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Publications

Browse FSI scholarship on geopolitics, global health, energy, cybersecurity and more.

Featured Publications

Everything Counts: Building a Control Regime for Nonstrategic Nuclear Warheads in Europe

Building a Control Regime for Nonstrategic Nuclear Warheads in Europe

A new report led by Rose Gottemoeller on non-strategic nuclear warhead policies in Europe, particulary in light of Russia's changing status in the global nuclear community.
3D mockup cover of APARC's volume 'South Korea's Democracy in Crisis'

South Korea’s Democracy in Crisis

A close look at what is driving illiberalism and democratic delcine in today’s Korea, including political polarization, politicization of institutions, societal inequality, education, and social media.
System Error book cover and authors

System Error: Where Big Tech Went Wrong and How We Can Reboot

A forward-thinking manifesto which reveals how big tech’s obsession with optimization and efficiency has sacrificed fundamental human values.

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Douglas K. Owens
Journal Articles

The potential impact of an HIV vaccine with rapidly waning protection on the epidemic in Southern Africa: examining the RV144 trial results

Andersson KM, Paltiel AD, Douglas Owens
Vaccine, 2011 December 31, 2011

BACKGROUND:

The prime-boost HIV vaccine regimen used in the recent RV144 trial resulted in modest efficacy of 31% over 3.5 years, but was substantially higher in the first year post-vaccination. We sought to explore the potential impact of a vaccine with rapidly waning efficacy in a South African population.

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Journal Articles

A double-blind, randomized, controlled, multicenter study to assess the safety and cardiovascular effects of skeletal myoblast implantation by catheter delivery in patients with chronic heart failure after myocardial infarction

Povsic TJ, O'Connor CM, Henry T, Taussig A, Kereiakes DJ, Fortuin FD, Niederman A, Schatz R, Spencer R 4th, Douglas K. Owens, Banks M, Joseph D, Roberts R, Alexander JH, Sherman W
American Heart Journal, 2011 December 31, 2011

BACKGROUND:

We sought to determine the safety and preliminary efficacy of transcatheter intramyocardial administration of myoblasts in patients with heart failure (HF).

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Books

BioWatch and Public Health Surveillance: Evaluating Systems for the Early Detection of Biological Threats: Abbreviated Version

Douglas Owens
National Academies Press, 2011 December 31, 2011

Author information: IOM (Institute of Medicine) and NRC (National Research Council). (Committee: Goldstein BD, DeSimone JM, Ascher MS, Buehler JW, Cook KS, Crouch NA, Doyle FJ, Foldy S, Gursky EA, Hoffman S, Johnson CB, Keim P, Kellerman AL, Kleinman KP, Layton M, Lee EK, Mayor SD, Moshier TF, Murphy FA, Murray RW, Owens DK, Pollock SM, Resnick IG, Schaudies RP, Schultz JS)

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Journal Articles

Cost Effectiveness of Elective Induction of Labor at 41 Weeks in Nulliparous Women

Aaron B Caughey, Vandana Sundaram, Anjali J Kaimal, Yvonne W. Cheng, Allison Gienger, Sarah E Little, Jason Lee, Luchin Wong, Brian L Shaffer, Susan H Tran, Amy Padula, Kathryn M. McDonald, Elisa F Long, Douglas Owens, Dena Bravata
American Journal Of Obstetrics Gynecology, 2011 December 31, 2011

BACKGROUND: Induction of labor is on the rise in the U.S., increasing from 9.5 percent in 1990 to 22.1 percent in 2004. Although, it is not entirely clear what proportion of these inductions are elective (i.e. without a medical indication), the overall rate of induction of labor is rising faster than the rate of pregnancy complications that would lead to a medically indicated induction. However, the maternal and neonatal effects of induction of labor are unclear. Many studies compare women with induction of labor to those in spontaneous labor.

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Journal Articles

Systematic Review: Benefits and Harms of In-Hospital Use of Recombinant Factor VIIa for Off-Label Indications

Veronica Yank, C. Vaughan Tuohy, Aaron C Logan, Dena M. Bravata, Kristan Staudenmayer, Robin Eisenhut, Vandana Sundaram, Donal McMahon, Ingram Olkin, Kathryn M. McDonald, Douglas K. Owens, Randall S. Stafford
Annals of Internal Medicine, 2011 April 19, 2011

Background:Recombinant factor VIIa (rFVIIa), a hemostatic agent approved for hemophilia, is increasingly used for off-label indications.

Purpose:To evaluate the benefits and harms of rFVIIa use for 5 off-label, in-hospital indications: intracranial hemorrhage, cardiac surgery, trauma, liver transplantation, and prostatectomy.

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Journal Articles

Cost-effectiveness of a Modestly Effective HIV Vaccine in the United States

Elisa F Long, Douglas K. Owens
Vaccine, 2011 April 18, 2011

BACKGROUND: The recent RV144 clinical trial showed that an ALVAC/AIDSVAX prime-boost  HIV vaccine regimen may confer partial immunity in recipients and reduce transmission by 31%. Trial data suggest that efficacy may initially exceed 70% but decline over the following 3.5 years. Estimating the potential health benefits associated with a one-time vaccination campaign, as well as the projected benefits of repeat booster vaccination, may inform future HIV vaccine research and licensing decisions.

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Journal Articles

Effect of Treatment Interruption and Intensification of Antiretroviral Therapy on Health-related Quality of Life in Patients with Advanced HIV

Vilija Joyce, Paul G. Barnett, Adam Chow, Ahmed M. Bayoumi, Susan C. Griffin, Huiying Sun, Mark Holodniy, Sheldon T. Brown, Tassos C. Kyriakides, D. William Cameron, Mike Youle, Mark Sculpher, Aslam H. Anis, Douglas K. Owens
Medical Decision Making, 2011 March 7, 2011

Background. The effect of antiretroviral therapy (ART) interruption or intensification on health-related quality of life (HRQoL) in advanced HIV patients is unknown.

Objective. To assess the impact of temporary treatment interruption and intensification of ART on HRQoL.

Design. A 2 x 2 factorial open label randomized controlled trial.

Setting. Hospitals in the United States, Canada, and the United Kingdom.

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Journal Articles

Effectiveness and Cost Effectiveness of Expanding Harm Reduction Programs and HIV Antiretroviral Therapy in a Mixed HIV epidemic: An Analysis for Ukraine

Sabina S. Alistar, Douglas Owens, Margaret Brandeau
PLoS Med, 2011 March 1, 2011

Background Injection drug use (IDU) and heterosexual virus transmission both contribute to the growing mixed HIV epidemics in Eastern Europe and Central Asia. In Ukraine—chosen in this study as a representative country—IDU-related risk behaviors cause half of new infections, but few injection drug users (IDUs) receive methadone substitution therapy. Only 10% of eligible individuals receive antiretroviral therapy (ART). The appropriate resource allocation between these programs has not been studied.

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Journal Articles

Results of Antiretroviral Treatment Interruption and Intensification in Advanced Multi-drug Resistant HIV Infection from the OPTIMA trial

Mark Holodniy, Sheldon T. Brown, D. William Cameron, Tassos C. Kyriakides, Brian Angus, Abdel Babiker Abdel Babiker, Joel Singer, Douglas K. Owens, Aslam Anis, Ruth Goodall, Fleur Hudson, Mirek Piaseczny, John Russo, Martin Schechter, Lawrence Deyton, Janet Darbyshire
PLoS ONE, 2011 March 1, 2011

Background Guidance is needed on best medical management for advanced HIV disease with multidrug resistance (MDR) and limited retreatment options. We assessed two novel antiretroviral (ARV) treatment approaches in this setting.

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Journal Articles

Diagnostic Imaging for Low Back Pain: Advice for High-value Health Care from the American College of Physicians

Roger Chou, Amir Qaseem, Douglas K. Owens, Paul Shekelle
Annals of Internal Medicine, 2011 February 1, 2011

Diagnostic imaging is indicated for patients with low back pain only if they have severe progressive neurologic deficits or signs or symptoms that suggest a serious or specific underlying condition. In other patients, evidence indicates that routine imaging is not associated with clinically meaningful benefits but can lead to harms. Addressing inefficiencies in diagnostic testing could minimize potential harms to patients and have a large effect on use of resources by reducing both direct and downstream costs. In this area, more testing does not equate to better care.

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Journal Articles

High-value, Cost-Conscious Health Care: Concepts for Clinicians to Evaluate Benefits, Harms, and Costs of Medical Interventions

Douglas K. Owens, Amir Qaseem, Roger Chou, Paul Shekelle
Annals of Internal Medicine, 2011 February 1, 2011

Health care costs in the United States are increasing unsustainably, and further efforts to control costs are inevitable and essential. Efforts to control expenditures should focus on the value, in addition to the costs, of health care interventions. Whether an intervention provides high value depends on assessing whether its health benefits justify its costs. High-cost interventions may provide good value because they are highly beneficial; conversely, low-cost interventions may have little or no value if they provide little benefit.

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Journal Articles

Effectiveness and Cost-effectiveness of HIV Antiretroviral Regimens Recommended in the World Health Organization’s Guidelines for Resource-limited Settings

Eran Bendavid, Philip Grant, Annie Talbot, Douglas Owens, Andrew Zolopa
AIDS (Official Journal of the International AIDS Society), 2011 January 14, 2011

Objective: The World Health Organization (WHO) recently changed its first-line antiretroviral treatment guidelines in resource-limited settings. The cost-effectiveness of the new guidelines is unknown.

Design: Comparative effectiveness and cost-effectiveness analysis using a model of HIV disease progression and treatment.

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Journal Articles

The cost-effectiveness and population outcomes of expanded HIV screening and antiretroviral treatment in the united states

Long, E. F., Margaret Brandeau, Douglas Owens
Annals of Internal Medicine,, 2010 December 31, 2010

Abstract

BACKGROUND:

Although recent guidelines call for expanded routine screening for HIV, resources for antiretroviral therapy (ART) are limited, and all eligible persons are not currently receiving treatment.

OBJECTIVE:

To evaluate the effects on the U.S. HIV epidemic of expanded ART, HIV screening, or interventions to reduce risk behavior.

DESIGN:

Dynamic mathematical model of HIV transmission and disease progression and cost-effectiveness analysis.

DATA SOURCES:

Published literature.

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Journal Articles

Health Outcomes and Costs of Community Mitigation Strategies for an Influenza Pandemic in the United States

Daniella Perlroth, Glass RJ, Davey VJ, Cannon D, Alan Garber, Douglas Owens
Clinical Infectious Diseases, 2010 December 31, 2010

Background. The optimal community-level approach to control pandemic influenza is unknown. Methods. We estimated the health outcomes and costs of combinations of 4 social distancing strategies and 2 antiviral medication strategies to mitigate an influenza pandemic for a demographically typical US community. We used a social network, agent-based model to estimate strategy effectiveness and an economic model to estimate health resource use and costs. We used data from the literature to estimate clinical outcomes and health care utilization. Results.

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Journal Articles

The Cost Effectiveness and Population Outcomes of Expanded HIV Screening and Antiretroviral Treatment in the United States

Elisa F. Long, Margaret Brandeau, Douglas Owens
Annals of Internal Medicine, 2010 December 20, 2010

Background: Although recent guidelines call for expanded routine screening for HIV, resources for antiretroviral therapy (ART) are limited, and all eligible persons are not currently receiving treatment.

Objective: To evaluate the effects on the U.S. HIV epidemic of expanded ART, HIV screening, or interventions to reduce risk behavior.

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Journal Articles

Cost Effectiveness of Genetic Eesting in Family Members of Patients with Long QT Syndrome

Marco V. Perez, Narmadan A. Kumarasamy, Douglas K. Owens, Paul J Wang, Mark Hlatky
Circulation: Cardiovascular Quality and Outcomes, 2010 December 7, 2010

Background— Family members of patients with established long-QT syndrome (LQTS) often lack definitive clinical findings, yet may have inherited an LQTS mutation and be at risk of sudden death. Genetic testing can identify mutations in 75% of patients with LQTS, but genetic testing of family members remains controversial.

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Journal Articles

Cost-Effectiveness of Dabigatran Compared With Warfarin for Stroke Prevention in Atrial Fibrillation

James Freeman, Ruo Zhu, Douglas K. Owens, Alan M. Garber, David Hutton, Alan Go, Paul Wang, Mintu Turakhia
Annals of Internal Medicine, 2010 November 1, 2010

Background: Warfarin reduces the risk for ischemic stroke in patients with atrial fibrillation (AF) but increases the risk for hemorrhage. Dabigatran is a fixed-dose, oral direct thrombin inhibitor with similar or reduced rates of ischemic stroke and intracranial hemorrhage in patients with AF compared with those of warfarin.

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Journal Articles

Scaling Up Circumcision Programs in Southern Africa: The Potential Impact of Gender Disparities and Changes in Condom Use Behaviors on Heterosexual HIV Transmission

Andersson KM, Douglas Owens, Paltiel AD
AIDS and behavior, 2010 September 11, 2010

Circumcision significantly reduces female-to-male transmission of HIV infection, but changes in behavior may influence the overall impact on transmission. We sought to explore these effects, particularly for societies where women have less power to negotiate safe sex. We developed a compartmental epidemic model to simulate the population-level impact of various circumcision programs on heterosexual HIV transmission in Soweto. We incorporated gender-specific negotiation of condom use in sexual partnerships and explored post-circumcision changes in condom use.

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Journal Articles

Cost-Effectiveness of Using High-Sensitivity C-Reactive Protein to Identify Intermediate- and Low-Cardiovascular-Risk Individuals for Statin Therapy

Lee KK, Cipriano LE, Douglas K. Owens, Go AS, Mark Hlatky
Circulation, 2010 September 1, 2010

BACKGROUND: -Many myocardial infarctions and strokes occur in individuals with low-density lipoprotein cholesterol levels below recommended treatment thresholds. High sensitivity C-reactive protein (hs-CRP) testing has been advocated to identify low- and intermediate-risk individuals who may benefit from statin therapy. Methods and Results-A decision analytic Markov model was used to follow hypothetical cohorts of individuals with normal lipid levels but without coronary artery disease, peripheral arterial disease, or diabetes mellitus.

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Journal Articles

Comparative Effectiveness of HIV Testing and Treatment in Highly Endemic Regions

Eran Bendavid, Margaret L. Brandeau, Wood R, Douglas K. Owens
Archives of Internal Medicine, 2010 August 9, 2010

BACKGROUND: Universal testing and treatment holds promise for reducing the burden of human immunodeficiency virus (HIV) in sub-Saharan Africa, but linkage from testing to treatment sites and retention in care are inadequate.

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Journal Articles

The Development of Clinical Practice Guidelines and Guidance Statements of the American College of Physicians: Summary of Methods.

Qaseem A, Snow V, Douglas K. Owens, Shekelle P
Annals of Internal Medicine, 2010 August 3, 2010

The American College of Physicians (ACP) established its evidence-based clinical practice guidelines program in 1981. The ACP's Guidelines Committee and the staff of the Clinical Programs and Quality of Care Department develop the clinical recommendations. The ACP develops 2 different types of clinical recommendations: clinical practice guidelines and clinical guidance statements.

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Journal Articles

Comparative Effectiveness of Recombinant Factor VIIa for Off-label Indications Versus Usual Care

V Yank, V Tuohy, AC Logan, Dena M. Bravata, K Staudenmayer, Vandana Sundaram, D McMahon, CD Stave, JL Zehnder, I Olkin, Kathryn M. McDonald, Douglas K. Owens, Randall Stafford Randall Stafford
Comparative Effectiveness, 2010 May 1, 2010

This report evaluates the level of evidence currently available to support the effectiveness and safety of using recombinant activated coagulation factor VII (rFVIIa) for clinical indications not approved by the U. S. Food and Drug Administration (FDA). rFVIIa is approved for a variety of uses in hemophilia patients who have developed antibody inhibitors that compromise the use of standard factor replacement. Use of this costly biologic product has expanded beyond these hemophilia-related indications to encompass a range of off-label uses, most of which are in-hospital uses.

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Journal Articles

Cost-Effectiveness of Strategies to Improve HIV Testing and Receipt of Results: Economic Analysis of a Randomized Controlled Trial.

Gillian D. Sanders, Anaya HD, Asch S, Hoang T, Golden JF, Bayoumi AM, Douglas Owens
Journal of General Internal Medicine, 2010 March 4, 2010

BACKGROUND: The CDC recommends routine voluntary HIV testing of all patients 13-64 years of age. Despite this recommendation, HIV testing rates are low even among those at identifiable risk, and many patients do not return to receive their results. OBJECTIVE: To examine the costs and benefits of strategies to improve HIV testing and receipt of results. DESIGN: Cost-effectiveness analysis based on a Markov model. Acceptance of testing, return rates, and related costs were derived from a randomized trial of 251 patients; long-term costs and health outcomes were derived from the literature.

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Journal Articles

Desalination of the American Diet: Population Strategies to Decrease Sodium Intake and the Burden of Cardiovascular Disease

Crystal Smith-Spangler, Jessie L. Juusola, Eva A. Enns, Douglas Owens, Alan Garber
Annals of Internal Medicine, 2010 March 1, 2010

Background: Sodium consumption raises blood pressure, increasing the risk for heart attack and stroke. Several countries, including the United States, are considering strategies to decrease population sodium intake.

Objective: To assess the cost-effectiveness of 2 population strategies to reduce sodium intake: government collaboration with food manufacturers to voluntarily cut sodium in processed foods, modeled on the United Kingdom experience, and a sodium tax.

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Journal Articles

Population Strategies to Decrease Sodium Intake and the Burden of Cardiovascular Disease: A Cost-Effectiveness Analysis

Crystal Smith-Spangler, Juusola JL, Enns EA, Douglas Owens, Alan Garber
Annals of Internal Medicine, 2010 March 1, 2010

Background: Sodium consumption raises blood pressure, increasing the risk for heart attack and stroke. Several countries, including the United States, are considering strategies to decrease population sodium intake.

Objective: To assess the cost-effectiveness of 2 population strategies to reduce sodium intake: government collaboration with food manufacturers to voluntarily cut sodium in processed foods, modeled on the United Kingdom experience, and a sodium tax.

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