The copper mining industry is increasingly using artificial intelligence methods to improve copper production processes. Recent studies reveal the use of algorithms, such as Artificial Neural Network, Support Vector Machine, and Random Forest, among others, to develop models for predicting product quality. Other studies compare the predictive models developed with these machine learning algorithms in the mining industry as a whole. However, not many copper mining studies published compare the results of machine learning techniques for copper recovery prediction. This study makes a detailed comparison between three models for predicting copper recovery by leaching, using four datasets resulting from mining operations in Northern Chile. The algorithms used for developing the models were Random Forest, Support Vector Machine, and Artificial Neural Network. To validate these models, four indicators or values of merit were used: accuracy (acc), precision (p), recall (r), and Matthew’s correlation coefficient (mcc). This paper describes the dataset preparation and the refinement of the threshold values used for the predictive variable most influential on the class (the copper recovery). Results show both a precision over 98.50% and also the model with the best behavior between the predicted and the real values. Finally, the obtained models have the following mean values: acc = 0.943, p = 88.47, r = 0.995, and mcc = 0.232. These values are highly competitive when compared with those obtained in similar studies using other approaches in the context. At present, the copper mining industry in Chile and the world is undergoing big changes owing to the use of modern techniques such as predictive models based on Artificial Intelligence ,2,3. An These methods relate to data-driven techniques used in several engineering areas, showing good results in most cases . TechniqA proper amount of data related to processes and results are necessary for these algorithms to work, but not all machine-learning algorithms work properly in these domains. This is because the copper production industry neither provides good results in all domains nor works on relevant datasets concerning the suitability of data and accuracy rates ,9.There are well-known methods used for producing metallic copper via hydrometallurgy in the copper industry: dynamic heap leaching, solvent extraction, and electro-winning. The ultimate goal of these processes is to produce the most amount of copper, saving resources and being the least aggressive for the environment. However, the quality of copper recovery is difficult to predict with this method due to the big number of process parameters  and other aspects, such as performance fluctuations depending on time due to complex irrigation systems and product validation.3 grade”, “Leaching ratio”, “Operation day”, and “Soluble copper grade stacked”.Recent studies such as  report pRecent studies highlight an increasing interest in using machine-learning algorithms to develop predictive models for the mining industry ,8.Recently, a big number of studies on data-driven approaches have been published. They deal with the use of predictive model techniques for metallic copper recovery processes. For example, the authors of  reportedThere are recent studies that compared the results of predictive models used in mining. For example, the authors of  comparedFor example, the authors of  presenteThe authors of  reportedMore recently, the authors of  reportedTo develop models using data-driven techniques, the stages generally grouped together in ,10,11,12The models developed with data-driven techniques, as compared with those developed with other techniques, have the following advantages: they are more intuitive for interpretation when they are made by mining exploitation experts. However, the non-specialists in artificial intelligence techniques can help identify non-evident relations between some aspects of the context to improve performance and reduce necessary resources and processing time, among others.The following disadvantages can be mentioned: to use a supervised learning technique, it is necessary to have data, good data, and also previous knowledge to generate a good training set. The combination of data and experience is not quite frequent in mining since experimentation may be too expensive. In addition, the time of one or several experts for participating in tasks such as data cleaning and model training may be too costly and even unviable for mining companies.Furthermore, it is not feasible to know a priori the most appropriate data mining method meeting certain characteristics of a mining exploitation since a big number of parameters come into play, some of which cannot be measured in operation or may vary, for example, mineralogy.A comparison between the models already developed must be made to evaluate the most appropriate data mining methods and generate another model. For example, the literature reports comparisons between models developed with Bayesian networks and ANN. The authors of ,16 reporThis study aims to compare the performance of three supervised machine learning algorithms used to develop predictive models of copper recovery by leaching. Here, an assessment using cross-validation accuracy among three algorithms is presented: Artificial Neural Networks (ANN), Support Vector Machines (SVM), and RF. It aims to compare the results and determine the one contributing with the most knowledge to the leaching process. The question of what can be learned, discovered, and predicted with each model will be addressed and the quality measures of each model to compare their performance will be determined. All this follows previous works ,18.The paper is organized as follows: As described by the authors of , the FraThis usually involves poor planning of the irrigation module start-up, agglomerate and irrigation conditions, drainage distribution, inventories of poor solutions, Pregnant Leaching Solution (PLS) flow to the Solvent Extraction (SX) plant, and copper deposited and extracted at the electrowinning (EW) plant. The leaching process is similar in most mining companies. Principal steps of the mining leaching process are represented in The ore is obtained from the open pit mine by extracting copper oxides mostly composed of atacamite. Then, it is sent to the primary crushing section by means of belts. The ore mixture obtained from the primary crushing is classified according to granulometry and then, sent to either a stockpile, or a secondary or tertiary crusher. If the material meets the granulometry of the company, it is sent to stockpile 1 (defined as coarse stockpile) and later to the secondary crusher.2, covering 120,000 tons of ore.The pile-leaching of copper is a percolation process that operates above the ground, as illustrated in The grain classification is checked again, and the ore is sent to the tertiary crusher, if necessary. Finally, it goes to stockpile 2 (fines), where it is stored to finally enter the agglomeration process. This process takes place in two agglomeration tanks with the same dimensions. Here, the ore gets in contact with a sulfuric acid solution and water. The objective of this process is to form uniform agglomerates of a proper size with the fine material. In addition, it contributes to copper sulfation due to its contact with acid solutions.At the end of this process, the material is sent to the dry area. Here, stock-piling ends. A radial stockpiler forms a dynamic stockpile used for leaching. It has a maximum of 12 slots, each of them formed by eight modules. Each module has certain dimensions and operates with 10,000–15,000 tons of agglomerate.The process to produce copper ends with the drainage of the solution going to PLS. The copper in the PLS solution has an average concentration which is assessed at different times during the stockpile operation.These measurements allow determining the quality of the leached copper and also help to validate both the planning process of the leaching stockpile life cycle and also how well each part of the process is designed for the stockpile to operate. At this moment, two partial results are obtained: PLS and Intermediate Liquid Solution (ILS) solutions. The PLS solution is used in the solvent extraction stage, while the ILS solution is used for leaching new modules. Stockpile exploitation is conducted during a period of time called exploitation cycle. These may last 30–45 days in which the tasks described above take place. The goal in these processes is to achieve the highest copper production by saving resources with the lowest possible environmental impact.In this regard, during the leaching stockpile exploitation, the company collected copper recovery data and also data in a controlled environment with stockpile material, although piled in columns and processed in the laboratory. In this study and similar to other studies ,10, the One of the most common difficulties companies face when using the leaching technique to recover copper is the lack of historical data for planning the stockpile exploitation and forecasting or planning the operation . Some ofHowever, these techniques usually result in high interdependence indexes, possible errors, and subjective interpretation of significance . TherefoFor example, the authors of  develope® software to create three statistical models: linear, quadratic, and cubic fit. A regression of the best subsets was conducted for each model, obtaining an R2 = 92.3% fit for the cubic fit model. On the other hand, machine learning methods are used in studies such as those above, which are further described in the section below.An example of the use of mathematical and statistical techniques to predict copper recovery by leaching is given in , where tFurthermore, there are many cases and discussions on how supervised learning methods  and deep learning methods  may be used in different kinds of analyses ,24 and uArtificial Neural Networks (ANNs) imitate the biological neural network function of the human brain. They can approach every continuous function showing structural formation and complexity ,27. In pThe basic elements of a neural network include layers, neurons, and activation functions. The neural network structure is simplified by using a feedback-based neural network with a hidden layer.The neurons in two adjacent layers are connected by a weighted linear combination and an activation function to introduce non-linearity. The most common activation functions are sigmoid, ReLU, and TanH.i are input records, wi is the corresponding weight to xi, and σ is the sigmoid function defined as:Owing to the dataset size herein, the activation function is limited to a sigmoid function for the hidden layer and a SoftMax function for the output layer. However, ReLU and TanH are preferred for deep neural networks because they do not have the vanishing gradient problem . The vali, the cost and gradient functions are calculated using backpropagation and the weights are optimized with a conjugated gradient solver.For each xSupport Vector Machine (SVM) is a classifier that defines a decision limit by optimally separating two classes. In linear cases, the decision limit becomes a hyperplane. The construction of the hyperplane separating two classes is based on a sample subset near the decision limit (support vectors). In the linear case, two classes are defined by limits, that is, wx-b ≥ 1 and wx-b ≤ −1. A margin is defined as the distance between these two hyperplanes, 2/|w|.SVM training maximizes the margin between the training points of two different classes. A restriction-delimiting parameter C is used to control penalization when training instances are classified incorrectly. For a high value of C, the SVM tends to generate a smaller margin at the risk of overfit. A small value of C results in more erroneous classifications at the expense of training precision ,12. An SThe Gaussian radial basis function (RBF) is defined as shown in Equation (4). For the RBF and to reduce the number of hyperparameters, only Gauss kernel functions are considered. The kernel is controlled by kernel scale y. A one-to-one classification is implemented in the process to improve the multiclass classification results because the computing cost does not significantly increase with the number of classes.Random Forest (RF) is a supervised learning algorithm derived from decision trees (DT), which is frequently used for developing a predictive model ,32. As dThe RF works in a labelled dataset (training set) to make predictions and produce a model. The resulting model can be later used to classify non-labelled data. The method combines the idea of bagging with the random selection of characteristics so as to construct decision trees with controlled variance . One of Currently, there are some cases in which data-driven algorithms are used in the industry of copper production by leaching to analyze data and provide results, such as models for predicting the quality of the copper recovered . Based oIn the field of copper recovery by leaching, there are a lot of parameters that have an influence on the resulting recovery; some of them can be controlled but other cannot be directly controlled . This seThe methodology used in this study is detailed graphically in Data preparation. For this first step data from the copper heap  and data from the laboratory  were used, both data sets were acquired in accordance with an experimental design, described below. The datasets contain the features of both processes (the leaching process on the plant and the leaching process in the lab). In both cases, data were prepared according to the results of the predictive variable measurements on the heap and in the lab. In this stage, .csv archives were used with data collected at the plant and in the lab. The class “copper recovery”, and associated variables are detailed in Labels generation. The second stage consisted in generating labels for the dependent variable Y . For each of them, a dataset composed by records used in  (2017) aIn order to facilitate the interpretation and relationship with the input data, the following notations were used: A1 and B1 identify the datasets that were collected for the work reported in  (2017) aOperational data correspond to data that were collected during periods called leaching cycles beginning after soil piling and the starting of the irrigation process, since day one to the last day of production. Similarly, laboratory data corresponds to production that was conducted in two agglomerate tanks of the same dimensions with a material whose granulometry was less than 13 mm in diameter : ore particle size after the crushing process.2): amount of ILS solution added per m2 of the upper stockpile surface.Irrigation rates : concentration of acid added per liter of ILS.Stocked high (m): the height of the stockpile in operation.Total copper grade (%): the amount of copper in the ore to be leached.3 grade (%): the amount of carbonate in the mineral to be leached. This variable increases the acid consumption during the leaching process.CO3/TMS): the amount of ILS added to the stockpile per amount of ore in the stockpile.Leaching ratio (mOperation (days): the number of days during which the stockpile is in operation.Soluble copper grade stacked (%): in mineralogy, some ores can be leached, while others such as sulfates cannot. The amount of copper soluble in the ore is measured.Number of stockpiles: corresponding to the identification of the stockpile to be leached.Copper recovery (%): the copper recovered daily during the leaching process.® was used. This software tool allows developing models with desired characteristics and available datasets ..38]. TheIn the same line of thought, this study allows improving and optimizing the leaching process, whose results enable predicting stockpile behavior. Recent studies show the interest of mining companies to optimize their processes and planning to make a better use of resources.The results of this study are somehow comparable to those of previous studies ,14. ThisThe work described in  also shoAn interesting study for comparison is reported in , which pThis study compares three supervised machine learning algorithms for classifying copper recovery quality prediction in a leaching process, using real data collected in a copper mine in the north of Chile. In summary, the three artificial intelligence methods—RF, SVM, and ANN—may be used to develop predictive models for copper recovery, identifying and validating the most influential predictive variables of class Y (copper recovery). This study uses datasets prepared and tested in previous studies to develop predictive models as detailed in ,10. One The resulting models were validated using the cross-validation method, 80% data were used for cross-validation and 20% for validation. This allowed developing validated and reliable models with a minimal error value in trainings. This resulted in an average accuracy of over 95% in all the predictive copper recovery models using the four datasets prepared for this study and an average precision of over 98% in all the classifier trainings. In addition, measures of merit  for each classifier were used in order to determine the quality of the predictive models developed. The models obtained show the following mean values: acc = 0.943, p = 88.47, r = 0.995, and mcc = 0.232. These values are highly competitive as compared with those obtained in similar studies using other approaches in the context.For this work some interesting results with respect to RF, SVM, and ANN have been achieved. For example, the parameter optimization with SVM models is noticeable for handling non-linear data. This method was useful to draw decision boundaries between data points from different classes and separate them with maximum margin. The RF method was also useful for identifying the threshold values of the predictive variables that influence class values in the prediction. Another interesting conclusion is related to the closeness of predictions to real results.Particularly in this case, the best method was ANN, confirming its potential for developing accurate machine learning models for copper mining exploitation and showing that the ANNs have the capability to tackle this non-linear problem in a better way than the other two algorithms. The above is not detrimental to the results of the other methods used (RF and SVM) since the results obtained with these two methods are also quite good and accurate.Finally, as has been said throughout this paper, the use of artificial intelligence methods, in particular the use of three machine learning algorithms in conjunction with real data is not very common in the copper industry. Thus, we believe that the comparative study among these machine learning methods builds an excellent platform for future studies in this area.Analyzing the system’s behavior with variables not currently measured in the field, such as stockpile permeability and mineralogy.Automatizing operational variables according to the predictive model to improve the planning of the leaching plant.The authors consider the followings topics for future research:


Health is an essential element of economic life and is therefore considered a source of comparative economic development of countries. The aim of the study was to examine the associations between health care financing, specific treatable mortality of males and females of working age, and economic prosperity, taking into account to the classification of health systems applied in the countries of the Organization for Economic Co-operation and Development (OECD). An insurance-based health system and a tax-based health system were identified in these countries, and data were collected for the period 1994–2016. Descriptive analysis, panel regression analysis and cluster analysis were used to achieve the aim. The analytical process included economic indicators  and health indicators . The results revealed significant negative associations of health care financing with treatable mortality from circulatory system diseases and endocrine, nutritional, and metabolic diseases in both health systems and both gender categories. There were also negative associations between treatable mortality in both diagnosis groups and economic prosperity. These results have shown that health care financing is linked to economic prosperity also through health variability in the working age population. In terms of assessing economic and health outcomes, less positive and more positive countries were identified using cluster analysis. Countries such as Latvia with a tax-based health system and Hungary, Lithuania, Estonia with an insurance-based health system were characterized by great potential for improvements. Although reducing treatable mortality is a great motivation for public health leaders to increase health care financing, the importance for economic prosperity may be a more compelling argument. Effective interventions should be considered in the light of their regional, social and economic contexts. The current global situation underlines the need to focus on public health in order to eliminate unnecessary deaths and ensure economic growth. The economic impact of health is well-known, and therefore measures leading to better population health contribute to the creation of richer economies . In thisIn line with the above-mentioned facts, the main aim of the study was to examine the associations between health care financing, specific treatable mortality of males and females of working age, and economic prosperity, taking into account to the classification of health systems applied in OECD countries. The main idea of the research was based on the assumption that the way and level of health care financing could be reflected in specific health outcomes, which can also affect the economic prosperity of OECD countries. If health systems are well-designed, they should achieve comparable results. The importance of the issue is unquestionable due to the ongoing pandemic, which has caused health and economic losses around the world, but the need for attention has also been before it. The continuing need for research into treatable mortality is underlined by the importance of this indicator, which is poorly investigated in the economic dimension. The results of the presented study are important for understanding the extent to which health and economic elements are interconnected, in a diverse classification according to the applied health system and gender characteristics of the working age population. Knowledge of these results makes it possible to design optimal forms of health policies at the national and international levels in order to eliminate health inequalities not only within individual countries but also between countries. Along with health improvements, leaders can expect economic benefits.It is well-known that health is a value in itself, it is also a prerequisite for economic prosperity. Population health is linked to economic performance in terms of productivity, labor supply, human capital, and public expenditure. In this context, individuals in good health represent the driving force of the economy, but individuals in poor health spend public resources and represent a potential burden in times of disease and death. Therefore, the issue of health and economic life requires an increased attention of researchers, professionals and policy makers in order to improve the health of the population. One of the many ways to improve it is adequate financing. Health expenditure can ensure the good health of individuals which can increase the volume and productivity of their work and bring benefits to the economy . In thisThe relationship between health care financing and public health has received considerable attention in recent decades, and the authors of several international studies support the idea that health outcomes are influenced, among other factors, by the level of health care financing –9. NovigAlthough health care financing varies from country to country, it should be based on pillars such as solidarity and equity, in order to provide accessible and quality health care. That is the core of modern health systems applied in countries based on tax or insurance principles. At the macroeconomic level, the overall effectiveness of health systems is assessed in terms of improving health, while health outcomes are often confronted with health expenditure . Van derThe issue under investigation provides many health indicators as appropriate measures. One of the most commonly used indicators of population health is mortality, and the results of many studies support the claim that reducing population mortality improves aspects of economic life in countries such as economic development and prosperity –19. On tThe above-mentioned facts underline the importance of examining the associations between treatable mortality and economic outcomes. As could be seen, the link between health and economic life has been often examined in one dimension, while this study applies multilevel research, first the association between health care financing and treatable mortality, and then the association between treatable mortality and economic prosperity. Health policy makers should know how health care financing can be reflected in economic prosperity through population health represented by treatable mortality. The novelty of the presented study also lies in the international comparison of OECD countries classified according to their applied health system. In addition to the classification according to health systems, the study respects gender differentiation in treatable mortality from circulatory system diseases and endocrine, nutritional and metabolic diseases. This allows a deeper insight into the issue.The main aim of the study was to examine the associations between health care financing, specific treatable mortality of males and females of working age, and economic prosperity, taking into account to the classification of health systems applied in OECD countries. Based on this aim, the following research questions were formulated:RQ1: Are there significant associations between health care financing and selected diseases as a cause of treatable mortality for males and females of working age in OECD countries that apply a tax-based health system?RQ2: Are there significant associations between health care financing and selected diseases as a cause of treatable mortality for males and females of working age in OECD countries that apply an insurance-based health system?RQ3: Are there significant associations between selected diseases as a cause of treatable for males and females of working age and economic prosperity in OECD countries that apply a tax-based health system?RQ4: Are there significant associations between selected diseases as a cause of treatable mortality for males and females of working age and economic prosperity in OECD countries that apply an insurance-based health system?For the purposes of this research, data were collected from available OECD , 26 and Economic variables – health care financing, economic prosperity of countries represented by their GDP,Health variables – treatable mortality of males and females with a closer look at diseases of the circulatory system and endocrine, nutritional and metabolic diseases.The financing of health care represented total health expenditure as a percentage of countries' GDP. Health expenditure expressed the final consumption of health products and services, including personal health care  and collective services  .Economic prosperity covered the GDP of countries, which is a standard measure of the added value generated in a country. GDP is considered to be one of the most important outcome indicators that capture countries' economic activity. This indicator was based on GDP expressed in dollars and converted per capita (in current PPP prices) .Health variables included mortality from treatable diseases in males and females, specifically circulatory system diseases and endocrine, nutritional and metabolic diseases. These diagnosis groups were selected on the basis that they mainly include non-communicable diseases, which tend to be long-lasting. Treatable mortality is mortality from causes that can be avoided in particular by early and effective interventions in health care, including secondary prevention and treatment  . The calCirculatory system diseases: I01–I26, I60–I71, I73, I80, I82,Endocrine, nutritional and metabolic diseases: E00–E14, E24–E25, E27, E74.Numbers of deaths from these treatable causes were collected across countries for all available years for which countries reported a value (including zero). Data were available for various age categories separately for males and females. The data collected on treatable deaths were recalculated per 100,000 inhabitants of a given country in a specific gender and age category . This step was preceded by the collection of population data in this specific gender and age category for each country and each analyzed year, when individual treatable deaths were reported. Population data were provided from the United Nations database as part of their report “World Urbanization Prospects” .From a macroeconomic point of view, productivity is the connecting element of all analyzed variables and the associations between them. The selected indicators present the level of health care financing in countries as a percentage of their productivity (GDP), the treatable mortality of the working age population and the level of economic productivity (GDP) as such. The age category was selected on the basis of several studies examining the age and productivity of the population –32, but The research sample consisted of countries that have developed a health system for the provision of primary and specialized (secondary and tertiary) health care. Thus, 37 OECD countries were included in the analytical process. The classification of OECD countries in terms of applied health system was performed on the basis of data from surveys of health systems characteristics in OECD countries , 34, on Tax-based health system: Australia (AU), Canada (CA), Denmark (DK), Finland (FI), Iceland (IS), Ireland (IE), Italy (IT), Latvia (LV), Norway (NO), New Zealand (NZ), Portugal (PT), Spain (ES), Sweden (SE), the United Kingdom (GB);Insurance-based health system: Austria (AT), Belgium (BE), Chile (CL), Colombia (CO), the Czech Republic (CZ), Estonia (EE), France (FR), Germany (DE), Greece (GR), Hungary (HU), Israel (IL), Japan (JP), Korea (KR), Lithuania (LT), Luxembourg (LU), Mexico (MX), the Netherlands (NL), Poland (PL), Slovakia (SK), Slovenia (SI), Switzerland (CH), Turkey (TR), the United States (US).Based on this classification of countries, it can be seen that a tax-based health system was applied by a total of 14 countries and an insurance-based health system was applied by 23 countries.The assessment of the collected data was performed in the first step of the statistical processing through a descriptive analysis, which provided a closer look at the economic and health outcomes in OECD countries. In this context, central tendency measures , variability measure (standard deviation), quartiles, minimum and maximum, as well as position measures (skewness and kurtosis) were used in this analysis. It was the position measures in most of the cases that indicated a possible disruption of the normal distribution of data. Hair et al.  declare Regression analysis was used to evaluate the significance of the associations between health care financing, treatable mortality in selected diagnosis groups, and the economic prosperity of countries. Robust methods were used to estimate the coefficients, specifically models with random or fixed effects in one-way  or two-ways variants. The regression analysis was preceded by panel diagnostics to select appropriate regression models using the F test for the presence of individual effects (or time effects) and the Hausman test. The one-way variant was supported if a statistically significant effect was demonstrated only within countries or only within years, then the effect was taken into account in the corresponding model. As pointed out in the following section, if there was only one significant effect in the data structure, it was the country structure, not the time structure. Thus, the one-way variant of the models always took into account the effects identified in the country structure. On the contrary, the two-ways variant was supported if a statistically significant effect was demonstrated both within countries and within years (time effect), and these effects were taken into account in the relevant models. Subsequent decision-making processes led to a preference for a model with random or fixed effects, and Hausman's test statistics helped with this choice. If the result of the Hausman test confirmed the significance at the level α < 0.05, the preference was in favor of choosing a model with fixed effects (the null hypothesis was rejected). Otherwise (α > 0.05), the choice was focused on a model with random effects (the null hypothesis was not rejected).The HC3 estimator was used to estimate the regression coefficients, with respect to the data showing outliers and heteroscedasticity. The Arellano estimation method  for fixeIn the last third step of the statistical processing, a cluster analysis of the links between economic outcomes and treatable mortality outcomes was performed in the specification of gender and health systems. The number of clusters was supported by the result of the silhouette method , while tThe analytical processing was performed in the programming language R v 4.1.1 .This section focuses on the statistical description of variables to provide a closer look at economic and health outcomes across OECD countries.Based on the results in With a focus on health variables, the results revealed the following facts. In both types of health system, males of working age were characterized by considerably higher rates of treatable mortality from circulatory system diseases, as well as endocrine, nutritional and metabolic diseases. Treatable mortality from circulatory system diseases dominated over mortality from endocrine, nutritional and metabolic diseases. Regarding circulatory system diseases, in countries with a tax-based health system, the results indicated that males annually achieved an average of 49.12 more deaths  than females . In countries with an insurance-based health system, this inequality represented an average of 69.18 more deaths at the expense of males. Based on the mean values, it was also clear that countries with an insurance-based health system reported higher mortality rates than countries which applied a tax-based health system.This subsection aims to assess the significance of the examined associations between health care financing, treatable mortality in individual diagnosis groups, and the economic prosperity of countries in gender differentiation of the working age population, as well as in the specification of health systems.R2) provide only an informative value and it is not necessary to consider them in terms of model strength, as the low value is given by a relatively low number of observations due to the classification of the panel data structure, i.e., within diagnosis groups, gender and health system specification.The use of specific panel regression models was preceded by testing the assumptions. The balance statistics of panel regression models in the analyzed cases leaned more toward a balanced model. This was supported by the following values of gamma (γ) and nu (ν), and it is true that the closer their value is to 1, the more the panel appears to be balanced. For countries with a tax-based health system, both diagnosis groups acquired γ = 0.8463299 and ν = 0.9060825 when examining all the associations. For countries with an insurance-based health system, these were γ = 0.7470208 and ν = 0.9352060 when examining the associations between health care financing and treatable mortality due to given causes, and γ = 0.7376557 and ν = 0.9380606 when examining the associations between treatable mortality and economic prosperity. The presented coefficients of determination  were first averaged separately in each country for the analyzed period, but gender differentiation was not applied. In the next step, these health and economic outcomes were standardized in the range of 0–1, with a value of 0 indicating the least positive result and a value of 1 indicating the most positive result. In the case of economic indicators, the data were again averaged to create one economic outcome per country. This process created two variables assessing economic indicators and indicators of treatable mortality in individual countries, which were included in the cluster analysis.This part of the analytical processing is devoted to the evaluation of the investigated associations and their significance in the diagnosis group of circulatory system diseases (CRC). The results of testing the assumptions for the preference of the regression model are shown in p < 0.05 testified in favor of a model with fixed effects. An exception was the case in the male population of countries with an insurance-based health system, in which a one-way model was preferred but with random effects, as the result of the Hausman test was not significant. In most cases, a two-ways fixed effects model was recommended to assess the significance of the associations between treatable mortality due to circulatory system diseases and economic prosperity (CRC→ GDP). The results of F tests, where appropriate, showed effects in the data structure in terms of countries and years, and the results of the Hausman test favored a model with fixed effects (p < 0.05). An exception could be observed in the female population in countries with an insurance-based health system, in which the preference leaned toward a two-ways model with random effects.From the results in With a focus on the associations between treatable mortality from circulatory system diseases and economic prosperity, it is clear that a significance (α < 0.001) was revealed in the female population of countries with an insurance-based health system, when the result of the two-ways random effects model was taken into account. It is also evident that no significant associations were observed in the other cases when considering panel two-ways models with fixed effects. The choice of two-ways variants should be considered correct, but there was room to accept the results of a two-ways model with random effects. This model still appeared to be effective, although it may not be consistent as a model with fixed effects. Therefore, the results of this model could be supported with some caution, which also suggested a limitation of the research. On the other hand, the value of the determination coefficients indicated the possibility to lean toward the two-ways model with random effects. From the results of the two-ways random effects model, it was evident that treatable mortality from circulatory system diseases was negatively associated with economic prosperity. In this way, an increase in GDP was associated with a reduction in treatable mortality from circulatory system diseases and vice versa. These inverse associations with a significance at the level of α < 0.001 were revealed in both health systems and both gender categories of the population.The cluster maps shown in The evaluation of individual associations and their significance in the diagnosis group of endocrine, nutritional and metabolic diseases (END) is presented in this part of the analytical process. Also in this diagnosis group, a panel diagnostic for model selection was first performed and its results are presented in F tests indicating significant effects in the data structure only within countries and on the results of the Hausman test with a p > 0.05 recommending a model with random effects. Conversely, a one-way model with fixed effects was preferred in the case of the female population of countries with a tax-based health system, as the results of the Hausman test showed a p < 0.05. In terms of the associations between treatable mortality due to endocrine, nutritional and metabolic diseases, and economic prosperity (END→ GDP), a two-ways variant of the model was preferred, as the results of F tests revealed significant effects in the data structure across countries and years. The results of the Hausman test with a p > 0.05 supported the choice of a model with random effects in the male population in both health systems, and the results with a p < 0.05 were in favor of a model with fixed effects in the female population in both health systems. The main results of the panel regression models are shown in Based on the results in The results in Focusing on the associations between treatable mortality from endocrine, nutritional and metabolic diseases and economic prosperity, a significant negative association was found in the male population in both health systems. For this diagnosis group, a reduction in the treatable mortality in males of working age was associated with an increase in GDP. A different situation could be observed in the female population in both health systems, as no significant association was confirmed by the preferred two-ways model with fixed effects. As in the previous diagnosis group, there was a room for cautious acceptance of the results of the two-ways random effects model, which revealed a significant negative association in the female population of countries with an insurance-based model. This could be considered a limitation.As in the previous diagnosis group, By comparing the examined diagnosis groups, the presented study and its results showed that diseases of the circulatory system contributed to a greater extent to treatable mortality in OECD countries with a tax-based health system and an insurance-based system. These findings are consistent with the results of Jarčuška et al. , as wellIn terms of gender, the results clearly showed that males were characterized by a higher average mortality than females in the examined diagnosis groups of treatable mortality. These findings are consistent with the findings of other studies that confirmed a higher mortality rate for males, reflecting the fact that females live longer –50. In tIn addition to gender differences, cluster maps also indicated differences between individual OECD countries. Similar findings were revealed by Weber and Clerc , who poiIn both diagnosis groups, health care financing has been shown to play an important role in the treatable mortality of both males and females in both systems. The regression analysis revealed a significant negative association between health care financing and treatable mortality in each analyzed case, with greater strength of the associations observed in countries with an insurance-based health system. Also, a greater strength of the significant association was identified for diagnosis group of circulatory system diseases. These findings indicated that an increase in health expenditure may be associated with a reduction in treatable mortality of females and males of working age in both diagnosis groups. The results of the regression analysis also indicated that the associations were greater in the male population than in the female population. Despite the findings of several authors suggesting that health care financing is not such an important aspect in population health , 14, theIt should be borne in mind that treatable mortality includes avoidable deaths that are considered unnecessary and dependent on health care interventions and secondary prevention . For thiThe cluster analysis offered the categorization of countries into clusters according to the assessment of treatable mortality outcomes and economic outcomes. In countries with a tax-based health system, almost all countries formed a homogeneous cluster in terms of assessing economic outcomes and treatable mortality from circulatory system diseases. The only exception was Latvia with the least positive outcomes among these countries. In countries with an insurance-based health system, higher treatable mortality from circulatory system diseases and lower economic outcomes were found in Lithuania, Hungary, Estonia, and Slovakia. On the contrary, Switzerland, Luxembourg and France could be considered the most positive countries with an insurance-based health system. With a focus on the endocrine and metabolic treatable causes of deaths, Latvia, as well as Denmark, New Zealand, Canada, and Portugal with a tax-based health system have taken a position indicating higher mortality. Mexico showed the least positive assessment of treatable mortality from endocrine and metabolic diseases and economic outcomes compared to other countries with an insurance-based health system. In addition to this country, Colombia and Turkey also reported less positive outcomes. Special attention should also be paid to the United States, which, despite high levels of health expenditure and GDP, has not acquired such positive results in terms of treatable mortality as other developed Western countries. This could be due to the high cost of health care in this country. In this comparative manner, the findings in this study are consistent with the findings of authors such as Pritchard et al. , who exaAt this point, it is possible to highlight the results of the regression analysis, which revealed that the financing of health care represents one of the important tools for improving the health of the population. The findings indicated that if less positively evaluated countries in the cluster analysis increase their level of financing for health care, this could translate into lower treatable mortality and consequently higher economic prosperity. This could improve their position, and therefore it is possible to look at less positively evaluated countries as countries with great potential and opportunities for improvement. At the same time, other countries with a positive assessment can be an inspiration for these countries.A look at the problem in this study suggests that health expenditure is one of the important factors in the treatable mortality of both males and females, which supports the need to take this factor into account when developing strategic plans. The financing of health care is highlighted as key aspect in universal health coverage . MoreoveAs there were clear differences in treatable mortality across OECD countries , 44, polIn view of the above-mentioned facts, international cooperation is needed to address global challenges in terms of treatable mortality and related economic risks. This cooperation would strengthen the global health system by improving collaboration and coordination across international organizations. This effort can fill gaps in knowledge with respect to treatable causes of death, research and development needs, financing models, and the social and economic impacts of potential threats. Also, this international response would provide high-level, evidence-based recommendations for managing the global risks associated with treatable mortality .The study clarified the economic perspective of treatable mortality and its strength lies in a multi-level investigation. Thus, the study explained the associations between health care financing and treatable mortality, and, subsequently, the associations between treatable mortality and economic prosperity in a comprehensive data classification, which made it possible to avoid superficial findings. The analyzes respected specific diagnosis groups, gender differentiation and individual health systems and their results provided a deeper insight to the issue. Based on multidimensional research and multilevel classification, it was possible to answer the question of what strength of associations exists in individual health systems, individual diagnosis groups, and gender categories. The study also provided a comparison of countries and contributed to the creation of a valuable platform of evidence at national and international level. The results of this study were able to clarify the comprehensive view of the associations that existed in the scientific community. Last but not least, given the low availability of treatable mortality data in specific diagnosis groups in individual countries, it should be emphasized that the study contains the most up-to-date data on treatable mortality for up to 37 OECD countries.This research did not avoid the limitations that could be addressed in future research. In this sense, it should be pointed out that the findings concern only OECD countries and cannot be generalized to less developed countries or countries with other health systems. The unbalanced structure of the panel data is also a weakness of the research, but it should be noted that not every country reported the number of specific treatable deaths each year and the presented research covered the widest possible range of treatable mortality in 37 OECD countries. Limitations also include the fact that the results of a regression model other than the recommended one were taken into account. Nevertheless, a reliable model was chosen. Regarding the limitations of the models, it should be noted that the models used in this study did not examine causality as such, and therefore the results cannot be interpreted as causal relationships. All results can only be seen in terms of associations, while a consideration of causal relationships can be misleading. Last but not least, it must be emphasized that the financing of health care is not the only factor in the health of the population. Thus, the results should not be considered the only right pathway. Factors such as doctors' qualifications, their working conditions, equipment, access to medicines, or hospital management play an important role in treatable mortality. Future research should address them.This study focuses on the associations between health care financing, specific treatable mortality of males and females of working age, and economic prosperity in the classification of health systems applied in OECD countries. The main aim was met by descriptive analysis, panel regression analysis, and cluster analysis. Based on the results, it was possible to answer the research questions in the affirmative. The treatable mortality was represented by two diagnosis groups, namely circulatory system diseases and endocrine, nutritional, and metabolic diseases. In addition to these diagnosis groups, the analyzes respected the specification of gender and health systems, which provided a deeper insight into the main findings. There were significant negative associations between health care financing and treatable mortality, as well as between treatable mortality and economic prosperity in both health systems. The study also provides an international comparison of OECD countries, on the basis of which less positive and more positive countries were identified. The main findings of the study supported the idea that the economic life of countries is linked to the health of the population. Healthy individuals are considered the driving force of the economy, but sick individuals represent a potential burden in times of disease and death. In any case, it should be borne in mind that investing in public health can translate into economic benefits, and therefore the financing of health care requires special attention. This is true, although it is not the only significant factor. Successful management of health systems requires an individualized approach to decision-making that takes into account proven evidence and implements it in procedures aimed at achieving health goals. This study would help policy makers to understand the nature of the problem from the presented perspective and to make the right decisions given the diversity of systems, population groups and other country specificities. The study supports the strengthening of health systems and offers a basis for further research and the creation of international databases of evidence.https://data.oecd.org/healthres/health-spending.htm#indicator-chart. Data on GDP can be found in the OECD database: https://data.oecd.org/gdp/gross-domestic-product-gdp.htm. Data on treatable mortality can be found in the WHO database: https://www.who.int/data/data-collection-tools/who-mortality-database?fbclid=IwAR2gVBBqbMEUf6Y1g505FjN_hg77TkINf_VWGO3-efYrTr-J9sC7_Wkpy7Q. Data on population can be found in the United Nations database: https://population.un.org/wup/.Publicly available datasets were analyzed in this study. Data on health expenditure can be found in the OECD database: Ethical approval was not required for the study on human participants in accordance with the local legislation and institutional requirements. Written informed consent for participation was not required for this study in accordance with the national legislation and the institutional requirements.VI, BG, GS, and SK: conceptualization, investigation, visualization, and writing—review and editing. BG and SK: original draft preparation, supervision, project administration, and funding acquisition. VI: methodology, formal analysis, data curation, and original draft preparation. BG: resources. All authors contributed to manuscript revision, read, and approved the submitted version.This research was funded by the Scientific Grant Agency of the Ministry of Education, Science, Research, and Sport of the Slovak Republic and the Slovak Academy Sciences and Quantification of Environmental Burden Impacts of the Slovak Regions on Health, Social and Economic System of the Slovak Republic as part of the research project VEGA 1/0797/20.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


Stroke is a key cerebrovascular disease that is related to high morbidity and mortality in the globe. The Kingdom of Saudi Arabia (KSA) is not an exception where stroke is fast developing into a serious challenge due to the high mortality rate. Additionally, stroke presents a tremendous economic burden and has a devastating effect on the quality of lives of individuals. The number of stroke cases are increasing yearly, thus posing a major challenge to the health care system. Therefore, it is crucial to implement primary and secondary prevention strategies in the KSA. Nevertheless, as compared with developed countries, information on the prevalence, socio-demographic properties and prevention of stroke remains scarce that could be attributed to the shortage of research conducted in this specified region. The review is written to address the various aspects of stroke in the KSA, based on current literatures search using PubMed, Scopus, Web of Science and Google Scholar databases, to identify studies published since inception to Dec 2020. AlthoughThe largest country in the Middle East, the KSA makes up almost 80% of the Arabian Peninsula in terms of size in km . Robert It has gBased on the data reported by the World Health Organization, stroke is the second contributor to mortality in the KSA.  The situ2 . . As shown in 2.3Helicobacter pylori, Legionella pneumophilia and Chlamydia pneumoniae. . Additionally, the combination of hypertension and diabetes mellitus is said to carry a higher risk for stroke especially among female patients.  which is an imperative index for stroke outcome making its assessment is pivotal for a stroke survivor.  Many fac3.1Length of hospitalization (LoS) of stroke patients is generally influenced by factors such as age, gender, ethnicity, severity of stroke as well as the presence of any other medical comorbidities like hypertension, diabetes or cardiac illnesses that may unfavorably upset the outcome and LoS of stroke patients.  A currenAccording to the study conducted by With regards to ethnicity, the LoS of Saudis have been reported to be slightly higher (48 days) than that for non-Saudis (42 days)  thus sup3.2Extensive research is conducted worldwide on stroke care service planning to form national guidelines and recommendations on workforce as well as infrastructure needs to provide high-quality care in order to improve patient outcomes.  The KSA Rehabilitation programs and facilities which are central to modern health care provision are prioritized by the government and some private non-profit centers with high quality services accessible to all individuals with disabilities as well as in other populations in the country. However, most programs offer only physical, occupational, speech and hearing therapies besides prosthetic and orthotic services within the current state-of-the-art health care service system and infrastructure.  Based onAdditionally, although there are more than 350 hospitals in the KSA, only one established active stroke center  and seven centers that provide thrombolysis for the stroke patients exist. Other than these, only two hospitals have a team dedicated to stroke patients which implements triaging pathways and a beeper system.  A report4Increase in stroke cases and mortality in the KSA is related to multiple factors like aging population, inequity of care across the KSA, low self-awareness and insufficient knowledge of stroke risk factors, causes and symptoms. This calls for an urgent need to develop a more competent and precise strategy for screening and diagnosis of stroke in the KSA along with having proper policies planning for proper primary prevention strategies, management programs and provision of health reserves. Additionally, there is a crucial need to increase public awareness especially among the younger population and those with lower education levels as to the risk factors causes and symptoms of stroke for better understanding of the negative impact of stroke on quality of life. The steps taken can help in disease prevention, also achievable by changing unhealthy lifestyles. Other than these initiatives, the development of well-equipped and trained health-care providers, a more coordinated multi-disciplinary approach as well as collaborative efforts among multidisciplinary teams are equally important.None


Endocrine Connections Accepted Preprint on 20 November 2013.The above article has been retracted. The retraction was made before the article reached its final form in the publication process. However, the authors’ accepted manuscript, prior to copy editing, page layout and proofing, was made available online as an The article was submitted to the journal in error and retracted at the request of the authors.


The tendency towards the radicalization of abortion law is observed in numerous countries, including Poland. The aim of the present paper was to determine the main factors influencing the number of abortions performed worldwide and to indicate the main directions which should be followed to improve the patients’ well-being. The authors conducted their search in the PubMed of the National Library of Medicine and Google Scholar. Databases were extensively searched for all original and review articles/book chapters in English until June 2021. The main problems associated with the contemporary policy of birth regulation include no possibility of undergoing a termination because of the conscience clause invoked by the medical personnel, restrictive abortion law and lack of sexual education. Minimal changes that should be considered are: improved sex education and the availability of contraception, free access to abortion-inducing drugs with adequate information provided by qualified medical personnel in countries with a conscience clause invoked by the personnel, and the development of an international network which would facilitate undergoing a pregnancy termination abroad to provide women with access to legal abortion assisted by professional medical personnel. The Conference on Population and Development held in 1994 in Cairo harmonized population policy all over the world, recognizing the women’s right of access to abortion, sterilization, and contraception. The objectives of the Cairo Action Plan permitted the adjustment of its provisions to the national laws of individual countries to respect their religious, cultural, and ethical separateness . RegrettThe percentages of pregnancy terminations vary significantly in different locations worldwide ,7. The aPregnancy termination is completely prohibited in 3 European Union countries and over 20 countries worldwide . AccordiCurrently, due to the ruling of the Polish Constitutional Tribunal dated from 22 October 2020 in which the Tribunal adjudicated that the regulation allowing pregnancy termination in the case of a high probability of severe and irreversible fetal defect was unconstitutional, pregnancy termination is only possible in the case of a threat to maternal life and rape . The TriThe main problems associated with the contemporary policy of birth regulation include no possibility of undergoing a termination because of the conscience clause invoked by the medical personnel . The pheAccording to Berer “the road to law reform is long and difficult… The biggest challenge is to determine what is possible to achieve, build a critical mass of support, and work together with legal experts, parliamentarians, health professionals, and women themselves to change the law” . AbortioWe reviewed articles concerning abortion from various countries. The authors conducted their search in the PubMed of the National Library of Medicine and Google Scholar. Databases were extensively searched for all original and review articles/book chapters using keywords (one or in combinations): abortion, pregnancy termination, termination of pregnancy, published in English until September 2021. Moreover, additional articles in the references of the reviewed articles were searched. Overall, the most relevant articles were reviewed and included as appropriate.In the majority of the European Union states, abortion is available on demand in the first trimester . In highNumerous countries still have restrictive abortion laws  23]. A . A 23]. Ireland was a country with the most radical abortion law in Europe. However, in May 2018, the abortion law was eased after a referendum and terminations due to medical indications were permitted ,25. AborIn Australia, the most extensive list of indications for termination is in place in Victoria, where the main reason for termination is a threat to the broadly defined mother’s health. The northern and southern territories permit abortion until week 14 of pregnancy, while in Tasmania abortion is illegal . Only onIn MENA countries (the Middle East and North Africa), one in ten pregnancies ends in an abortion. An individual interpretation of the law is the key principle in place in Islamic countries. Muslims determine their principles of conduct based on historic Arabic writings. In Sunni Islam, there are four official schools of interpretation, with Shiites having their separate law. Sharia law differs in individual countries. In the event of unclear answers in their holy books, spiritual guides issue a fatwa (religious edict with guidance) . Most scIn Nigeria, pregnancy terminations are accepted only in the case of a threat to maternal life. However, abortion is also acceptable if the patient self-administered abortion drugs . DespiteIn China, abortion has been a form of birth control and a family planning tool since 1988 . Due to In India it had become such a popular method of sex selection that ultrasound scans performed to determine sex were officially prohibited. Despite the ban on sex selection in India, this phenomenon still occurs, even in affluent families. Selection takes place both directly—through abortion, and indirectly—by providing better nutrition to male babies which translates into a higher survival rate. Due to sex selection, the number of females has been dropping year by year in India and China as compared to the number of males. In 1994, the Indian government officially prohibited sex selection, which was legally authorized in 2002 . Due to Compared to other European countries, the Polish law is one of the most restrictive ones in terms of indications for abortion. In Poland, similarly to other ex-Soviet Union states, legal abortion had been widely available since 1956. An act issued in 1993 set out significantly stricter indications for termination, restricting them to strict medical grounds and sexual offenses . CurrentAccording to official data, 1057 legal terminations were recorded in Poland in 2017, including 22 procedures performed due to a threat to the mother’s life and health, 1035 due to severe and irreversible fetal defects, and zero due to criminal offenses . No infoDue to the common access to contraception and sex education, developed countries have observed a drop in the number of abortions performed . Developp < 0.05) [High-income countries, which usually have a liberal abortion law, are characterized by lower abortion rates . It is d < 0.05) . Moreove < 0.05) . A study < 0.05) . Joodaki < 0.05) .The ACOG (American College of Obstetrics and Gynecology) recommended the use of abortion-inducing drugs (mifepristone and misoprostol) until 10 gestational weeks . The outGuttmacher Institute, basing on a study conducted in 14 countries worldwide, re-ported that the main reason for abortion was related to the socioeconomic causes and the wish to limit the birth rate in countries characterized by high parity and large populations . It is uThe Guttmaher Institute analyzed data from a study carried out in 14 countries worldwide and reported that socioeconomic causes and the wish to limit parity were the most common reasons for undergoing . Sex eduNumerous countries accept the self-administration of abortion drugs during the first trimester which excludes the issue of the conscience clause of the medical personnel and facilitates an independent decision concerning abortion . It alsoCurrently, in the case of the diagnosis of incurable fetal defects many Polish women travel abroad to undergo pregnancy terminations. Such a situation increases costs and constitutes a logistic challenge for mothers and their families. Numerous organizations are established in Poland to facilitate contact with clinics abroad. The situation contributes to limiting the access to pregnancy termination procedures for women with lower income and poorer access to information concerning alternative solutions available abroad.Abortion law undergoes constant and multiple changes, so it is no longer valid at the moment of the publication of this paper. No systematic reviews could be found as regards numerous small countries, especially African ones, so the authors have not comprised all countries worldwide. Moreover, we have no information concerning sex education and the availability of abortion-inducing drugs. The issue of social indications has not been standardized and it is defined in different ways in each country. Similarly, the issue of maternal indications for abortion is defined in a variety of ways. In some countries it includes possible mental complications which may occur after childbirth, while in others it only refers to the direct threat to maternal life.(1)improved sex education and the availability of contraception would prove to be the most beneficial in reducing the percentage of abortions without medical indication;(2)free access to abortion-inducing drugs with adequate information provided by qualified medical personnel in countries with a conscience clause invoked by the personnel;(3)the development of an international network which would facilitate undergoing a pregnancy termination abroad to provide women with access to a legal abortion assisted by professional medical personnel.The possibility of conscious motherhood at an age appropriate for a woman is a basic right guaranteed to women by the WHO. Some minimal changes should be considered by countries dealing with complications of dangerous abortions and which have restrictive abortion laws:


Cancer is one of the diseases with the highest incidence and mortality in the world, and one that requires greater care . At present, the traditional informal caregiver is disappearing. The objective is to analyse the sociodemographic and health factors associated with the possible catastrophic financial effect on households of replacing informal care by formal care for patients with blood cancer, during the different stages of treatment in Spain.A total of 139 patients with haematological neoplasm who underwent stem cell transplantation completed a longitudinal questionnaire during each of three treatment phases. Of this population, 88.49% received informal care. The households were classified into those where the replacement of informal care with formal care would impose a financial burden exceeding 40% of equivalent household income, versus those who would not suffer this consequence. Three logistic regression models (one for each treatment phase) were estimated and the corresponding marginal effects determined.The factors associated with a higher probability of financial catastrophe were married marital status, low education level, fair to very poor self-perceived health status, the diagnosis of leukaemia in the pre-transplant and first-year post-transplant phases and of multiple myeloma disease in the final post-transplant phase.These findings reveal the need to design social policies to meet the care needs of patients with blood cancer which at present are covered by informal care. Given the foreseeable elimination of this option, these families must be protected from the financial burden incurred from the use of privately-contracted assistance. According to the World Health Organization, cancer, cardiovascular diseases and AIDS will soon be the three diseases making the greatest impact on society, in terms of incidence, limitation of daily life and mortality . CurrentIn 2018, 18.1 million new cases of cancer and 9.6 million deaths from this disease were detected worldwide . Of thesIn 2018, the cancer with the highest incidence worldwide was lung cancer  followed by female breast cancer (11.6%) and prostate cancer (7.1%). The highest levels of mortality were recorded for lung cancer , followed by colorectal cancer (9.2%), stomach cancer and liver cancer (8.2%). In fourth and fifth place, for incidence and mortality, respectively, was the group of haematological neoplasms, or blood cancer , of which there were 1.19 million cases in 2018 with an incidence of 6.56%, producing 0.7 million deaths  . The incAggressive cancer treatment can provoke multiple side effects, such as nausea and vomiting , fatigueFor haematological neoplasms, and depending on the patient’s clinical situation, the indicated treatments are chemotherapy, radiation therapy, supportive therapy, targeted therapy and haematopoietic stem cell transplantation (HSCT) . The latTwo types of care may be provided for cancer patients: formal and informal. Formal care refers to services that are contracted and paid for, and provided by care professionals working either for public institutions or in the private sector , 27. ThiThe needs of persons with cancer can be so intense and constant that informal caregivers must reduce or give up their working hours, and hence suffer a significant drop in income , in ordeIn both types of care, a wide range of tasks are performed. However, informal caregivers rarely receive training or instruction in this respect, in contrast to formal caregivers, although in the latter case, too, the level and intensity of training received may vary considerably . VariousIn today’s society, with the increasing presence in the job market of women, who have historically played a leading role in providing informal care , and theA recent study revealed that over 75% of patients diagnosed with blood cancer receive informal care , and thaIn view of the above considerations, our study aim is to analyse the sociodemographic and health factors associated with the financial catastrophe that may be provoked by the replacement of informal care by formal care for patients with cancer. As informal caregivers do not receive financial compensation for performing these tasks, while formal care must be paid for, our working hypothesis is that of the perfect substitution of informal care by formal care.The present study is based on the results obtained in previous research into the catastrophic financial effects experienced following the replacement of informal care by formal care for patients diagnosed with haematological neoplasms . The basn = 299) were contacted by telephone. Patients that randomly (n = 230) responded to the first or second call, were informed and invited to participate in the study by sending a questionnaire by mail. The patients completed the questionnaire, providing information about their socio-demographic and clinical characteristics. In addition, they were asked to identify their primary informal caregiver during their illness and to answer the questions related to the primary caregiver and the number of hours and months of informal care they received from him or her.The information was collected between January 2012 and December 2013. All of the eligible patients  is obtained according to the number of hours of informal care required in each of the above phases  and is uBoth of the above studies used the three traditional methods for assessing informal care, i.e., opportunity cost, proxy good and contingent valuation . In the Accordingly, and following other indications in the literature, the households were classified into two groups: those that, if informal care were replaced by formal care, would have to dedicate more than 40% of their equivalent income to such care ; and those which would need to dedicate less than 40% of their equivalent income to this purpose. For these calculations, we used the measure of financial catastrophe defined by Wagstaff and Van Doorslaer (2003) . The undIn accordance with our study aims, and in line with previous work in this field –72, we rThe above models were used to analyse the sociodemographic and health characteristics that present statistically significant parameters, and therefore are associated with the corresponding dependent variables, adjusted for all other features. Marginal effects were estimated for all the variables.Taking previous work in this field into consideration, the following explanatory variables, essentially sociodemographic characteristics, were selected –72 .In our study sample, 123 patients reported having received informal care at some time during their treatment (88.49% of survey respondents). Table Tables Table In the last phase of analysis, phase 3 , aged less than 35 years and married marital status. This is consistent with the findings in the literature, according to which male gender increases the probability of a catastrophic financial outcome , 68. HowRelative youth (age 35 years or younger) is only a significant factor in the risk of financial catastrophe with respect to the first phase . This result contrasts with most previous findings , 71, 72,In this context, married marital status was found to increase the risk. However, prior results are conflicting: only one study obtained the same result , while oCorroborating previous research findings, we show that a low level of education is a very important factor for financial catastrophe when informal care is replaced by formal care , 72, 88,The self-perceived level of health is a very significant variable for receiving informal care , 92 and,In Spain, an extraordinary home care service provided by the State and Autonomous Communities existed for those who needed care at home in an extraordinary or exceptional situation. This service was dependent on two aspects: 1) duration of the need for care was temporary and limited (not permanent), and 2) the family or closest relatives could not provide the care. However, this important service practically disappeared under the major legislative development in 2006, that is, the approval of Act 39/2006 of 14 December on the Promotion of Personal Autonomy and Assistance for Persons in a Situation of Dependency, also known as the Dependency Act . The purOn the other hand, social protection systems in Europe for the care of people are heterogeneous: while some countries rely on exclusive professional care, others have strong support for informal care. In this sense, a first recommendation would be to achieve a balance between the well-being of the people cared for and the caregivers. A second general recommendation, appropriate for Spain, is the need to achieve effective work-family reconciliation as regards care provision, especially in those countries where a large number of caregivers of working age are unemployed or are homemakers . In the The study described in this paper has certain limitations. First, the sample only included patients with haematological neoplasia and who had received stem cell transplantation. This restriction was made to enable us to analyse the situation of informal caregiving not only during the chemotherapy phase, but also prior to the transplant and in the subsequent phases, which are often characterised by severe health complications. Secondly, the hypothesis of perfect and absolute substitution of all informal care by formal care is very severe. In practice, we believe the families concerned would acquire only the formal care believed to be indispensable, covering the patient’s most severe needs, thus minimising the financial impact on the household. In other words, we believe that formal care would replace certain specific tasks, beyond the reach of informal care , or taskFuture lines of research should be undertaken to extend the scope of the present study and to better characterise the sociodemographic and health profiles that are relevant to the current demand for informal care, in view of the fact that the foreseeable disappearance of this option would impose an enormous financial burden on the households affected. This type of research is necessary in the field of cancer in general, and for specific types of cancer in particular, as the future incidence of some cancers (such as those considered in this paper) is expected to increase. Finally, an analysis of the need for informal care should be included as an integral part of cost analyses in cancer studies, together with the direct health and non-health costs considered and indirect costs such as the loss of labour productivity.To the best of our knowledge, this is the first study to identify the sociodemographic and health factors associated with the catastrophic financial consequences of replacing informal care by formal care for persons with haematologic neoplasms.Our findings highlight the need for legislators to design healthcare policies that include the aim of protecting patients with cancer from the risk of suffering an intolerable financial burden if informal care must be replaced by formal care. Therefore, specific sociodemographic and health profiles should be identified and taken into consideration. Among these characteristics, those that increase the probability of patients and their families suffering a catastrophic financial impact are married marital status, low education level, a self-perceived health status that is only fair or worse, and a diagnosis of leukaemia  or multiple myeloma (in phase three).Before 2006, there existed a temporary and extraordinary home help service in Spain. Restoring this within the framework of the Dependency Act would improve the quality of life of patients with haematological neoplasm while reducing the workload of the informal caregiver.


The manufacturing process of propylene has extremely high impacts on global warming potential, fossil resource depletion (1.722 kg Oil eq./kg-PP), human toxicity , acidification (0.0049 kg SO2 eq./kg-PP), and petrochemical oxidant formation (0.0042 kg NMVOC/kg-PP). Additionally, based on the results of this present research, this study proposes possible improvements and alternative solutions such as applying advanced technologies, clean energy, and safe recycling processes in the GCC that are environmentally friendly.The environmental impacts of the polypropylene (PP) manufacturing process are not fully understood in the Gulf Cooperation Council (GCC) region. There is a growing interest in assessing the environmental impacts of this highly demanded product, especially for the petrochemical industry sector. This research examines the environmental impacts of the polypropylene manufacturing process using a life cycle assessment (LCA) approach. Gabi software is selected to carry out this research study and quantify the risks associated with manufacturing one ton of polypropylene, chosen as the functional unit for this LCA study. This work has the following merits: (i) an evaluation of environmental impacts specific to GCC region based on actual plant data; (ii) the results in this work can be used to evaluate LCA impacts of PP based products; and (iii) emphasizing the importance of waste management in reducing environmental impacts. This study shows that the polypropylene manufacturing process releases numerous pollutants into the environment, as the gross CO The petrochemical industry is considered one of the most rapidly growing petroleum industries that fulfill most of the world’s industrial and financial needs. By producing the largest daily volume of petrochemical products such as plastics, pharmaceuticals, fertilizers, and textile products, this industry is the leading industry for many industrial zones in the world. Furthermore, the need for these petrochemical products has grown rapidly and dominates the global chemical market. As a result, the petroleum and petrochemical industry has experienced sustained growth and remains a critical factor in the underlying economies of every industrial nation . The petPP can be recycled, which makes it ideal for use in various applications . It is aThe GCC is considered the major producer and exporter of PP to markets worldwide and is a steady global supplier . This isKeeping in mind the rapidly growing consumption and demand of PP products worldwide, it has become important to optimize the PP manufacturing process, improve it, and examine the effects of manufacturing PP products on the environment. Such careful research studies aim to ensure that PP production takes the most sustainable and environment-friendly approach, rooting from the facts-driven suggestions from this assessment. Furthermore, polymers have been used to produce thermally enhanced polymers in the past few years due to good heat transfer characteristics that may replace the metallic parts that require fabrication at high temperatures (and hence more energy) ,12. On tMoreover, this study focuses on understanding the industrial manufacturing process of PP by conducting an LCA study based on an existing PP production plant located in the GCC to quantify the environmental impacts of each stage of the PP manufacturing process. The LCA results for the manufacturing process of one ton of PP pellets based on the plant located in the GCC region should deliver a clear overview for the decision-makers in the petrochemical industries sector and the customers of polymer producers in the GCC to be aware of the environmental impacts and how to improve the PP production technology. This LCA study aims to encapsulate the differences and uses among the PP grades while also providing a proper and complete assessment of the environmental impacts of PP manufacturing. It also draws conclusions based on the study regarding the PP industry with its increasing demands and applications. Therefore, researchers can conduct LCA studies for applications of PP based on this LCA study. Furthermore, the environmental impacts of the manufacturing process of PP are weakly quantified or understood in the GCC due to the confidentiality of the PP plant data in the petrochemical sector.With the rise in demand for manufacturing plastic products, developing a mechanism to protect against environmental degradation has remained a concern. Thus, there is still a need to analyze what is available in the market and come up with better strategies in the manufacturing process in order to reduce pollution . This isPP is an addition-polymer whose manufacturing process involves the combination of several monomers. This implies there is still a research gap regarding whether other methods could be applied in manufacturing to make this product more effective . In term2 eq. per unit kg of polymer, correspondingly.Greener production refers to using environmentally friendly principles, strategies, and technologies to achieve environmentally sustainable production that substitutes manufacturing materials with safer and non-toxic materials ,19,20. T2 eq. per unit kg of PP. However, this study is particular and detailed compared to the GPCA study since it was conducted based on an existing PP plant located in a certain country in the GCC region, which remains anonymous due to confidentiality reasons. Narita et al. [2 eq. per unit kg of PP. Overall, the various studies conducted on PP and its associated products prove that even though there is a growing interest in the use of plastics. Therefore, future research on this subject must focus on efficient processes, use of renewables for required heat and electricity, better recycling methods, and developing combinations that would make PP less polluting, as it is used as a raw material for manufacturing many kinds of commercial products.Ingarao et al.  carried a et al.  analyzedIn this study, the LCA approach is followed to assess the environmental impacts associated with the PP manufacturing process. This approach provides the opportunity to determine the effects of each specific stage of the manufacturing process of PP, which consists of four main steps.Many PP plants are operating around the world. Each plant uses a special process technology for PP production. Moreover, each PP plant produces different types of PP grades based on market demand. This LCA study is conducted to identify the associated environmental impacts of an existing PP plant in the GCC. This particular plant uses UNIPOL PP processing technology, a gas-phase technology that occurs in a fluidized bed reactor system. There are three main grades of PP produced in this particular plant. The first is the crack grade (HT-251), which is mainly used for fiber applications. The second grade is the raffia grade (HT-031), which is mainly used for tape applications. Finally, biaxial-oriented PP (BOPP or HF-029) is used for film applications. These three PP grades differ in the melt flow rate, as well as in their applications. To switch from one grade to another, a fixed technology process is used, but the manipulated variable is the percentage of Xylene. 3H6). As illustrated in 2, and O2. This process occurs due to volatility due to differences in the boiling points, as heavy gases will exit from the bottom of the column and light gases will exit from the top of the degassing column. Next, the propylene will pass by the purification unit to purify the propylene before entering the reaction unit. After purifying the liquid propylene, it passes through the reaction area where the main purpose is to convert the liquid propylene into powder resin PP. At this specific stage, the grade type can be decided as it is the area where the catalyst is fed at a certain percentage to produce a particular PP grade, which is decided before running the plant. Next, the PP resin is fed into the pelleting area, where the main objective is to convert the powder PP resin into pellets of a specific size. Finally, the PP pellets are transported using a conveying system to the packaging area.In this particular PP plant, the manufacturing process of PP consists of four main areas or stages which are as follows: the utility and purification area, the reaction area, the pelleting area, and finally the packaging area. The LCA approach used in this PP plant will measure the environmental implications for the whole manufacturing process. PP granular pellets specifically for the raffia grade are produced from liquid propylene , life cycle impact assessment (LCIA), and the LCA interpretation phase, which were formalized and defined by the International Organization for Standardization (ISO), 14,040 and 14,044 ,30.This particular stage of the LCA study is extremely significant. The main purpose of this study is defined to make it easier for reviewers or the audience to understand the benefits of conducting this LCA study. The main goal of this LCA study is to quantify the environmental impacts associated with the manufacturing process of PP, based on a case study that has been implemented for an existing PP plant located in the GCC. Since an LCA study is used for the manufacturing process of PP production, the functional unit is defined in terms of the system’s output, which is determined to be one ton of PP pellets of raffia grade. Generally speaking, a functional unit is considered the basis upon which this LCA study is conducted. This LCA study will be beneficial for future researchers who wish to conduct LCA studies for products that are made of PP since this study focuses on measuring the environmental impacts associated with the manufacturing process of 1 ton of PP pellets according to data obtained from an existing PP plant located in the GCC. The PP pellets are used as a raw material for many other applications.For modeling, the GaBi software, a LCA tool was used to model or construct the LCA flow chart for this particular PP manufacturing process . To evalAt the life cycle inventory analysis (LCI) phase, all of the data regarding the production of one ton of PP pellets were collected from an existing plant in the GCC, based on the input and output data of the plant. At this stage of the LCA study, the energy and raw material requirements and the atmospheric emissions are quantified for the results of the LCI analysis. Most of the data analysis used in this section is obtained from a technical advisor working at the PP plant. The GaBi database is explicitly used for the energy data input for the GCC. The chemical formula of the catalyst is extremely confidential and could not be provided due to confidentiality from the manufacturer. However, the catalyst used in the PP plant is called Shell High Activity Catalyst 320 (SHAC 320).Moreover, the PP manufacturing process selected for this study has a high degree of influence on the results of the LCI analysis, where the basis of this process had a flow rate of 17 tons of PP pellets per hour. Eventually, all of the results are converted to meet the actual functional unit, namely one ton of PP pellets . Technically speaking, the process of producing other PP grades doesn’t differ in the technology applied for the manufacturing process studied in this LCA study. However, some factors can be manipulated in the plant to switch from producing one grade to another based on the market demand since each PP grade is produced for distinct applications.The life cycle impact assessment (LCIA) is the phase in which the real data is obtained from the existing PP plant and used to analyze the environmental impacts of the PP manufacturing process. The production of PP pellets in the analyzed plant consisted of several processes, which are as follows: feed and purification process, reaction processes, pelleting processes, and packaging. The overall environmental loads have been determined for the entire manufacturing process of PP.2 emissions annually that is certain to have both short and long-term impacts on the surrounding environment and human health. For the functional unit, i.e., 1 ton of PP, the estimated equivalent carbon emissions are 1586 kg of CO2, which means the weight of associated carbon emissions is more than the weight of the product. Therefore, it is essential to implement modifications or apply new technologies that are more environmentally friendly to cut down on CO2 emissions and other undesired emissions. For example, the heat and electrical energy required can be furnished by means of renewable sources (cleaner energy mix) that may lower the overall GWP impact and the production cost as the power from renewables have achieved lower prices than the fossil-based power [2 from the carbon capture can be utilized for polymers production [The PP manufacturing process releases numerous pollutants into the environment. This is proven throughout the LCA study, which is conducted for this particular process using GaBi software. Some common pollutants are selected in this study based upon their impact categories, which are listed in ed power ,35. In aoduction .x, SO2, and NH3. The total impact is evaluated in terms of an equivalent mass of SO2. The production of PP pellets causes 84.92 kg of SO2 annually for total production and 4.99 kg of SO2 per ton of PP pellets. The petrochemical oxidant formation (POF) is estimated by the total emissions of non-methane volatile organic compounds (NMVOC), including formaldehyde, ethanol, benzene, cyclohexane, acetone, etc. The presence of NMVOC raises the concertation tropospheric ozone and aerosols, and can significantly affect the human health such as cardiovascular and respiratory diseases.The terrestrial acidification (TA) implies the decline in soil fertility due to the accumulation of nitrogen and sulfur-based acidic forms such as NOFurthermore, some of the NMVOC substances are carcinogenic. One ton of PP production emitted 4.24 kg of NMVOC as the PP is the derivative of petrochemical product, so volatile organic compounds emissions during production are reasonable. The fossil resource depletion (FD) indicates fossil-based resource consumption during a particular process and is calculated as kg of oil equivalent. The PP pellets manufacturing required 1.72 tons of oil. As the PP is a petrochemical product, so the usage of fossil resources is understandable. However, if it is possible to use alternatives such as biofuels, this impact may be reduced. The human toxicity (HT) impact determines how much a process can harm human health and is measured as the equivalent weight of 1, 4-dichlorobenzene (DB) equivalents . The HT for one ton of PP pellets manufacturing is found to be 77 kg 1,4-DB eq. Both HT and POF represent major impacts related to human health. The analyzed areas have been divided into four sub-processes for the ease of understanding, and the relative contribution for each phase is demonstrated in 2 emissions is estimated to be 1.58 kg CO2 per kg of PP pellets and 1586.4 kg CO2 per 1 ton of PP pellets.According to The gross carbon dioxide emission for the PP manufacturing plant located in the GCC is compared with the results of other LCA studies that have been conducted previously in the literature, and with the values available in the Gabi database for US and Germany. There are differences between this LCA-based study and the previous studies regarding process inputs, energy and process efficiency, methodology, and datasets certainty. The value of gross carbon dioxide emissions obtained from this study are compared to the results of earlier studies as listed in The data that was collected from the existing PP plant, and is confidential .Other data not provided from the PP plant were instead obtained from GaBi software and applied to other regions.For the GCC region, most previously conducted LCA studies have been for products that are made from PP or other polymers, but very few studies have been conducted for a PP manufacturing plant. Thus, this particular study may have some uncertainties for several reasons, which are demonstrated below:The results indicate 1.58 kg of carbon emissions and 1.72 kg of oil depletion for each kilogram of PP pellet production.The feed and purification phase has the highest contribution environmental impacts followed by reaction process. Furthermore, the pelleting and packaging processes have negligible contributions in GWP, POF, and FD compared to the total environmental impacts of the PP plant. However, pelleting and packaging processes have a smaller impact on terrestrial acidification.The GPCA study showed 1.95 kg of equivalent carbon emissions for the production of 1 kg of PP pellets. This value represents the averaging of PP manufacturing plants in the GCC region and is more than the present study. The variation is mainly due to the difference in data sets used as the study by GPCA was based on data sets collected from seven petrochemical plants located in different GCC countries. The fuel type, energy mix, production capacity, plant age, energy and process efficiency, and process type may differ from plant to plant, increasing the average carbon emissions valuesThe GWP in this work is compared with values available in the literature, and it is found that the present work aligns within the range available in the literature. These results guide the petrochemical industrial sector to shift the production technology, especially the feed purification and reaction phases since they have the highest impact results to overcome undesired environmental impacts such as greenhouse gas emissions.PP is a heavily utilized material that is the backbone of countless significant industries, and products made with PP are used globally. This has resulted in the rapid and extraordinary growth of plastic production, surpassing most other synthetic materials. Thus, the global production of PP is increasing tremendously every year to meet the growing demand. It has become necessary to understand the chemical composition of PP, its several grades, and its applications. Therefore, this research is conducted to thoroughly examine the impact of the PP manufacturing process on the ecosystem. This is carried out using LCA in Gabi software. Through this LCA process, this study aspires to observe and measure the environmental burdens associated with the manufacturing of PP. It also aims to implement further technologies to reduce the environmental impacts of the PP manufacturing processes. Some of the key findings of our work are as follows:There remains a gap that hinders effective waste management, which would offer a lasting solution for environmental impacts. This does not eliminate the fact that PP is affordable and has high flexural strength due to its semi-crystalline nature, with a low coefficient of friction and better chemical resistance to many bases and acids. Therefore, future research on this subject must focus on better recycling methods and developing combinations that would make PP less polluting. Moreover, the PP production process should be more sustainable and environmentally friendly, as it is used as a raw material for manufacturing many kinds of commercial products.