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

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