The future is distributed: a vision of sustainable economies

“The Future is distributed: a vision of sustainable economies” is a collection of case studies on distributed economies, a concept describing sustainable alternatives to the existing business models. The authors of this publication are international Masters students of the Environmental Sciences, Policy and Management Programme at the International Institute for Industrial Environmental Economics at Lund University in Sweden. The aim of their work is to demonstrate that local, small-scale, community-based economies are not just part of the theory, but have already been implemented in various sectors and geographical settings

The future is distributed: a vision of sustainable economics

“The Future is distributed: a vision of sustainable economies” is a collection of case studies on distributed economies, a concept describing sustainable alternatives to the existing business models. The authors of this publication are international Masters students of the Environmental Sciences, Policy and Management Programme at the International Institute for Industrial Environmental Economics at Lund University in Sweden. The aim of their work is to demonstrate that local, small-scale, community-based economies are not just part of the theory, but have already been implemented in various sectors and geographical settings

Pre-Conception Interventions for Subfertile Couples Undergoing Assisted Reproductive Technology Treatment: Modeling Analysis

BACKGROUND: Approximately 1 in 7 couples experience subfertility, many of whom have lifestyles that negatively affect fertility, such as poor nutrition, low physical activity, obesity, smoking, or alcohol consumption. Reducing lifestyle risk factors prior to pregnancy or assisted reproductive technology treatment contributes to the improvement of reproductive health, but cost-implications are unknown. OBJECTIVE: The goal of this study was to evaluate reproductive, maternal pregnancy, and birth outcomes, as well as the costs of pre-conception lifestyle intervention programs in subfertile couples and obese women undergoing assisted reproductive technology. METHODS: Using a hypothetical model based on quantitative parameters from published literature and expert opinion, we evaluated the following lifestyle intervention programs: (1) Smarter Pregnancy, an online tool; (2) LIFEstyle, which provides outpatient support for obese women; (3) concurrent use of both Smarter Pregnancy and LIFEstyle for obese women; (4) smoking cessation in men; and (5) a mindfulness mental health support program using group therapy sessions. The model population was based on data from the Netherlands. RESULTS: All model-based analyses of the lifestyle interventions showed a reduction in the number of in vitro fertilization, intracytoplasmic sperm injection, or intrauterine insemination treatments required to achieve pregnancy and successful birth for couples in the Netherlands. Smarter Pregnancy was modeled to have the largest increase in spontaneous pregnancy rate (13.0%) and the largest absolute reduction in potential assisted reproductive technology treatments. Among obese subfertile women, LIFEstyle was modeled to show a reduction in the occurrence of gestational diabetes, maternal hypertensive pregnancy complications, and preterm births by 4.4%, 3.8%, and 3.0%, respectively, per couple. Modeled cost savings per couple per year were €41 (US $48.66), €360 (US$427.23), €513 (US $608.80), €586 (US$695.43), and €1163 (US $1380.18) for smoking cessation, mindfulness, Smarter Pregnancy, combined Smarter Pregnancy AND LIFEstyle, and LIFEstyle interventions, respectively. CONCLUSIONS: Although we modeled the potential impact on reproductive outcomes and costs of fertility treatment rather than collecting real-world data, our model suggests that of the lifestyle interventions for encouraging healthier behaviors, all are likely to be cost effective and appear to have positive effects on reproductive, maternal pregnancy, and birth outcomes. Further real-world data are required to determine the cost-effectiveness of pre-conception lifestyle interventions, including mobile apps and web-based tools that help improve lifestyle, and their effects on reproductive health. We believe that further implementation of the lifestyle app Smarter Pregnancy designed for subfertile couples seeking assistance to become pregnant is likely to be cost-effective and would allow reproductive health outcomes to be collected

Policy process theories in autocracies: Key observations, explanatory power, and research priorities

The policy process frameworks and theories that are currently considered mainstream were originally de-veloped in the United States, before traveling to other countries. Despite their roots in democratic values, these frameworks and theories are increasingly applied to autocracies. Given important differences between de-mocracies and autocracies, this raises questions about the desirability, limitations, and future directions of this development. In response, this article synthesizes findings from studies that apply existing policy process frameworks and theories to autocracies with the aim of assessing the extent to which the theories are, can, and should be used to explain key aspects of the policy process in autocracies. Based on qualitative content analysis of 146 English- language peer- reviewed journal articles that apply the Advocacy Coalition Framework, the Multiple Streams Framework, the Narrative Policy Framework, and the Punctuated Equilibrium Theory to 39 autocracies, we show that these theories help identify influential institutions, actors, networks, ideas, beliefs, and events. The analysis reveals important differences in policy processes between autocracies and democra-cies. Future research ought to bring existing literature on authoritarianism and authoritarian politics into pol-icy process research to test existing and new hypotheses

Business case for psychosocial interventions in clinics: potential for decrease in treatment discontinuation and costs

Research question From a value-based healthcare (VBHC) perspective, does an assessment of clinical outcomes and intervention costs indicate that providing cognitive behavioural therapy (CBT) or mindfulness to women seeking fertility treatment have added value compared with no such intervention? Design Proof-of-concept business case based on a VBHC perspective that considers both clinical outcomes and costs. Potential impacts in psychological and fertility outcomes were based on existing literature. Cost outcomes were estimated with a costing model for the Dutch fertility treatment setting. Results 32 studies were identified; 13 could be included. Women who received CBT had 12% lower anxiety, 40% lower depression, and 6% higher fertility quality of life; difference in clinical pregnancy rates was 6-percentage points (CBT=30.2%; Control=24.2%); difference in fertility discontinuation rates was 10-percentage points (CBT=5.5%; Control=15.2%). Women who received training in mindfulness had 8% lower anxiety, 45% lower depression, and 21% higher fertility quality of life; difference in mean clinical pregnancy rate was 19-percentage points (Mindfulness=44.8%; Control=26.0%). Potential total cost savings for the was approximately €1.2 million per year if CBT was provided and €11 million if mindfulness was. Corresponding return-on-investment for CBT was 30.7% and for mindfulness 288%. Potential cost benefits are influenced by the assumed clinical pregnancy rates; such data related to mindfulness was limited to one study. Conclusions This proof-of-concept VBHC business case suggests providing CBT or mindfulness to women seeking fertility treatment could have added value. This conclusion would be bolstered by higher quality primary studies on the effect of mindfulness on clinical pregnancy rates

The Dynamics of Compound, Transcript, and Protein Effects After Treatment With 2OMePS Antisense Oligonucleotides in mdx Mice

Antisense-mediated exon skipping is currently in clinical development for Duchenne muscular dystrophy (DMD) to amend the consequences of the underlying genetic defect and restore dystrophin expression. Due to turnover of compound, transcript, and protein, chronic treatment with effector molecules (antisense oligonucleotides) will be required. To investigate the dynamics and persistence of antisense 2′-O-methyl phosphorothioate oligonucleotides, exon skipping, and dystrophin expression after dosing was concluded, mdx mice were treated subcutaneously for 8 weeks with 100 mg/kg oligonucleotides twice weekly. Thereafter, mice were sacrificed at different time points after the final injection (36 hours–24 weeks). Oligonucleotide half-life was longer in heart (~65 days) compared with that in skeletal muscle, liver, and kidney (~35 days). Exon skipping half-lives varied between 33 and 53 days, whereas dystrophin protein showed a long half-life (>100 days). Oligonucleotide and exon-skipping levels peaked in the first week and declined thereafter. By contrast, dystrophin expression peaked after 3–8 weeks and then slowly declined, remaining detectable after 24 weeks. Concordance between levels of oligonucleotides, exon skipping, and proteins was observed, except in heart, wherein high oligonucleotide levels but low exon skipping and dystrophin expression were seen. Overall, these results enhance our understanding of the pharmacokinetics and pharmacodynamics of 2′-O-methyl phosphorothioate oligos used for the treatment of DMD