scholarly journals Fecal Transplant: How an Ancient Therapy Is Finding a New Use in Today’s Antibiotic-Resistant Era

2019 ◽  
Vol 8 (1) ◽  
pp. 19-29
Author(s):  
Andrea McBeth ◽  
Piper Dobner
Keyword(s):  
Cost Effective ◽  
Standard Of Care ◽  
The United States ◽  
Fecal Microbiota ◽  
Fecal Transplant ◽  
Healthy Human ◽  
Fecal Microbiota Transplant ◽  
Antibiotic Resistant ◽  
Effective Manner ◽  
Human Stool

Fecal transplant refers to any method of delivery of healthy human stool to the colon of a recipient. This therapy is now gaining standard-of-care designation in the United States, Australia, and many parts of Europe for treating resistant Clostridium difficile infection). This literature review describes fecal transplant protocols. It highlights the variety of techniques used to screen stool donors; prepare and deliver treatment; and how, despite these variations, safety and efficacy remain high. It highlights the various ways to best mitigate safety while also recommending the direction in which clinical and research communities can move to continue to provide access to fecal microbiota transplant in a cost-effective manner.

A Tool for Designing Policy Packages To Achieve India’s Climate Targets: Methods, Data, and Reference Scenario of the India Energy Policy Simulator

2021 ◽  
Author(s):  
Deepthi Swamy ◽  
Apurba Mitra ◽  
Varun Agarwal ◽  
Megan Mahajan ◽  
Robbie Orvis
Keyword(s):  
Energy Policy ◽  
Ghg Emissions ◽  
Cost Effective ◽  
The United States ◽  
Technical Note ◽  
Reference Scenario ◽  
Low Carbon ◽  
Climate Targets ◽  
Effective Manner ◽  
Business As Usual

India is currently the world’s third-largest emitter of greenhouse gases (GHGs) after China and the United States and is set to experience continued growth in its population, economy, and energy consumption. Exploring low-carbon development pathways for India is therefore crucial for achieving the goal of global decarbonization. India has pledged to reduce the emission intensity of its gross domestic product (GDP) by 33–35 per cent relative to 2005 levels by 2030 through its Nationally Determined Contribution (NDC), among other related targets for the renewable energy and forestry sectors. Further, countries, including India, are expected to respond to the invitation of the Conference of the Parties (COP) to the Paris Agreement to communicate new or updated NDCs with enhanced ambition and long-term low-GHG development strategies for 2050. To design effective policy packages to support the planning and achievement of such climate targets, policymakers need to identify policies that can reduce GHG emissions in a timely and cost-effective manner, while meeting development-related and other national objectives. The India Energy Policy Simulator (India EPS), an open-source, system dynamics model, can enable an integrated quantitative assessment of different cross-sectoral climate policy packages for India through 2050 and their implications for key variables of interest such as emissions, GDP, and jobs. The tool was developed by Energy Innovation LLC and adapted for India in partnership with World Resources Institute. It is available for open access through a Web interface as well as a downloadable application. This technical note describes the structure, input data sources, assumptions, and limitations of the India EPS, as well as the setup and key results of its reference scenario, referred to as the business-as-usual (BAU) scenario in the model. It is intended as an update to the first technical note on the India EPS (Mangan et al. 2019) and accounts for the changes incorporated into the model since the first version.

Why Carbon Pricing Is Appealing

2018 ◽  
pp. 1-12
Author(s):  
Barry G. Rabe
Keyword(s):  
United States ◽  
Fossil Fuels ◽  
Cost Effective ◽  
Carbon Price ◽  
The United States ◽  
Carbon Taxes ◽  
Excise Taxes ◽  
Effective Manner ◽  
Reduce Emissions ◽  
Direct Tax

The use of taxes to elevate the price of popular commodities in order to reduce consumption and risks related to use did not originate with carbon taxes. Excise taxes on tobacco have been used aggressively by governments in the United States and beyond in recent decades to achieve significant reductions in smoking. Fossil fuel use has long been deemed by diverse economists as a viable target for a sequel, leading to innumerable reports and scholarly arguments making the case for a carbon price. This can take the form of either a direct tax on the carbon content of fossil fuels or a cap-and-trade system that allows for purchase of rights to release emissions at a price. Both are thought to offer effective paths to reduce emissions in a cost-effective manner.

scholarly journals Investing in Natural and Nature-Based Infrastructure: Building Better Along Our Coasts

2018 ◽  
Vol 10 (2) ◽  
pp. 523 ◽  
Author(s):  
Ariana Sutton-Grier ◽  
Rachel Gittman ◽  
Katie Arkema ◽  
Richard Bennett ◽  
Jeff Benoit ◽  
...  
Keyword(s):  
Green Infrastructure ◽  
Water Conservation ◽  
Cost Effective ◽  
Well Being ◽  
The United States ◽  
Community Safety ◽  
Ecosystem Functions ◽  
Storm Events ◽  
Economic Wealth ◽  
Effective Manner

Much of the United States’ critical infrastructure is either aging or requires significant repair, leaving U.S. communities and the economy vulnerable. Outdated and dilapidated infrastructure places coastal communities, in particular, at risk from the increasingly frequent and intense coastal storm events and rising sea levels. Therefore, investments in coastal infrastructure are urgently needed to ensure community safety and prosperity; however, these investments should not jeopardize the ecosystems and natural resources that underlie economic wealth and human well-being. Over the past 50 years, efforts have been made to integrate built infrastructure with natural landscape features, often termed “green” infrastructure, in order to sustain and restore valuable ecosystem functions and services. For example, significant advances have been made in implementing green infrastructure approaches for stormwater management, wastewater treatment, and drinking water conservation and delivery. However, the implementation of natural and nature-based infrastructure (NNBI) aimed at flood prevention and coastal erosion protection is lagging. There is an opportunity now, as the U.S. government reacts to the recent, unprecedented flooding and hurricane damage and considers greater infrastructure investments, to incorporate NNBI into coastal infrastructure projects. Doing so will increase resilience and provide critical services to local communities in a cost-effective manner and thereby help to sustain a growing economy.

Breast Cancer Screening and Diagnosis Clinical Practice Guidelines

2006 ◽  
Vol 4 (5) ◽  
pp. 480 ◽  
Author(s):  
_ _
Keyword(s):  
Breast Cancer ◽  
United States ◽  
Practice Guidelines ◽  
Clinical Decision Making ◽  
Cost Effective ◽  
Clinical Decision ◽  
The United States ◽  
Mammographic Screening ◽  
Effective Manner ◽  
Recent Version

The lifetime risk of a woman developing breast cancer has increased over the past 5 years in the United States: of every 7 women, 1 is at risk based on a life expectancy of 85 years. An estimated 214,640 new cases (212,920 women and 1,720 men) of breast cancer and 41,430 deaths (40,970 women and 460 men) from this disease will occur in the United States in 2006. However, mortality from breast cancer has decreased slightly, attributed partly to mammographic screening. Early detection and accurate diagnosis made in a cost-effective manner are critical to a continued reduction in mortality. These practice guidelines are designed to facilitate clinical decision making. For the most recent version of the guidelines, please visit NCCN.org

scholarly journals Precision Genomic Practice in Oncology: Pharmacist Role and Experience in an Ambulatory Care Clinic

Pharmacy ◽  
2020 ◽  
Vol 8 (1) ◽  
pp. 32 ◽  
Author(s):  
Farah Raheem ◽  
Pauline Kim ◽  
Meagan Grove ◽  
Patrick J. Kiel
Keyword(s):  
Clinical Trial Design ◽  
Cost Effective ◽  
Standard Of Care ◽  
The United States ◽  
Tumor Board ◽  
Patient Specific ◽  
Cancer Center ◽  
Molecular Testing ◽  
Precision Oncology ◽  
Care Clinic

Recent advancements in molecular testing, the availability of cost-effective technology, and novel approaches to clinical trial design have facilitated the implementation of tumor genome sequencing into standard of care oncology practices. Current models of precision oncology practice include specialized clinics or consultation services based on a molecular tumor board (MTB) approach. MTBs are comprised of interprofessional teams of clinicians and scientists who evaluate tumors at the molecular level to guide patient-specific targeted therapy. The practice of precision oncology utilizing MTB-based models is an emerging approach, transforming precision genomics from a novel concept into clinical practice. This rapid shift in practice from cytotoxic therapy to targeted medicine poses challenges, yet brings exciting opportunities to clinical pharmacists practicing in hematology and oncology. Only a few precision genomics programs in the United States have a strong pharmacy presence with oncology pharmacists serving in leadership roles in research, interpreting genomic sequencing, making treatment recommendations, and facilitating off-label drug procurement. This article describes the experience of the precision medicine clinic at the Indiana University Health Simon Cancer Center, with emphasis on the role of the pharmacist in the precision oncology initiative.

Clostridioides difficile-Infection (CDI)

2022 ◽  
Author(s):  
Jennifer Moisi
Keyword(s):  
Developed Countries ◽  
The United States ◽  
Fecal Microbiota ◽  
Oral Route ◽  
Incidence Rates ◽  
Phase Iii ◽  
Fecal Microbiota Transplant ◽  
Variable Effect ◽  
Clostridioides Difficile ◽  
Hygiene Measures

Clostridioides difficile is a Gram positive, spore-forming bacillus colonizing the lower gastrointestinal tract. Use of antibiotics, older age, and underlying diseases contribute to changes in the microbial flora of the gut, which may lead to the production of toxins that cause C. difficile infection (CDI), with symptoms ranging from mild to moderate diarrhea to severe diarrhea, pseudomembranous colitis, toxic megacolon and sepsis. CDI is difficult to treat and has a high risk of recurrence. The fecal-oral route is the predominant mode of C. difficile transmission. The highest CDI incidence rates are reported from developed countries, particularly the United States, but limited disease awareness and surveillance capacity may lead to underestimation of disease burden elsewhere. Treatment consists of stopping ongoing antibiotic treatment, specific anti-CDI antibiotics and fecal microbiota transplant (FMT). CDI recurrence can be prevented by an anti-toxin B monoclonal antibody, bezlotoxumab. Various hygiene measures should be applied but they are costly and of variable effect. A candidate vaccine directed at the C. difficile toxin failed in the past, possibly due to a change in the epitope through inactivation or to a suboptimal immunization schedule. Currently, only one vaccine candidate based on genetically and chemically detoxified toxins A and B is in phase III studies.

scholarly journals Hepatitis C Variability, Patterns of Resistance, and Impact on Therapy

2012 ◽  
Vol 2012 ◽  
pp. 1-10 ◽  
Author(s):  
Cristina Simona Strahotin ◽  
Michael Babich
Keyword(s):  
Hepatitis C ◽  
Antiviral Agents ◽  
Cost Effective ◽  
Standard Of Care ◽  
The United States ◽  
Resistance Mechanisms ◽  
Cost Effective Method ◽  
New Treatments ◽  
Cure Rates ◽  
Effective Treatments

Hepatitis C (HCV), a leading cause of chronic liver disease, cirrhosis, and hepatocellular carcinoma, is the most common indication for liver transplantation in the United States. Although annual incidence of infection has declined since the 1980s, aging of the currently infected population is expected to result in an increase in HCV burden. HCV is prone to develop resistance to antiviral drugs, and despite considerable efforts to understand the virus for effective treatments, our knowledge remains incomplete. This paper reviews HCV resistance mechanisms, the traditional treatment with and the new standard of care for hepatitis C treatment. Although these new treatments remain PEG-IFN-α- and ribavirin-based, they add one of the newly FDA approved direct antiviral agents, telaprevir or boceprevir. This new “triple therapy” has resulted in greater viral cure rates, although treatment failure remains a possibility. The future may belong to nucleoside/nucleotide analogues, non-nucleoside RNA-dependent RNA polymerase inhibitors, or cyclophilin inhibitors, and the treatment of HCV may ultimately parallel that of HIV. However, research should focus not only on effective treatments, but also on the development of a HCV vaccine, as this may prove to be the most cost-effective method of eradicating this disease.

scholarly journals Cost-Effectiveness of Olaratumab in Combination with Doxorubicin for Patients with Soft Tissue Sarcoma in the United States

Sarcoma ◽  
2018 ◽  
Vol 2018 ◽  
pp. 1-14 ◽  
Author(s):  
Santiago Zuluaga-Sanchez ◽  
Lisa M. Hess ◽  
Sorrel E. Wolowacz ◽  
Yulia D’yachkova ◽  
Emma Hawe ◽  
...  
Keyword(s):  
United States ◽  
Cost Effectiveness ◽  
Soft Tissue ◽  
Soft Tissue Sarcoma ◽  
Meta Analysis ◽  
Single Agent ◽  
Cost Effective ◽  
Standard Of Care ◽  
The United States ◽  
Life Years

Background. Standard first-line treatments for advanced soft tissue sarcoma (STS) have changed little for 40 years, and outcomes have been poor. Recently, the United States (US) Food and Drug Administration conditionally approved olaratumab in combination with doxorubicin (Olara + Dox) based on a randomized phase II trial that reported a significant 11.8-month improvement in median survival versus single-agent doxorubicin (Dox). The present study investigated the cost-effectiveness of Olara + Dox compared with Dox and five other standard-of-care regimens from the US payer perspective. Methods. An economic model was constructed to estimate costs and outcomes over patients’ lifetimes from start of therapy. Progression-free and overall survival were based on survival analysis of patient-level data and a meta-analysis. Adverse-event rates were based on trials. Costs were from published sources. Results. Olara + Dox resulted in an estimated additional 1.27 life-years (LYs) compared with Dox, with an increase in total expected lifetime costs of $133,653. The incremental cost-effectiveness ratio (ICER) was estimated at $105,408 per LY gained; in a fully incremental analysis, all other regimens were dominated (higher costs and lower LYs or a higher ICER). Conclusion. Olara + Dox is cost-effective for STS treatment compared with Dox and other standard-of-care regimens at willingness-to-pay thresholds of $150,000 per LY and above.

Why Carbon Pricing Has Often Failed

2018 ◽  
pp. 37-82
Author(s):  
Barry G. Rabe
Keyword(s):  
United States ◽  
Life Cycle ◽  
Cost Effective ◽  
The United States ◽  
Carbon Pricing ◽  
Leadership And Management ◽  
Effective Manner

This chapter examines nearly two decades of experience (1997-2015) in federal and sub-federal governments in the United States and Canada but also European and Asian nations in attempting to adopt carbon pricing. It explores various stages of the policy life-cycle and concludes that there are many points that challenge the adoption and durability of these policies. Even in cases where a policy is approved, its launch process, survival through a subsequent election and change of leadership, and management over the longer term can pose great challenges, frequently resulting in an erosion of support and reversal of policy. Enduring those stages of the life cycle is no guarantee that a surviving policy actually succeeds in reducing emissions in a cost-effective manner.

Thermal-Mechanical Analysis of Annular Target Design for High Volume Production of Molybdenum-99 Using Low-Enriched Uranium

2009 ◽  
Author(s):  
Kyler K. Turner ◽  
Gary L. Solbrekken ◽  
Charlie W. Allen
Keyword(s):  
Contact Resistance ◽  
Thermal Contact Resistance ◽  
Nuclear Reactor ◽  
Thermal Contact ◽  
Cost Effective ◽  
High Volume ◽  
The United States ◽  
Mechanical Analysis ◽  
Effective Manner ◽  
Enriched Uranium

Techenetium-99m is a diagnostic radioactive medical isotope that is currently used 30,000 times a day in the United States. All supplies of techenetium-99m’s parent isotope molybdenum-99 currently originate from nuclear reactor facilities located in foreign countries and use highly enriched uranium (HEU). In accordance with the Global Threat Reduction Initiative all uranium used in future molybdenum-99 production will use low enriched uranium (LEU). A design approach to using LEU in a cost-effective manner is to use a target that is based on LEU foil. A potential failure mode for the LEU foil based target is temperature excursion during irradiation due to poor thermal contact between the foil and the target cladding. The purpose of this study is to establish the theoretical basis for experimentally measuring the thermal contact resistance. Replicating in service heating conditions is nearly impossible when testing the thermal contact resistance as part of a study to establish LEU foil warpage tolerances, thus it is necessary to establish an alternate heating configuration that will allow a conservative estimate of the contact resistance. Thermal and mechanical analysis suggests that external heating of an annular target will place the interface into a state that will over-estimate the contact resistance relative to use conditions. Further, the magnitude of the heat load used for testing can be adjusted to control the degree of overestimation.

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