Bacterial Resistance and the Optimal Use of Antibiotics

The increasing resistance of harmful biological organisms (bacteria, parasites, and pests) to selection pressure from the widespread use of control agents such as antibiotics, antimalarials, and pesticides is a serious problem in both medicine and agriculture. Modeling resistance —or, conversely, the effectiveness of these control agents as a biological resource—yields insights into how these agents should be optimally managed to maximize their economic benefit to society. This paper uses a model of evolution of bacterial resistance to antibiotics—in which resistance places an evolutionary disadvantage on the resistant organism—to develop a simple sequential algorithm of optimal antibiotic use. Although the solution to this problem follows the well-recognized rule of using resources in the order of increasing marginal cost, the unique ways in which these economic costs arise from differing biological traits distinguishes this problem from others in the natural resources arena. This paper also examines the option of periodically rotating between two or more antibiotics and characterizes the economic and biological criteria under which a cycling strategy is superior to simultaneous use of two or more antibiotics.antibiotic resistance, natural resource, optimization.

ACT Now or Later: The Economics of Malaria Resistance

In the past, malaria control efforts in sub-Saharan Africa have relied on a combination of vector control and effective treatment using chloroquine. With increasing resistance to chloroquine, attention has now turned to alternative treatment strategies to replace this failing drug. Although there are strong theoretical arguments in favor of switching to more expensive artemisinin-based combination treatments (ACTs), the validity of these arguments in the face of financial constraints has not been previously analyzed. In this paper, we use a bioeconomic model of malaria transmission and evolution of drug resistance to examine questions of optimal treatment strategy and coverage when drug resistance places an additional constraint on choices available to the policymaker. Our main finding is that introducing ACTs sooner is more economically efficient if the planner had a relatively longer time horizon. However, for shorter planning horizons, delaying the introduction of ACTs is preferable.Malaria; mathematical models; drug resistance; bioeconomics

Monopoly Extraction of an Exhaustible Resource with Two Markets

Although much has been written about the implications of monopoly power for the rate of extraction of natural resources, the specific case in which the resource can be sold in two markets with different elasticities of demand has escaped notice. We find that a monopolist facing two markets with differing iso-elastic demand schedules extracts more rapidly than the social planner, whether or not arbitrage prevents price discrimination between markets. This analysis is relevant in the case of many resources — such as natural gas used for power generation and household heating, or petroleum used for making plastics and as fuel.exhaustible resources, monopoly, markets, price discrimination

Socioeconomic Determinants of Disease Transmission in Cambodia

The process of acquiring an infection has two components: first, exposure through proximity to another infected individual, and second, transmission of the disease. Earlier studies of the socioeconomic factors that affect the probability of acquiring an illness assume uniform exposure to infected individuals and may therefore result in biased estimates. This paper develops an empirical model, consistent with epidemiological models of spread of infections, to estimate the impact of socioeconomic variables on the extent of disease transmission within villages in Cambodia. Data from the 1997 Cambodia Socioeconomic Survey are used in this analysis.

Ehs Risk Assesment of M.R.C.S.B Project, L&T, Goa (Under Construction) and Design of City Gas Distribution Network by Using Technical Standards and Specification Including Safety Standards

An EHS leader must Fully understand the philosophy of L.I.F.E. & Zero Harm Vision along with Inspire others to behave safely and have due regard for the environment. He must have ability to recognize the connection between good EHS and good business practices and Posses up-to-date EHS knowledge. He must have communication skills to convey and demonstrate leadership to all levels of the workforce and committed to action at all times. EHS culture has four stages namely pathological, reactive, calculative, proactive and generative stage. Zero harm vision has seven key elements. First element is leadership and commitment so Leaders must promote & demonstrate visual EHS commitment, excellence and lead by example. Second element is the risk management. Class one risk activity incorporated with working at height, vehicles, plants and equipment, tunneling, excavation, form work, mechanical lifting, work in confined space, work with electricity, working adjacent to public areas and hot work. Third element is setting of objectives and targets which should be measurable, attainable, and relevant and must have time bound. Fourth element is training and competence which includes of evaluation of training needs and periodical training for all personnel. Daily tool box talk to create awareness and propagate the incident and case studies among all the workmen. Fifth element is the communication and consultation. It includes monthly EHS meeting, EHS notice board, and EHS newsletter. Sixth element is to measure performance by inspection, internal audit and external audit. Seventh element is review and changes. Reviewing & managing changes is designed to expedite control and manage changes to policies, procedures, standards, organizational management and the execution or sequence of EHS related critical activities. Risk management has four stages namely identifying hazards, access the risk, determine the controls, and implement the controls, monitor, review and update. The approach must passes through a hierarchy of elimination, substitution, engineering control, administrative control, training and Personal protective equipment. In this study I have done risk assessment of different activities of construction of MRCSB Project, L&T, Goa. Then a comparable study between RA and RR has been done. After analyzing all the facts it is found that despite Risk assessment for every activities the KPI are not up to expectation. So to find out the root cause of this nonconformity gap analysis has been done. Real field data collected along with lagging and leading indicator, discussion with ground people. Fish bone analysis and by studying different laws, code of practices suggest some recommendation to improve site condition

Diversify or focus: spending to combat infectious diseases when budgets are tight

We consider a health authority seeking to allocate annual budgets optimally over time to minimize the discounted social cost of infection(s) evolving in a finite set of R >= 2 groups. This optimization problem is challenging, since as is well known, the standard epidemiological model describing the spread of disease (SIS) contains a nonconvexity. Standard continuous-time optimal control is of little help, since a phase diagram is needed to address the nonconvexity and this diagram is 2R dimensional (a costate and state variable for each of the R groups). Standard discrete-time dynamic programming cannot be used either, since the minimized cost function is neither concave nor convex globally. We modify the standard dynamic programming algorithm and show how familiar, elementary arguments can be used to reach conclusions about the optimal policy with any finite number of groups. We show that under certain conditions it is optimal to focus the entire annual budget on one of the R groups at a time rather than divide it among several groups, as is often done in practice; faced with two identical groups whose only difference is their starting level of infection, it is optimal to focus on the group with fewer sick people. We also show that under certain conditions it remains optimal to focus on one group when faced with a wealth constraint instead of an annual budget.public health spending; nonconvexity; dynamic programming

Treatment of dental complications in sickle cell disease.

BACKGROUND: Sickle cell disease is the most common single gene disorder and the commonest haemoglobinopathy found with high prevalence in many populations across the world. Management of dental complications in people with sickle cell disease requires special consideration for three main reasons. Firstly, dental and oral tissues are affected by the blood disorder resulting in several oro-facial abnormalities. Secondly, living with a haemoglobinopathy and coping with its associated serious consequences may result in individuals neglecting their oral health care. Finally, the treatment of these oral complications must be adapted to the systemic condition and special needs of these individuals, in order not to exacerbate or deteriorate their general health.Guidelines for the treatment of dental complications in this population who require special care are unclear and even unavailable in many aspects. Hence this review was undertaken to provide a basis for clinical care by investigating and analysing the existing evidence in the literature for the treatment of dental complications in people with sickle cell disease. OBJECTIVES: To assess methods of treating dental complications in people with sickle cell disease. SEARCH METHODS: We searched the Cochrane Haemoglobinopathies Trials Register, compiled from electronic database searches and handsearching of journals and conference abstract books.Date of last search: 11 April 2016.Additionally, we searched nine online databases (PubMed, Google Scholar, ClinicalTrials.gov, WHO International Clinical Trials Registry Platform, Literature in the Health Sciences in Latin America and the Caribbean database, African Index Medicus, Index Medicus for South East Asia Region, Index Medicus for the Eastern Mediterranean Region, Indexing of Indian Medical Journals). We also searched the reference lists of relevant articles and reviews and contacted haematologists, experts in fields of dentistry, organizations, pharmaceutical companies and researchers working in this field.Date of last search: 03 March 2016. SELECTION CRITERIA: We searched for published or unpublished randomised controlled studies of treatments for dental complications in people with sickle cell disease. DATA COLLECTION AND ANALYSIS: Two review authors intended to independently extract data and assess the risk of bias of the included studies using standard Cochrane methodologies; however, no studies were identified for inclusion in the review. MAIN RESULTS: No randomised controlled studies were identified. AUTHORS\u27 CONCLUSIONS: This Cochrane review did not identify any randomised controlled studies assessing interventions for the treatment of dental complications in people with sickle cell disease. There is an important need for randomised controlled studies in this area, so as to identify the most effective and safe method for treating dental complications in people with sickle cell disease