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MATERIALS AND METHODS: A total of 457 blood transfusion requests for 244 patients were received over a 3-month period. Registered demographic characteristics (age, sex, and nationality), ward, type of blood, and hemoglobin concentration before transfusion for all the patients were collected. RESULTS: A total of 1328 blood products were requested, while 780 (59%) units were transfused. The cross-matched packed red cells/transfusion ratio was 1.8, while request/transfusion was 1.7 for the fresh frozen plasma and 1.23 for platelets. Packed red blood cells were the main blood product used in blood transfusion (BT). General surgery/orthopedics and intensive care unit were reported with a greater number of requests. The main indications noted for blood requisition were surgery and anemia. CONCLUSIONS: Current guidelines appear to be respected within services regarding BT decision criteria. However, about half of the requested blood is not transfused which suggest further improvement. Adherence to established guidelines seems variables among different departments. Elective transfusion medicine rotations for all trainees and specialized dedicated sessions for doctors may help in further betterment of utilization of blood bank services.

The proportion of Thoroughbred (TB) horses that commence training and eventually race, is an important industry‐level indicator of how successful it is at producing horses suitable for racing. It is also of interest to the wider community and is central to the issue of whether there is overbreeding in the Australian TB industry. This study investigated the training and racing records for the 2005 and 2010 Victorian TB foal crops to determine the proportion of TBs that train and race, and the age of entering training and first race start. Subsets of the foal crop were also examined to determine if premier yearling sale cohorts would produce selection bias. The Australian Stud Book (ASB) registered 7662 TB horses born in Victoria in 2005 (n = 4116) and 2010 (n = 3546). Of these, 5614 (73%) entered training and 4868 (64%) started in at least one race. Fourteen percent (n = 1045) of the study cohort had their first race start as 2‐year‐olds and 35% (n = 2644) had their first start as 3‐year‐olds. A higher proportion of TB horses that attended premier yearling sales entered training (93%) and raced (84%). This study established a baseline for training and racing milestones, such as the proportion and age that horses commenced training, and age of first start using population‐level data. It also established that the use of subsets of the population can introduce selection bias. [ABSTRACT FROM AUTHOR]

Purpose: The goal of blood bank audit is to continuously improve services to the patients by reducing rework, wastage, and inappropriate care. This can be done by establishing certain quality indicators. The rate of discarded blood and its components due to wastage, expiry, and transfusion-transmitted infection are one of such indicator. Design: Retrospective data on the number of whole blood, components prepared, and discarded were collected from the blood bank information system and analyzed. Results: During the study period, the total number of blood and components prepared were 3922. Out of which, a total of 226 units (5.76%) were discarded. In order to alleviate the shortage of blood, we should do intermittent auditing, quality monitoring, thorough evaluation and training of staff, proper management of the resources, and workforce. [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: Despite the advancement of technology and the emergence of innovations in the field of healthcare, scientists have not yet been able to find a suitable alternative to human blood. As a result, inventory management of blood and blood products has always been a major concern of the medical community. Among blood products, platelet management is very important because of their specific usages and their rapid perishabilities. The main objective of this research is to present a platelet supply chain design for decreasing the number of shortages and wastages simultaneously. Methods: In this study, a mixed nonlinear location-inventory model is presented by using inventory concepts in order to manage platelet inventory in blood centers and hospitals and locating collection facilities to reduce platelet supply chain costs. The proposed location-inventory model has approximately converted into mixed linear programming using the piecewise linearization method and then has been solved with the Gams software. Results: Using the proposed model, blood centers are able to meet a high percentage of hospital demands, which reduces the number of platelet shortage units and supply chain cost. Also, using inventory concepts and better hospital assignment to blood centers with FIFO policy, the restriction of wastage on the number of lost units in hospitals and blood centers will be removed. Conclusion: Using the developed contribution and applying inventory control and economic order quantity (EOQ) relations, the platelet inventory in the blood centers can be managed in such a way that in each period the maximum demand of hospitals has been met and the shortage has been reduced. Also, due to the specific features of the blood, platelets would be kept in more proper conditions, which will reduce the wastes in hospitals. In addition, the number of blood donors can be improved by using mobile blood collection facilities

Uranium is the most important material in the nuclear fuel cycle that produces in the various stages of uranium production and processing research and after-use in reactors, as well as laboratory researches as uranium wastage. The uranium in these wastages is valuable and may cause radiation problems if they enter the environment, so their separation is essential. The solvent extraction method is one of the most important separation methods in the nuclear industry that produced uranium components from wastages is recovered using this method in the current study. After identifying the presented components in the wastage, the amount of each component was determined by using Inductively Coupled Spectrometry (ICP) analysis and finally the type of present uranium compound in the wastage was specified. According to the desired compound, the extraction experiments were performed with two different solvents of trioctylamine (TOA) and di-2-ethylhexyl phosphoric acid (D2EHPA) which the extraction percentages were achieved 96.12% and 99.01%, respectively. Also, the effects of extractant type, extraction temperature, acid concentration, extractant concentration, initial uranium concentration, diluent type, aqueous to organic phase ratio, phase mixing time on extraction percentage as well as the effect of various rinses on the reverse process were investigated.

The article deals with consumer behavior in terms of food and its wastage. The main aim is to identify consumer behavior in relation to food consumption and food waste in the households in the Czech Republic as an effect of healthy competitive environment. Food consumption and its wastage is analyzed in terms of quantity and food expenditure in general as well as with the use of primary data from the Household Budget Survey. According to a household diary survey, the highest wastage is of cereal and dairy products, with the lowest being meat. The consumption and quantity of wasted food are significant in relation to price. The data obtained during daily monitoring of wasted food in September 2018 are used to test the impact of the household identification characteristics on the quantity of wasted food along with the types. A logit regression is used to estimate the anticipated quantity of wasted food according to individual kinds of food and in relation to household identification characteristics. The age, education and economic activity of consumers have a significant effect on the quantity of wasted food. In addition, the results show that the people who waste the most are over 65 years of age, with the lowest wastage connected with university graduates.

Wastage of construction materials can be estimated by the difference between the value of materials delivered and accepted on site and those properly used as identified and exactly computed in the work. The elements of construction wastage are wastage due to labor, material and machine. This research study organized to identify the percentage of construction materials wastage and the main factors which cause wastage in residential houses in Erbil. The questionnaire form was designed and sent to foremen, masons, supervisor engineers at construction sites as respondents who have at least 10 years’ experience in construction of houses. Data analyzed by the statistical package SPSS program (version 22). The results showed that the maximum percentage of wastage were in the sand, gypsum, wall tiles and floor tiles with relative average percentage of 13.7 ,12.08, 12.03 and 9.10 respectively, while the minimum percentage of wastage in construction material are false ceiling and paints with relative average percentages of 4.70 and 4.67 respectively. The most effective causes of wastages are due to cutting uneconomical shapes, ordering additional amount more than required, damages due to transportation, storage and handling. The best ways for reducing wastages of materials are procuring, handling, and storing properly.

Background: The aim of this study was to evaluate surplus drugs left over from medications used via the intravenous and intramuscular routes in a pediatric emergency unit of a tertiary hospital in Turkey and to determine the financial burden imposed by drug wastage. Materials and Methods: The study was planned prospectively on patients presenting to the pediatric emergency department of a tertiary university hospital between January 1 and April 30, 2017, on weekdays and between 08:00 and 16:00, for any reason, and receiving intravenous and/or intramuscular drug administration resulting in drug wastage after treatment. Results: The number of patients enrolled in the clinical trial was 1620 (35.9%). Twenty-one different medications were administered via the intravenous or intramuscular (IM) routes during the study. The proportion of total medication wastage at the end of trial was estimated to be 0.425. The drug with the highest proportion of mean wastage to drug form was paracetamol (1000mg vial) at 0.79. The total cost of the drugs used for the patients in the study was US$580.98, and the overall burden of drug wastage was US$288.09. The three medications involving the highest wastage costs were methylprednisolone, ondansetron, and dexamethasone. The total wastage cost/total drug cost ratio was 0.495. Conclusion: If commercial drugs with intravenous and IM formulations are used by the pediatric age group, then dosage formulations appropriate for pediatric age group use also need to be produced. The development by manufacturers of ampoules and similar products suitable for multiple use will also reduce drug wastage. Reducing levels of drug wastage will inevitably reduce the drug expenditure.

Effective management of perishable inventory systems is often strewn with challenges, especially when a strong trade-off relationship exists between shortage and wastage of perishables: A smaller inventory increases the chance to lose sales (leading to higher expected shortage cost), while a larger inventory increases the chance to waste perishables (leading to higher expected wastage cost). The root cause of this strong trade-off relationship is high product demand variability. To mitigate the issue and reduce the cost of operating perishable inventory systems, some grocery stores utilize an opaque selling scheme: selling an anonymous product whose brand or exact specification is shielded from customers at the time of sale. The use of opaque products has now become a popular means to reduce shortage/wastage at grocery stores. However, there has been little discussion of the effectiveness of opaque schemes applied to perishable inventory systems.In this paper, we propose an opaque scheme based on the balancing policy on demand, which tries to average out orders for products. We confirm both analytically and numerically that this opaque scheme effectively reduces product demand variability, thereby reducing both shortage and wastage for perishable inventory systems under a base-stock policy. We also present an analytical formula that reveals insights into the opaque scheme: The ratio between the opaque proportion and the coefficient of variation of product demands plays a key role to determine the effectiveness of our opaque scheme. Furthermore, we provide a rule of thumb to find the threshold opaque scheme parameters needed to achieve the maximum total cost savings for perishable inventory systems. We hope that many retailers selling perishables (e.g., fresh produce and baked goods) find the opaque scheme useful, implement it, and contribute to the reduction of the food wastage.

Background: Gonadotropins represent an important component of IVF costs. In order to reduce costs, much attention was given to the type of gonadotropins (recombinant versus urinary) and the daily dose. In this study, we decided to focus on gonadotropin wastage, a neglected aspect that may harbor a relevant source of useless economic expenditure.Materials and Methods: Women who performed oocytes collection following ovarian hyperstimulation with gonadotropins in two Italian IVF Centers were prospectively recruited. They were interviewed using a standardized questionnaire aimed at capturing drug wastage. Physicians of the participating units were blinded to the study. Recruited women were requested to hide their participation to their physicians.Results: Three-hundred nine women were recruited. Two hundred eighty-eight (93 %; 95 %CI: 90-96 %) reported to have wasted some drug. For the whole cohort, the median [Interquartile range] IUs of drug used and drug wasted was 2,100 [1,575 - 2,850] and 825 [400 - 1,200], respectively. This corresponds to a median increase in the costs of ovarian hyperstimulation of 39 %. When data on wastage was analyzed separately for the different available drugs, a statistically significant difference emerged (p = 0.026). Reasons behind this difference could not be clearly disentangled.Conclusions: IVF is associated with a considerable wastage of gonadotropins. Improving this aspect can allow to reduce the costs of the procedure. [ABSTRACT FROM AUTHOR]

Background and objectives Abstract Transfusion of blood and blood products plays a central role in various life-saving procedures and clinical conditions. Wastage of blood and blood products in a country where concept of voluntary blood donation is still naïve and blood banks strive to fulfill the ongoing requirement is inexcusable. This study focused on collecting the baseline wastage data of various blood products and identifying reasons behind wastage. Materials and methods The study was conducted from January 2018 to December 2019 in a hospital blood bank of a tertiary care center. Retrospective analysis was done on the data retrieved. Wastage rate and potential reasons of wastage of different blood products were analyzed. Results A total of 11 594U of blood were issued from blood bank during the study duration. Expired platelets were found to be the most frequently wasted blood products (3998/4861). Overall wastage rate as a percentage of issue was 41.9%. Conclusion Blood product wastage in our institute is high, translating to immense financial burden. The study highlighted various key elements and malpractices that contributed to overall wastage. A follow-up study after implementation of corrective measures is planned to regularly monitor wastage of blood and blood products. [ABSTRACT FROM AUTHOR]

Performance and welfare status of stable and regrouped Beetal does (N=28) was assessed at hexagonal and linear feeder (n=14 does per group, 7 lactating and 7 non-lactating). Stable groups were compared at hexagonal (DH) and linear (DL) feeders for a period of four weeks. Thereafter, does were regrouped (7 does interchanged, i.e. 4 lactating and 3 non-lactating) at hexagonal (DHM) and linear (DLM) feeder and compared as following four subgroups, i.e. hexagonal retained (DHR), linear-to-hexagonal (DLH), hexagonal-to-linear (DHL) and linear retained (DLR) does (n=7 each). Body weight, milk yield, feed intake, wastage, injuries and blood biochemical parameters were recorded. Blood samples were collected at weekly interval before regrouping and on day 1, 3, 7 and 14 after regrouping. Most of the parameters did not differ between feeder groups before as well as after regrouping. One doe received horn injury after regrouping at hexagonal feeder. Does retained at respective feeder (DHR and DLR) showed increase in plasma cortisol level after regrouping indicative of rise in stress to defend their stable position at feeder or space inside the pen. Results showed that two types of feeder had little influence on performance and welfare of stable does with marginal advantages at linear feeder in regrouped does.

Background: The paediatric massive transfusion protocol (MTP) is activated in the paediatric population for both trauma and non-trauma related indications. While it helps to improve the efficiency and efficacy of the delivery of blood products, it can also result in increased wastage. We aimed to evaluate the wastage rates from our paediatric MTP activations from 2013 to 2018. Method: As part of an audit, we retrospectively reviewed the records of the paediatric patients who had MTP activations. We collected the following data: reason for MTP activation, weight of patient, number of cycles of MTP required, blood products used, blood products wasted, deviation from our institution’s recommended MTP blood product ratio, and reason for wastage. Result: We had 26 paediatric MTP activations within the audit period. There was an overall wastage rate of 1.5%, with wastage occurring in 3 out of 26 patients. The reason for all wastage was demise of the patient. Most patients’ transfusion ratios deviated from our institution’s MTP protocol. Conclusion: Our wastage rates are low likely because of clear MTP activation guidelines and a flexible MTP workflow.

Considering the climatic changes,the overall urbanization problems and the technological advances, drinking water demand shouldalwaysbea matter to research yet. In developing countries,many people still do not get drinking water enough to satisfy their basic needs.There is not sufficient technical information to apply in water management in order to optimize drinking water consumption(DWC)and to distribute it better. This study identifies the correlation between DWC and sanitary devices (SD). It provides some models to calculate the DWC by knowing how many SD there are in a residential building. The primary data obtained from 11 Ecuadorean cities, contains information about social, economic, climatic, demographic and anthropogenic characteristics,as well as DWCduring 6 months.Some SD outliers handled withBox plots. Through descriptive statistical assessment we got some lineal models with a perfect or very strong correlation (R>0.75; p values

Background: Anesthesiologists draw up a selection of drugs for emergency use at the start of their list; unused drugs are discarded at the end of the list, to prevent contamination and spread of infections. We audited the practice in our department to evaluate the scale and cost impact of anesthesia emergency drugs wastage. Subjects and Methods: A questionnaire was randomly given to anesthesiologists in our department, working in some of the operating rooms in our main floor, every morning over 7 working days. Completed forms were collected at the end of respective lists. Results: A total of 93 completed forms were returned. Ephedrine (96%) and phenyepherine (95%) were the most frequently drawn drugs; atropine (96%) and suxamthonium (92%) were the most frequently discarded drugs. Phenylepherine was the single most expensive item wasted, representing 160% of the cost of all other drugs wasted together, and the price of discarded ephedrine and phenylephrine together represented 3/4th of the total wastage. Some practices carried room for rationalization, such as drawing up of atropine and glycopyrolate simultaneously, of both the vasopressors in patients unsuspected for developing significant hypotension, or of suxamethonium in a patient planned to be intubated and postoperative ventilation. Conclusion: Significant savings may be realized through switching to prefilled syringes, making protocols available for rational use of emergency drugs, and safe pooling of expensive drugs between adjacent operating rooms, in an anesthesia department.

Background: Irrational household storage of medicines is a world-wide problem, which triggers medicine wastage as well as its associated harms. This study aimed to include all available evidences from literature to perform a focused examination of the prevalence and factors associated with medicine storage and wastage among urban households. This systematic review and meta-analysis mapped the existing literature on the burden, outcomes, and affective socio-economic factors of medicine storage among urban households. In addition, this study estimated pooled effect sizes for storage and wastage rates.Methods: Household surveys evaluating modality, size, costs, and affective factors of medicines storage at home were searched in PubMed, EMBASE, OVID, SCOPUS, ProQuest, and Google scholar databases in 2019. Random effect meta-analysis and subgroup analysis were used to pool effect sizes for medicine storage and wastage prevalence among different geographical regions.Results: From the 2604 initial records, 20 studies were selected for systematic review and 16 articles were selected for meta-analysis. An overall pooled-prevalence of medicine storage and real wastage rate was 77 and 15%, respectively. In this regard, some significant differences were observed between geographical regions. Southwest Asia region had the highest storage and wastage rates. The most common classes of medicines found in households belonged to the Infective agents for systemic (17.4%) and the Nervous system (16.4%). Moreover, income, education, age, the presence of chronic illness, female gender, and insurance coverage were found to be associated with higher home storage. The most commonly used method of disposal was throwing them in the garbage.Conclusions: Factors beyond medical needs were also found to be associated with medicine storage, which urges effective strategies in the supply and demand side of the medicine consumption chain. The first necessary step to mitigate home storage is establishing an adequate legislation and strict enforcement of regulations on dispensing, prescription, and marketing of medicines. Patient's pressure on excessive prescription, irrational storage, and use of medicines deserve efficient community-centered programs, in order to increase awareness on these issues. So, hazardous consequences of inappropriate disposal should be mitigated by different take back programs, particularly in low and middle income countries. [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]

Introduction: Cancer drug therapy costs continue to rise and threaten the sustainability of Canada's public healthcare system. Previous studies have calculated potential savings utilizing different dosing regimens of cancer treatments. Our objectives were to determine the financial impact of drug wastage and to explore cost-effective dosing regimens for pembrolizumab. Methods: This was a retrospective study reviewing data for non-small cell lung cancer and melanoma patients at all six BC Cancer Regional Centres during fiscal years 2017 and 2018. Pembrolizumab waste amounts recorded in pharmacy wastage logs were totalled. Estimates of the number of vials used were compared between vial sharing and non-vial sharing practices to determine the cost differences. Costs for dosing regimens used during fiscal years 2017 and 2018 were compared to 2 mg/kg weight-based dosing (to a maximum of 200 mg), 2 mg/kg dosing rounding down within 5% and 10%, and flat dosing of 200 mg. Results: There were a total of 202 non-small cell lung cancer and 182 melanoma patients with 2948 doses dispensed. Documented wastage was valued at $1,829,047.44 (8.65%) and across all six centres, vial sharing could reduce costs by $3,207,600.00 using the 100 mg vials. Compared to fiscal years 2017 and 2018, 2 mg/kg dosing (to a maximum of 200 mg) was the most cost-effective, decreasing costs by $222,719.20; flat dosing of 200 mg was the most expensive, increasing costs by $6,625,260.40. Conclusions: Having smaller vial sizes, practicing vial sharing, and using weight-based dosing all improve cost savings. Further investigations on the allocation of resources to optimize drug use and minimize wastage are needed. [ABSTRACT FROM AUTHOR]

Aim This study aims to analyze the discard rates and causes of blood and blood component wastage in a hospital transfusion service and identify strategies for improvement. Methodology We conducted a retrospective study reviewing data from the Department of Transfusion Medicine over five years. We calculated discard rates for different blood components and categorized the reasons for discard. Results The overall discard rate was 18%. Platelets were the most commonly discarded component (91.6%), followed by plasma (4.4%) and packed red blood cells (3.8%). Expired shelf life was the most frequent reason for discard (97%), followed by transfusion-transmitted infection (TTI) reactivity (2.9%), and bag breakage (0.01%). Conclusions Platelets were the most commonly discarded component, and expiry due to non-utilization was the main cause. Implementing strategies such as improved blood utilization guidelines, staff training, and inventory management can help reduce wastage., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Haran et al.)

Purpose: The healthcare system emits greenhouse gas emissions and produces waste that in turn threatens the health of populations. The objective of our study was to measure the ecological threat related to intravitreal injections., Methods: Emissions were separated into scope 2 corresponding to Heating, Ventilation and Air Conditioning (HVAC) of the building, and scope 3 corresponding to travels (patients and staff), and life cycle assessment (LCA) of medical devices (MD) and pharmaceutics. Greenhouse gas (GHG) emissions and waste for a single injection were first measured through a waste audit, and secondly anticipated theoretically with a calculator., Results: The average GHG emissions and waste measured were 277kgCO2eq/IVI and 0.5kg/IVI, respectively. Pharmaceuticals were responsible for 97% of total emissions. Emissions unrelated to pharmaceuticals counted for 8.4kgCO2eq/IVI. GHG emissions and waste estimated with the calculator were 276kgCO2eq/IVI and 0.5kg/IVI, respectively, showing that the calculator was accurate., Conclusion: Our study provides a puzzle piece to carbon footprint and waste assessment in the field of ophthalmology. It may help provide concrete data for future green vs. vision discussions., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

Today’s market determinants and most importantly, very dynamically changing customer requirements significantly shortened the product life cycle. This situation reflects in companies by common extension of the assortment offered and personalised serial production. The result of a flexible approach to market changes is the implementation of LEAN concept, which, both in terms of management and production aims to develop efficiency within an organisation, which will then enable quick and dynamic response to changes in the environment. The popularity of LEAN concept (in management and production) among managers comes from its universality and a wide range of instruments used to maximise the use of existing potential. The main assumptions of LEAN concept are aimed at the maximum use of an organisation’s resources, defining the activities necessary to execute an order and identifying the areas generating losses and then minimising them and eventually eliminating. LEAN concept is based on flagship-main tools for identification and modernisation of processes, the difficulty in using them results from the need to recognise and select the most effective ones that meet the expectations of a given organisation. The article presents issues related to the first stage of implementing LEAN concept in a company’s structures, i.e. identification of opportunities and selection of appropriate tools.

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]

Purpose: To identify the cost and reasons of returned parenteral chemotherapy regimens at a tertiary hospital in Kuala Lumpur, Malaysia. Methods: Data were retrospectively extracted from all the Chemotherapy Return Forms in 2016, which is a compulsory documentation accompanying each return of parenteral chemotherapy regimen. The following data were extracted: patient's diagnosis, gender, location of treatment (i.e. ward/daycare clinic), start date of chemotherapy regimen, type of cytotoxic drug returned, dose of cytotoxic drug returned, number of cytotoxic drug preparations returned and reason for return as well as whether the returned cytotoxic drug preparations could be re-dispensed. The cost of wastage was calculated based on the cost per mg (or per unit) of the particular returned cytotoxic drug. Results: One hundred and fifty-nine cases of returned chemotherapy regimen comprising of 231 parenteral cytotoxic drug preparations were analysed. The total cost of returned chemotherapy regimen for 2016 was €3632, with €756 (20.8%) worth of chemotherapy regimens returned due to preventable reasons and €2876 (79.2%) worth of chemotherapy regimens returned due to non-preventable reasons. Approximately 50% of cases returned chemotherapy regimen were due to deterioration of patient's clinical condition and another 24.5% of cases of returned chemotherapy regimen were attributed to adverse drug reactions. Conclusion: Wastage associated to non-preventable reasons such as adverse drug reactions and preventable causes like refusal of patients can be further reduced by using newer healthcare innovations and establishment of written institutional protocols or standard operating procedures as references for in-charge healthcare personnel when cytotoxic drug-related issues occur. Adoption of cost-saving strategies that have been proven by studies could further improve current cost containment strategies. [ABSTRACT FROM AUTHOR]

Background Platelet products have a limited shelf life and are costly. Therefore, to balance clinical usage/availability and wastage in a tertiary hospital setting without a trauma center, an innovative system model was established. This system reduced wastage by transferring platelet unit approaching their expiration date to a nearby facility (with the same blood supplier and a trauma center) before expiration, when there is no anticipated need for the product at the original location. Methods A review of data to determine the degree of platelet wastage and wastage costs one year before implementation of this measure in October 2017 and one year after implementation of this measure. Results Since the implementation of this measure, no platelet units have expired on the shelf. In contrast, from October 2016 to October 2017, before implementation of platelet transfer, platelet products expired regularly. Conclusion This new system model is highly effective in maintaining platelet inventory without wastage. [ABSTRACT FROM AUTHOR]

• Fear of vaccine wastage may lead to lower immunization coverage. • Mixed method study compared the use of 5-dose and 10-dose vials of measles-rubella. • Districts using 5-dose MR saw increase coverage and reduced wastage. • Health workers reported more willing to open a 5-dose MR vial. • Switching to 5-dose MR vials can be accommodated within existing cold chain capacity and the wastage-adjusted cost differential per dose is negligible. Vaccines procured for low-income countries are often packaged in multi-dose vials to reduce program costs. To avoid wastage, health workers may refrain from opening a vial if few children attend an immunization session, possibly leading to lower coverage. Lowering the number of doses in a vial may increase coverage and reduce wastage. We used a mixed methods approach to measure the effects of switching from conventional 10-dose measles containing vaccine (MCV) vials to 5-dose MCV vials on coverage and open vial wastage in 14 districts purposely selected from two provinces in Zambia. The districts were paired based on the number of health facilities and the average size of the health facility catchment population. One district from each pair was randomly allocated to receive 5-dose vials while the other continued with the conventional vials. We applied propensity score matched difference-in-difference analysis to estimate intervention effects on coverage using pre-intervention household survey and post-intervention household survey after 11 months of the intervention. The intervention effects on wastage rates were estimated from multivariate analysis of the administrative data. Key informant interviews were conducted to better understand health workers' behavior and preferences at baseline, midline and endline, and analyzed using thematic analysis techniques. MCV coverage rates increased across both arms for both doses. A five percentage-point intervention effect was detected for MCV1 and 3.5 percentage-point effect for MCV2. The MCV wastage rate was 47% lower in facilities using 5-dose vials (16.2%) versus 10-dose vials (30.5%). Healthcare workers reported being more willing to open a 5-dose vial than a 10-dose vial for one child, as they were less concerned about wastage. Switching 10-dose MCV vials to 5-dose vials improved coverage, decreased wastage, and improved willingness to open a vial. These findings can contribute to strategies for reducing missed opportunities for vaccination. [ABSTRACT FROM AUTHOR]

Objective: To describe the causes of death or culling in cattle in Victoria, Australia, through surveillance at knackeries. Methods: Data were collected from 2797 adult cattle consigned to four Victorian knackeries over a 10‐year period (2009‐2018, inclusive). Cattle were sampled either at the point of collection or at a knackery. A single best‐fit diagnosis was assigned to each case to describe the cause of loss. Results: Sampled cattle were predominantly female dairy cattle originating from the three main dairying regions in Victoria. The most commonly diagnosed conditions were calving paralysis (6.8%), followed by mastitis (6.4%), hypocalcaemia (6.4%) and dystocia (5.9%). "Unknown" accounted for 24.2% of the cattle examined. Conclusion: This study provides a unique insight into the causes of death and culling in cattle consigned to Victorian knackeries. The periparturient period was identified as a high risk period for knackery consignment in adult female cattle. [ABSTRACT FROM AUTHOR]

The article deals with consumer behavior in terms of food and its wastage. The main aim is to identify consumer behavior in relation to food consumption and food waste in the households in the Czech Republic as an effect of healthy competitive environment. Food consumption and its wastage is analyzed in terms of quantity and food expenditure in general as well as with the use of primary data from the Household Budget Survey. According to a household diary survey, the highest wastage is of cereal and dairy products, with the lowest being meat. The consumption and quantity of wasted food are significant in relation to price. The data obtained during daily monitoring of wasted food in September 2018 are used to test the impact of the household identification characteristics on the quantity of wasted food along with the types. A logit regression is used to estimate the anticipated quantity of wasted food according to individual kinds of food and in relation to household identification characteristics. The age, education and economic activity of consumers have a significant effect on the quantity of wasted food. In addition, the results show that the people who waste the most are over 65 years of age, with the lowest wastage connected with university graduates. [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]

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.

Background and Objectives It is likely that there will be an increased emphasis on production of whole blood as evidence for efficacy in massively transfused patients increases. Depending on the magnitude of the increase, this has the potential to impact many blood collectors’ practices and to influence the whole supply chain. Methods The review uses current knowledge of practices and discusses the impacts on blood collectors, suppliers and the implications for blood donation, manufacturing, inventory and distribution. Results Increased whole blood utilisation will influence the production, supply and distribution of blood donation consumables with suppliers further influenced by likely equipment redundancy in the event of a significant increase. New blood components or consumables require regulatory approval and registration, a complex and resource-consuming area. Wastage would increase directly as a result of the need to have whole blood constantly available at the right location despite stochastic demand. Efficiency and yield would be influenced due to the reduced number of separated blood components and plasma for fractionation volumes. To ameliorate this, whole blood may need to be returned later in shelf life so that plasma can be recovered. A high uptake of whole blood requires a review of the blood donation and manufacturing infrastructure with the possibility of amendments to fixed assets such as blood processing centres. Conclusion The impacts are across the whole supply chain, and whilst the topics discussed are not directly applicable to any specific blood collector, the general principles will apply to many. [ABSTRACT FROM AUTHOR]

Background: Targeted oral agents are now increasingly being utilized in cancer treatment, but are expensive. Changing the dose of these medications due to toxicity or discontinuation secondary to disease progression or death causes waste from unused medication. Limiting waste is an important goal, as waste has a substantial financial impact on patients and insurance companies. Methods: Patients started on oral targeted agents' sunitinib, everolimus, axitinib, or vemurafenib between January 2012 and February 2015 who obtained their medications at Holden Comprehensive Cancer Center specialty pharmacy were included in the analysis. We acquired dispensing data retrospectively for each of the agents and reviewed patient charts. Wasted tablets/capsules were calculated from their last fill to the dates of stoppage or dose adjustment. The amount associated with the wastage was calculated using the average wholesale price. Repository drug usage data during the same time period was obtained. Results: Eighty-eight patients had their prescriptions filled at Holden Comprehensive Cancer Center during the study time period. Waste occurred in 41% of all patients with primary reasons attributed to cancer progression in 25 patients, death in five patients, toxicity in five patients and increase in dosage of targeted therapy in two patients. A total of 1179 tablets or capsules were wasted from all causes, priced at a total of $248,595.69. Conclusion: Oral chemotherapy medications are associated with wastage, which is a significant financial burden to society. Progression of disease emerged as the single most important factor accounting for wastage. Novel ideas are needed to prevent wastage, thereby reducing healthcare costs. [ABSTRACT FROM AUTHOR]

Small ruminants which are mainly sheep and goats play significant role in providing food and financial security for rural populations. However, the slaughter of breeding stock and pregnant animals serves as threat to the production of these animals because of foetal wastages. This study was conducted to determine the proportion of foetuses destroyed due to slaughter of pregnant sheep and goats in Jalingo abattoir, Taraba State, and the consequent economic implications. The abattoir was visited every day for a period of two months between August and September, 2017. The number of pregnant sheep and goats slaughtered, and foetuses wasted were recorded. Data obtained were analyzed using descriptive statistics. A total of 3,455 goats and 1554 sheep were slaughtered during the study period and 313 (22.1%) out of 1417 does, 341 (27.4%) out of 1,243 ewes were pregnant respectively. 368(23.1%) fetuses from pregnant does and 386(31.1%) foetuses from pregnant ewes were wasted. There was an estimated economic loss of ₦ 3,404,000.00 and ₦ 10,615,000.00 from goats and sheep respectively. These values hold at $9,455.55 and $29,486.11. The study revealed that foetal wastage was high in Jalingo abattoir with a consequent high economic loss in the livestock industry. Foetal waste also presents a threat on food security with resultant effects of decreased nutritional values of animal origin to humans. Proper ante mortem inspection especially, pregnancy diagnosis, should always be carried out prior to slaughter to curtail foetal wastages and most importantly, laws prohibiting the slaughter of pregnant sheep and goats be enforced, and policy efforts should concentrate on instituting routine veterinary checks at control posts and abattoirs. [ABSTRACT FROM AUTHOR]

Purpose: Drug wastage is a major concern in oncology where costs of antineoplastic drugs are exorbitant, and the disposal of toxic drugs increases the chances of occupational hazards to healthcare and sanitary workers and environmental pollution at the site of disposal. The principal objective of this study was to ascertain the extent of drug wastage and calculate its financial costs.Materials and Methods: This was a prospective pilot study conducted to ascertain the quantity of drug wastage in a tertiary care hospital. This pilot study was conducted in day care and inpatient facilities in February 2016. The prescription of cytotoxic drugs, recommended dose, the quantity used, and remainder (waste) left were recorded from the nurses and pharmacy files of the hospital. Cost evaluation of the actual use and the waste was undertaken and an audit was conducted to understand in which anticancer drug the maximum wastage was generated.Results: The results of this study indicated that 6.1% of the total amount of reconstituted drugs was wasted. The highest drug wastage was observed in trastuzumab (29.55%), followed by etoposide (20.4%), dacarbazine (17.14%), daunorubicin (16.67%), and carboplatin (11.29%). Cost analysis showed that the total cost of the drug issued during the study period was Rs. 1,294,975 and the cost of drug wastage amounted to Rs. 143,820 (11.1%).Conclusion: To the best of authors' knowledge, this is the first study from India and the results indicate that the financial impact of anticancer drug wastage was substantial. Attempts should be directed at minimizing the wastage and cost savings without risking patients' treatment regimen and administering effective dose schedule. [ABSTRACT FROM AUTHOR]

Ewe wastage is the combination of on-farm mortality and premature culling. Internationally, there is limited research on actual wastage incidence and causes in commercial sheep flocks. To the authors’ knowledge, this is the first study that reports both lifetime wastage and detailed annual wastage in a sample of commercial New Zealand flocks. This study utilized data collected from 13,142 ewes from four cohorts on three commercial New Zealand farms (Farm A 2010-born, Farm A 2011-born, Farm B, Farm C), during the period 2011–2017, as they aged from replacement hoggets to 6-year-old ewes (Farm A and Farm B) or 3-year-old ewes (Farm C). Data collection visits occurred at three or four key management times each year, namely pre-mating, pregnancy diagnosis, pre-lambing and weaning. At each visit, body condition score (BCS) was assessed and any ewes that were culled or had died on farm were recorded. As this was a lifetime study, each ewe was assigned an outcome and corresponding ‘exit age’. By the end of the study, all ewes that had exited their respective flocks, were classified as either prematurely culled, or dead/missing, or if still in the flock, as censored, and either the exact date or interval in which they exited the flock was recorded. Semi-parametric competing risk (premature culling vs. dead/missing), interval-censored survival models were developed to: 1. describe the association between hogget reproductive outcomes and risk of subsequent wastage, and 2. assess pre-mating BCS as a predictor of wastage in that production year. Of the 13,142 enrolled ewes, 50.4% exited their respective flocks due to premature culling and 40.0% due to on-farm dead/missing, giving a total of 90.4% that exited due to wastage. Annual mortality incidence ranged from 3.5 to 40.2%. As a hogget, wastage incidence ranged from 7.6 to 45.4%. Pregnancy or rearing a lamb as a hogget did not increase risk of subsequent wastage. In all years, pre-mating BCS was a predictor of ewe wastage, with odds of wastage lower with increasing BCS. Therefore, farmers should focus on improving pre-mating BCS to 3.5/5.0 by assessing ewe BCS at weaning, allowing poorer-BCS ewes to be managed to gain BCS before re-breeding.

Musculoskeletal injuries (MSI) continue to affect Thoroughbred racehorses internationally. There is a strong interest in developing training and management strategies to reduce their impact, however, studies of risk factors report inconsistent findings. Furthermore, many injuries and fatalities occur during training rather than during racing, yet most studies report racing data only. By combining racing and training data a larger exposure to risk factors and a larger number of musculoskeletal injuries are captured and the true effect of risk factors may be more accurately represented. Furthermore, modifications to reduce the impact of MSI are more readily implemented at the training level. Our study aimed to: (1) determine the risk factors for musculoskeletal injuries and whether these are different for two-year-old and older horses and (2) determine whether risk factors vary with type of injury. This was performed by repeating analyses by age category and injury type. Data from 202 cases and 202 matched controls were collected through weekly interviews with trainers and analysed using conditional logistic regression. Increasing dam parity significantly reduced the odds of injury in horses of all age groups because of the effect in two-year-old horses (odds ratio (OR) 0.08; 95% confidence interval (CI) 0.02, 0.36; p < 0.001). Increasing total preparation length is associated with higher odds of injury in horses of all ages (OR 5.56; 95% CI 1.59, 19.46; p = 0.01), but particularly in two-year-old horses (OR 8.05; 95% CI 1.92, 33.76; p = 0.004). Increasing number of days exercised at a slow pace decreased the odds of injury in horses of all ages (OR 0.09; 95% CI 0.03, 0.28; p < 0.001). The distance travelled at three-quarter pace and above (faster than 13 m/s; 15 s/furlong; 800 m/min; 48 km/h) and the total distance travelled at a gallop (faster than 15 m/s; 13 s/furlong; 900 m/min; 55 km/h) in the past four weeks significantly affected the odds of injury. There was a non-linear association between high-speed exercise and injury whereby the odds of injury initially increased and subsequently decreased as accumulated high-speed exercise distance increased. None of the racing career and performance indices affected the odds of injury. We identified horses in this population that have particularly high odds of injury. Two-year-old horses from primiparous mares are at increased odds of injury, particularly dorsal metacarpal disease. Two-year-old horses that have had a total preparation length of between 10 and 14 weeks also have increased odds of injury. Horses of all ages that travelled a total distance of 2.4–3.8 km (12–19 furlongs) at a gallop in the last four weeks and horses three years and older that travelled 3.0–4.8 km (15–24 furlongs) at three-quarter pace and above also have increased odds of injury. We recommend that these horses should be monitored closely for impending signs of injury. Increasing the number of days worked at a slow pace may be more effective for preventing injury, if horses are perceived at a higher risk, than resting the horse altogether. Early identification of horses at increased risk and appropriate intervention could substantially reduce the impact of musculoskeletal injuries in Thoroughbred racehorses.

• 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]

Big data contains lots of information about consumers and allows companies real-time and data-assisted decision making to gain significant competitive advantages. Digital advertising is an important application for tailoring services to individual needs. Customized advertising is expected to be more effective, cost less, and better received by society. But what looks deceptively simple when it succeeds is frequently quite difficult to implement in practice. It is difficult to judge and validate the quality of automatically generated data. And besides quality, there are other aspects that make it tricky to determine the value of the data. A reasonable price for data depends on the context of its application and the potential cost savings it generates. And not only the price per impression is unclear. The number of contacts is also less obvious than it seems at first glance. Primarily third party data providers often incur problems with the monetization of big data and many are struggling to survive. They depend on the fairness of the data buyer and a successful business model has yet to be developed.

The information technology often have delays since they have been established in the organizations, and reduce the prioritization and decision making methods, also it is a barrier to the best benefits of productivity in this domain. On the other hand, the lean philosophy is a useful attitude to minimize the loss and maximize the productivity of facilities, human resources and investment. Using the lean theory in information technology systems, the wastage will be deceased and productivity will be promoted. This study investigated the role of the effective factors in being lean on IT productivity in banking domain. The research method was descriptive-survey. The statistical population included the experts in banking domain in Iranian banking industry which included 260 people, out of which 156 people were chosen as the sample size, using Morgan’s table. Using confirmatory factor analysis, the results showed that the factors had a positive effect on promoting the trend of being lean. The most effective factors were the proper designing of information processes of IT.

The article outlines the theoretical approaches to the assessment of technological losses of petroleum products during storage in flexible tanks with flexible account of steady and unsteady regimes fuels diffusion through structural material of tanks. The proposed algorithm and mathematical model for determining technological losses, taking into account the unsteady measurement mode structural material elastic reservoirs, can significantly (up to 40 %) improve the accuracy of the valuation of natural loss of hydrocarbon fuels at fuel depots field.