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Background and importanceDrug shortages have become a worldwide phenomenon which has repercussions on patient care and on the hospital’s budget.Aim and objectivesThe aim of our study was to assess the risk of shortages of drugs included in our hospital therapeutic formulary (HTF), for which there is shortage reporting, using a hazard vulnerability analysis (HVA).Material and methodsWe performed an HVA on 43 drugs in our HTF, which were also included in the Italian Medicines Agency list of shortages. The HVA used to assign the risk of shortage (ROS) included three macro areas: probability that the shortages will occur based on shortages in the past 2 years; magnitude factors which increase the risk of shortages; and mitigation factors which reduce it. Probability was assigned a score from 0 to 2 based on previous shortages.Magnitude factors wererelevance of active substance; budget impact; and percentage of patients treated. Mitigation factors were: therapeutic alternative; stock availability; and import of drug. For each of these items a score from 0 to 3 was assigned. For magnitude factors, a higher score was assigned for increasing severity values. In contrast, for mitigation factors, a higher score was assigned in relation to mitigation reduction. The value of the risk was calculated multiplying the percentage of probability (P) and the percentage of severity (S). According to the score obtained, three classes of ROS were assigned: low (<30%); medium (30–60%); and high (>60%).ResultsNo drug was found to be at high risk of shortage (>60%), 32/43 (74.4%) were at low risk of shortage and 11/43 (25.6%) were at medium risk of shortage. The latter had previously been lacking; 6/11 had the same active ingredient as a therapeutic alternative, 3/11 had a different active ingredient as an alternative while 2/11 had no alternative.Conclusion and relevanceThe HVA is an important method to assess the ROS and implement targeted strategies for drugs at risk of shortages. Knowledge of the risk level facilitates the timeliness of the interventions to resolve the shortages themselves.References and/or acknowledgementsNo conflict of interest.

The sudden fuel shortage isn't the first time Americans have endured long lines and high gas prices.

BackgroundPurchasing procedures in hospital are subject to the public procurement code and vary with the amounts of the purchase. The tender must be implemented when the purchase amount exceeds 200 000 Euros HT during the contract period. Although suppliers tender on estimated quantities, sometimes laboratories do not fulfil the first orders.PurposeThe objective of this study was to analyse the proportion of new markets whose orders were not honoured in the first 3 months after the beginning of the market.Material and methodsThe study focused on the local tender for generics starting in July 2015. The number of molecules for which the suppliers changed compared with the previous market were listed. The number of molecules for which the orders were not met by the contract holders in the first 3 months were also listed. Then we analysed the causes of these stock shortages. We also recorded if the upholder of the market was the best bidder or not, and if the previous market was subject to drug shortages or not.ResultsThe local market included 111 market changes. The proportion of new markets whose orders were not honoured in the first 3 months was 10%. 82% of these stock-outs concerned generics. 5 different suppliers were concerned, including 4 generic manufacturers. In 82% of cases, the successful supplier was the best bidder. 4 different causes of drug shortages were reported, the most common was a problem of quality control of raw material. In 18% of cases. the previous market was also subject to stock-outs.ConclusionDrug shortages on new markets are significant, and they may impact on quality of patient care and are time consuming for teams managing stock-outs (calls to other suppliers, orders, etc). It would be interesting to quantify the management cost of a drug shortage (human time, financial cost) and to establish indicators for the performance of suppliers that could help in the choice of future tenders.References and/or AcknowledgementsDirective 2004/18/EC of the European Parliament and of the Council of 31/03/2004 on the coordination of procedures for the award of public contracts.No conflict of interest.

Excess nitrogen causes problems in developed nations, but nitrogen-poor soils threaten food security elsewhere Human activities have greatly perturbed the global nitrogen cycle. Planetary boundaries, which describe a safe operating space for humanity, have already been exceeded for the nitrogen cycle ( 1 ). In some parts of the world, excess nitrogen has negative impacts on biological diversity, human health, and climate. However, in other parts of the world, nitrogen shortages mean that food needs cannot be met. This large-scale disturbance of the nitrogen cycle presents considerable challenges that require wide-scale adoption of locally appropriate nitrogen management approaches.

This study aimed to examine the current situation of anti-cancer drug shortages in Pakistan, namely its determinants, impacts, adopted mitigation strategies, and proposed solutions. Qualitative semi-structured, in-depth interviews were conducted with 25 pharmacists in oncology hospitals in Pakistan from August to October 2021. Data were collected in person and online, recorded, and subjected to inductive thematic analysis after being transcribed verbatim. Most participants experienced anti-cancer drug shortages that increased during the pandemic. Etoposide, paclitaxel, vincristine, dacarbazine, and methotrexate were frequently short. Important causes included the compromised role of regulatory authorities, lack of local production, and inventory mismanagement. The impacts were delayed/suboptimal treatment and out-of-pocket costs for patients, patients’ prioritization, increased workload, negative work environment, and patients’ trust issues for pharmacists. The participants proposed that a cautious regulator’s role is needed to revise policies for all stakeholders and support all stakeholders financially at their level to increase access to these medicines. Based on the outcomes, it is clear that anti-cancer medicine shortages are a current issue in Pakistan. Governmental authorities need to play a role in revising policies for all levels of the drug supply chain and promoting local production of these drugs. Stakeholders should also collaborate and manage inventory.

The effective acquisition of clean water from atmospheric water offers a potential sustainable solution for increasing global water and energy shortages. In this study, an asymmetric amphiphilic surface incorporating self-driven triboelectric adsorption was developed to obtain clean water from the atmosphere. Inspired by cactus spines and beetle elytra, the asymmetric amphiphilic surface was constructed by synthesizing amphiphilic cellulose ester coatings followed by coating on laser-engraved spines of fluorinated ethylene propylene. Notably, the spontaneous interfacial triboelectric charge between the droplet and the collector was exploited for electrostatic adsorption. Additionally, the droplet triboelectric nanogenerator converts the mechanical energy generated by droplets falling into electrical energy through the volume effect, achieving an excellent output performance, and further enhancing the electrostatic adsorption by means of external charges, which achieved a water harvesting efficiency of 93.18 kg/m 2 h. This strategy provides insights for the design of water harvesting system. The effective acquisition of clean water from atmospheric water offers a potential sustainable solution for increasing global water shortages. Here, authors developed a bioinspired asymmetric amphiphilic surface incorporating self-driven triboelectric adsorption to obtain clean water.