Basal Insulin Regimens for Adults with Type 1 Diabetes Mellitus : A Cost-Utility Analysis

Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.OBJECTIVES: To assess the cost-effectiveness of basal insulin regimens for adults with type 1 diabetes mellitus in England. METHODS: A cost-utility analysis was conducted in accordance with the National Institute for Health and Care Excellence reference case. The UK National Health Service and personal and social services perspective was used and a 3.5% discount rate was applied for both costs and outcomes. Relative effectiveness estimates were based on a systematic review of published trials and a Bayesian network meta-analysis. The IMS CORE Diabetes Model was used, in which net monetary benefit (NMB) was calculated using a threshold of £20,000 per quality-adjusted life-year (QALY) gained. A wide range of sensitivity analyses were conducted. RESULTS: Insulin detemir (twice daily) [iDet (bid)] had the highest mean QALY gain (11.09 QALYs) and NMB (£181,456) per patient over the model time horizon. Compared with the lowest cost strategy (insulin neutral protamine Hagedorn once daily), it had an incremental cost-effectiveness ratio of £7844/QALY gained. Insulin glargine (od) [iGlarg (od)] and iDet (od) were ranked as second and third, with NMBs of £180,893 and £180,423, respectively. iDet (bid) remained the most cost-effective treatment in all the sensitivity analyses performed except when high doses were assumed (>30% increment compared with other regimens), where iGlarg (od) ranked first. CONCLUSIONS: iDet (bid) is the most cost-effective regimen, providing the highest QALY gain and NMB. iGlarg (od) and iDet (od) are possible options for those for whom the iDet (bid) regimen is not acceptable or does not achieve required glycemic control.Peer reviewe

Pedigree reconstruction reveals large scale movement patterns and population dynamics of wolverines (Gulo gulo) across Fennoscandia

Dispersal is a biological imperative for many species, facilitating gene flow and influencing population dynamics. Modern landscapes are increasingly fragmented, leaving species that rely on dispersal trapped in ever shrinking areas. Measuring connectivity at the population level is difficult using traditional tracking methods, especially for species that are rare or cryptic, but important for both theoretical and applied questions relating to animal movement. Using genetic monitoring data collected from 2004 to 2018, SNP (single nucleotide polymorphism) genotyping was used to reconstruct pedigrees of wolverines from the whole of Sweden, Norway, and Finland. The resulting pedigree contained over 900 individuals, and six generations. These family triads were then used to identify patterns of natal dispersal for offspring, and breeding related movement between known mated pairs. The results reveal a metapopulation of several reproductive cores spread over three countries, with animals moving across borders in order to breed and disperse. Patterns of movement on this scale identify sources and sinks across the entire range, with little ambiguity due to sample size or study site. To achieve favourable conservation status, management scales should reflect the scales at which populations function

Phosphorus Responses to Soil Moisture in Southern Ontario Agricultural Soil

Agricultural landscapes are known to increase phosphorus (P) losses to waterways, contributing to the eutrophication of freshwater surface water bodies. In cold agricultural regions, the nongrowing season drives annual P transport and discharge. Previous research has focused on discharge from fields and watersheds to understand P dynamics in response to hydroclimatic events such as snowmelt and rain storms. Although P supply in soils has been considered a dominant mechanism driving P runoff, the dynamic nature of this supply on an annual basis in response to climate drivers is poorly understood. The goal of this thesis is to determine climatic (seasonal, moisture and temperature) controls on the supply of soluble P in agricultural soils. Two experiments were set up: one in a field setting and the other in a lab setting. The field study involved a snow-manipulation experiment in an agricultural field, in which soil P pools and net transformation rates were quantified under snow and limited-snow conditions. The lab experiment explored the impacts of frost severity, frost duration, frost cycle number and moisture addition on soil concentrations of water-extractable soluble reactive P (SRP), total dissolved P (TDP) and Olsen P, microbial biomass P, aggregate stability, and concentrations of SRP, TDP and TP (total phosphorus) in leachate draining from cores. In both studies, frost magnitude did not significantly impact soil P fractions or supply. Although soil water extractable P (WEP) was greater during the non-growing season than summer, this was not impacted by increased frost due to the removal of snow cover. The lab study also showed that frost magnitude did not impact P supply; however, both frost duration and moisture additions appeared to affect P supply. Water extractable P was positively related to moisture content in both experiments. An improved understanding of climate drivers on P cycling is needed in light of climate change. This thesis suggests that the supply of P may be impacted by a changing climate, but more due to moisture shifts rather than temperature

Refugees are a valuable but overlooked economic resource, and it is time to update our approach to migration

The view that welcoming refugees represents a cost to a country's welfare services has become anachronistic; nowadays refugees are increasingly recognised for their high levels of education and skills, and their ability to make an economic contribution to a host country. Yet, most states' approach to migration management prevents displaced people from migrating based on the human capital that they can supply. Australia is trialling a new approach that enables refugees to access skilled migration through employer sponsorship. This article describes the pilot project and suggests ways to encourage employers to view refugees as a valuable solution to workforce shortages

Phase 1 – Community Forums Deaf ACCESS: Adapting Consent Through Community Engagement and State-Of-The-Art Simulation [English and Spanish versions]

A Spanish translation of this publication is available to download under Additional Files. In 2016, the University of Massachusetts Medical School (UMMS), in partnership with Brown University, was awarded a 2-year grant from the National Institute on Deafness and Other Communication Disorders (NIDCD) to improve Deaf people’s trust and involvement in biomedical research. The Deaf ACCESS: Adapting Consent through Community Engagement and State-of-the-art Simulation research team is led by Melissa Anderson from UMMS and Co-Investigator Timothy Riker from Brown University. The study team also includes four Deaf Community Advisors. Because the research team includes five Deaf members, American Sign Language is the primary language used while working together. The first research brief for the Deaf ACCESS project at UMass Medical School related to Phase 1: Community Forums is available in ASL