Developing Local Treatments for Acutely Malnourished Children in Sub-Saharan Africa: A Novel Optimization Approach Automatically Ensuring Protein Quality (FS14-06-19)

Objectives To develop an improved optimization tool for formulating locally suitable low-cost specialized nutritious foods (SNF) that can promote health and growth in malnourished children. Methods My method involves three parts: develop linear programming optimization tool automatically ensuring protein quality through protein digestibility-corrected amino acid score; optimize recipes according to current standards for ready-to-use therapeutic food, ready-to-use supplementary food, and super cereal plus, and compare nutrient composition and ingredient cost of optimized recipes with those of current recipes; and prepare, test, and refine a prototype super cereal plus recipe. Results My linear programming optimization tool maintains nutrient and composition constraints conforming to current standards (including the newly updated codex on protein quality in ready-to-use therapeutic food), creating low-cost recipes from local ingredients. Deriving estimates from extant data, the tool automatically ensures protein digestibility-corrected amino acid score without needing animal protein, balancing essential amino acids of ingredients. Applying the tool, I optimized SNF recipes first according to international commodity prices and next for each of 24 sub-Saharan African countries with published local price data, meeting the existing nutrient requirements, including protein quality, at minimal estimated ingredient cost, lower than ingredient cost of current recipes. Following prototyping of the optimized super cereal plus recipe, laboratory analysis verified the tool's accuracy and sensory analysis suggested appropriate acceptability. Conclusions Based on the preliminary results, my linear programming optimization tool offers an alternative, potentially effective approach to develop low-cost recipes using local crops. Funding Sources No funding was provided. Prototyping and testing of optimized super cereal plus was conducted in Kenya with the support of Valid Nutrition and Ajinomoto. Supporting Tables, Images and/or Graphs

A New Mechanism To Identify Cost Savings in NHS Prescribing: Minimising “Price-Per-Unit”

BackgroundMinimising prescription costs while maintaining quality is a core element of delivering high value healthcare. There are various strategies to achieve savings, but almost no research to date on determining the most effective approach. We describe a new method of identifying potential savings due to large national variations in drug cost, including variation in generic drug cost; and compare these with potential savings from an established method (generic prescribing).MethodsWe used English NHS Digital prescribing data, from October 2015 to September 2016. Potential cost savings were calculated by determining the price-per-unit (e.g. pill, ml) for each drug and dose within each general practice. This was compared against the same cost for the practice at the lowest cost decile, to determine achievable savings. We compared these price-per-unit savings to the savings possible from generic switching; and determined the chemicals with the highest savings nationally. A senior pharmacist manually assessed whether a random sample of savings were practically achievable.ResultsWe identified a theoretical maximum of £410M of savings over 12 months. £273M of these savings were for individual prescribing changes worth over £50 per practice per month; this compares favorably with generic switching, where only £35M of achievable savings were identified. The biggest savings nationally were on glucose blood testing reagents (£12M), fluticasone propionate (£9M) and venlafaxine (£8M). Approximately half of all savings were deemed practically achievable.DiscussionWe have developed a new method to identify and enable large potential cost savings within NHS community prescribing. Given the current pressures on the NHS, it is vital that these potential savings are realised. Our tool enabling doctors to achieve these savings is now launched in pilot form. However savings could potentially be achieved more simply through national policy change.AbbreviationsBNFBritish National FormularyCCGClinical Commissioning GroupGPGeneral PracticeMRModified ReleaseNHSNational Health ServiceNICNet Ingredient CostNP8Non-Part VIII, i.e. drugs not listed in Part VIII of the Drug TariffPPUPrice-Per-Unit

EFFECTS OF SOYFLOUR IN MILK REPLACER ON THE PERFORMANCE OF ARTIFICIALLY REARED LAMBS

Two artificial rearing experiments were conducted to evaluate both preweaning and postweaning performance of artificially reared lambs, ad libitum fed a milk replacer having one-third of the milk protein replaced by soyflour protein (S) compared with those fed MR with all the protein provided by milk products (M). From weaning at 21 d of age to 91 d of age all the lambs were fed the same high-concentrate diet. In the first experiment there were no significant differences in lamb weights, daily gains, postweaning feed conversion or lamb survival. In the second experiment there were lower (P < 0.05) postweaning daily gains, lower (P < 0.05) 91-d weights and higher (P < 0.05) postweaning feed conversion (2.69 vs. 2.52 kg feed kg−1 gain) for S lambs compared with M lambs, although there were no significant differences due to MR treatment for weaning weights, preweaning daily gains or lamb survival. In both experiments the S lambs consumed slightly more MR than M lambs. Using prices prevailing at the time of the study the lower ingredient cost of the soyflour resulted in a saving in MR cost of $1.45 per lamb weaned. In the second experiment, the lower MR cost would have been partially offset by the approximately 1 kg extra liveweight per lamb at 91 d of age. It was concluded that soyflour could contribute one-third of the total protein in MR for ad libitum fed, artificially reared lambs with little, if any, reduction in lamb performance. However, savings in feed costs resulting from the cheaper ingredient cost might be partially offset by lower postweaning lamb gains. Key words: Lambs, artificial rearing, milk replacer, soy protein

Survey and control of small mammal populations on two hardwood plantations in southern Ontario

Live trapping and tagging methods were employed to assess small mammal populations within two hardwood plantations in southern Ontario. Excessive girdling damage in past years to young planted trees necessitated an evaluation of rodent populations and development of effective control measures. The application of an anticoagulant rodenticide to oat groats bait broadcast over the study area at an ingredient cost of approximately three dollars per acre virtually wiped out the small mammals. Reinvasion from surrounding areas was, however, fairly rapid, particularly during late summer. Further research on longer term control measures using poisoned bait feeder stations is recommended.