Practical allocation system for the distribution of specialised care during cellular therapy access scarcity

2019 ◽  
Vol 45 (8) ◽  
pp. 532-537 ◽  
Author(s):  
Andrew Hantel ◽  
Gregory A Abel ◽  
Mark Siegler
Keyword(s):  
Cellular Therapy ◽  
Medical Product ◽  
Treatment Modalities ◽  
Practical Implementation ◽  
Novel Approach ◽  
Life Years ◽  
The Usa ◽  
Innovative System ◽  
Oncology Practice ◽  
Provider Shortages

Novel cellular therapy techniques promise to cure many haematology patients refractory to other treatment modalities. These therapies are intensive and require referral to and care from specialised providers. In the USA, this pool of providers is not expanding at a rate necessary to meet expected demand; therefore, access scarcity appears forthcoming and is likely to be widespread. To maintain fair access to these scarce and curative therapies, we must prospectively create a just and practical system to distribute care. In this article, we first review previously implemented medical product and personnel allocation systems, examining their applicability to cellular therapy provider shortages to demonstrate that this problem requires a novel approach. We then present an innovative system for allocating cellular therapy access, which accounts for the constraints of distribution during real-world oncology practice by using a combination of the following principles: (1) maximising life-years per personnel time, (2) youngest and robust first, (3) sickest first, (4) first come/first served and (5) instrumental value. We conclude with justifications for the incorporation of these principles and the omission of others, discuss how access can be distributed using this combination, consider cost and review fundamental factors necessary for the practical implementation and maintenance of this system.

scholarly journals Current Understanding of Novel Coronavirus: Molecular Pathogenesis, Diagnosis, and Treatment Approaches

Immuno ◽  
2021 ◽  
Vol 1 (1) ◽  
pp. 30-66
Author(s):  
Niraj Kumar Jha ◽  
Madhan Jeyaraman ◽  
Mahesh Rachamalla ◽  
Shreesh Ojha ◽  
Kamal Dua ◽  
...  
Keyword(s):  
Paradigm Shift ◽  
Functional Outcomes ◽  
Cellular Therapy ◽  
Treatment Modalities ◽  
Unknown Etiology ◽  
Huge Number ◽  
The World ◽  
To Come ◽  
Novel Coronavirus ◽  
Nano Medicine

An outbreak of “Pneumonia of Unknown Etiology” occurred in Wuhan, China, in late December 2019. Later, the agent factor was identified and coined as SARS-CoV-2, and the disease was named coronavirus disease 2019 (COVID-19). In a shorter period, this newly emergent infection brought the world to a standstill. On 11 March 2020, the WHO declared COVID-19 as a pandemic. Researchers across the globe have joined their hands to investigate SARS-CoV-2 in terms of pathogenicity, transmissibility, and deduce therapeutics to subjugate this infection. The researchers and scholars practicing different arts of medicine are on an extensive quest to come up with safer ways to curb the pathological implications of this viral infection. A huge number of clinical trials are underway from the branch of allopathy and naturopathy. Besides, a paradigm shift on cellular therapy and nano-medicine protocols has to be optimized for better clinical and functional outcomes of COVID-19-affected individuals. This article unveils a comprehensive review of the pathogenesis mode of spread, and various treatment modalities to combat COVID-19 disease.

Residential segregation of same-sex partnered households in the US

2018 ◽  
Vol 38 (11/12) ◽  
pp. 973-981
Author(s):  
Danielle Xiaodan Morales
Keyword(s):  
Residential Segregation ◽  
Quantitative Research ◽  
Scale Effects ◽  
Sex Partners ◽  
Same Sex ◽  
Dissimilarity Index ◽  
Geographic Scale ◽  
Content Type ◽  
Novel Approach ◽  
The Usa

Purpose Quantitative research on the segregation of same-sex partners in the USA is new, and limited by challenges related to the accurate measurement of segregation and data errors. The purpose of this paper is to provide a novel approach to re-examine residential segregation between same-sex partners and different-sex partners in the USA. Design/methodology/approach Two versions of the dissimilarity index and corrected same-sex partners data from the 2010 decennial census were used. Effects of different geographic scales were examined. Findings Results reveal that the levels of segregation of both male and female same-sex partners were higher at metropolitan- vs state-levels; the levels of segregation was lower when measured using the unbiased as compared to the conventional version of the D-index; and male same-sex partnered households were more segregated from different-sex partnered households than were female same-sex partnered households. Research limitations/implications Future studies should be attuned to geographic scale effects and should not ignore the bias of the D-index. Originality/value This study provides a better test of the differences between the two versions of the D-index and contributes to the literature by examining the segregation of both male same-sex partners and female same-sex partners across different geographic scales.

scholarly journals Gastrodia elata Blume (Tianma): Hope for Brain Aging and Dementia

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Klaus Heese
Keyword(s):  
Brain Aging ◽  
Complementary Therapy ◽  
Treatment Modalities ◽  
Efficacy And Safety ◽  
Gastrodia Elata ◽  
Herbal Preparations ◽  
Gastrodia Elata Blume ◽  
Novel Approach ◽  
Potential Efficacy ◽  
Physician Scientists

Since aging-related diseases, including dementia, represent major public health threats to our society, physician-scientists must develop innovative, interdisciplinary strategies to open new avenues for development of alternative therapies. One such novel approach may lie in traditional Chinese medicine (TCM). Gastrodia elata Blume (G. elata, tianma) is a TCM frequently used for treatment of cerebrocardiovascular diseases (CCVDs). Recent studies of G. elata-based treatment modalities, which have investigated its pharmacologically relevant activity, potential efficacy, and safety, have employed G. elata in well-characterized, aging-related disease models, with a focus on models of aging-related dementia, such as Alzheimer’s disease (AD). Here, I examine results from previous studies of G. elata, as well as related herbal preparations and pure natural products, as prophylaxis and remedies for aging-related CCVDs and dementia. Concluding, data suggest that tianma treatment may be used as a promising complementary therapy for AD.

Radio-iodine treatment of hyperthyroidism

2011 ◽  
pp. 481-484
Author(s):  
Markus Luster ◽  
Michael Lassmann
Keyword(s):  
Radioactive Iodine ◽  
Massachusetts General Hospital ◽  
Geographical Location ◽  
Antithyroid Drug ◽  
Treatment Modalities ◽  
Iodine Isotope ◽  
Great Heterogeneity ◽  
The Usa ◽  
Benign Thyroid Disorders

Radioactive iodine has been used successfully for almost 70 years since the first treatment took place at the Massachusetts General Hospital in Boston in 1941. However, it was not until after the Second World War that 131I became generally available for clinical applications (1). The radioactive iodine isotope is chemically identical to ‘stable’ iodine (127I) and thus becomes a part of the intrathyroidal metabolism. Its principle of action is based on the emission of β‎-rays with a range of 0.5–2 mm in the tissue leading to high local radiation absorbed doses while sparing surrounding structures. The additional γ‎-ray component of 131I allows for scintigraphic imaging of the distribution in the gland and can also be used for pre- and post-therapeutic individual dosimetry (see below). Several therapeutic options are available for the treatment of benign thyroid disorders, namely hyperthyroidism: surgical resection (hemithyroidectomy, near-total, or total thyroidectomy), long-term antithyroid drug medication (ATD), and radio-iodine therapy (RAIT) (2, 3). These different treatment modalities are used in varying frequencies depending on geographical location, e.g. iodine supply, availability and logistics, cultural background, and patient-specific features, e.g. goitre size, presence of local symptoms, age, and hormonal status. The diversity of approaches on an international scale still remains impressive and is reflected by a great heterogeneity throughout Europe and also when compared to the USA where radio-iodine therapy is still being applied more frequently than in most European countries (4–8). Radio-iodine therapy was originally aimed at eliminating hyperthyroidism and thus leaving the patient euthyroid. Up-to-date strategies, however, established postradio-iodine induction of hypothyroidism as the treatment objective and, thus, it is included in the category of ‘cure’. This definition holds especially true for the management of Graves’ disease when long-term hypothyroidism was the rule and stabilization of euthyroidism failed in the majority of cases. In fact, the term ‘ablation’, meaning removal or destruction, has been increasingly used to characterize radio-iodine therapy and administration of larger amounts of radio-iodine have tended to make this a self-fulfilling prophecy. Although many clinicians prefer that the end result of treatment be the more easily managed hypothyroidism, others are still reluctant to give up the therapeutic ideal of euthyroidism as the preferred result of radio-iodine therapy and continue their efforts to solve the enigma of thyroid radiosensitivity.

Lung cancer

2007 ◽  
pp. 451-464
Keyword(s):  
Lung Cancer ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Diagnostic Procedures ◽  
Small Cell ◽  
Treatment Modalities ◽  
Nursing Management ◽  
Small Cell Lung ◽  
The Usa ◽  
The Uk

Introduction 452 Management of non-small cell lung cancer (NSCLC) 456 Management of small cell lung cancer (SCLC) 458 Mesothelioma 460 Nursing management issues 462 Lung cancer is a mainly preventable disease, the main cause being cigarette smoking. It was relatively rare until the 20th century, but is now the leading cause of cancer death in the UK, Europe, and the USA. This is despite changes in treatment modalities, diagnostic procedures, and recent falling smoking rates amongst many sectors of society....

Efficient J-Based Failure Assessment Diagrams for Engineering Critical Assessments of Circumferentially Cracked Pipes Subjected to Axial Force, Pressure, and Bending

2013 ◽  
Author(s):  
G. Graham Chell ◽  
Yi-Der Lee ◽  
Stephen J. Hudak
Keyword(s):  
Driving Forces ◽  
Material Behavior ◽  
Practical Implementation ◽  
Element Analysis ◽  
Strain Behavior ◽  
Axial Forces ◽  
Large Matrix ◽  
Novel Approach ◽  
Failure Assessment ◽  
Pipe Geometry

Engineering critical assessments (ECAs) of cracked pipes increasingly involve situations of high strains (e.g., reeling and ratcheting fatigue), multiple loads (combined bending, axial forces, and internal pressure), and multi-axial stressing (due to pressure). In this paper, some of the implications of these loading conditions on ECAs are investigated by generating BS 7910 Level 3C Failure Assessment Diagrams (FADs) from the results of a large matrix of finite element analysis (FEA) J computations for circumferentially cracked pipes. The Level 3C (J-based) FADs (which provide the most accurate FAD approach to ECAs) are compared with the corresponding and more widely employed (but less accurate) Level 2B (material dependent) FADs in order to assess the accuracy of the latter. Use of FEA J solutions in a Level 3C FAD ensures that the effects of material behavior, load type, crack type, crack geometry, and pipe geometry are accurately captured whereas a Level 2B FAD only attempts to accurately capture the effects of material stress-strain behavior. It is demonstrated that under some circumstances a Level 2B assessment will result in non-conservative results compared to the corresponding Level 3C assessment. The current comparison between Levels 3C and 2B addresses the mechanics involved in these approaches and does not take into account the possible differing treatments of material property uncertainties on ECAs within the two approaches. Based on the current results, an efficient J formulation is described that facilitates the practical implementation of a J-based ECA. The novel approach used is based on determining material dependent shift factors that transform Level 3C FADs derived from the fully plastic components of J solutions into Level 3C FADs that represent J behaviors in the linear elastic and fully plastic regimes, and the transition region in-between. This new J formulation treats combined axial forces, pressure, and bending when applied proportionally or non-proportionally and forms the basis of the monotonic and cyclic crack tip driving forces employed in the program FlawPRO. This program performs comprehensive conventional and high strain J-based ECAs that involve reeling, arbitrary strain cycling, ratcheting fatigue, and ductile tearing that are equivalent to a Level 3C FAD approach.

A novel approach to estimate methane oxidation in interim landfill covers across the USA

2015 ◽  
Vol 15 (4) ◽  
pp. 309 ◽  
Author(s):  
Tarek Abichou ◽  
Tarek Kormi ◽  
Cheng Wang ◽  
Jeffrey P. Chanton ◽  
Roger Green ◽  
...  
Keyword(s):  
Methane Oxidation ◽  
Novel Approach ◽  
The Usa ◽  
Landfill Covers

scholarly journals The World Bacterial Biogeography and Biodiversity through Databases: A Case Study of NCBI Nucleotide Database and GBIF Database

2013 ◽  
Vol 2013 ◽  
pp. 1-11 ◽  
Author(s):  
Okba Selama ◽  
Phillip James ◽  
Farida Nateche ◽  
Elizabeth M. H. Wellington ◽  
Hocine Hacène
Keyword(s):  
Geographical Area ◽  
Geographic Area ◽  
Global Scale ◽  
Service Access ◽  
Novel Approach ◽  
Online Databases ◽  
The Usa ◽  
Nucleotide Database ◽  
Bacterial Biodiversity

Databases are an essential tool and resource within the field of bioinformatics. The primary aim of this study was to generate an overview of global bacterial biodiversity and biogeography using available data from the two largest public online databases, NCBI Nucleotide and GBIF. The secondary aim was to highlight the contribution each geographic area has to each database. The basis for data analysis of this study was the metadata provided by both databases, mainly, the taxonomy and the geographical area origin of isolation of the microorganism (record). These were directly obtained from GBIF through the online interface, whileE-utilitiesandPythonwere used in combination with a programmatic web service access to obtain data from the NCBI Nucleotide Database. Results indicate that the American continent, and more specifically the USA, is the top contributor, while Africa and Antarctica are less well represented. This highlights the imbalance of exploration within these areas rather than any reduction in biodiversity. This study describes a novel approach to generating global scale patterns of bacterial biodiversity and biogeography and indicates that theProteobacteriaare the most abundant and widely distributed phylum within both databases.

scholarly journals Terrain-blind walking of planar underactuated bipeds via velocity decomposition-enhanced control

2019 ◽  
Vol 38 (10-11) ◽  
pp. 1307-1323 ◽  
Author(s):  
Martin Fevre ◽  
Bill Goodwine ◽  
James P Schmiedeler
Keyword(s):  
Feedback Control ◽  
Biped Robot ◽  
Rate Of Change ◽  
Energetic Cost ◽  
Practical Implementation ◽  
Leg Length ◽  
Cost Of Transport ◽  
Velocity Decomposition ◽  
Novel Approach ◽  
Hybrid Zero Dynamics

In this article, we develop and assess a novel approach for the control of underactuated planar bipeds that is based on velocity decomposition. The new controller employs heuristic rules that mimic the functionality of transverse linearization feedback control and that can be layered on top of a conventional hybrid zero dynamics (HZD)-based controller. The heuristics sought to retain HZD-based control’s simplicity and enhance disturbance rejection for practical implementation on realistic biped robots. The proposed control strategy implements a feedback on the time rate of change of the decomposed uncontrolled velocity and is compared with conventional HZD-based control and transverse linearization feedback control for both vanishing and non-vanishing disturbances. Simulation studies with a point-foot, three-link biped show that the proposed method has nearly identical performance to transverse linearization feedback control and outperforms conventional HZD-based control. For the non-vanishing case, the velocity decomposition-enhanced controller outperforms HZD-based control, but takes fewer steps on average before failure than transverse linearization feedback control when walking on uneven terrain without visual perception of the ground. The findings were validated experimentally on a planar, five-link biped robot for eight different uneven terrains. The velocity decomposition-enhanced controller outperformed HZD-based control while maintaining a relatively low specific energetic cost of transport (~0.45). The biped robot “blindly” traversed uneven terrains with changes in terrain height accumulating to 5% of its leg length using the stand-alone low-level controller.

scholarly journals The TEAM (Trauma Evaluation and Management) course: medical student knowledge gains and retention in the USA versus Ghana

2019 ◽  
Vol 4 (1) ◽  
pp. e000287 ◽  
Author(s):  
Allison E Berndtson ◽  
Martin Morna ◽  
Samuel Debrah ◽  
Raul Coimbra
Keyword(s):  
Trauma Care ◽  
Level Of Evidence ◽  
Middle Income ◽  
Institutional Review ◽  
Knowledge Deficit ◽  
Life Years ◽  
Before And After ◽  
The Usa ◽  
Knowledge Gains ◽  
The Impact

IntroductionTrauma and injury are significant contributors to the global burden of disease, with 5 million deaths and 250 million disability-adjusted life years lost in 2015. This burden is disproportionally borne by low- and middle-income countries (LMICs). Solutions are complex, but one area for improvement is basic trauma education. The American College of Surgeons has developed the Trauma Evaluation and Management (TEAM) course as an introduction to trauma care for medical students. We hypothesized that the TEAM course would be an effective educational program in LMICs and result in increased knowledge gains and retention similar to students in high-income countries (HICs).MethodsThe TEAM course was taught and students evaluated at two sites, one LMIC (Ghana) and one HIC (USA), after obtaining approval from the HIC Institutional Review Board and medical schools at both sites. Participation was optional for all students and results were de-identified. The course was administered by a single educator for all sessions. Multiple-choice exams were given before and after the course, and again 6 months later.ResultsA total of 62 LMIC and 64 HIC students participated in the course and completed initial testing. Demographics for the two groups were similar, as was participant attrition over time. LMIC students started with a relative knowledge deficit, scoring lower on both pre-course and post-course tests than HIC students, but gained more knowledge during the initial teaching session. After 6 months, the LMIC students continued to improve, whereas the HIC students’ knowledge had regressed. Most students recommended course expansion.ConclusionThe TEAM course is a useful tool to provide the basic principles of trauma care to students in LMICs, and should be expanded. Further study is needed to determine the impact of TEAM education on patient care in LMICs.Level of evidenceLevel III; Care Management

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