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Removal of ewes from a flock before the end of their productive life, sometimes described as ewe wastage, can potentially lead to reduced flock productivity. While the main reasons for culling ewes are largely known, their relative importance to New Zealand farmers and farmers' rational behind their culling decisions are not. Therefore, this study involved semi-structured interviews with 38 sheep farmers from throughout New Zealand to explore their ewe culling decisions. Farmers consistently culled mixed-age and two-tooth ewes who failed to become pregnant or who had a vaginal prolapse. For other culling reasons, farmers' use of them and their rationale for doing so was diverse and varied between farmers based on ewe age-group, severity, season, perceived economic consequences and farmers' personal preference. This diversity indicates that there is scope for some farmers to carefully evaluate some of their culling decisions. [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]

A cost-minimization model was developed to compare recombinant factor VIII Fc (rFVIIIFc) and emicizumab as prophylaxis for hemophilia A without inhibitors. The model was based on 100 patients from the healthcare payer perspective in the UK, France, Italy, Spain, and Germany (5-year time horizon). Costs included: drug acquisition; emicizumab wastage by bodyweight (manufacturer's dosing recommendations); and additional FVIII for breakthrough bleeds. Scenario analyses (UK only): reduced emicizumab dosing frequency; and emicizumab maximum wastage. Total incremental 5-year savings for rFVIIIFc rather than emicizumab use range from €89,320,131 to €149,990,408 in adolescents/adults (≥12 years) and €173,417,486 to €253,240,465 in children (<12 years). Emicizumab wastage accounts for 6% of its total cost in adolescents/adults and 26% in children. Reducing the emicizumab dosing frequency reduces the incremental cost savings with rFVIIIFc, but these remain substantial (adolescents/adults, >€92 million; children >€32 million). Maximum emicizumab wastage increases by 86% and 106%, respectively, increasing the incremental cost savings with rFVIIIFc to €125,352,125 and €105,872,727, respectively. Based on cost-minimization modeling, rFVIIIFc use for hemophilia A prophylaxis in patients without inhibitors is associated with substantial cost savings in Europe, reflecting not only higher acquisition costs of emicizumab, but also other costs including wastage related to available vial sizes. [ABSTRACT FROM AUTHOR]

Objective: To assess total and allergic rhinitis (AR)-related healthcare costs among AR patients residing in the United States with a focus on patients persisting with AIT.Methods: AR patients were identified in the IBM MarketScan database between 1 January 2014 to 31 March 2017. Patients receiving allergy immunotherapy (AIT) were identified with relevant billing codes (earliest AIT claim = index date); non-AIT patients were identified with claims containing a diagnosis code for AR (earliest AR claim = index date). AIT patients reaching 25+ injection claims were analyzed as a separate maintenance cohort. All patients were required to have continuous enrollment for 12 months preceding and following index.Results: A total of 2,334,530 AR patients were included; 103,207 had at least 1 AIT claim, with 45,279 (43.9%) of these patients reaching maintenance, and 24,640 AIT patients (23.9%) never presenting a single injection claim. Compared to non-AIT patients, patients initiating AIT presented higher rates of baseline comorbidities, including asthma (30.1% vs. 7.5%) and conjunctivitis (21.7% vs. 4.4%). During the follow-up period, patients reaching the maintenance phase of AIT incurred lower total costs than the overall AIT cohort ($10,431±$16,606 vs. $11,612±$24,797), and also presented lower follow-up hospitalization costs ($698±$7,248 vs. $1,281±$12,991) and total medical costs ($7950±$13,844 vs. $8989±$22,019).Conclusions: Continued efforts are needed to increase patient awareness of available options and adherence to AIT, along with reducing wastage. Despite AIT patients presenting fairly progressed disease at the time of treatment initiation, this therapy remains an economical treatment option, as it was not accompanied by substantial increases in overall healthcare expenditure, and may promote positive societal impacts beyond the direct medical costs.What is known on this topicThe prevalence of allergic diseases has increased over the past 50 years and affects between 10-30% of the world population.Allergic rhinitis (AR) poses a significant economic burden in the form of both direct and indirect costsAllergy immunotherapy (AIT) is the only treatment option able to modify the underlying course of the disease.What this study addsSpecific all-cause and AR-related healthcare costs decreased following the initiation of AIT among patients diagnosed with AR, with the largest decreases observed among AIT patients reaching the maintenance phase of treatment, while non-AIT patients showed increases in all categories assessed over a similar follow-up period.Cost decreases among AIT patients were observed despite increased levels of comorbidities compared to non-AIT patients, as the AIT cohort presented elevated rates of atopic dermatitis (7.1% vs. 2.7%), conjunctivitis (21.7% vs. 4.4%), asthma (30.1% vs. 7.5%), and chronic sinusitis (22.6% vs. 4.9%).An analysis of patients' index subcutaneous AIT consultation revealed substantial variability in the initial treatment costs, with nearly 20% of paid amounts exceeding $1,000; given nearly 1 in 4 AIT patients who get AIT mixed never came back for their first injection, this highlights an opportunity to target frontloaded billing practices and the timing of mixing/injection as an area to minimize healthcare waste. [ABSTRACT FROM AUTHOR]

Thoroughbred racing is promoted as the ‘Sport of Kings’ and thousands of racegoers emulate a wealthy leisured elite at the track and through gambling and horse ownership, seek large financial profits. One of the norms of this racing culture involves a particular clothing style of high fashion which helps to promote racing as glamorous and exciting. In recent years racing has been subjected to a number of shocks resulting from high-profile media work by activist groups concerning horrific horse injuries and deaths at the track, plus claims of widespread cruelty, ‘wastage’ and whipping. This paper juxtaposes these two racing worlds. It illuminates the position of the animals upon which the industry so heavily depends and argues that in an age of increasing concern for animal welfare, racegoers and the community ought to know how their entertainment was produced. The paper results from a collaboration between academic endeavour and animal activist work. [ABSTRACT FROM PUBLISHER]

The Commonwealth is failing to face up to the main obstacles to achieving the United Nations Millennium Development Goals (MDGs). Instead it is pinning the aspirations of the developing world on the benevolence of the developed world through aid. The author suggests this risks perpetuating the current state of play. No overhaul is likely until and unless the Commonwealth grasps the nettle of the nature of politics in many African states. [ABSTRACT FROM AUTHOR]

Background: Medicines wastage is one of the challenges of health supply chain management in developing countries including Ethiopia. However, there is lack of objective evidence on the detailed underlying causes of medicines wastage. Therefore, the aim of this study is to explore factors contributing for medicines wastage in selected public health facilities of South West Shoa Zone, Oromia Regional State, Ethiopia. Methods: A qualitative study was conducted in 10 public health facilities (1 General hospital and 9 health centers). An in-depth interview with flexible probing techniques was employed to collect the data from 20 key informants from May 2, 2016 to May 27, 2016. A semi structured interview guide was prepared to explore key informants' idea about current situation of contributing factors and efforts made to reduce medicines wastage in public health facilities. A thematic analysis was then used to analyze the data. Results: Almost all key informants felt that medicines wastage is increasing from time to time in their health facility due to supplier's issuing of medicines without health facilities' needs and request, failure to follow first expired first out principle in issuing medicines from stores to different dispensing units, lack of communication between supplier and health facilities, inadequate number of pharmacy personnel and weak monitoring system of supply chain in the health facilities. They also revealed budget constraint, stock out of medicines and congested store are of the major challenge that are compromising their service provision. Conclusion: Medicine wastage is an ever-increasing problem in public health facilities of South West Shoa Zone. The problem is exacerbated due to absence of mechanisms to minimize the wastage. Health facilities, therefore, should place a mechanism to exchange medicines from overstocked facilities to under stocked ones; has to improve store management capacity by employing competent professionals, equipping the store with necessary technology and introducing a monitoring and evaluating health supply chain performance system in the health facilities. [ABSTRACT FROM AUTHOR]

Background: Few studies have specifically examined practical treatment experiences of hemophilia A (HA) patients such as product wastage, number of vials needed per infusion, and preparation time. In addition, differences in these experiences across a wide array of factor VIII (FVIII) products have not been examined. Objectives: To examine differences among FVIII products with respect to product wastage, number of vials needed per/infusion, and preparation time. Methods: A total of 134 HA adults (n = 70) and caregivers (n = 64) of pediatric HA patients completed a cross-sectional survey. Participants completed several questionnaires assessing patient preference for FVIII product attributes, demographic, the Hemophilia Impact Questionnaire (HIMS) as well as disease and treatment characteristics. The extent of FVIII product wastage, number of vials needed/infusion, and preparation time was collected as well. Descriptive statistics by product were calculated, Dunnett’s test was used for comparisons between products. Results: A total of 22 patients (16% of the total sample) reported experiencing wastage over the past year. Of the patients reporting wastage 31.8% (n = 7) were on Advate®, 18% (n = 4) were on Eloctate®, 9.1% (n = 2) were on Recombinate®, and 13.7% (n = 3) were on Advate®/Adynovate®. The most frequently reported reasons for wastage were “faulty device administration/set up” (59%) and “left too long outside of refrigerator in high temperatures” (36%). No significant differences among the products were observed for number of vials/infusion. There was a significant difference for preparation time. The preparation time for NovoEight® (3.9 min; SD = 2.2) was comparable to the other FVIII products, with the exception of Adynovate® 6.6 min; SD = 2.1) which has a significantly higher preparation time (p < .05) than NovoEight®. Conclusions: Issues with a faulty device during preparation and refrigeration of the FVIII product are the two most common reasons HA patients reported for unintentionally wasting their FVIII products. Although small sample size does not allow for comparisons between products, these results may suggest patients experience more wastage with certain products and devices. Overall, the number of vials per infusion and time needed to prepare their factor prior to infusion was comparable across FVIII products. These findings should be confirmed in a larger study. [ABSTRACT FROM AUTHOR]

Background: Reducing vaccine wastage is important. Bacille Calmette-Guérin (BCG) vaccine is produced in vials of 20 infant doses. The reconstituted vaccine is discarded after 4–6 hours. Therefore, to reduce vaccine wastage, a 20-dose vial of BCG is often only opened if at least 10–12 infants are present, jeopardising BCG vaccination coverage and timely vaccination. We observed that nurses were not able to withdraw 20 doses from the vials and aimed to quantify how many doses could be obtained from these vials by experienced nurses under real-life circumstances. Methods: At the maternity ward of the national hospital in Guinea-Bissau, since 2002 the same two nurses have been vaccinating all eligible children with BCG before discharge. During a month in 2015, within a randomised trial comparing BCG-Denmark and BCG-Russia, we registered how many doses the nurses were able to withdraw from the two types of vaccine vials. Results: The median number of doses which it was possible to withdraw from the vials was 13 (range 11–17): 13 (11–16) for BCG-Denmark (based on 39 vials) and 15 (12–17) for BCG-Russia (based on 29 vials). Conclusions: In real life, experienced nurses could only obtain 13–15 doses from the 20-dose vials. Thus, vaccine wastage is much lower than assumed. Adjusting practice to the real-life number of doses would immediately suggest vials should be opened if 7 rather than 10 infants are present. As other studies have indicated that BCG may have beneficial non-specific effects on overall mortality, the potential gain by opening a 20-dose vial even for one child may be considerable. [ABSTRACT FROM PUBLISHER]