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Recruitment to oral and maxillofacial Surgical (OMFS) specialty training was centralised in 2010. The 'flexibility' for OMFS to respond to specialty specific recruitment issues is reducing and many Specialty Trainees' (ST) posts are left unfilled. The National Institute for Health and Care Research (NIHR) appointment process designed to address the problem of recruiting and appointing academic surgeons with local selection with national benchmarking has worked. Using a database of all UK OMFS consultants/trainees, an electronic questionnaire was shared by e-mail, WhatsApp, and other social media. Of 306 replies, 125 (41%) were Consultants/post-certificate of completion training (CCT) individuals, 66 (22%) ST, 61 (20%) second degree students, 27 (9%) pre-second degree, 26 (9%) dual degree pre-ST trainees, and one did not indicate their status. A total of 249 (76%) studied dentistry first and 230 (75%) were male. Of those replying, 147 (48%) had no direct experience of national selection. 120 (39%) had experience as a candidate, 20 (7%) as a selector only, 17 (6%) as a candidate and selector, and two did not record their experience. Of 250 expressing an opinion, 156 (62%) supported local selection with 140 (56%) supporting local selection and national benchmarking, which is a process used for research training posts by the NIHR. Geographical continuity was most important for 78% of pre-second-degree trainees, 45% of STs, and 54% of second-degree students. A total of 57 respondents completed free text comments. There is support for changes in OMFS ST selection including creating OMFS posts which include Foundation and second-degree training in NIHR style locally recruited nationally benchmarked posts. [ABSTRACT FROM AUTHOR]

Background: Medical grade oxygen is classified as a drug and needs to be prescribed by a qualified healthcare professional. Oxygen therapy is prescribed to people who cannot maintain normal blood oxygen saturation while breathing atmospheric air. The coronavirus disease 2019 (COVID-19) pandemic highlighted the importance of the rational use of this scarce commodity. This study investigated oxygen therapy practices in adult ward patients. Methods: A cross-sectional study design with an analytical component was used in the adults wards at a National District Hospital and the Pelonomi Academic Hospital in Bloemfontein. Data were collected from patient files, interviews and oxygen measurements of adult patients that received oxygen. Results: One hundred and fifteen patients were included in the study, of whom 47.0% received oxygen without an oxygen prescription. Around 62.3% of the patients with prescriptions did not receive oxygen as prescribed. The prescriptions and oxygen administration for COVID-19 patients were better than for non--COVID-19 patients. A quarter of the patients possibly received oxygen therapy unnecessarily. Conclusion: Poor oxygen therapy practices were identified, including prescription errors, oxygen administration errors and oxygen wastage. A protocol should be developed and implemented for the prescription and administration of oxygen therapy. Training should occur to prevent oxygen wastage. Contribution: This study highlighted poor oxygen practices and prescriptions, as well as oxygen wastage in the absence of local oxygen therapy guidelines. [ABSTRACT FROM AUTHOR]

To determine the level and timing of lamb loss that occurs during the first year of life on a typical hill country sheep and beef farm in the central North Island of New Zealand and to determine how much of this loss can be prevented through vaccination against the five main clostridial diseases using a commercially available multivalent clostridial vaccine. The study was conducted on a single commercial hill country sheep and beef farm in the central North Island of New Zealand, with a history of never vaccinating their stock against clostridial disease. Lambs were blocked on sex and randomly selected at docking into treatment (n = 1,705 lambs) and control (n = 1,709 lambs) groups. Treated lambs were vaccinated at docking and 4 weeks later with 1 mL of multivalent clostridial vaccine. Control lambs were not vaccinated. Different coloured ear tags were used to identify the lambs in the treatment and control groups. All lambs were counted at docking (October 2019) and at six other management event times between docking and when the replacement hoggets were set stocked for lambing (August 2020). The number of lambs sold between each management event, from each group was also counted. The difference in the number of lambs from one management event to another, minus the lambs sold between these events was regarded as the lamb losses for that period. The total percentage of lamb losses from docking to pre-lamb was 4.8% (81/1,705) and 6.2% (106/1,709) in the vaccinated and unvaccinated lambs respectively OR = 0.75 (95% CI = 0.56–1.02; p = 0.06). Most lamb loss occurred in the period after docking, followed by the period between weaning and the first post-weaning drench. Less lamb loss occurred in the vaccinated lambs (27/1,705; 1.6%) after docking than in the unvaccinated lambs (66/1,709; 3.9%). This was mainly due to lower female lamb losses in the vaccinated (5/868; 0.6%) compared to the unvaccinated (38/868; 4.4%) group (p < 0.001). Vaccination of lambs at docking and 4 weeks later, with a multivalent 5-in-1 clostridial vaccine was associated with a 23.6% (25/106) reduction in total lamb loss from docking to pre-lambing. In female lambs, vaccination was associated with an 87% (33/38) reduction in lamb loss after docking and a 37% (22/59) reduction over the total trial period. [ABSTRACT FROM AUTHOR]

BACKGROUND: Botulinum neurotoxin type A (BoNT-A) is an effective treatment for many chronic conditions, but the economic implications of repeated treatments can be a burden on patients. The 3 commercial preparations of BoNT-A types available today are onabotulinumtoxinA, abobotulinumtoxinA, and incobotulinumtoxinA, but no clear differences have been found in clinical efficacy between these 3 type A toxins in blinded comparative studies. OBJECTIVE: To conduct a cost-minimization analysis in a cohort of patients with chronic neurologic conditions who switched treatment from onabotulinumtoxinA to incobotulinumtoxinA. METHODS: The study was a single-center, retrospective review of data from a large, private, neurological practice in Spokane, WA. A comprehensive patient chart review was conducted of all patients who were switched from established onabotulinumtoxinA therapy to incobotulinumtoxinA therapy between 2012 and 2019. The patients were switched at a 1:1-unit ratio. All patients had commercial insurance or Medicare coverage. Dosage, injection intervals, wastage, treatment costs, switchback data, and patient savings program eligibility were evaluated for the period of 1 year before and 1 year after the switch from onabotulinumtoxinA to incobotulinumtoxinA therapy. RESULTS: The most frequently treated indication was cervical dystonia (N = 61; 54.5%), followed by chronic migraine (N = 36; 32.1%). After switching to incobotulinumtoxinA therapy, botulinum toxin wastage was reduced by 87.3% (from 150.9 units to 19.1 units), and the cost was reduced by 32.2% (from $5108 to $3461) per patient annually. A total of 14,635 units in unavoidable wastage and $182,792 in annual botulinum toxin costs were saved as a result of the switch in therapy. Patients remained at consistent dosing intervals after switching to incobotulinumtoxinA therapy. A total of 8 patients switched back to onabotulinumtoxinA treatment during this review, including 3 patients who switched back because of insurance reasons, and 5 who had self-reported efficacy concerns. The 70 commercially insured patients in the study who were eligible for the patient savings program for each of the 2 therapies saved an average of $2076 (241.5%) in annual costs after switching from onabotulinumtoxinA to incobotulinumtoxinA. CONCLUSION: Our findings showed that switching from onabotulinumtoxinA to incobotulinumtoxinA at similar intervals and dosages achieved considerable cost-savings, with a low incidence of switching back. [ABSTRACT FROM AUTHOR]

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Current platelet concentrates are perishable blood products with short shelf lives. Combined with often unpredictable demand, this results in platelet inventory management problems, manifested by high rates of outdating frequently reported at 10% to 20%, and sometimes inadequate clinical supply. The objective of this study was to critically review the published methodologies on measures to reduce platelet outdating rates, in order to determine how platelet outdating and availability can be improved. We performed a systematic review of journal articles published in English to May 2019 identified from MEDLINE, with reported methods to improve platelet inventory outdating rates and availability. The complexity of each methodology was scored based on whether a typical blood bank manager could design, implement and run a platelet outdating program based on the methodology. Twenty-four relevant citations were found—these included 8 citations employing operational research (OR) methodologies, 7 evaluation/best practice, 6 simulation and 3 forecasting. Over half the included studies have been published within the last decade. The citations reporting the lowest predicted outdating were also the most complex methods. Overall predicted outdating and shortages were less than 4% based on the available data. In conclusion, we found that research interest in platelet inventory management problems has increased in line with platelet demand and methods to assist in reducing outdating rates without increased shortages have been available now for 4 decades; high rates of platelet outdating do however continue to be reported around the world. Developments in platelet preparation and storage, and other new approaches, may assist in addressing this problem. • High rates of platelet outdating continue to be reported. • Published methods to reduce platelet wastage are available. • Low rates of platelet outdating (below 4%) and shortages are possible. [ABSTRACT FROM AUTHOR]

• The success rate of PIVC insertion is just a little over 50% on the first attempt. • Items thrown due to unsuccessful insertion amount to about 30% of the total costs. • Increasing age of the patient is associated with an increased number of attempts required. • BMI of the patient does not influence the success rate of insertion. Multiple failed attempts at securing intravenous catheter access cause increased patient dissatisfaction and higher costs. We aimed to identify the factors leading to multiple failed attempts and estimate the cost of resources wasted. Participants were recruited from the emergency department for a prospective, observational study. Healthcare workers inserting peripheral intravenous catheters were observed. Patient characteristics and the number of attempts needed were recorded. Three hundred thirty-four patients were enrolled, and an average of 1.74 ± 1.026 (Range: 1 – 5) access attempts were needed per patient. Only 56.28% of the insertions were successful on the first attempt. On multivariate linear regression with attempts as the outcome variable, age (β = 0.01, 95%CI 0.004 – 0.014, p = 0.0006), catheter calibre (β 20G = -0.25, 95%CI −0.45 – −0.07, p = 0.008), visibility (β = 0.23, 95%CI 0.02 – 0.44, p = 0.026) and palpability (β = 0.44, 95%CI 0.21 – 0.66, p = 0.0001) of the vein were statistically significant predictors. The average total cost of materials required was $6.4 USD per patient, of which $1.76 USD was spent towards unsuccessfully inserted catheters that were consequently thrown away. Our study shows that securing IV access often requires multiple attempts, with nearly 30% of the total cost amounting towards materials wasted. The risk of multiple attempts is highest for older patients with invisible and non-palpable veins. [ABSTRACT FROM AUTHOR]

Objective: To quantify vaccinations administered outside minimum and maximum recommended ages and to determine attendant costs of revaccination by analyzing immunization information system (IIS) records.Study Design: We analyzed deidentified records of doses administered during 2014 to persons aged <18 years within 6 IIS sentinel sites (10% of the US population). We quantified doses administered outside of recommended ages according to the Advisory Committee on Immunization Practices childhood immunization schedule and prescribing information in package inserts, and calculated revaccination costs. To minimize misreporting bias, we analyzed publicly funded doses for which reported lot numbers and vaccine types were consistent.Results: Among 3 394 047 doses with maximum age recommendations, 9755 (0.3%) were given after the maximum age. One type of maximum age violation required revaccination: 1344 (0.7%) of 194 934 doses of the 0.25-mL prefilled syringe formulation of quadrivalent inactivated influenza vaccine (Fluzone Quadrivalent, Sanofi Pasteur, Swiftwater, PA) were administered at age ≥36 months (revaccination cost, $111 964). We identified a total of 7 529 165 childhood, adolescent, and lifespan doses with minimum age recommendations, 9542 of which (0.1%) were administered before the minimum age. The most common among these violations were quadrivalent injectable influenza vaccines (3835, or 0.7% of 526 110 doses administered before age 36 months) and Kinrix (GlaxoSmithKline Biologicals, Rixensart, Belgium; DTaP-IPV) (2509, or 1.2% of 208 218 doses administered before age 48 months). The cost of revaccination for minimum age violations (where recommended) was $179 179.Conclusion: Administration of vaccines outside recommended minimum and maximum ages is rare, reflecting a general adherence to recommendations. Error rates were higher for several vaccines, some requiring revaccination. Vaccine schedule complexity and confusion among similar products might contribute to errors. Minimization of errors reduces wastage, excess cost, and inconvenience for parents and patients. [ABSTRACT FROM AUTHOR]

This study critiques available methods for the national-level, sector specific, characterisation of food waste. Such estimates are required to account for the environmental and socio-economic implications of food waste, and to identify the highest impact and most cost-effective solutions to reduce those negative outcomes associated with wasted food. Australian results are compared using three fundamentally different approaches taken from the literature, along with two variants implemented for this study. The results are extremely inconsistent, suggesting that our current quantitative knowledge on Australian food waste may not be sufficient for optimal prioritisation of mitigation options. While these ‘conventional’ methodologies may not be sufficient in isolation, their strengths are complementary and would ideally be integrated into a single analytical framework that incorporates the best available top-down and bottom-up datasets. [ABSTRACT FROM AUTHOR]

The paper focuses on Romanian consumers' habits and perceptions related to meat consumption, following that it is deeply embedded in their dietary food culture. The aim of this study was to determine the main directions for achieving environmental resilience through meat consumption. The novelty of the study originates from underlying consumers' contribution to sustainable development on two pillars - "buy less, eat the same" and "buy less, eat less". Statistical analysis revealed that 13.3% of meat is perceived to be wasted, which is significantly less than other food waste (Z=-5.485, p=0.000). Two thirds (65.1%) of tested people eat meat at least 4 days/ week and, when an environmental motivation is added, 67.7% of them are willing to make a high reduction of their meat intake, casting light on a pro-environmental attitude. Based on the results, Romanian consumers should be considered as reliable partners in finding new ways for meat consumption reduction that can alleviate environmental pressure. [ABSTRACT FROM AUTHOR]

The use of Mathematical models for manpower planning has increased in recent times for better manpower planning quantitatively. In respect of organizational management, numerous previous studies have applied Markov chain models in describing title or level promotions, demotions, recruitments, withdrawals, or changes of different career development paths to confirm the actual manpower needs of an organization or predict the future manpower needs. The movements of staff called transitions are usually the consequences of promotions, transfer between segments or wastage and recruitment into the system. The objective of the study is to determine the proportions of staff recruited, promoted and withdrawn from the various grades and to forecast the academic staff structure of the university in the next five years. In this paper, we studied the academic staff structure of university of Uyo, Nigeria using Markov chain models. The results showed that there is a steady increase in the number of Graduate Assistants, Senior Lecturer and Associate professors, while, there is a steady decrease in the number of Assistant Lecturer, Lecturer II, Lecturer I, and Professor in the next five years. The model so developed can only be applied when there is no control on recruitment but the research can be extended to include control on recruitment. The model can also be applied in school enrollment projection. [ABSTRACT FROM AUTHOR]

Retrospective management and owner-reported injury data, and measurement of forelimb hoof conformation, were collected via a cross-sectional survey from a convenience sample of 96 registered show jumping (n = 67) and dressage (n = 29) horses. Most of the horses were medium- to upper-level performers, aged 9 (interquartile range [IQR] 7–12) years, and in the current rider's ownership for 28 (IQR 12–60) months. The horses were trained 45 (IQR 35–60) minutes, 6 days per week, on a sand or sand mix arena. Failure to train for ≥7 days was reported in 26 of 96 horses, generally associated with lameness diagnosed by a veterinarian (16/29), with a median time-off of 26 (IQR 14–93) days. During the preceding 12 months, 33% of the riders had been working with the farrier on hoof-related issues, 30% of which had involved ≤2 issues. This remedial work often involved a veterinarian (14/30) or allied health practitioner (6/30). Most horses were hot shod (67/89) with conventional fullered shoes. Uneven feet were identified in 16 of 89 horses but were not positively associated with inability to train, possibly reflecting the minor variation between feet. Uneven feet were associated with variation in heel length and angle measurements and a greater sole length and reduced sole width, rather than smaller and boxy. Multiple correspondence plots identified an association of uneven feet with the dressage horses rather than show jumping horses. [ABSTRACT FROM AUTHOR]

Blood product supply and utilization are understudied in Saudi Arabia. This study evaluates the trends in Saudi blood banks readiness, donors' demography, and blood product utilization and wastage. A retrospective, cross-sectional study of records obtained from the Ministry of Health (MOH) was initiated to report trends and statistics on annual whole blood donors and blood product utility from 2010 to 2020. Data collected in 2020 was further characterized for donors' demographics, laboratory readiness, and staffing. The average number of annual blood donors over the last decade (2010–2020) was 325,847.3 ± 43,160. The forecasted blood donation and dispatch trends suggest a significant increase in blood demand (R2 = 0.7582) over annual donation rates (R2 = 0.2356). In 2020, 342,460 nationwide blood donations were registered in governmental donation centers and females constituted a mere 2.5 %. Approximately 60 % of whole blood donation was voluntary, 36% was compensatory, and 4% was part of driving license renewal. The highest blood donation rate per 1,000 inhabitants was observed in Taif (69.8) and Alqonfoda (45.0). Eastern directory and Madinah had the most successful donation campaigns attracting 53% and 50% of total annual donations, respectively. Notably, Tabouk, Hai'l, and Albaha had the highest blood product wastage medians. Blood donation rates and impetus, staffing ratios, and laboratory readiness and wastage varied among the various directories. Laboratory managers and medical directors need to increase efforts to refine current guidelines in order to comply with the transformation plan of the health sector. [ABSTRACT FROM AUTHOR]

Summary: Most of the attrition from nursing courses occurs in the first year of study. Devising university strategies to reduce attrition requires an understanding of why students leave. The aim of this study was to explore whether students who leave a nursing course in the first semester leave for the same or different reasons than students who leave in the second semester of study. Seventeen students who had left the course were interviewed by telephone: seven in the first semester and ten in the second. In the first semester, students who leave consider themselves unprepared for university, have competing roles outside university and develop a strong dislike of the nursing course. They decide quickly that the course is unsuitable and leave. Those who leave in second semester would prefer to stay but events in their life create a crisis where they can no longer cope with university studies. These students hope to return to nursing whereas students who leave in the first semester are unlikely to consider returning. Attempts to retain students in the first semester may be futile as these students may be unsuited or uncommitted whereas there is greater scope to retain those who leave in the second semester. [Copyright &y& Elsevier]

Abstract: Scope: Many studies have provided evidence that favor the use of insulin pens over traditional insulin vials due to lower overall costs. The cost of insulin in the Royal Medical Services in Jordan is subject to other considerations due to the favorable tender prices and the process of dispensing of insulin within the Royal Medical Services. Objective: To highlight further cost considerations associated with the wastage in the use of insulin vials and cartridges in the Jordanian Royal Medical Services. Methods: Two random samples were selected from prescriptions dispensed for diabetic patients using insulin in January 2012 from the outpatient pharmacy in Al-Hussein Hospital, King Hussein Medical Center, Amman, Jordan. First sample was selected from prescriptions of patients using vials; second sample was selected from prescriptions of patients using pens and cartridges. Average costs for insulin and wastage were calculated per patient from the Royal Medical Services perspective. Results: The average direct cost per patient using vials was JD 5.197 and for those using cartridges was JD 22.135. The average wasted quantity per patient in the first sample was more than ten times that of the second sample. The cost of the average wasted quantity per patient in the first sample (1.022 JD) was more than the double that in the second sample (0.441 JD). Conclusion: Although, the direct cost of insulin per patient by using vials was lower than cartridges, there was a substantial reduction in the cost of wastage by using the cartridges in the Jordanian Royal Medical Services outpatients. [Copyright &y& Elsevier]

In Romania, the problems of environment protection and food safety are acutely raised, especially as a result of local pollutions observed in several activity fields, such as: transport, town management, food industry and agriculture. Environment protection and food health are among the most substantial and important fields within the social politics of the European Union. The activity of Bere Ltd. From Cefa commune constitutes an example in this respect and makes the subject of the current case study. On the basis of the researches made on the location and according to the information provided by the company's technologist, it was developed a "conceptual model" of location management which underlines the interraction between the polluting sources resulting from the technological process of beer production and environmental factors. The impact upon the environmental factors may be classified into two categories. The first one is the significant potential impact and refers to the controlled emissions resulting from the thermal power station, diffused dust emissions resulting from the dust retaining installation existing in the malt grinding and processing plant, soil contamination by accidental black oil leakages in the area of railway and automobile unloading platforms, the evacuation of the purified residual waters in the natural recipient -- Crisul Repede River. The second category refers to the insignificant impact and regards soil infiltrations affecting the quality of the ground-water table, the indirect impact of the pollutants emissisions in the environment upon the residential area from the neighbourhood. [ABSTRACT FROM AUTHOR]