Cost and benefits for the segregation of GM and non-GM compound feed

Measures are being developed and implemented enabling the co-existence of conventional, genetically modified (GM) and organic cropping systems. In order to segregate GM from conventional crops in the entire supply chain, a food or feed company has to reorganise its production. This may involve for dedication of the production line to non-GM, or production can be organised on the same plant, using spatial or temporal segregation. In practice, only the latter method is used in the feed industry, as no investments in new machinery are necessary in the case. The segregation and identity preservation of GM and non-GM crops has to be well organised. An important tools used to proof the identity of the imported raw materials is the batch or product declaration and in some cases, a supplementary certificate of analysis for the raw materials is provided. In compound feed production, specific procedures to reduce carry-over are introduced and described in a book of charge, such as rinsing of transportation and production line, empty declaration of transport systems or storage bins and specific discharge and production orders. All these measures however imply supplementary costs to the manufacturer. A major additional cost is the price difference between GM and non-GM raw materials. Other extra costs result from losses in flexibility, a devaluation of the rinsing product, analysis and audits. As a result, the cost of a compound feed using non-GM is higher than with GM. Benefits to the segregation measures are an increased gamut of products and an improved organisation and management of the production. Together with an improved traceability system, consumers’ confidence is also increased

Cost of co-existence of GM and non-GM animal feed production

The segregation and identity preservation of GM and non-GM crops implies an extra cost for all actors in the supply chain. This study describes and calculates the surplus costs related to the production of compound feed products. The co-existence of GM and non-GM soy in the production facilities leads to a loss of flexibility and therefore profitability. The intake of feed ingredients has to be altered, flushing of production lines becomes necessary, storage and transport has to be reorganised. A major additional cost is the increased price of non-GM soy. As a result, the cost of a compound feed using non-GM soy is at least 2.3% higher than with GM soy

The management of chronic paediatric Monteggia fracture-dislocation

Background: Monteggia fracture-dislocation is a rare and often missed injury in the paediatric population. The neglected radial head dislocation might go unnoticed for several months, but usually becomes symptomatic at a certain point in time, posing a complex clinical problem. Management strategies for chronic Monteggia lesions have been proposed by many authors. A consensus therapy is nonetheless lacking. In recent years an increasing number of case series reporting the outcomes of various treatment options have been published to gain insight into this challenging pathology. The purpose of this review is to provide a general background on chronic, paediatric Monteggia fracture-dislocation, followed by a systematic analysis and discussion of various management strategies and their outcomes, described in recent outcome studies. Methods: A literature search was conducted within the online databases PubMed, Cochrane Central, EMBASE and Google Scholar, to identify outcome studies on the management of chronic Monteggia lesions published between January 2015 and April 2020. A total of 23 outcome studies were identified and included in this study. Results: Obtaining stable radial head reduction can be regarded as the main objective of any management strategy for chronic, paediatric Monteggia fracture-dislocation. In recent literature, many surgical techniques have been put forward to obtain this goal, with the mainstay of most treatment strategies being ulnar osteotomy and open reduction with or without reconstruction of the annular ligament. Watchful neglect is a strategy that got more or less abandoned and is challenged in recent literature. Conclusions: Due to the complexity of long-standing radial head dislocation and the unpredictability of outcomes in the treatment of chronic Monteggia lesions, early diagnosis and achieving a stable reduction, preferably in the acute setting, are paramount. Because of the tendency to obtain more satisfactory radiological and clinical results in younger patients, with a short injury-to-surgery interval, it is advisable to promptly proceed to surgical treatment when chronic Monteggia fracture-dislocation is diagnosed

Can robot-assisted total knee arthroplasty be a cost-effective procedure? A Markov decision analysis

Background Total knee arthroplasty (TKA) is a frequently and increasingly performed surgery in the treatment of disabling knee osteoarthritis. The rising number of procedures and related revisions pose an increasing economic burden on health care systems. In an attempt to lower the revision rate due to component malalignment and soft tissue imbalance in TKA, robotic assistance (RA) has been introduced in the operating theatre. The primary objective of this study is to provide the results of a theoretical, preliminary cost-effectiveness analysis of RA TKA. Methods A Markov state-transition model was designed to model the health status of sixty-seven-year-old patients in need of TKA due to primary osteoarthritis over a twenty-year period following their knee joint replacement. Transitional probabilities and independent variables were extracted from existing literature. Results The value attributed to the utility both for primary and revision surgery has the biggest impact on the ICER, followed by the rate of successful primary surgery and the cost of RA-technology. Only 2.18% of the samples yielded from the probabilistic sensitivity analysis proved to be cost-effective (threshold set at $50000/QALY). A calculated surgical volume of at least 253 cases per robot per year is needed to prove cost-effective taking the predetermined parameter values into account. Conclusion Based upon transitional probabilities and independent variables derived from existing studies, RA TKA may be cost-effective at a surgical volume of 253 cases per robot per year when compared to conventional TKA