Bridging Patient Outcome Gap for Type 2 Diabetes : Can We Bridge Physician Practices to Produce Results Achieved in Evidence-Based Lifestyle Intervention Research?

The United States is abounding in the prevalence and incidence of avoidable chronic diseases, and high among these diseases is type 2 diabetes. Further, according to the National Institute of Health (NIH) Common Fund, 40% of harmful health behaviors is what contributes to chronic diseases, such as type 2 diabetes. NIH noted there are few personalized, effective ways to inspire people to change their behaviors in the shortterm, but if done, this behavior is not sustained long-term (The NIH Common Fund, 2011). Yet, this research discovered a Diabetes Prevention Program (DPP) is one of these few personalized, effective interventions that has not become widespread in application. The DPP has over 10 years of effectively demonstrating an impact on diabetes by these outcomes: 1) decrease in the incidence of diabetes, 2) decrease in the costs of diabetes, 3) decrease in death rates of diabetes, 4) absence of differences across ethnic groups, and 5) sustainability over ten years with lifestyle intervention significantly having the greatest impact. Hence this research sought to explore why DPP has not found its way into the practice of treating and preventing diabetes. The over arching research question was: Can we bridge physician practices to produce results achieved in evidence-based lifestyle intervention research? Primary research was conducted with physicians treating diabetic and pre-diabetic patients in Connecticut, New Jersey, New York and Pennsylvania using both quantitative and qualitative methods to pursue this inquiry. Research findings revealed unfamiliarity with DPP, barriers to implementing DPP in real world practices, yet an overwhelming interest in DPP, particularly because of the nutrition-based lifestyle component. Consequently, nutrition educators and counselors have an opportunity to emerge as change agents in translating DPP evidence into practice with the goal of bridging the patient outcome gap for type 2 diabetes. The best opportunity is addressing barriers and limitations identified in this research

Safety and efficacy of the ChAdOx1 nCoV-19 vaccine (AZD1222) against SARS-CoV-2: an interim analysis of four randomised controlled trials in Brazil, South Africa, and the UK.

BACKGROUND: A safe and efficacious vaccine against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), if deployed with high coverage, could contribute to the control of the COVID-19 pandemic. We evaluated the safety and efficacy of the ChAdOx1 nCoV-19 vaccine in a pooled interim analysis of four trials. METHODS: This analysis includes data from four ongoing blinded, randomised, controlled trials done across the UK, Brazil, and South Africa. Participants aged 18 years and older were randomly assigned (1:1) to ChAdOx1 nCoV-19 vaccine or control (meningococcal group A, C, W, and Y conjugate vaccine or saline). Participants in the ChAdOx1 nCoV-19 group received two doses containing 5 × 1010 viral particles (standard dose; SD/SD cohort); a subset in the UK trial received a half dose as their first dose (low dose) and a standard dose as their second dose (LD/SD cohort). The primary efficacy analysis included symptomatic COVID-19 in seronegative participants with a nucleic acid amplification test-positive swab more than 14 days after a second dose of vaccine. Participants were analysed according to treatment received, with data cutoff on Nov 4, 2020. Vaccine efficacy was calculated as 1 - relative risk derived from a robust Poisson regression model adjusted for age. Studies are registered at ISRCTN89951424 and ClinicalTrials.gov, NCT04324606, NCT04400838, and NCT04444674. FINDINGS: Between April 23 and Nov 4, 2020, 23 848 participants were enrolled and 11 636 participants (7548 in the UK, 4088 in Brazil) were included in the interim primary efficacy analysis. In participants who received two standard doses, vaccine efficacy was 62·1% (95% CI 41·0-75·7; 27 [0·6%] of 4440 in the ChAdOx1 nCoV-19 group vs71 [1·6%] of 4455 in the control group) and in participants who received a low dose followed by a standard dose, efficacy was 90·0% (67·4-97·0; three [0·2%] of 1367 vs 30 [2·2%] of 1374; pinteraction=0·010). Overall vaccine efficacy across both groups was 70·4% (95·8% CI 54·8-80·6; 30 [0·5%] of 5807 vs 101 [1·7%] of 5829). From 21 days after the first dose, there were ten cases hospitalised for COVID-19, all in the control arm; two were classified as severe COVID-19, including one death. There were 74 341 person-months of safety follow-up (median 3·4 months, IQR 1·3-4·8): 175 severe adverse events occurred in 168 participants, 84 events in the ChAdOx1 nCoV-19 group and 91 in the control group. Three events were classified as possibly related to a vaccine: one in the ChAdOx1 nCoV-19 group, one in the control group, and one in a participant who remains masked to group allocation. INTERPRETATION: ChAdOx1 nCoV-19 has an acceptable safety profile and has been found to be efficacious against symptomatic COVID-19 in this interim analysis of ongoing clinical trials. FUNDING: UK Research and Innovation, National Institutes for Health Research (NIHR), Coalition for Epidemic Preparedness Innovations, Bill & Melinda Gates Foundation, Lemann Foundation, Rede D'Or, Brava and Telles Foundation, NIHR Oxford Biomedical Research Centre, Thames Valley and South Midland's NIHR Clinical Research Network, and AstraZeneca

Safety and efficacy of the ChAdOx1 nCoV-19 vaccine (AZD1222) against SARS-CoV-2: an interim analysis of four randomised controlled trials in Brazil, South Africa, and the UK

Background A safe and efficacious vaccine against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), if deployed with high coverage, could contribute to the control of the COVID-19 pandemic. We evaluated the safety and efficacy of the ChAdOx1 nCoV-19 vaccine in a pooled interim analysis of four trials. Methods This analysis includes data from four ongoing blinded, randomised, controlled trials done across the UK, Brazil, and South Africa. Participants aged 18 years and older were randomly assigned (1:1) to ChAdOx1 nCoV-19 vaccine or control (meningococcal group A, C, W, and Y conjugate vaccine or saline). Participants in the ChAdOx1 nCoV-19 group received two doses containing 5 × 1010 viral particles (standard dose; SD/SD cohort); a subset in the UK trial received a half dose as their first dose (low dose) and a standard dose as their second dose (LD/SD cohort). The primary efficacy analysis included symptomatic COVID-19 in seronegative participants with a nucleic acid amplification test-positive swab more than 14 days after a second dose of vaccine. Participants were analysed according to treatment received, with data cutoff on Nov 4, 2020. Vaccine efficacy was calculated as 1 - relative risk derived from a robust Poisson regression model adjusted for age. Studies are registered at ISRCTN89951424 and ClinicalTrials.gov, NCT04324606, NCT04400838, and NCT04444674. Findings Between April 23 and Nov 4, 2020, 23 848 participants were enrolled and 11 636 participants (7548 in the UK, 4088 in Brazil) were included in the interim primary efficacy analysis. In participants who received two standard doses, vaccine efficacy was 62·1% (95% CI 41·0–75·7; 27 [0·6%] of 4440 in the ChAdOx1 nCoV-19 group vs71 [1·6%] of 4455 in the control group) and in participants who received a low dose followed by a standard dose, efficacy was 90·0% (67·4–97·0; three [0·2%] of 1367 vs 30 [2·2%] of 1374; pinteraction=0·010). Overall vaccine efficacy across both groups was 70·4% (95·8% CI 54·8–80·6; 30 [0·5%] of 5807 vs 101 [1·7%] of 5829). From 21 days after the first dose, there were ten cases hospitalised for COVID-19, all in the control arm; two were classified as severe COVID-19, including one death. There were 74 341 person-months of safety follow-up (median 3·4 months, IQR 1·3–4·8): 175 severe adverse events occurred in 168 participants, 84 events in the ChAdOx1 nCoV-19 group and 91 in the control group. Three events were classified as possibly related to a vaccine: one in the ChAdOx1 nCoV-19 group, one in the control group, and one in a participant who remains masked to group allocation. Interpretation ChAdOx1 nCoV-19 has an acceptable safety profile and has been found to be efficacious against symptomatic COVID-19 in this interim analysis of ongoing clinical trials

The Paris Declaration: Five reasons why it is working

In 2005, almost all DAC donor countries and over 60 developing countries endorsed the Paris Declaration, a comprehensive attempt to change the way donor and developing countries do business together. The declaration was based on five principles: alignment, ownership, harmonisation, managing for results and mutual accountability. This article looks at each of these principles in turn and explores how they are being applied for the better by donors and partner countries alike. It takes examples from across the globe – from the Pacific to Asia, sub-Saharan Africa and Latin America – to show that the Paris Declaration has significantly changed attitudes to development co-operation and relationships between donor and partner country. This has been achieved through generating fairer and more inclusive global development partnerships, introducing a monitoring system to track progress in achieving commitments and establishing the foundations for greater accountability.

Contributions of public infrastructure investment to economic growth: New estimates using ridge regression

The role of public expenditure has become a hotly debated topic. Initiated by David A. Aschauer, this debate is over the extent to which public expenditure increases private sector productivity growth. Aschauers\u27 evidence that public expenditure has a strong, positive impact on economic output and productivity generated a strong reaction in the research community and opinions vary widely. This research examines the initial work produced by Aschauer and others who either attempted to confirm or disprove his results, and offers new insight into the relationship between public investment, transportation and economic growth. This research will show with robust and stable estimates, that the relationship between economic output and public infrastructure is significantly positive, consistent throughout the country, and in some instances, appear to be affected by interaction with other factors. An additional finding not previously observed elsewhere is that under perfect competition and profit maximizing behavior of the firms and households, output is fully distributed back to three factors, private capital, labor and government, when there are constant returns to scale. This research will also show that all components of public capital stock, particularly transportation are complementary to both private capital and labor. Finally, this research has empirically tested the level at which investment in public infrastructure is optimal. The methods employed during this research include the use of a ridge regression estimator (RR) rather than the ordinary least squares estimator (OLS) and other direct measures of public infrastructure as alternative estimation variables. Interaction variables were also used to evaluate the importance of factors which might enhance the impact of public infrastructure investments on economic growth

Revista Integración & Comercio: Año 17: No. 36: Enero-junio, 2013

Este número aborda el tópico de la Cooperación Sur-Sur (CSS) y demuestra que es más que ¿mucho ruido y pocas nueces¿. La CSS se presenta como algo muy tangible y más complejo de lo que parece, reflejando nuevos mecanismos, nuevas maneras de pensar y un constante realineamiento económico. Se incluyen contribuciones sobre los siguientes temas: el papel de las instituciones en la provision de bienes públicos y sus implicaciones para el desarrollo sustentable, la CSS y su creciente contribución al diálogo internacional; la relevancia e implicaciones de la CSS entre ALC, China, Japón y Corea; el papel de las organizaciones de la sociedad civil (OSC) en la definición, ejecución y evaluación de las intervenciones de CSS en la región; comparaciones entre proveedores de CSS y donantes tradicionales, con énfasis en el sector privado; así como estudios de caso.