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Community support programmes can simultaneously improve human and ecosystem health. However, whether and how supported communities maintain these sustainable trajectories during major disruptions remains unclear. We used a mixed-methods approach to document how the COVID-19 pandemic impacted rural communities and protected rainforests in West Kalimantan. We surveyed 1016 households across six villages with non-governmental organisation (NGO)-affiliated health-livelihood support and four nearby unaffiliated villages to understand their pandemic experiences and logging activity. We also independently estimated weekly forest loss in protected rainforests in 28 NGO-affiliated and 698 unaffiliated villages using satellite imagery. The pandemic created an economic shock, whereby 50% of households lost income, struggled with increased costs of basic needs, or both. We expected this shock to increase the amount of logging; however, the average forest loss across West Kalimantan decreased by 39% after the pandemic declaration. This decrease was due to the combined effects of the global timber market crash in early 2020, pandemic travel restrictions, and heavy precipitation in 2020 and 2021. Before the pandemic, the average forest loss was 52% lower in NGO-affiliated villages than in unaffiliated villages, with this difference increasing to 68% during the pandemic. Correspondingly, NGO-affiliated households were more likely to report having alternative sustainable livelihoods, several sources of external support (eg, loans), and access to affordable health care and less likely to report increased spending on basic needs during the pandemic. Health and livelihood support can buffer communities during major disturbances, sustaining progress towards improved human wellbeing and forest conservation. David and Lucile Packard Foundation and the National Geographic Society.

Despite substantial excitement around the use of AI in law, little information exists on the performance and associated risks of the domain's widely marketed tools. Recent work, for instance, has demonstrated the significant potential for "hallucinations"-wherein models make up facts, law, and precedent-leading Chief Justice Roberts to spotlight this risk in his annual report on the judiciary. We argue that there is a need for public AI benchmarking in law. First, relative to other AI application domains, the legal AI ecosystem lacks legibility-there is little information about the design and performance of many commercial legal AI systems. Legal AI has not benefited from the types of benchmarking that have catalyzed, measured, and informed AI innovation and responsible use in other domains. Second, we articulate the challenges of the institutional design of benchmarking. We illustrate how benchmarks can be captured, watered down, and abused. Careful institutional design around the why, who, what, and how of benchmarking will be critical to navigate difficult tradeoffs of transparency, objectivity, expertise, and resources. Third, addressing legal AI's illegibility requires matching institutional models to available resources and constraints. Rather than advocating for a single "best" approach to benchmarking, we show how benchmarking strategies depend on available resources.

Mobile apps marketed to support mental health have become increasingly popular in recent years. Given their widespread use, it is important to identify issues that users experience while using such apps. Understanding these issues may provide insight into the safety and suitability of these apps for individuals seeking mental health support. Unlike existing research, where user experience issues have been identified through researchers' direct analysis of apps, this study aimed to generate themes relating to user experience issues using comments from app users themselves. An additional aim was to evaluate a human-in-the-loop machine learning approach using structural topic modeling (STM) to analyze vast volumes of data gathered from X (formerly Twitter, developed by Twitter, Inc). Data relating to five of the most popular mental health apps were collected from the X API using R. A machine-assisted thematic analysis approach combined STM with human qualitative analysis to interpret user-generated posts. An unsupervised topic-modeling approach was tested using models with 5-40 topics and differing covariates (ultimately, a model without covariates was selected). Two researchers independently conducted thematic analysis to interpret and contextualize model outputs. A structural topic model with 10 topics, each comprising 20 X posts, was selected as most appropriate for generating insights. Using R (developed by the R Core Team), 79,703 X posts were collected via the X API relating to five popular mental health apps. After negative sentiment filtering, 19,603 posts remained. Posts spanned March 2006 (the launch of X/formerly Twitter) to December 2022. Researchers collaboratively labeled the 10 topics to identify the primary user experience issue represented in each. Topic 3 was discarded due to low coherence and inconsistency in relation to app user experience, and Topic 5 was discarded because posts reflected app X account activity rather than user experience of the apps. The remaining eight topics were organized into four themes. The first theme, guidance shortfall, included difficulties following guided meditations, challenges selecting appropriate content from large libraries, and incompatibility between app use and home environments. The second theme, technical difficulties, involved subscription access issues and technical faults within apps. The third theme, heightened emotions related to app-affiliated celebrities, captured both over-excitement linked to celebrity involvement and anger directed toward specific celebrities. The final standalone theme, negative impacts of sleep self-monitoring, demonstrated users reporting that tracking sleep adversely affected sleep experience. The combination of STM and human qualitative analysis of X posts identified several user-experienced issues associated with popular mental health apps, often linked to negative outcomes. This study provides evidence that STM can be combined with qualitative methods to rapidly analyze large-scale social media data and generate insights into user experience of mass-reach digital health interventions.

In 2025, the FDA approved 46 drug marketing applications, 31 of which were small molecule drugs. Despite the advancements in biotechnologies such as antibody drugs, RNA-based treatments, and antibody-drug conjugates, small molecule drugs remain dominant in new drug discovery. With progress in computer-aided drug design and scaffold-based drug design etc, modern drug discovery has stepped into a phase of rapid development. The marketed drugs in the same field often share similar structures and biological activities, while development of me-too drugs can notably enhance potency and streamline the development process. Comprehending the development process of newly launched drugs helps to identify mainstream technologies and provides structural scaffolds and inspirations for future research. This review comprehensively summarises the development progress of new drugs approved in 2025, including molecular design, structural modification, structure-activity relationship, and enhancement of drug-like properties to offer valuable insights to pharmaceutical chemists and bring inspiration for future research.

In this article, we designate the hydrazonoyl halides and thiosemicarbazone employed in the synthesis of novel naphthyl thiazoles. Under reflux conditions and exclusion of water, thiosemicarbazone reacted with aldehydes to produce thiosemicarbazones. Aryl naphthyl-thiazoles are synthesized from the reaction of thiosemicarbazones with hydrazonoyl halides. In every case, the reaction yielded a specific product. This method is beneficial from a preparative perspective due to the cost-effectiveness and appropriateness of the reaction conditions, the purity of the products, the availability of the reagents in the market, and the favorable yields. As detailed in the experimental section, elemental analysis along with spectral data (MS, NMR, and FT-IR) was employed to elucidate the chemical structures of the final products. The reaction between thiosemicarbazones and hydrazonoyl led to the formation of novel naphthyl thiazole compounds. The description of this reaction begins with a nucleophilic attack followed by elimination of hydrochloric acid to produce the S-alkylated intermediate, which is followed by loss of water. This approach will prove beneficial because of its low cost, simple reaction conditions, and the ready availability of the chemicals.

Safe and sustainable by design (SSbD) is key to the European Chemicals Strategy for Sustainability (CSS), which aims to reduce the negative impacts of chemicals, materials and products introduced onto the EU market on human health and the environment associated. The EC Joint Research Centre (JRC) SSbD methodological guidance published in 2024 introduced a Scoping Analysis that supports the contextualization of the assessment phase of the SSbD framework in R&I activities that now has been included in the revision of the SSbD framework. This article describes the application of the Scoping Analysis to a case study on graphene oxide functionalized with chitosan (N-acetylglucosamine) to be used as an alternative to the currently used flame-retardant additives for its application in battery cases in electric vehicles. The SSbD scoping analysis supports safety and sustainability assessments and identifies areas for improvement iteratively as the innovation progress towards full SSbD implementation.

Our objective was to determine the impact of migraine on women's fertility and birth planning. Migraine preferentially affects women of childbearing age, and previous studies have suggested that migraine negatively affects a woman's decision to have children. We used the Swedish National Registry to determine the impact of migraine on women's fertility patterns including overall likelihood of childbirth, number of children, age at first birth, and birthing outcomes. Our study used a retrospective matched cohort design including all women born in Sweden between 1973 and 1996 who were registered in the Swedish Medical Birth Register and resided in Sweden as of 2018. Cases comprised women in the National Patient Register diagnosed with migraine between 2001 and 2018. Each case was matched by birth year to two controls without a recorded migraine diagnosis. We first assessed partum outcomes including number of children, age at first birth, length of gestation, and interval between first and second pregnancy. We then analyzed postpartum outcomes including birth weight less than 2500&#x2009;g, preterm delivery before 37&#x2009;weeks, Apgar score less than 7 at 5 min, postpartum depression, and preeclampsia. Our inclusion criteria yielded a cohort of 49,318 women with migraine and 98,636 women without, of whom 37,455 had data in the birth register: 7198 with a diagnosis of migraine before pregnancy (MBP), 6575 with migraine after pregnancy (MAP), and 23,682 with no diagnosis of migraine. Overall, women with any diagnosis of migraine in the study window had an increased likelihood of having any births relative to women without migraine (adjusted odds ratio&#x2009;=&#x2009;1.21, 95% confidence interval [CI] =&#x2009;1.18-1.24; p&#x2009;<&#x2009;0.001) and had 0.072 more children (95% CI&#x2009;=&#x2009;0.063-0.081; p&#x2009;<&#x2009;0.001). However, when stratified by whether the diagnosis of migraine occurred before or after pregnancy, women with MBP had 0.23 fewer children (95% CI = -0.24 to -0.21; p&#x2009;<&#x2009;0.001), whereas those with MAP had 0.33 more children (95% CI = +0.30 to +0.35; p&#x2009;<&#x2009;0.001). Similarly, women with MBP were older than controls (+0.52&#x2009;years, 95% CI = +0.40 to +0.63; p&#x2009;<&#x2009;0.001), whereas those with MAP were younger by 1.65&#x2009;years (95% CI = -1.77 to -1.53; p&#x2009;<&#x2009;0.001). Women with MBP waited less time between pregnancies (-0.69&#x2009;years, 95% CI = -0.74 to -0.64; p&#x2009;<&#x2009;0.001), whereas those with MAP waited longer (+0.82, 95% CI = +0.74 to +0.90; p&#x2009;<&#x2009;0.001). Preterm deliveries were increased only in MBP with aura. Vaginal deliveries only decreased in those with MAP, whereas postpartum depression was increased in those with both MBP and MAP. Preeclampsia was increased in those with MBP only. Our study suggests that women in Sweden with MBP delay having children, have fewer children, and are at an older age than women without migraine, but may wait less time between pregnancies. Our study further confirms the increased risk of preeclampsia and postpartum depression in mothers with migraine as well as preterm delivery in infants born to mothers with migraine with aura. Migraine has been thought to be associated with women having fewer children and a delayed first pregnancy, but this is primarily based on survey studies. We examined the national health care database of Sweden to better evaluate how migraine affects a woman's decision to have children and the timing of her pregnancies. We found that women diagnosed with migraine before pregnancy had their first child at a later age and had fewer children overall compared to women without migraine; however, they waited less time between pregnancies, had shorter pregnancies, fewer vaginal deliveries, and increased risk for postpartum depression and preeclampsia.

Biological control using copepods, predatory freshwater crustaceans, has been explored as a strategy for suppressing Aedes mosquito larvae in domestic water containers. Although predation efficacy has been documented in laboratory and field settings, less attention has been given to how community-based copepod interventions are organised, delivered, monitored, and sustained under routine conditions. To support operational planning and adaptation, clearer insight is needed into how programmes mobilise communities, produce and distribute copepods, and maintain coverage over time. We conducted a narrative, purposive synthesis of published and grey literature, complemented by the authors' field experience in Asia and Latin America. Sources were considered when they described field-based copepod deployments with sufficient operational detail to inform comparison of production arrangements, distribution channels, community roles, monitoring routines, or replenishment mechanisms. Using iterative cross-case comparison, we identified recurrent implementation configurations and organised them into a provisional typology of delivery models. Documented approaches include centralised public-health-led programmes, community-facilitated support and rearing systems, household-maintained post-programme approaches, and market-oriented or microenterprise pathways. Across settings, interventions differed in where copepods were produced, who placed them into containers, how communities participated, and how monitoring and replenishment were organised. The evidence base is uneven: centralised public health programmes are the most extensively documented, whereas household-led continuation and market-oriented approaches are less consistently reported and should be interpreted more cautiously. Cost information was limited and difficult to compare across contexts, with total programme costs shaped by staffing, training, monitoring intensity, transport, and facilitation requirements. This narrative review proposes a heuristic typology for describing and comparing implementation modalities of community-based copepod deployment for Aedes vector control. Rather than identifying a single preferred model, the framework clarifies organisational choices that influence operational continuity, including production, last-mile delivery, community engagement, monitoring, and replenishment. Making these delivery architectures explicit can support better reporting, planning, adaptation, and evaluation of copepod-based interventions within integrated vector management.

Frequent origin mislabeling of Xinjiang Nilka black bee honey has caused market chaos and harmed the interests of producers and consumers. This study integrated electronic nose (e-nose) technology with explainable artificial intelligence (XAI) to identify the geographical origin of Xinjiang Nilka black bee honey, addressing the "black box" limitation of conventional machine learning models and improving the transparency of honey traceability. The results showed that the ANN model achieved optimal performance, with 82% test accuracy and an AUC value of 0.87. Monte Carlo-based feature selection screened 16 key sensor features to reduce data dimensionality while preserving model performance. Shapley Additive exPlanations and 3D Partial Dependence Plot analyses further interpreted the model's decision mechanism. This study validates the feasibility of combining e-nose and XAI for honey origin identification, providing a novel technical reference for food safety supervision.

The correlates of mind wandering are well studied in younger adult samples. However, little is known about the correlates of mind wandering among older adults. The current study took a comprehensive approach to investigating age-related differences in the correlates of mind wandering. Participants (n&#x2009;=&#x2009;150 younger and n&#x2009;=&#x2009;150 older adults) completed a series of attention tasks. During some of these tasks, participants were periodically probed to report on their mind-wandering experiences. Additionally, participants completed several questionnaires capturing theoretically relevant constructs such as motivation, affect, and dispositional factors. We used confirmatory factor analysis to assess correlations between our predictors and mind wandering at the construct level. We found that some factors (e.g., task-based motivation) were significantly correlated with mind wandering in both age groups, while other factors were significant correlates in one age group but not the other. Despite these apparent differences, many of the correlations did not statistically differ across the groups. We did find, however, that the association between behavioral attention lapses and mind wandering was significantly stronger in younger adults compared to older adults. A secondary aim was to replicate and extend prior work examining the mediating factors in the age-mind wandering relationship. Consistent with prior findings, we showed that motivational and affective factors only partially mediated the relationship between age and mind wandering. Our findings can help inform and refine theories of mind wandering by showing that key predictors of mind wandering are largely consistent across younger and older adults. While we have a good understanding of which factors are associated with mind wandering in younger adults, less is known about which factors predict mind wandering in older adults. The current study provides novel evidence that the correlates of mind wandering are largely consistent across younger and older adults. Our findings can help inform and refine theories of mind wandering by showing that key predictors of mind wandering are largely consistent across younger and older adults.

Household and non-profit institutions serving households (NPISH) final consumption expenditure is widely used to characterize welfare, demand, and living standards, but official statistics are typically available at national and regional scales and therefore cannot support fine-grained analyses. Here we present a global 1&#x2009;km gridded dataset of household and NPISH final consumption expenditure in purchasing power parity (PPP) for 2013-2024. The dataset integrates World Bank economy-level totals, expressed in constant 2021 international dollars, with annual nighttime lights, population, built-up surface, roads, and consumer-oriented points-of-interests (POIs) in a stacked Super Learner framework. Harmonized annual covariates are used to generate grid-level predictions of per-capita consumption. The dataset is a model-based spatial disaggregation constrained by economy totals. We release two products: an observed-only variant based exclusively on directly reported World Bank totals, and a regionally completed variant that fills missing economy totals from World Bank regional aggregates. Each product includes annual cell-total rasters, per-capita rasters, QA rasters, and an economy-year metadata table. Independent validation against official subnational consumption statistics in the United States, Canada, and the United Kingdom, together with a provincial retail sales proxy validation for China, shows that the dataset captures spatial heterogeneity while retaining economy-level consistency. The dataset is intended to support analyses of welfare geography, market access, and consumption-related human activity, including applications relevant to the Sustainable Development Goals (SDGs), such as poverty, equity and inclusive development.

This study presents a comprehensive three-dimensional anatomical atlas of the adult Nilaparvata lugens using micro-CT and FIB-SEM. The reconstructions reveal the spatial organization of the flight muscle system, digestive tract, reproductive organs, and nervous system. The indirect flight muscles, including dorsal longitudinal and dorsoventral muscles, are structurally similar between sexes but show size differences in certain components. The female reproductive system occupies most of the abdominal cavity, reflecting high fecundity, while the male reproductive system features a specialized ejaculatory duct associated with muscular control. Notably, the genital coupling during copulation involves a sophisticated interlocking structure, ensuring stable alignment and preventing separation. These structural insights offer a holistic framework for understanding dispersal and reproduction in N. lugens, with implications for developing novel pest management strategies.

Places widely known as "wet markets" have been identified as posing a risk to human health, since these food retail spaces are broadly considered to have unhygienic conditions and support the wild animal trade. While costly regulatory interventions into these markets have been proposed, there is little scientific consensus about responsibility for developing evidence about the risks of such markets or conducting surveillance of markets. The aim of this scoping review was to assess the empirical research that has been done using this term, "wet markets," in order to better understand the kinds of knowledge generated about places referred to as "wet markets" and to identify relevant policy recommendations related to these spaces. We conducted a scoping review searching PubMed, Web of Science, and Scopus databases in March 2024 and identified 335 unique articles, 144 of which met inclusion criteria for final review. The majority of studies focused on the prevalence of pathogens in meat from domesticated sources and vegetables. Studies were predominantly conducted in Asia. Notably, this scoping review did not find any empirical studies on the wild animal trade alongside food trade at "wet markets." We did find distinct differences between narratives among Western public health institutions and empirical evidence on food safety and foodborne illness in Asia. Institutions concerned with health security and One Health should consider research designed to improve the evidence base for targeted interventions and strengthen surveillance in order to better respond to risks as well as better grasp their measurable magnitude.

Gratitude is a key contributor to well-being, yet the roles of individual factors such as age, gender, and socioeconomic status in this relationship remain unclear. In addition, little is known about whether this relationship varies across cultural and societal contexts. Across three studies (total N = 220,204; 67 countries) using cross-sectional data, we show that well-being is closely tied to gratitude experiences, with no meaningful universal individual differences across age, gender, socioeconomic status, or education. However, we did find that the strength of this connection varied across countries, which could be explained by various country-level moderators. For instance, the link was weaker in countries with lower national income and more collectivistic values. These patterns establish the strong connection between gratitude and well-being across a wide variety of cultures, but also suggest that gratitude may be less strongly associated with well-being in contexts where resources are scarce. As the first systematic study to examine the gratitude-well-being relationship across a broad range of individual and contextual differences, these findings underscore the significant role of gratitude in well-being and reveal both the universal as well as the contextually contingent aspects of this connection. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

National medicines reimbursement systems play a key role in supporting access to medicines. Although inclusion in these systems is important for patients to obtain necessary treatments at affordable costs, medicines exit reimbursement each year. However, research on the later stages of the medicine lifecycle, including reimbursement discontinuation, remains limited. Therefore, we evaluated medicines exiting the national reimbursement system in Finland. Data on all market-authorized medicinal products that exited the reimbursement system for at least one full calendar year between 2010 and 2022 were retrieved from a nationwide database maintained by the Social Insurance Institution of Finland (SII). Reimbursement discontinuation was validated using data from the Pharmaceuticals Pricing Board and the SII's Pharmaceutical Price Register. The study was conducted at the level of active pharmaceutical ingredients (APIs), focusing on whether the entire API exited the reimbursement system. Therapeutic categories, age, price levels, criticality, and market availability after reimbursement discontinuation were examined. Prices per treatment day were calculated using Defined Daily Doses where available. APIs were categorized into short- and long-term use based on expert assessment supported by literature. Descriptive analyses were conducted. A total of 150 APIs exited the reimbursement system. The most common therapeutic categories were alimentary tract and metabolism (15%), cardiovascular system (15%), and nervous system (11%). Of all identified APIs, 49% were intended for short-term use 51% for long-term use. Overall, 6% of the APIs, including phenoxymethylpenicillin, were listed as critical medicines by the EU. After reimbursement discontinuation, 62% of the APIs remained on the market without reimbursement, whereas 38% were immediately withdrawn. APIs remaining on the market were older than those withdrawn (median age 31 vs. 28 years) and had a lower median price per treatment day (&#x20ac;0.90 vs. &#x20ac;1.50). APIs, even some classified as critical in the EU, exit the national reimbursement system each year. APIs that remain on the market tend to be older and less expensive than those leaving the market. These findings highlight the importance of monitoring changes in the range of reimbursable medicines and their potential implications for availability and affordability.

There is growing pressure on the Nigerian construction sector to reduce construction waste, resource depletion, and carbon dioxide emissions. The circular economy (CE) approach, which emphasizes reuse, recycling, resource efficiency, and design for deconstruction, offers a sustainable alternative to the dominant linear construction model. However, CE adoption remains limited in many developing economies, including Nigeria. This study examines the major enablers and barriers associated with CE integration in the Nigerian construction sector using a structural equation modelling (SEM) approach. The study was conducted using a questionnaire survey of 386 usable responses from professionals and stakeholders in the Nigerian construction sector. Eight latent constructs were examined: Stakeholder Awareness and Engagement (SAE), Technological Readiness (TR), Policy Support and Regulation (PSR), Financial and Market Constraints (FMC), Institutional and Regulatory Weakness (IRW), Information Opacity (IOP), CE Awareness and Implementation Intention (CEAI), and Implementation of CE Practices (ICEP). The results showed that SAE and TR had statistically significant but weak positive relationships with CEAI, while CEAI had a small positive relationship with ICEP. However, several expected direct effects involving PSR, FMC, IRW, and IOP were not statistically significant. The model explained 11.3% of the variance in CEAI and 19.7% of the variance in ICEP, indicating low explanatory power. The model-fit indices produced mixed results, with SRMR&#x2009;=&#x2009;0.071 and &#x3c7;2/df&#x2009;=&#x2009;2.96 suggesting acceptable residual fit, while CFI&#x2009;=&#x2009;0.88, TLI&#x2009;=&#x2009;0.86, and RMSEA&#x2009;=&#x2009;0.082 indicated marginal fit. The findings suggest that awareness, stakeholder engagement, and technological readiness may serve as early-stage entry points for CE integration in the Nigerian construction sector. However, the weak measurement-model indicators require caution in interpreting the SEM results. The study contributes a preliminary SEM-based framework for understanding CE integration in Nigeria and highlights the need for stronger measurement refinement, improved policy implementation, digital capacity development, and industry-wide collaboration to support circular construction practices.

Most of our AI governance efforts focus on substance: What rules do we want in place? What limits or checks do we want to impose on AI development and deployment? But a key role for law is not only to establish substantive rules but also to establish legal and regulatory infrastructure to generate and implement rules. The transformative nature of AI calls especially for attention to building legal and regulatory frameworks. In this Perspective, I review three examples: the creation of registration regimes for frontier models; the creation of registration and identification regimes for autonomous agents; and the design of regulatory markets to facilitate a role for private companies to innovate and deliver AI regulatory services.

Nutri-Score front-of-package labels are designed to guide consumers toward healthier food choices, yet evidence on their effectiveness is mixed. We examined when Nutri-Score shifts purchasing choices and whether its impact depends on making health goals salient at the moment of choice and whether Nutri-Score ratings confirm versus contradict consumers' preexisting beliefs about which product is healthier. In a randomized online experiment with Italian adults (N = 792), participants made purchase choices across 30 pairs of familiar grocery products. Nutri-Score presence (present vs. absent) and a brief health-goal prompt ("Which product is healthier?"; present vs. absent) were manipulated between participants. We also categorized product pairs based on whether Nutri-Score ratings aligned with participants' prelabel healthiness judgments. Overall, displaying Nutri-Score increased the selection of the higher Nutri-Score option. This shift was largest when the label confirmed prior beliefs and the health-goal prime was present. When Nutri-Score contradicted prior beliefs, the label shifted choices even without the prime. These findings suggest that Nutri-Score effectiveness depends on goal salience and on whether the label provides expectation-consistent versus expectation-inconsistent information; in some cases, unexpectedly favorable ratings on tempting products may also be experienced as more permissible, a possibility that policymakers should consider. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

Lecanemab is dosed by body weight but supplied as fixed-size single-dose vials, which can leave unavoidable leftover drug after preparation. Using published summary statistics from the Japanese lecanemab post-marketing surveillance on body weight, we fitted a body-weight distribution and ran Monte Carlo simulations. Uncertainty was quantified by a parametric bootstrap. With current 200/500-mg vials, mean waste rate was 8.60%. A strategy with 200/250-mg vials reduced waste to 6.30%, and adding a 75-mg vial (&#x2264;4 vials/infusion) to 3.67%. At 10,000 person-years, annual waste cost was &#x223c;&#xa5;2.36 billion under assumed pricing. Vial-size and dispensing optimization may help reduce avoidable waste.