How do diabetes models measure up? A review of diabetes economic models and ADA guidelines

Introduction: Economic models and computer simulation models have been used for assessing short-term cost-effectiveness of interventions and modelling long-term outcomes and costs. Several guidelines and checklists have been published to improve the methods and reporting. This article presents an overview of published diabetes models with a focus on how well the models are described in relation to the considerations described by the American Diabetes Association (ADA) guidelines. Methods: Relevant electronic databases and National Institute for Health and Care Excellence (NICE) guidelines were searched in December 2012. Studies were included in the review if they estimated lifetime outcomes for patients with type 1 or type 2 diabetes. Only unique models, and only the original papers were included in the review. If additional information was reported in subsequent or paired articles, then additional citations were included. References and forward citations of relevant articles, including the previous systematic reviews were searched using a similar method to pearl growing. Four principal areas were included in the ADA guidance reporting for models: transparency, validation, uncertainty, and diabetes specific criteria. Results: A total 19 models were included. Twelve models investigated type 2 diabetes, two developed type 1 models, two created separate models for type 1 and type 2, and three developed joint type 1 and type 2 models. Most models were developed in the United States, United Kingdom, Europe or Canada. Later models use data or methods from earlier models for development or validation. There are four main types of models: Markov-based cohort, Markov-based microsimulations, discrete-time microsimulations, and continuous time differential equations. All models were long-term diabetes models incorporating a wide range of compilations from various organ systems. In early diabetes modelling, before the ADA guidelines were published, most models did not include descriptions of all the diabetes specific components of the ADA guidelines but this improved significantly by 2004. Conclusion: A clear, descriptive short summary of the model was often lacking. Descriptions of model validation and uncertainty were the most poorly reported of the four main areas, but there exist conferences focussing specifically on the issue of validation. Interdependence between the complications was the least well incorporated or reported of the diabetes-specific criterion

Doctor of Philosophy

dissertationAsymmetries in movement and muscle function are ubiquitous and long lasting in those who survive after hip fracture. Enduring asymmetries in lower limb muscle function (i.e., strength and power) have been associated with fall frequency and impaired physical mobility among older adults. Lower limb discrepancies in vertical ground reaction forces (vGRFs) are evident during performance of mobility tasks, including ambulation and transfers from a seated to a standing position. Movement asymmetry during a sit-to-stand task (STST) made a small, independent contribution (r2 = 7%) to stair climb test performance when coupled with gait speed (r2 = 41%), balance confidence (r2 = 4%), and self-reported function (r2 = 4%); while STST asymmetry did not independently predict modified physical performance test score. To date, there is no specific rehabilitation strategy to restore movement pattern and muscle function symmetry after hip fracture. Thus, the potential impact of specific strategies to improve symmetry in vGRF variables during STST performance, and muscle function after hip fracture is unclear. We examined the feasibility and beneficence of High Intensity Task-Oriented strategies designed to improve Strength and Symmetry (HI-TOSS). We determined that asymmetries in strength, power, and vGRFs evident during STST, were each significantly reduced (i.e., improved) with training. Finally, improvements in muscle quality and its components with training after hip fracture have not been tested. We identify the surgical limb to be 10%-15% lower in muscle mass and muscle quality compared to the nonsurgical limb after discharge from usual care. Following HI-TOSS, muscle mass in the surgical limb improved by 9%, muscle strength improved by 21%, and muscle quality improved by 14%. Expectedly, physical performance improved significantly with training (~20% improvement); exceeding established clinically meaningful difference values. In summary, specific strategies to reduce asymmetries in movement and improve muscle function are well-tolerated in community-dwelling older adults after hip fracture and can yield improvements in STST and muscle function symmetry. Substantial improvements in STST performance, muscle function, muscle composition, and physical function are expected with HI-TOSS. Further studies should determine long-term effects and optimal HI-TOSS implementation practices in a restorative effort to enhance recovery after hip fracture

The Role of Public Utilities

The regulation of public utilities in Maine continues to evolve in response to changing economic, political and social forces. Not only has the structure of regulation of the electrical and telecommunications industry seen dramatic changes in the past 20 years, but it also is certain the next decade will see equally fundamental changes. Maine Policy Review invited three key participants in Maine\u27s regulatory arena to interpret the changes of the past two decades and what future changes we can expect. This article provides the perspectives of Robert Briggs of Bangor Hydro-Electric

Craig Santos Perez: Poetry as Strategy Against Military Occupation in Guåhan (Guam)

This thesis is interested in hearing the voices seldom heard. It looks at the poetry of Craig Santos Perez, a native Chamorro from Guam, in an attempt to begin puzzling out the idea of transformation in Guam and the military\u27s complicity in the process. While erasure seems to be trending and emerging as a term that would, on the surface, adequately bring attention to the loss of culture, land, and language in Guam, it has the tendency to overshadow and ignore the varying degrees that Guam has changed in the presence of military rule. Other forms of transformation include, but are not limited to, silencing, damaging, displacement, oppression, repurposing, appropriation, hybridization, recruitment, and assimilation. All of these, to some degree, are represented in Perez\u27s poetry. A hybrid project that includes a creative nonfiction introduction and an interview with the poet, this thesis examines the diverse forms of transformation through a close look at Perez\u27s three books of his multi-book project. Perez\u27s poetry creates focus and familiarity for readers. In other words, it emplaces Guam, an unfamiliar militarized space for most readers, and creates a personal connection to the vernacular spiritual place of Guam that is Chamorro culture. Also, I will show how focus and familiarity present in Perez\u27s work result in shifted environmental commitments, especially as they relate to the consequences of military occupation. In doing so, I will posit the poetry into the current environmental justice discussion that exists among literary scholars and eco-philosophers like Rob Nixon and Ursula Heise, who have successfully demonstrated the important role the imagination plays in understanding, responding to, and doing something about anthropogenically driven environmental change