 95% for all four dogs. The sensitivity and specificity by any positive sample detected by at least one dog was 83.9, 95% CI: 75.8-90.2 and 94.9%; 95% CI: 93.9-95.8, respectively. The use of scent detection dogs was also found to be cost-saving compared to antigen rapid diagnostic tests, based on a marginal cost of approximately $14,000 USD for testing of the 5,253 samples which makes 2.67 USD per sample. Testing turnaround time was also faster with the scent detection dogs, at 3 h compared to 11 h with routine diagnostic testing. Conclusion: The findings from this study indicate that trained dogs can accurately identify respiratory secretion samples from asymptomatic and symptomatic COVID-19 patients timely and cost-effectively. Our findings recommend further uptake of this approach for COVID-19 detection.

An Optimized and Safety-aware Maintenance Framework: A Case Study on Aircraft Engine

The COVID-19 pandemic has recently exacerbated the fierce competition in the transportation businesses. The airline industry took one of the biggest hits as the closure of international borders forced aircraft operators to suspend their international routes, keeping aircraft on the ground without generating revenues while at the same time still requiring adequate maintenance. To maintain their operational sustainability, finding a good balance between cost reductions measure and safety standards fulfillment, including its maintenance procedure, becomes critical. This paper proposes an AI-assisted predictive maintenance scheme that synthesizes prognostics modeling and simulation-based optimization to help airlines decide their optimal engine maintenance approach. The proposed method enables airlines to utilize their diagnostics measurements and operational settings to design a more customized maintenance strategy that takes engine operations conditions into account. Our numerical experiments on the proposed approach resulted in significant cost savings without compromising the safety standards. The experiments also show that maintenance strategies tailored to the failure mode and operational settings (that our framework enables) yield 13% more cost savings than generic optimal maintenance strategies. The generality of our proposed framework allows the extension to other intelligent, safety-critical transportation systems. © 2022 IEEE.

COVID-19 Telehealth Service Can Increase Access to the Health Care System and Become a Cost-Saving Strategy.

Introduction: Data addressing the economic aspects of telehealth initiatives are incipient. This study aimed to evaluate the labor costs for running a COVID-19 telehealth system and its potential incremental access to health care service. Methods: From July 2020 to July 2021, data from a Brazilian teleconsultation service were analyzed. Labor costs were estimated by time-driven activity-based costing. A Generalized Reduced Gradient solving method was coded to maximize the mean incremental access rate and two scenarios were considered to compare the teleconsultation with the in-person consultation: (1) only the length of time that patients spent with a clinician in an in-person consultation was accounted and (2) in addition to the medical consultation, nursing screening was accounted. The mean incremental access rate of the teleconsultation service was defined as a maximization objective in the model. Results: Mean labor costs per medical and nursing teleconsultations are Int$ 24 and Int$ 10, based on data analyses from 25,258 patients. Telemonitoring a patient with a daily call for 7 days costs, on average, Int$ 14. COVID-19 teleconsultation service represents, on average, an incremental access to medical consultation rate of 35% to 52% (min 23% max 63%) for the scenarios (1) and (2), respectively, and considering the current consumed budget for this service. Discussion: A COVID-19 telehealth service contributes to increasing access to the health care system without increasing costs. These services can be included in the bundle of care strategies offered in a national public health care system that looks for more sustainable strategies to provide care.

Intravenous Immunoglobulin in Treating Nonventilated COVID-19 Patients with Moderate-to-Severe Hypoxia: A Pharmacoeconomic Analysis

Objective: To compare the costs of hospitalization of patients with moderate-to-severe COVID-19 who received intravenous immunoglobulin (IVIG) with those of patients of similar comorbidity and illness severity who did not. Design(s): Analysis 1 was a case-control study of 10 nonventilated, moderately to severely hypoxic patients with COVID-19 who received IVIG (Privigen [CSL Behring]) matched 1:2 with 20 control patients of similar age, body mass index, degree of hypoxemia, and comorbidities. Analysis 2 consisted of patients enrolled in a previously published, randomized, open-label prospective study of 14 patients with COVID-19 receiving standard of care vs 13 patients who received standard of care plus IVIG (Octagam 10% [Octapharma]). Setting and participants: Patients with COVID-19 with moderate-to-severe hypoxemia hospitalized at a single site located in San Diego, California. Measurements: Direct cost of hospitalization. Result(s): In the first (case-control) population, mean total direct costs, including IVIG, for the treatment group were $21,982 per IVIG-treated case vs $42,431 per case for matched non-IVIG-receiving controls, representing a net cost reduction of $20,449 (48%) per case. For the second (randomized) group, mean total direct costs, including IVIG, for the treatment group were $28,268 per case vs $62,707 per case for untreated controls, representing a net cost reduction of $34,439 (55%) per case. Of the patients who did not receive IVIG, 24% had hospital costs exceeding $80,000;none of the IVIG-treated patients had costs exceeding this amount (P=.016, Fisher exact test). Conclusion(s): If allocated early to the appropriate patient type (moderate-to-severe illness without end-organ comorbidities and age <70 years), IVIG can significantly reduce hospital costs in COVID-19 care. More important, in our study it reduced the demand for scarce critical care resources during the COVID-19 pandemic. Copyright © 2022 Turner White Communications Inc.. All rights reserved.

Integrating Hybrid and Remote Workplaces into the Post COVID-19 Engineering Corporate Landscape

The COVID-19 pandemic has forced engineering firms to reconsider the role of traditional, corporate work facilities for their full-time workers. During the height of the pandemic, over 40% of engineering employees worked remotely. This greatly changed their perceptions and expectation about the remote work environment. Over 40% of engineering employees are now willing to “take a salary cut in order to have more flexible work arrangements, such as full-time remote and hybrid work facilities arrangements, from their employers.” Employers also learned firsthand the limitations and benefits of a large-scale remote workforce including cost savings. This has forced engineering managers to consider how to integrate remote and hybrid corporate work facilities into the traditional workplace, post COVID-19. We examined the data on the dynamics of traditional, hybrid, and remote workplace facilities to determine the best default work facilities arrangement. While we suspected the traditional work facilities arrangement would be the least viable option, we were surprised to find the benefits of hybrid work facilities be so clearly dominant, that we consider it to be the default engineering workplace of the future. © 2022 IISE Annual Conference and Expo 2022. All rights reserved.

Liquid Biopsy at Home: Delivering Precision Medicine for Patients with Cancer During the COVID-19 Pandemic.

CoronaVirus disease-2019 has changed the delivery of health care worldwide and the pandemic has challenged oncologists to reorganize cancer care. Recently, progress has been made in the field of precision medicine to provide to patients with cancer the best therapeutic choice for their individual needs. In this context, the Foundation Medicine (FMI)-Liquid@Home project has emerged as a key weapon to deal with the new pandemic situation. FoundationOne Liquid Assay (F1L) is a next-generation sequences-based liquid biopsy service, able to detect 324 molecular alterations and genomic signatures, from May 2020 available at patients' home (FMI-Liquid@Home). We analyzed time and costs saving for patients with cancer, their caregivers and National Healthcare System (NHS) with FMI-Liquid@Home versus F1L performed at our Department. Different variables have been evaluated. Between May 2020 and August 2021, 218 FMI-Liquid@Home were performed for patients with cancer in Italy. Among these, our Department performed 153 FMI-Liquid@Home with the success rate of 98% (vs. 95% for F1L in the hospital). Time saving for patients and their caregivers was 494.86 and 427.36 hours, respectively, and costs saving was 13 548.70€. Moreover, for working people these savings were 1084.71 hours and 31 239.65€, respectively. In addition, the total gain for the hospital was 163.5 hours and 6785€, whereas for NHS was 1084.71 hours and 51 573.60€, respectively. FMI-Liquid@Home service appears to be useful and convenient allowing time and costs saving for patients, caregivers, and NHS. Born during the COVID-19 pandemic, it could be integrated in oncological daily routine in the future. Therefore, additional studies are needed to better understand the overall gain and how to integrate this service in different countries.

Development and Validation of a Two-Step Predictive Risk Stratification Model for Coronavirus Disease 2019 In-hospital Mortality: A Multicenter Retrospective Cohort Study.

Objectives: An accurate prognostic score to predict mortality for adults with COVID-19 infection is needed to understand who would benefit most from hospitalizations and more intensive support and care. We aimed to develop and validate a two-step score system for patient triage, and to identify patients at a relatively low level of mortality risk using easy-to-collect individual information. Design: Multicenter retrospective observational cohort study. Setting: Four health centers from Virginia Commonwealth University, Georgetown University, the University of Florida, and the University of California, Los Angeles. Patients: Coronavirus Disease 2019-confirmed and hospitalized adult patients. Measurements and Main Results: We included 1,673 participants from Virginia Commonwealth University (VCU) as the derivation cohort. Risk factors for in-hospital death were identified using a multivariable logistic model with variable selection procedures after repeated missing data imputation. A two-step risk score was developed to identify patients at lower, moderate, and higher mortality risk. The first step selected increasing age, more than one pre-existing comorbidities, heart rate >100 beats/min, respiratory rate ≥30 breaths/min, and SpO2 <93% into the predictive model. Besides age and SpO2, the second step used blood urea nitrogen, absolute neutrophil count, C-reactive protein, platelet count, and neutrophil-to-lymphocyte ratio as predictors. C-statistics reflected very good discrimination with internal validation at VCU (0.83, 95% CI 0.79-0.88) and external validation at the other three health systems (range, 0.79-0.85). A one-step model was also derived for comparison. Overall, the two-step risk score had better performance than the one-step score. Conclusions: The two-step scoring system used widely available, point-of-care data for triage of COVID-19 patients and is a potentially time- and cost-saving tool in practice.

Study of Customer Sentiment Towards Smart Lockers

Understanding customer sentiment associated with delivery solutions, such as smart lockers, is an area of increasing interest for package delivery companies. Applications of this data could result in cost savings through vehicle route planning, cross docking, fleet size optimization, and increased placement of smart locker technology for stop reduction. However, there has been little effort applied to gathering information related to public sentiment applications to last mile package delivery. Therefore, through a survey instrument we gather sentiment data related to smart lockers for review and analysis. Sentiment analysis by region (suburban, urban, and rural) is accomplished through a survey instrument with the goal of understanding the difference in sentiment by region and the effects of COVID-19 on customer sentiment towards the use of smart lockers. Some significant findings were that suburban residents were willing to travel further to pick-up a package from a smart locker (α = 0.01) and previous experience was correlated with increased sentiment (α = 0.05). © 2022, ICST Institute for Computer Sciences, Social Informatics and Telecommunications Engineering.

Role of Breast-Conserving Surgery on the National Health System Economy From and to SARS-COVID-19 Era.

Day surgery breast-conserving surgery (DS-BCS) is a surgical approach applied in many specialized breast surgery departments. This study demonstrates the benefits of this approach from the perspectives of patients and of the Hospital/National Health System compared to ordinary breast-conserving surgery (ORD-BCS) under general anesthetic. A comparison of costs and diagnosis-related group (DRG) reimbursement demonstrated improved cost-effectiveness in DS-BCS compared to ORD-BCS.

The cost-effectiveness of social distancing measures for mitigating the COVID-19 pandemic in a highly-populated country: A case study in Indonesia.

BACKGROUND: As one of the strategies to mitigate the COVID-19 pandemic, social distancing (SD) measures are recommended to control disease spread and reduce the attack rate. Therefore, this study aims to estimate the costs and effects of SD measures through school closures, workforce, and community contact reductions for mitigating the COVID-19 pandemic in Indonesia. METHODS: Two mitigation scenarios of SD for 1 month and continuous SD were compared with the baseline (no intervention). A modified Susceptible-Exposed-Infected-Recovered (SEIR) compartmental model accounting for disease spread during the latent period was applied by considering a 1-year time horizon. The costs of healthcare, school closures, and productivity loss due to disease as well as intervention were considered to estimate the total pandemic cost among all scenarios. RESULTS: In a comparison with the baseline, the result showed that total savings in scenarios of SD for 1 month and continuous SD was approximately $415 billion and $699 billion, respectively, while the averted deaths were 4.6 million and 8.5 million, respectively. Sensitivity analysis showed that basic reproduction number, infectious period, daily wage, incubation period, daily ICU admission cost, and case fatality rate were the most influential parameters affecting the savings and the number of averted deaths. CONCLUSIONS: SD measures through school closures, workforce, and community contact reductions were concluded to be cost-saving. Increasing the duration of social distancing tends to increase both the savings and the number of averted deaths.

Economic benefits of pharmacy technicians practicing at advanced scope: A systematic review.

OBJECTIVE: To critically appraise the literature to determine the cost and time savings for institutions when pharmacy technicians practice in advanced scope roles. METHODS: A systematic review was registered with Prospero and conducted in January 2019. Searches were conducted in Business Source Pro, CINAHL, EconLit, EMBASE, InformGlobal, Medline, ProQuest, PubMed, Scopus and Web of Science. Search terms included pharmacy technician/pharmacy assistant and cost or time or economic evaluation. After article selection in the web-based platform Covidence©, data was extracted, and a narrative review was performed. RESULTS: A total of 16 publications were eligible for inclusion in the review. Pharmacy technicians practicing at advanced scope led to both cost savings and time savings. Six studies reported a cost saving, six reported a time saving and four reported both time and cost savings. Annual savings ranged from AUD $4526 - $88,719.89, linked primarily to the difference in wages between pharmacists and pharmacy technicians. Studies that focused on time savings evaluated checking dispensed items, taking medication histories and entering chemotherapy orders; demonstrating savings of up to 5 min per task completed. CONCLUSION(S): Appropriately trained pharmacy technicians practicing at advanced scope have the potential to save time and reduce hospital costs. Identifying the cost saving opportunities from technicians acting in advance scope roles will provide incentives for hospitals to expand their technician workforce.

Remote interviews for medical residency selection during the initial COVID-19 crisis: a national survey.

BACKGROUND: Medical training programs candidate's interview is an integral part of the residency matching process. During the coronavirus disease 2019 (COVID-19) pandemic, conducting these interviews was challenging due to infection prevention restrains (social distancing, namely) and travel restrictions. E-interviews were implemented by the Saudi Commission for Healthcare Specialties (SCFHS) since the matching cycle of March 2020 to hold the interviews in a safer virtual environment while maintaining the same matching quality and standards. AIM: This study was conducted to assess the medical training residency program applicants' satisfaction, stress, and other perspectives for the (SCFHS) March 2020 Matching-cycle conducted through an urgently implemented E-interviews process. METHOD: A cross-sectional, nationwide survey (Additional file 1) was sent to 4153 residency-nominated applicants to the (SCFHS) March 2020 cycle. RESULTS: Among the 510 candidates who responded, 62.2% applied for medical specialties, 20.2% applied for surgical specialties, and 17.6% applied for critical care and emergency specialties. Most respondents (61.2%) never had previous experience with web-based video conferences. Most respondents (80.2%) used the Zoom application to conduct the current E-interviews, whereas only 15.9% used the FaceTime application. 63.3% of the respondents preferred E-interviews over in-person interviews, and 60.6% rated their experience as very good or excellent. 75.7% of the respondents agreed that all their residency program queries were adequately addressed during the E-interviews. At the same time, 52.2% of them agreed that E-interviews allowed them to represent themselves accurately. 28.2% felt no stress at all with their E-interviews experience, while 41.2% felt little stressed and only 8.2% felt highly stressed. The factors that were independently and inversely associated with applicants' level of stress with E-interviews experience were their ability to represent themselves during the interviews (p = 0.001), cost-savings (p < 0.001), their overall rating of the E-interviews quality (p = 0.007) and the speed of the internet connection (p < 0.006). CONCLUSION: Videoconferencing was implemented on an urgent basis during the COVID-19 pandemic in the medical residency application process in Saudi Arabia. It was perceived as an adequate and promising tool to replace in-person interviews in the future. Applicants' satisfaction was mainly driven by good organization, cost-saving, and their ability to present themselves. Future studies to enhance this experience are warranted.

Role of bariatric surgery in a COVID-19 era: a review of economic costs.

Obesity has rapidly become a significant public health issue. As the prevalence of obesity continues to rise, so does its economic burden as a result of both direct and indirect costs. Likewise, since 2019, the coronavirus disease of 2019 (COVID-19) has become a global pandemic with rising infection rates carrying significant economic costs associated with treatment of the disease and the reduction in economic activity due to government regulations. The COVID-19 pandemic has had a detrimental impact on obesity, not only creating an increasingly obesogenic environment but also reducing access to bariatric care and treatment of obesity-related diseases. In this article, we form a compelling argument for the resumption of bariatric services as soon as it is safe to do so because bariatric surgery brings significant additional medical and economic benefits. Medically, obesity is a risk factor for increased severity of COVID-19 infections, and therefore, treatment of obesity should be a priority in the current pandemic. Additionally, bariatric surgery has been shown to be a cost-saving procedure in the long term and thus has significant economic benefit in reducing the costs of obesity in the future as we recover from the economic collapse following the global pandemic.

Optimal uses of pooled testing for COVID-19 incorporating imperfect test performance and pool dilution effect: An application to congregate settings in Los Angeles County.

INTRODUCTION: Pooled testing is a potentially efficient alternative strategy for COVID-19 testing in congregate settings. We evaluated the utility and cost-savings of pooled testing based on imperfect test performance and potential dilution effect due to pooling and created a practical calculator for online use. METHODS: We developed a 2-stage pooled testing model accounting for dilution. The model was applied to hypothetical scenarios of 100 specimens collected during a one-week time-horizon cycle for varying levels of COVID-19 prevalence and test sensitivity and specificity, and to 338 skilled nursing facilities (SNFs) in Los Angeles County (Los Angeles) (data collected and analyzed in 2020). RESULTS: Optimal pool sizes ranged from 1 to 12 in instances where there is a least one case in the batch of specimens. 40% of Los Angeles SNFs had more than one case triggering a response-testing strategy. The median number (minimum; maximum) of tests performed per facility were 56 (14; 356) for a pool size of 4, 64 (13; 429) for a pool size of 10, and 52 (11; 352) for an optimal pool size strategy among response-testing facilities. The median costs of tests in response-testing facilities were $8250 ($1100; $46,100), $6000 ($1340; $37,700), $6820 ($1260; $43,540), and $5960 ($1100; $37,380) when adopting individual testing, a pooled testing strategy using pool sizes of 4, 10, and optimal pool size, respectively. CONCLUSIONS: Pooled testing is an efficient strategy for congregate settings with a low prevalence of COVID-19. Dilution as a result of pooling can lead to erroneous false-negative results.