Recent Shortage Research Articles

Abstract 4128201: Reducing Blood Product Waste in a Pediatric Cardiac Catheterization Laboratory – A Quality Improvement Initiative

Background/Aim: Transfusion can be a life-saving intervention, however routine pre-procedural blood products frequently go unused. Recent national blood product shortages highlight the importance of blood product stewardship. In our pediatric cardiac catheterization laboratory (PCCL), packed red blood cells (pRBCs) were ordered prior to all cases. These units are rarely transfused and sometimes cannot be reallocated, resulting in waste. As a quality improvement project, we set a primary aim to reduce the percentage of monthly pRBC waste from a baseline mean of 7.4% to <5% over 12 months. Methods: Baseline data on all cardiac catheterization cases, excluding electrophysiology, lymphatic, and hybrid cases, were collected from 1/1/2022 to 2/28/2023. Interventions (Table 1) were implemented and outcomes measured from 3/1/2023 to 3/31/2024. Primary outcome measures were monthly percentage of blood wasted, and percent of unused pRBC orders. Emergency blood product activation was measured as a balancing metric. Statistical process control charts were used to display and analyze data. Results: During the intervention period 1,318 cases were performed of which 32% met low-risk criteria for pRBC order de-implementation. The percent of blood that was subsequently wasted was reduced from 7.4% to 5.5% (Figure 1A), primarily driven by the reduction in the anecdotal practice of pRBC unit splitting in patients <1 year old (Figure 1B). The percent of unused pRBC orders was reduced from 97% to 79% with sustained improvement following two cycles of routine blood order de-implementation for low-risk cases. No emergency blood activation occurred (0%, 97.5% CI: 0-0.28%). Conclusion: De-implementation of default pRBC orders for low-risk catheterization procedures and reduction in unit splitting reduced the percent of blood wasted in our PCCL, saving time and cost without compromising patient safety. A data-driven approach to blood stewardship may be broadly applicable across procedural areas.

Green Fruit‐Stem Pairing and Clustering for Machine Vision System in Robotic Thinning of Apples

ABSTRACTApples are one of the most highly‐valued specialty crops in the United States. Recent labor shortages have made crop production difficult for fruit growers, including the task of green fruit thinning. Current methods including hand, chemical, and mechanical thinning impose tradeoffs between selectivity, cost, tree damage, and speed. A robotic green fruit thinning system could potentially selectively thin fruit in a quick, cost‐effective, and non‐damaging manner. The machine vision system would be a critical component for robotic thinning, and would not only need to perform green fruit detection/segmentation, but also fruit‐stem pairing and clustering to facilitate proper decision‐making for thinning. A neural network‐based fruit and stem pairing algorithm was devised and evaluated; an LSTM‐based clustering algorithm was devised and compared to the density‐based clustering algorithm, OPTICS. The algorithms were evaluated on an image data set consisting of GoldRush, Fuji, and Golden Delicious cultivars at the green fruit stage, with evaluations on overall performance, cultivar‐wise performance, cluster size‐specific performance, and feature importance. For fruit and stem pairing, the neural network‐based pairing algorithm achieved an AP of 81.4% on all fruits and stems, and that reached 90.6% when only fruits and stems with labeled angles were considered. For green fruit clustering, the LSTM‐based clustering achieved a clustering success rate of 68.4%, whereas the OPTICS algorithm obtained 50.9%. The algorithms will be further implemented in a pipeline of a future green fruit thinning vision system, as well as integrate the use of point clouds and other 3D orchard information to improve pairing and clustering performance.

Pediatric Lead Chelation Managed During Critical Medication Shortages: Case Report and Literature Review.

Lead poisoning in children has the potential for devastating neurodevelopmental consequences. There is significant socioeconomic disparity in children with lead poisoning. Specific lead chelation regimens have been approved for children by the US Food and Drug Administration, however in the United States, there has been a recent national shortage of the primary therapy, edetate calcium disodium (CaNa2 EDTA). This case report presents a 23-month-old child with severe symptomatic lead poisoning during a national shortage of CaNa2 EDTA to highlight the need for advocacy regarding critical medication shortages, especially for antidote therapy. The infant's initial blood lead level was 364 mcg/dL and he received a continuous infusion of CaNa2 EDTA (1000 mg/m2/day), as well as dimercaprol (4 mg/kg intramuscularly every 4 hours). The supply of CaNa2 EDTA was exhausted on day 3 of therapy so he was transitioned to enteral succimer monotherapy. Initial parenteral therapy of 72 hours achieved a lead level of 72 mcg/dL; he then completed his enteral course of succimer along with environmental mitigation. However, elevated blood lead levels persisted and he subsequently required 3 more courses of enteral succimer, and he continues to have detectable blood lead levels 2 years after initial presentation. In the face of medication shortages including CaNa2 EDTA, and now also dimercaprol, clinicians must create and study alternative chelation therapy regimens for pediatric lead toxicity. Furthermore, public policy initiatives, including the development of a national supply stockpile of chelation agents, must be created in order to minimize supply chain disruption and ensure adequate and equitable antidote therapy for lead poisoning outbreaks.

Tomato dry farming as an agroecological model for California’s drought resilient future: Farmers’ perspectives and experiences

Small, diversified farms on California’s Central Coast have been dry farming for decades, allowing farmers to use water stored in soils from winter rains to grow tomatoes and other vegetables with little-to-no irrigation in summers without rainfall. As recent water shortages in California have forced a reckoning with the precariousness of the state’s water supply, policy groups and the general public have become increasingly interested in dry farming as a promising means of achieving water conservation goals. Academic research on this practice, however, has been scarce. Amid growing urgency to develop low-water agricultural systems in the state, we interviewed 10 Central Coast dry farmers, representing over half of the commercial dry farm operations in the region where this practice was developed, to collaboratively answer 2 central research questions: (1) What business and land stewardship practices characterize successful tomato dry farming on California’s Central Coast? (2) What is the potential for dry farming to expand beyond its current adoption while maintaining its identity as a diversified practice that benefits small-scale operations? We summarize farmers’ wisdom into 9 themes about current dry farm practice, its potential for expansion and future opportunities. We also synthesize farmer-stated environmental constraints on dry farm feasibility into a map of suitable areas in California. As we consider how dry farming might expand to new areas and operations, we highlight dry farming’s history as an agroecological alternative to industrial farming in the region and the need for careful policy planning to maintain that identity. In examining this California Central Coast dry farming system, we ask if and how it can enhance the viability of nonindustrial farming operations as the food system adapts to less water availability. Because policies that encourage dry farm expansion could change economic landscapes in which dry farming operates, we caution that well-intentioned policies could edge small growers out of dry farm markets if not carefully designed. At the same time, we emphasize the opportunity for dry farm tomato systems to model an agroecological transition toward water savings in California.

Practitioner Perspectives on Agency Social Work in Children and Families Social Work in England

Abstract This article examines practitioner perspectives on agency social work in Local Authority Children’s Services Departments in England. There have been ongoing concerns about the use of agency workers, relating to cost, quality and impact on services, despite a recognition that temporary staff may be needed for a range of reasons. However, recent labour shortages and the escalating costs of agency staffing are fuelling calls for some form of regulation of agency workers. The article reviews literature on agency workers from the UK and elsewhere. It presents demographic survey data about agency workers drawn from a five-year longitudinal study on the recruitment and retention of child and family social workers and reports qualitative data from forty semi-structured interviews with social workers in Year 4 (Johnson et al., 2022) of the project about their experience of agency social work and agency social workers. The findings indicate several reasons for choosing agency work, pay being the most significant but by no means the only one. The advantages and disadvantages of agency work for workers, employers and service users are considered, and suggestions are offered about further research to assist in understanding how employers can identify and address recruitment and retention factors to reduce dependence on agency staff.

Development and application of artificial hydraulic lime for Chinese architectural heritage restorations

Lime is commonly employed in the restoration of historic buildings due to its strength properties, which align well with the demands of architectural heritage conservation. However, recent shortages in high-quality limestone raw materials and the commercial inclusion of finely ground limestone powder in hydrated lime powder have led to significant challenges. These include low initial strength, pronounced shrinkage and cracking, and poor resistance to frost. Although natural hydraulic lime (NHL) offers moderate strength, its high cost presents an obstacle to widespread use in architectural heritage restoration. Three types of artificial hydraulic lime (AHL) — AHL1, AHL2, and AHL3 — were prepared with the objective of low cost and easy scalability. These were formulated by incorporating white cement (WC), blast furnace slag powder (BFSP), heavy calcium carbonate powder (HCCP), and industrial-grade white sugar (WS) into industrial-grade hydrated lime powder (IHLP). To align the setting time of the AHLs with the requirements of traditional builders, WS was incorporated as a retarding agent. The addition of WC, BFSP, and HCCP to IHLP resulted in enhancements over IHLP in several key aspects: compressive strength, pore structure post-hardening, dry shrinkage rate, and frost resistance. This approach will enhance the restoration quality of architectural heritage in China, leading to fewer repeated repairs and significant savings in manpower and material costs. Ultimately, AHL2 was applied in the restoration of the Confucius Temple, proving its efficacy and alignment with traditional construction requirements. This research provides valuable theoretical and practical insights for enhancing the preservation of architectural heritage.

Pharmacokinetics and pharmacodynamics of low doses of recombinant tissue plasminogen activator to establish a model for biosimilarity comparisons

BackgroundRecombinant tissue plasminogen activator (rt-PA) is a thrombolytic agent and essential in emergency medical care. Given recent supply shortages, the availability of biosimilar products is an urgent medical need. However, biosimilarity trials are difficult to perform in critically ill patients. ObjectivesThe aim of this pilot study was to investigate the pharmacokinetics and pharmacodynamics of low rt-PA doses to establish a model for testing proposed biosimilars in healthy volunteers. MethodsEight healthy volunteers received 0.02 to 0.05 mg/kg rt-PA on 3 study days; blood samples were obtained every 4 minutes after the end of the bolus infusion to measure rt-PA antigen levels by enzyme immunoassay, and the pharmacodynamics were assessed with rotational thromboelastometry. ResultsBolus infusion of low rt-PA doses was safe and well tolerated. Maximal plasma concentrations and the area under the curve increased dose-dependently. Time-concentration curves were clearly separated between the lower and the higher doses. As expected, the half-live of rt-PA was short (4.5-5 min), and representative for therapeutic doses. The intrasubject coefficient variations were moderate (<25%). Bolus infusion of rt-PA dose-dependently shortened lysis time and lysis onset time in both dose groups and caused maximum clot lysis of 100% in all participants. ConclusionIn conclusion, the pharmacokinetics of rt-PA was dose linear and displayed limited intrasubject variability even at subtherapeutic doses. The half-life and thus clearance of rt-PA was representative of full therapeutic doses. The lysis time was shortened in a dose and time-dependent fashion and was clearly distinguishable between doses. Thus, the model appears to be suitable and sensitive to test biosimilarity.

Abysmal Hike in Global Cocoa Price and its Implications on Cocoa Plantations in Tamil Nadu - A Critical Analysis

Cocoa belonging to the family Sterculiaceae has its origin in South America and later it had spread to Europe, Africa and Asia. In Tamil Nadu, cocoa is accommodated as an intercrop in arecanut and coconut plantations especially in South India. But over the past few years, the acreage under cocoa showed a steady decline and the area currently hovers around 5,000 ha especially concentrated in Coimbatore, Theni and Kanyakumari districts of the state. Price volatility is the key player in culminating cocoa plantations in the state. But the recent global shortage of cocoa associated with climatic vagaries and biotic stress like swollen shoot virus and black pod disease in the leading cocoa producers of the world has prompted a positive note in the price of cocoa beans in India. Government policies like ban on deforestation and engaging child labourers for farming and underinvestment in cocoa gardens in the West African countries also added hue to the problem. A record high of ten fold increase in price was observed during the last quarter of 2023 and first quarter of 2024. According to the International Cocoa Organization, global cocoa supply will decline by almost 11% over the 2023/2024 season. Global price has a direct impact on cocoa plantations in the state of Tamil Nadu as many cocoa orchards were cleared due to the lack of remunerative price. But the abysmal price hike in the global front has invited the farmers to rejuvenate the abandoned cocoa plantations and bring new area under cultivation in Tamil Nadu as price was the key player in giving up the crop during 2010s by the farmers. Abysmal hike in global cocoa price has brought a ray of hope for the expanding acreage of cocoa in the state of Tamil Nadu.

P-796 A novel method of somatic cell nuclear transfer to generate artificial oocytes

Abstract Study question Can we identify an alternative method to Sendai-Virus fusion for somatic cell nuclear transfer (SCNT) aiming at generating artificial oocyte? Summary answer The utilization lipofectamine proved itself as a valid alternative method to virus-mediated SCNT, allowing successful membrane fusion and supporting proper embryo development. What is known already SCNT involves transferring a diploid cell’s nucleus into an enucleated oocyte. Early attempts of SCNT involves direct injection and electrofusion but both approaches can affect oolemma integrity. To avoid mechanical damage to oolemma, fusogenic agents have been employed for SCNT including polyethylene glycol (PEG) and more efficient Hemagglutinating Virus of Japan Envelope (HVJ-E). However, despite its high efficiency, HVJ-E is difficult to be used in human because it is a virus derivative, and a recent shortage of this compound made it not readily available. On the other hand, cationic phospholipid is fusogenic and is widely utilized in transfection experiments. Study design, size, duration In the past 4 months, SCNT was carried out through PEG-mediated, HVJ-E-mediated, or novel lipofectamine-mediated fusion using cumulus cells as nuclear donor. Post-SCNT oocytes were inseminated and cultured up to the blastocyst stage. Embryo development and morphokinetics were assessed and compared among the three SCNT experimental cohorts. In some cases, blastocysts were transferred into pseudo-pregnant mice, post-natal development were monitored. Fertilization, embryo development, and offspring wellbeing were monitored. Participants/materials, setting, methods Oocytes from B6D2F1 mice were enucleated by micromanipulation. The ooplasts were allocated to 3 cohorts: 1) exposure to 45% PEG, 2) subzonal transfer of donor cell with HVJ-E, or 3) subzonal transfer the donor cell exposed to 1.75% lipofectamine. Reconstructed oocytes were monitored for fusion 30 minutes after exposure to fusogens and inseminated by spermatozoa from B6-EGFP mice to confirm paternal genome provenance. Fertilization and embryo development were monitored in a time-lapse system. Main results and the role of chance A total of 165 oocytes were enucleated and 160 (97.0%) survived and allocated to PEG-fusion (n = 50), Sendai-virus-fusion (n = 41) and lipofecamine-fusion (n = 80) cohorts. Fusion rate was 56.0% (28/50) for the PEG-fusion cohort, while Sendai-virus and lipofectamine-fusion cohorts yielded higher fusion rate at 92.7%(38/41) and 86.3%(69/80), respectively (P&amp;lt;0.0001). Control oocytes yielded 96.7% (145/150) fertilization rate and developed to 2-cell stage at 93.8% (136/145), and yielded an eventual blastocyst rate at 80.7% (117/145). Despite a lower oocyte reconstruction rate, PEG-fusion cohort fertilized at 89.3% (25/28), but cleavage rate to 2-cell stage was lower at 48.0% (12/25, P&amp;lt;0.0001) and did not yield any blastocyst. The HVJ-E cohort yielded a fertilization rate of 94.7% (36/38) and cleavage rate at 97.2% (35/36) similar to control. The blastocyst rate was observed at 22.9% (8/35, P&amp;lt;0.0001) when comparing to control. Lipofectamine-fusion cohort yielded 91.3% (63/69) fertilization rate and subsequent cleavage rate at 95.2% (60/63). Albeit at a lower blastocyst development rate comparing to control, the lipofectamine cohort yielded similar full-preimplantation rate at 19.0% (12/63) when comparing to HVJ-E cohort. All blastocysts (n = 20) were transferred into 2 pseudo-pregnant mice and 3 healthy female offspring were yielded to date. Limitations, reasons for caution HVJ-E mediated membrane fusion has been well established with proven safety record; however, its recent shortage has led to a temporary cessation of its utilization. Our lipofectamine-mediated cell fusion technique yielded satisfactory fusion, fertilization, blastocyst formation and some live offspring, however the safety and efficacy still remain to be validated. Wider implications of the findings This novel lipofectamine-mediated cell fusion has broader implications for advancing cloning technologies. Lipofection is a non-viral approach, overcomes shortage of HVJ-E and therefore propose itself as a more appealing cell fusion method for human SCNT. Trial registration number N/A

Pediatric Formulas: An Update.

The recent shortage of pediatric formulas in the United States, caused by supply chain issues and contamination of formula products in 1 of the major manufacturing plants, led many families to seek an alternate formula for their children. The Food and Drug Administration (FDA) allowed import of infant formulas from selected European and non-European countries. The European infant formulas differ from those produced in the United States regarding the primary source of the formula, age category, mixing instructions, labeling requirements, and formula composition in terms of macronutrients and micronutrients. Although most European infant formulas are nutritionally adequate, pediatricians and families need to be aware of the differences between the European and FDA-regulated formulas for their correct use and preparation for infants and young children. Supplementation with cow milk is recommended for children beyond infancy, and older infant formulas are not recommended for otherwise healthy growing children. However, pediatric formulas have been used to support the nutrition needs of children with feeding difficulties, especially those dependent on tube feeding and with certain medical conditions. The FDA does not regulate the production of pediatric formulas beyond infant formula, and significant variations exist in their composition. The pediatric formulas are available as polymeric (intact), hydrolyzed, elemental, or food-based blenderized formulas. The plant-based nonformula (milk) drinks are being used increasingly for children. These products might not be nutritionally complete and should be avoided in infants and children dependent on liquid nutrition.

Intravesical Gemcitabine and Docetaxel Therapy for BCG-Naïve Patients: A Promising Approach to Non-Muscle Invasive Bladder Cancer.

Bacillus Calmette-Guérin (BCG) therapy for patients with non-muscle invasive bladder cancer (NMIBC) faces limitations in efficacy and significant side effects, aggravated by a recent global shortage. In this prospective clinical study, we report the outcomes of sequential intravesical administration of gemcitabine and docetaxel (Gem/Doce) as a first-line treatment for BCG-naïve patients with high-risk NMIBC (HR NMIBC). From October 2019 until April 2022, we enrolled 52 patients and followed the treatment protocol set forth by the University of Iowa. Follow-up assessments were conducted every 3 months. In this cohort, 25 (48.1%) patients were diagnosed with high-grade T1 (T1HG) bladder cancer, 10 (19.2%) patients had carcinoma in situ (CIS), and 17 (32.7%) patients had a combination of T1HG+CIS. The median time to first recurrence in the T1HG, CIS, and T1HG+CIS groups was 11, 10.5, and 8.8 months, respectively. The recurrence-free survival was 98.1%, 94.2%, and 80.8% at 6, 9, and 12 months, respectively. The rate of progression-free survival was 100%, 98.1%, and 92.3% at 6, 9, and 12 months, respectively. We demonstrated the safety and efficacy of Gem/Doce therapy in BCG-naïve patients with HR NMIBC during a one-year follow-up. Further research with extended follow-ups, as well as direct comparisons of Gem/Doce with other anticancer agents, is essential.

Administration of 4% tetrasodium EDTA lock solution and central venous catheter complications in high-risk pediatric patients with intestinal failure: A retrospective cohort study.

Selection of central venous catheter (CVC) lock solution impacts catheter mechanical complications and central line-associated bloodstream infections (CLABSIs) in pediatric patients with intestinal failure. Disadvantages of the current clinical standards, heparin and ethanol lock therapy (ELT), led to the discovery of new lock solutions. High-risk pediatric patients with intestinal failure who lost access to ELT during a recent shortage were offered enrollment in a compassionate use trial with 4% tetrasodium EDTA (T-EDTA), a lock solution with antimicrobial, antibiofilm, and antithrombotic properties. We performed a descriptive cohort study including 14 high-risk pediatric patients with intestinal failure receiving 4% T-EDTA as a daily catheter lock solution. CVC complications were documented (repairs, occlusions, replacements, and CLABSIs). Complication rates on 4% T-EDTA were compared with baseline rates, during which patients were receiving either heparin or ELT (designated as heparin/ELT). Patients initiated 4% T-EDTA at the time they were enrolled in the compassionate use protocol. Use of 4% T-EDTA resulted in a 50% reduction in CVC complications, compared with baseline rates on heparin/ELT (incidence rate ratio: 0.50; 95% CI, 0.25-1.004; P = 0.051). In a compassionate use protocol for high-risk pediatric patients with intestinal failure, the use of 4% T-EDTA reduced composite catheter complications, including those leading to emergency department visits, hospital admissions, additional procedures, and mortality. This outcome suggests 4% T-EDTA has benefits over currently available lock solutions.

The complex interplay between sectoral energy consumption and economic growth: Policy implications for Iran and beyond

Iran's abundant energy reserves starkly contrast with recent power and gas shortages, particularly impacting the industrial sector. Furthermore, long-term trends reveal a concerning pattern where total primary energy consumption has outpaced economic growth, doubling in recent decades. These challenges emphasize the need for a thorough evaluation of the intricate interplay between sectoral energy consumption and economic output in Iran, bearing profound policy implications. The current study employs ARDL and VECM approaches to analyze empirical long- and short-term dynamics. Regarding Iran, the results unveil causal relationships from industrial energy consumption to GDP and from GDP to energy consumption in buildings. Notably the significant positive value of elasticity of GDP with respect to industrial energy use highlights the need for nuanced energy management measures. Variations across sectors underscore the justification for recognizing industrial energy consumption as productive energy use. The results gain additional support from a panel data analysis spanning fourteen diverse countries, bearing significance for IAMs applied in climate change research. While IAMs traditionally employ total energy consumption or the sectoral energy uses collectively, as production factors, the research highlights the need to reevaluate model frameworks for potential different outcomes from established practices.

Reducing reflex first-line prescriptions in a surgical pathology laboratory: toward sustainable practice with positive economic and clinical effects.

In surgical pathology departments, reflex first-line techniques (RFLTs) are aimed at reducing workloads and addressing recent shortages of medical personnel. However, the impacts thereof on economic and diagnostic factors have been poorly addressed. Also, in the era of global warming, environmental considerations are crucial. This study assessed the economic and diagnostic efficacies of routine pathological RFLT and the quality of care and sustainability. Ten RFLTs of the Bordeaux University Hospital pathology department (six special stains, one cytology technique, and three immunohistochemical tests) were studied. First, a retrospective economic analysis evaluated the average cost of these RFLTs per slide and per year. Second, diagnostic relevance was prospectively surveyed. Third, the effects of changes made were analyzed over 2years. The ten RFLTs were associated with average annual costs of €46,708. Diagnostic relevance analysis indicated that most stains were unnecessary; only 17% were requested as second-line techniques. Elimination of 7/10 tests afforded annual cost savings of €22,522 and reduced the workload by 5568 tests/year, without compromising the workflow or diagnostic quality. Seven of ten RFLTs could be eliminated without compromising diagnostic quality or the workflow. This afforded not only financial benefits but also positive social and environmental impacts. We offer valuable insights into appropriate practices in surgical pathology laboratories. Collaboration between the medical and technical teams was crucial; other healthcare sectors would also benefit from our approach.

How Did the Recent Infant Formula Shortage Affect Breastfeeding Rates in Northeast New York [ID 2683397

INTRODUCTION: To determine the effect of the recent infant formula shortage on breastfeeding rates in the northeast New York area. METHODS: This was a retrospective analysis of the Northeast New York (NENY) Regional Birth Registry database from January 2021 to June 2022. Breastfeeding rates of patients in the first 6 months of 2022 were compared to those from 2021. Maternal demographics, obstetrical history, breastfeeding, and delivery information were collected. We wanted to determine whether the recent infant formula shortage in the United States affected the breastfeeding rates. Statistical analyses were performed using STATA software (Stata/SE 12.1). A P value of &lt;.05 was considered statistically significant. This study was approved by the IRB at Albany Medical Center. We controlled for maternal marital status, education level, ethnicity, and employment status during pregnancy in our statistical analysis. RESULTS: We identified 19,610 patients in the NENY database from January 2021 to June 2022. 170 (0.87%) were excluded from our study due to breastfeeding data not being available. The exclusive breastfeeding rate increased from 55.97% to 57.25%. However, this was not statistically significant (P&lt;.104). The formula-only rates essentially stayed the same, 17.94% versus 17.54%. The rates of the infants who were supplemented with formula had a nonsignificant decrease from 25.23% to 24.33% (P&lt;.185). We did a secondary analysis in which the data were excluded for those infants who were admitted to the neonatal intensive care unit and the differences were even smaller with an overall P value of 0.949. CONCLUSION: Although the recent infant formula shortage in the United States led to a slight increase in exclusive breastfeeding rates and decrease in formula feeding in a first 6 months of 2022, none of these were statistically significant. These differences were not statistically significant even after controlling for demographic factors such as marital status, race, and education level and BMI.

Conservation of Helium while Maintaining High System Purity

Recent helium shortages and helium price increases have lead to an increased emphasis being placed on conserving helium. The need to conserve helium must be balanced with need to maintain the high levels of purity necessary to prevent operational problems caused by contamination. Helium losses and contamination control are especially important for test stands that have cryogenic distribution systems operating continuously with frequent changeover of cryogenic temperature components that are being tested. This paper describes a mathematical model to estimate the quantity of helium lost and the purity of the helium after the pump and backfill procedure is complete. The process to determine the optimal time during pump down to cut off pumping and start backfilling is described. There is a tradeoff between trying to achieve the lowest possible pressure during pumping and the quantity of air leaking into the volume while pumping is occurring. An additional benefit of careful selection of pump and backfill parameters in conjunction with real-time pressure monitoring can reduce the labor and time required to complete a successful pump and backfill procedure. This paper is intended to be a tool for engineers to review their pump and backfill procedures and measured data to optimize helium losses, system purity, and labor required.

Existing and emerging GLP-1 receptor agonist therapy: Ramifications for diabetic retinopathy screening.

GLP-1 receptor agonist treatment revolutionised the management of type 2 diabetes mellitus with significant enhancement of cardiovascular risk reduction. They have been instrumental in effectively managing the glycaemic control of this at-risk patient group. This class of drugs are associated with rapid improvement in glucose levels and consequently, transient early worsening of pre-existing diabetic retinopathy (DR) which is well-recognised, but this paradox is less commonly perceived in routine clinical practice. The recent shortage of supply has resulted in an enforced hiatus to prescribing all existing GLP-1 receptor agonists, which is expected to last all through 2024. This becomes even more pertinent as their DR could have progressed due to worsening HbA1c as a result of the unforeseen interruption to GLP-1 receptor agonist treatment. Therefore, when these medications are recommenced in a few months' time, all prescribers need to be aware of these patients' most up-to-date DR status and liaise with their affiliated screening service.

Concentrated Solar Radiation (CSR) Assisted Two-step, One-pot Synthesis of (S)-3-(4-phenylpiperazin-1-yl)propane-1,2-diol (Levodropropizine)

Background: The recent energy shortage has drawn much attention to synthesizing active pharmaceutical ingredients (API) using green chemistry concepts like renewable energy sources and solvents. The concentrated solar radiation (CSR) technique has several advantages, including simple, affordable, energy and time-efficient for synthesizing active pharmaceutical ingredients and new chemical entities. Here, we successfully developed a two-step, one-pot synthesis of levodropropizine for the first time using CSR as a clean energy source and in a green solvent. Objective: To synthesize levodropropizine using concentrated solar radiations to save energy and improve yields while maintaining essential properties like chirality and physical properties. Methods: Levodropropizine was synthesized in two steps and in one pot method in a glass apparatus under concentrated solar radiation using a Fresnel lens measuring 20 cm (l) X 20 cm (b). The outcome was compared with the one obtained from the conventional heating method. X-ray crystallography, FTIR, NMR, polarimetry, HPLC-MS, chiral HPLC, DSC, and DTA characterized the Levodropropizine produced by CSR and conventional heating. The product synthesized by CSR was in agreement with the one synthesized by conventional heating. Results: A two step, one pot synthetic protocol for Levodropropizine using concentrated solar radiations resulted in 87% yield in 38 minutes while conventional heating method took about 6 hours with 77% yield. Conclusion: A two-step, one-pot, environmentally friendly, and straightforward approach to synthesizing Levodropropizine using concentrated solar radiation has been established; this method minimized the reaction time from 6.08 h. to 38 minutes, saving up to 90.89% of the energy. Different analytical techniques for physical characterization, such as x-ray crystallography, DSC, DTA, and chemical identity and purity by FTIR, NMR, Polarimetry, chiral HPLC, and LC-MS, thoroughly characterized Levodropropizine synthesized by CSR.

Effectiveness of prime vendor system on availability of medicines and medical supplies in the selected public health facilities in Arusha district council

IntroductionThe shortage of medicines and medical supplies remains to be a major issue that is facing public health facilities in Tanzania. This situation has been influenced by lack of consistency in the supply chain, increase in healthcare demand, poor regulatory system, insufficient funds, and lack of conducive infrastructure. Formerly, the Government initiatives such as engagement with the Prime Vendor System (PVS) demonstrated great assistance in getting rid of this challenge. Despite the operation of PVS, a recent shortage of medicines and medical supplies has been noticed.ObjectivesThis study aimed to assess the effectiveness of PVS on the availability of medicine and medical supplies in the selected public health facilities in Arusha District Council.MethodsThe study used a case study design with mixed research approach. The study involved 77 respondents which included 25 health facility in-charges, 50 patients, 1 District Pharmacist and 1 Prime Vendor. Questionnaires, interviews, and observation methods were used to collect data. Data collected covered a period of 2021–2022. Thematic analysis was used to analyze the qualitative data whereas descriptive analysis was used to analyze the quantitative data with the help of Excel and the Statistical Package for Social Sciences (SPSS) version 28.0.ResultsThe analysis indicates that PVS is not completely effective in supplying medicines and medical supplies due to its low capacity to conform to the orders placed by the public health facilities, a lack of supply competition, and a failure to adhere to contractual terms. Furthermore, at the time of data collection, the average availability of medicines and medical supplies at the selected public health facilities was 74.8%, while 80% of the selected public health facilities reported having a scarcity of medicines and medical supplies, and 92% of the interviewed patients reported having no full access to medicines.ConclusionDespite the shortcomings associated with the operation of the PVS, the system still seems to be very important for enhancing the availability of medicines and medical supplies once its effectiveness is strengthened. This study recommends a routine monitoring of PVS operations and timely interventions to reinforce an adherence to the contracted terms and improve PVS effectiveness.

A system dynamics approach to building counterfeit avoidance programs

Recent disruptions and shortages across the global supply chain have heightened awareness of resiliency and security risks for consumers, industry, and consumers. Of particular concern is the rise in counterfeit information and communication technology (ICT) products. Commonly used technology solutions to avoid counterfeit are cost prohibitive to small-medium enterprises (SME), leading to an increased security, cost, and reputational risks to these firms. This research develops a novel mathematical model to illustrate how minor purchasing decisions can compromise the integrity of a supply chain and network infrastructure. We conduct interviews with industry leaders to understand why counterfeit ICT continues to be purchased by industry. We then construct a system dynamics (SD) model to illustrate the model is applied to a case study based on a US government contract and evaluated. The findings show even a short-term use of an untrusted supplier can result in significant quantities of counterfeit ICT being purchased. Finally, we propose a new framework to support SMEs developing a counterfeit ICT abatement program.