Where can obesity management policy make the largest impact? Evaluating sub-populations through a microsimulation approach

Background: There is a critical need to focus limited resources on sub-groups of patients with obesity where we expect the largest return on investment. This paper identifies patient sub-groups where an investment may result in larger positive economic and health outcomes.

Methods: The baseline population with obesity was derived from a public survey database and divided into sub-populations defined by demographics and disease status. In 2016, a validated model was used to simulate the incidence of diabetes, absenteeism, and direct medical cost in five care settings. Research findings were derived from the difference in population outcomes with and without weight loss over 15 years. Modeled weight loss scenarios included initial 5% or 12% reduction in body mass index followed by a gradual weight regain. Additional simulations were conducted to show alternative outcomes from different time courses and maintenance scenarios.

Results: Univariate analyses showed that age 45–64, pre-diabetes, female, or obesity class III are independently predictive of larger savings. After considering the correlation between these factors, multivariate analyses projected young females with obesity class I as the optimal sub-group to control obesity-related medical expenditures. In contrast, the population aged 20–35 with obesity class III will yield the best health outcomes. Also, the sub-group aged 45–54 with obesity class I will produce the biggest productivity improvement. Each additional year of weight loss maintained showed increased financial benefits.

Conclusions: This paper studied the heterogeneity between many sub-populations affected by obesity and recommended different priorities for decision-makers in economic, productivity, and health realms.     

Costs of providing infusion therapy for patients with inflammatory bowel disease in a hospital-based infusion center setting

Aims: Inflammatory bowel disease (IBD) (e.g. ulcerative colitis [UC] and Crohn’s disease [CD]) severely impacts patient quality-of-life. Moderate-to-severe disease is often treated with biologics requiring infusion therapy, adding incremental costs beyond drug costs. This study evaluates US hospital-based infusion services costs for treatment of UC or CD patients receiving infliximab or vedolizumab therapy.

Materials and methods: A model was developed, estimating annual costs of providing monitored infusions using an activity-based costing framework approach. Multiple sources (published literature, treatment product inserts) informed base-case model input estimates.

Results: The total modeled per patient infusion therapy costs in Year 1 with infliximab and vedolizumab was $38,782 and $41,320, respectively, and Year 2+, $49,897 and $36,197, respectively. Drug acquisition cost was the largest total costs driver (90–93%), followed by costs associated with hospital-based infusion provision: labor (53–56%, non-drug costs), allocated overhead (23%, non-drug costs), non-labor (23%, non-drug costs), and laboratory (7–10%, non-drug costs).

Limitations: Limitations included reliance on published estimates, base-case cost estimates infusion drug, and supplies, not accounting for volume pricing, assumption of a small hospital infusion center, and that, given the model adopts the hospital perspective, costs to the patient were not included in infusion administration cost base-case estimates.

Conclusions: This model is an early step towards a framework to fully analyze infusion therapies’ associated costs. Given the lack of published data, it would be beneficial for hospital administrators to assess total costs and trade-offs with alternative means of providing biologic therapies. This analysis highlights the value to hospital administrators of assessing cost associated with infusion patient mix to make more informed resource allocation decisions. As the landscape for reimbursement changes, tools for evaluating the costs of infusion therapy may help hospital administrators make informed choices and weigh trade-offs associated with providing infusion services for IBD patients.     

(Finding) Pathways out of homelessness: An engaged,trans-disciplinary collaborative in the City of Tshwane

ABSTRACT

Street homelessness in the City of Tshwane was brought to public attention in the winter of 2014. This led to a composite research project involving different constituencies, including homeless people, to reflect on ways of addressing street homelessness in the city. This article serves as a conceptual and epistemological introduction to this collaborative research project entitled Pathways Out of Homelessness. The article argues for the use of a broad working definition of street homelessness that allows for complexities of homelessness to emerge, in order to discern diverse and appropriate alternatives.     

知识创造场的动力机制与管理模式研究

知识创造的动力不仅存在于个人,而且存在于人与人以及人与环境相互作用的场中。从点、线、面3个层次剖析知识创造的场动力,并根据动力机制,进一步探讨知识创造场的管理模式,旨在为知识创新管理提供指导。     

The origins of the concept of ‘foresight’ in science and technology: An insider's perspective

This article explores how the term ‘foresight’ originally came to be used in connection with science and technology by the author and SPRU colleagues in 1983. It analyses how the rationale for its use evolved over time, first providing a ‘catchy’ title for a study (‘Project Foresight’), and then a convenient shorthand for the focus of that study, before eventually coming to formally signify a new approach to looking systematically into the future of science and technology, an inclusive and wide-ranging process that differed appreciably from that of traditional ‘technology forecasting’. The paper reflects on the importance of concepts and terminology in the field of science policy research, providing examples of how an inappropriate term or phrase can damn the prospects of the research having an impact on policy, while a more politically astute use of terminology can greatly enhance the probability of making a significant impact. The paper also examines other early uses of the concept of ‘foresight’ in the United States and Canada at about the same time. In addition, it highlights the conceptual similarities between foresight and la prospective, a novel approach developed in France not just for looking into the future but also for shaping or even ‘constructing’ the future of our choice, an ambitious aspiration that it shares with foresight. This case-study on the origins and early evolution of ‘technology foresight’ illustrates the essential importance of terminology in differentiating key concepts in social sciences (where it sometimes gives rise to unfortunate priority disputes), and particularly in the case of policy research.     

另类法律文化研究中的爱悦与规训——读《爱悦与规训：中国现代性中同性欲望的法理想象》

《爱悦与规训：中国现代性中同性欲望的法理想象》一书开拓了或者说“显化”了一种新的法学作品的写作模式,运用文化研究的进路,检视中国语境下同性恋身份的法律建构,动摇了异性恋正统制的霸权地位。作者对同性婚姻的论证却也在一定程度上揭示了批判性“文化研究”进路在法学领域里的限度。     

H指数作为科研评价的应用和局限性分析

H指数是美国物理学家乔治.赫什提出的一种旨在衡量科学家个人科研成就的指标。它作为一种科研评价的新指标,在很多领域得到了广泛应用。该文分析了H指数的特征,探讨了H指数在科研评价中的应用情况及其局限性。     

近五年国内外语自主学习实证研究成果评述

近5年来,国内外语自主学习领域的实证研究呈现出研究内容涉及面广、借助的研究手段日益丰富等特点,取得了显著成绩,但也有不足之处,应完善研究工具的设计、延长实验研究时间的跨度以及拓宽研究的学习者范围等。     

大学生创造力开发与发明创造实践研究

高校目前开发大学生创造力主要从创造发明教育、创造品格培养和创造性思维训练三方面进行。实践证明,适合大学生参加的发明创造类实践活动主要是发明创造大赛、创意大赛、创造创新成果展示以及创意园区和创意工作坊实践。     

高等职业院校体育教学模式的实验研究

目前高职院校体育教学与学生的培养目标和就业方向结合程度相对较低,这在一定程度上影响了高职院校的人才培养。根据高职院校培养“服务于生产第一线,具有较强的理论知识和专业技能人才”的目标,构建新的体育教学模式已经势在必行．通过对沈阳工程学院社区专业学生体育教学模式的实验研究,力求为高职体育教学改革提供新的视角,为建立具有高等职业院校特色的体育教学模式提供有价值的参考。