Economic Impact of Withdrawing Specific Agricultural Pesticides in the Lower Rio Grande Valley

The Air, Pesticides, and Toxics Division of the Environmental Protection Agency (EPA) has encouraged all states to develop a plan to manage the use of pesticides to prevent application that would result in unreasonable risks to human health and the environment from contamination of ground water. In February, 1988, EPA proposed a strategy where by they would regulate certain pesticides by prohibiting their use in areas vulnerable to leaching unless a state develops and implements a management plan acceptable to EPA. However, banning the use of a pesticide in a region is the worst case scenario available to the TWC for managing water quality. The Texas Water Commission (TWC) assessed the State for areas vulnerable to leaching and found the Lower Rio Grande Valley (LRGV) to be a highly vulnerable area. This study examines three pesticides (atrazine, dicrotophos, and aldicarb) currently used in the LRGV that were identified by the TWC as potential contaminants of ground water. Alternative methods of controlling pests in this region were identified, and the economic impacts of withdrawing one or all three of these pesticides from the study area were estimated. Regional impacts on gross receipts (sales), variable costs, and net returns were determined. If atrazine use were banned in the LRGV, corn and sorghum sales would decrease by approximately $1 million, variable costs to produce corn, sorghum, and sugarcane would increase by almost$2 million dollars, leaving farmers in the region with a $3 million dollar 1088 in net income per year. If dicrotophos use were prohibited in the LRGV, variable cost to produce cotton would increase by over$600,000 for the region as a whole. Banning aldicarb use in the study area would reduce citrus sales by almost $3 million, increase variable costs to produce citrus by over$200,000, and reduce farmer net income by over $3 million annually

Adjustment of nursing home quality indicators

Background: This manuscript describes a method for adjustment of nursing home quality indicators (QIs) defined using the Center for Medicaid & Medicare Services (CMS) nursing home resident assessment system, the Minimum Data Set (MDS). QIs are intended to characterize quality of care delivered in a facility. Threats to the validity of the measurement of presumed quality of care include baseline resident health and functional status, pattern of comorbidities, and facility case mix. The goal of obtaining a valid facility-level estimate of true quality of care should include adjustment for resident- and facility-level sources of variability. Methods: We present a practical and efficient method to achieve risk adjustment using restriction and indirect and direct standardization. We present information on validity by comparing QIs estimated with the new algorithm to one currently used by CMS. Results: More than half of the new QIs achieved a "Moderate" validation level. Conclusions: Given the comprehensive approach and the positive findings to date, research using the new quality indicators is warranted to provide further evidence of their validity and utility and to encourage their use in quality improvement activities

A novel therapeutic strategy for pancreatic neoplasia using a novel RNAi platform targeting PDX-1

Bi-functional shRNA (bi-shRNA), a novel RNA interference (RNAi) effector platform targeting PDX-1 utilizing a systemic DOTAP-Cholesterol delivery vehicle, was studied in three mouse models of progressive pancreatic neoplasia. Species-specific bi-functional PDX-1 shRNA (bi-shRNAPDX-1) lipoplexes inhibited insulin expression and secretion while also substantially inhibiting proliferation of mouse and human cell lines via disruption of cell cycle proteins in vitro. Three cycles of either bi-shRNA<sup>mousePDX-1</sup> or shRNA<sup>mousePDX-1</sup> lipoplexes administered intravenously prevented death from hyperinsulinemia and hypoglycemia in a lethal insulinoma mouse model. Three cycles of shRNA<sup>mousePDX-1</sup> lipoplexes reversed hyperinsulinemia and hypoglycemia in an immune-competent mouse model of pancreatic neoplasia. Moreover, three cycles of the bi-shRNA<sup>humanPDX-1</sup> lipoplexes resulted in near complete ablation of tumor volume and considerably improved survival in a human PANC-1 implanted SCID-mouse model. Human pancreatic neoplasia specimens also stained strongly for PDX-1 expression. Together, these data support the clinical development of a novel therapeutic strategy using systemic bi-shRNA<sup>PDX-1</sup> lipoplexes against pancreatic neoplasia

Economic Impact of Withdrawing Specific Agricultural Pesticides in the Lower Rio Grande Valley

The Air, Pesticides, and Toxics Division of the Environmental Protection Agency (EPA) has encouraged all states to develop a plan to manage the use of pesticides to prevent application that would result in unreasonable risks to human health and the environment from contamination of ground water. In February, 1988, EPA proposed a strategy where by they would regulate certain pesticides by prohibiting their use in areas vulnerable to leaching unless a state develops and implements a management plan acceptable to EPA. However, banning the use of a pesticide in a region is the worst case scenario available to the TWC for managing water quality. The Texas Water Commission (TWC) assessed the State for areas vulnerable to leaching and found the Lower Rio Grande Valley (LRGV) to be a highly vulnerable area. This study examines three pesticides (atrazine, dicrotophos, and aldicarb) currently used in the LRGV that were identified by the TWC as potential contaminants of ground water. Alternative methods of controlling pests in this region were identified, and the economic impacts of withdrawing one or all three of these pesticides from the study area were estimated. Regional impacts on gross receipts (sales), variable costs, and net returns were determined. If atrazine use were banned in the LRGV, corn and sorghum sales would decrease by approximately $1 million, variable costs to produce corn, sorghum, and sugarcane would increase by almost$2 million dollars, leaving farmers in the region with a $3 million dollar 1088 in net income per year. If dicrotophos use were prohibited in the LRGV, variable cost to produce cotton would increase by over$600,000 for the region as a whole. Banning aldicarb use in the study area would reduce citrus sales by almost $3 million, increase variable costs to produce citrus by over$200,000, and reduce farmer net income by over $3 million annually

Advocating Affordable Housing in New Hampshire: The Amicus Curiae Brief of the American Planning Association in Wayne Britton v. Town of Chester

In June 1990, The American Planning Association, a national Washington, D.C. based non-profit association of 27,000 professional planners, elected and appointed planning officials, and citizens interested in improving urban and rural planning filed this amicus curiae brief with the New Hampshire Supreme Court. The case on appeal is Wayne Britton v. Town of Chester, No. 85-E-342 (N.H. Super. Ct. June 27, 1989), brought by a builder/developer and low-income plaintiffs in need of affordable housing in Chester, New Hampshire

Cost-Effectiveness of Robot-Assisted Radical Cystectomy vs Open Radical Cystectomy for Patients With Bladder Cancer

IMPORTANCE: The value to payers of robot-assisted radical cystectomy with intracorporeal urinary diversion (iRARC) when compared with open radical cystectomy (ORC) for patients with bladder cancer is unclear. OBJECTIVES: To compare the cost-effectiveness of iRARC with that of ORC. DESIGN, SETTING, AND PARTICIPANTS: This economic evaluation used individual patient data from a randomized clinical trial at 9 surgical centers in the United Kingdom. Patients with nonmetastatic bladder cancer were recruited from March 20, 2017, to January 29, 2020. The analysis used a health service perspective and a 90-day time horizon, with supplementary analyses exploring patient benefits up to 1 year. Deterministic and probabilistic sensitivity analyses were undertaken. Data were analyzed from January 13, 2022, to March 10, 2023. INTERVENTIONS: Patients were randomized to receive either iRARC (n = 169) or ORC (n = 169). MAIN OUTCOMES AND MEASURES: Costs of surgery were calculated using surgery timings and equipment costs, with other hospital data based on counts of activity. Quality-adjusted life-years were calculated from European Quality of Life 5-Dimension 5-Level instrument responses. Prespecified subgroup analyses were undertaken based on patient characteristics and type of diversion. RESULTS: A total of 305 patients with available outcome data were included in the analysis, with a mean (SD) age of 68.3 (8.1) years, and of whom 241 (79.0%) were men. Robot-assisted radical cystectomy was associated with statistically significant reductions in admissions to intensive therapy (6.35% [95% CI, 0.42%-12.28%]), and readmissions to hospital (14.56% [95% CI, 5.00%-24.11%]), but increases in theater time (31.35 [95% CI, 13.67-49.02] minutes). The additional cost of iRARC per patient was £1124 (95% CI, -£576 to £2824 [US $1622 (95$831 to $4075)]) with an associated gain in quality-adjusted life-years of 0.01124 (95$144 312) per quality-adjusted life-year gained. Robot-assisted radical cystectomy had a much higher probability of being cost-effective for subgroups defined by age, tumor stage, and performance status. CONCLUSIONS AND RELEVANCE: In this economic evaluation of surgery for patients with bladder cancer, iRARC reduced short-term morbidity and some associated costs. While the resulting cost-effectiveness ratio was in excess of thresholds used by many publicly funded health systems, patient subgroups were identified for which iRARC had a high probability of being cost-effective. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03049410

Multi-domain quantitative recovery following Radical Cystectomy for patients within the iROC (Robot Assisted Radical Cystectomy with intracorporeal urinary diversion versus Open Radical Cystectomy) Randomised Controlled Trial: The first 30 patients

Many patients develop complications after radical cystectomy (RC) [1]. Reductions in morbidity have occurred through centralisation and technical improvements [2], and perhaps through robot-assisted RC (RARC). Whilst RARC is gaining popularity, there are concerns about oncological safety [3] and extracorporeal reconstruction [4], and randomised controlled trials (RCTs) find little difference [5]. We are conducting a prospective RCT comparing open RC and RARC with mandated intracorporeal reconstruction (Robot-assisted Radical Cystectomy with intracorporeal urinary diversion versus Open Radical Cystectomy [iROC] trial) [6]

Mixed-methods approach to exploring patients’ perspectives on the acceptability of a urinary biomarker test in replacing cystoscopy for bladder cancer surveillance

Objectives: To determine the minimal accepted sensitivity (MAS) of a urine biomarker that patients are willing to accept to replace cystoscopy and to assess qualitatively their views and reasons. Patients and Methods: Patients were part of a prospective multicentre observational study recruiting people with bladder cancer for a urine biomarker study (DETECT II; ClinicalTrials.gov: NCT02781428). A mixed-methods approach comprising (1) a questionnaire to assess patients' experience with cystoscopy and patients' preference for cystoscopy vs urinary biomarker, and (2) semi-structured interviews to understand patient views, choice and reasons for their preference. Results: A urine biomarker with an MAS of 90% would be accepted by 75.8% of patients. This was despite a high self-reported prevalence of haematuria (51.0%), dysuria/lower urinary tract symptoms (69.1%) and urinary tract infection requiring antibiotics (25.8%). There was no association between MAS with patient demographics, adverse events experienced, cancer characteristics or distance of patients' home to hospital. The qualitative analysis suggested that patients acknowledge that cystoscopy is invasive, embarrassing and associated with adverse events but are willing to tolerate the procedure because of its high sensitivity. Patients have confidence in cystoscopy and appreciate the visual diagnosis of cancer. Both low- and high-risk patients would consider a biomarker with a reported sensitivity similar to that of cystoscopy. Conclusion: Patients value the high sensitivity of cystoscopy despite the reported discomfort and adverse events experienced after it. The sensitivity of a urinary biomarker must be close to cystoscopy to gain patients' acceptance