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Managing population health requires meeting individual care needs while striving for increased efficiency and quality of care. Predictive models can integrate diverse data to provide objective assessment of individual prospective risk to identify individuals requiring more intensive health management in the present. The purpose of this research was to develop and test a predictive modeling approach, Multidimensional Adaptive Prediction Process (MAPP). MAPP is predicated on dividing the population into cost cohorts and then utilizing a collection of models and covariates to optimize future cost prediction for individuals in each cohort. MAPP was tested on 3 years of administrative health care claims starting in 2009 for health plan members (average n=25,143) with evidence of coronary heart disease. A 'status quo' reference modeling methodology applied to the total annual population was established for comparative purposes. Results showed that members identified by MAPP contributed $7.9 million and $9.7 million more in 2011 health care costs than the reference model for cohorts increasing in cost or remaining high cost, respectively. Across all cohorts, the additional accurate cost capture of MAPP translated to an annual difference of $1882 per member, a 21% improvement, relative to the reference model. The results demonstrate that improved future cost prediction is achievable using a novel adaptive multiple model approach. Through accurate prospective identification of individuals whose costs are expected to increase, MAPP can help health care entities achieve efficient resource allocation while improving care quality for emergent need individuals who are intermixed among a diverse set of health care consumers. ( Population Health Management 2015;18:290-299) [ABSTRACT FROM AUTHOR]

Background: To evaluate the longitudinal value of a chronic disease management program, My Health Guardian (MHG), in reducing hospital utilization and costs over 4 years. Methods: The MHG program provides individualized support via telephonic nurse outreach and online tools for self-management, behavior change and well-being. In follow up to an initial 18-month analysis of MHG, the current study evaluated program impact over 4 years. A matched-cohort analysis retrospectively compared MHG participants with heart disease or diabetes (treatment, N = 4,948) to non-participants (comparison, N = 28,520) on utilization rates (hospital admission, readmission, total bed days) and hospital claims cost savings. Outcomes were evaluated using regression analyses, controlling for remaining demographic, disease, and pre-program admissions or cost differences between the study groups. Results: Over the 4 year period, program participation resulted in significant reductions in hospital admissions (-11.4%, P < 0.0001), readmissions (-36.7%, P < 0.0001), and bed days (-17.2%, P < 0.0001). The effect size increased over time for admissions and bed days. The relative odds of any admission and readmission over the 4 years were 27% and 45% lower, respectively, in the treatment group. Cumulative program savings from reduced hospital claims was $3,549 over 4-years; savings values for each program year were significant and increased with time (P = 0.003 to P < 0.0001). Savings calculations did not adjust for pooled costs (and savings) in Australia's risk equalization system for private insurers. Conclusions: Results confirm and extend prior program outcomes and support the longitudinal value of the MHG program in reducing hospital utilization and costs for individuals with heart disease or diabetes and demonstrate the increasing program effect with continued participation over time. [ABSTRACT FROM AUTHOR]

Building upon extensive research from 2 validated well-being instruments, the objective of this research was to develop and validate a comprehensive and actionable well-being instrument that informs and facilitates improvement of well-being for individuals, communities, and nations. The goals of the measure were comprehensiveness, validity and reliability, significant relationships with health and performance outcomes, and diagnostic capability for intervention. For measure development and validation, questions from the Well-being Assessment and Wellbeing Finder were simultaneously administered as a test item pool to over 13,000 individuals across 3 independent samples. Exploratory factor analysis was conducted on a random selection from the first sample and confirmed in the other samples. Further evidence of validity was established through correlations to the established well-being scores from the Well-Being Assessment and Wellbeing Finder, and individual outcomes capturing health care utilization and productivity. Results showed the Well-Being 5 score comprehensively captures the known constructs within well-being, demonstrates good reliability and validity, significantly relates to health and performance outcomes, is diagnostic and informative for intervention, and can track and compare well-being over time and across groups. With this tool, well-being deficiencies within a population can be effectively identified, prioritized, and addressed, yielding the potential for substantial improvements to the health status, performance, and quality of life for individuals and cost savings for stakeholders. ( Population Health Management 2014;17:357-365) [ABSTRACT FROM AUTHOR]

The traditional view of the Pliocene is one of an epoch with higher than present global mean annual temperatures (∼2 to 3 °C) and stable climate conditions. Published data-model comparisons for the mid-Pliocene Warm Period (mPWP: ∼3.3 to 3 million years ago) have identified specific regions of concordance and discord between climate model outputs and marine/terrestrial proxy data. Due to the time averaged nature of global palaeoenvironmental syntheses, it has been hypothesised that climate variability during interglacial events within the mPWP could contribute to site-specific data/model disagreement. The Hadley Centre Coupled Climate Model Version 3 (HadCM3) is used to assess the nature of climate variability around two interglacial events within the mPWP that have different characteristics of orbital forcing (Marine Isotope Stages KM5c and K1). Model results indicate that ±20 kyr on either side of the MIS KM5c, orbital forcing produced a less than 1 °C change in global mean annual temperatures. Regionally, mean annual surface air temperature (SAT) variability can reach 2 to 3 °C. Seasonal variations exceed those predicted for the annual mean and can locally exceed 5 °C. Simulations 20 kyr on either side of MIS K1 show considerably increased variability in relation to KM5c. We demonstrate that orbitally-forced changes in surface air temperature during interglacial events within the mPWP can be substantial, and could therefore contribute to data/model discord. This is especially likely if proxies preserve growing season rather than mean annual temperatures. Model results indicate that peak MIS KM5c and K1 interglacial temperatures were not globally synchronous, highlighting leads and lags in temperature in different regions. This highlights the potential pitfalls in aligning peaks in proxy-derived temperatures across geographically diverse data sites, and indicates that a single climate model simulation for an interglacial event is inadequate to capture peak temperature change in all regions. We conclude that the premise of sustained global warmth and stable Pliocene climate conditions is incomplete. We also contend that the likely nature of Pliocene interglacial climate variability is more akin to interglacial events within the Quaternary, where the character of interglacials is known to be diverse. In the future, the utility of Pliocene data/model comparisons is dependent upon 1) establishing precise chronology of the proxy data, 2) providing climate models with fully proxy-consistent boundary conditions and 3) in utilising ensembles of climate simulations that can adequately capture orbital variability around any studied interval. [ABSTRACT FROM AUTHOR]

Magnetic resonance imaging (MRI) offers the opportunity to study biological tissues and processes in a non-disruptive manner. The technique shows promise for the study of the load-bearing performance (consolidation) of articular cartilage and changes in articular cartilage accompanying osteoarthritis. Consolidation of articular cartilage involves the recording of two transient characteristics: the change over time of strain and the hydrostatic excess pore pressure (HEPP). MRI study of cartilage consolidation under mechanical load is limited by difficulties in measuring the HEPP in the presence of the strong magnetic fields associated with the MRI technique. Here we describe the use of MRI to image and characterize bovine articular cartilage deforming under load in an MRI compatible consolidometer while monitoring pressure with a Fabry-Perot Interferometer-based fiber-optic pressure transducer. [ABSTRACT FROM AUTHOR]

Employers struggle with the high cost of health care, lost productivity, and turnover in their workforce. The present study aims to understand the association between overall well-being and these employer outcomes. In a sample of 11,700 employees who took the Well-being Assessment, the authors used multivariate linear and logistic regression to investigate overall well-being as a predictor of health care outcomes (total health care expenditure, emergency room visits, hospitalizations), productivity outcomes (unscheduled absence, short-term disability leave, presenteeism, job performance ratings), and retention outcomes (intention to stay, voluntary turnover, involuntary turnover). Testing this hypothesis both cross-sectionally and longitudinally, the authors investigated the association between baseline well-being and these outcomes in the following year, and the relationship between change in overall well-being and change in these outcomes over 1 year. The results demonstrated that baseline overall well-being was a significant predictor of all outcomes in the following year when holding baseline employee characteristics constant. Change in overall well-being over 1 year also was significantly associated with the change in employer outcomes, with the exception that the relationship to change in manager-rated job performance was marginally significant. The relationships between overall well-being and outcomes suggest that implementing a well-being improvement solution could have a significant bottom and top line impact on business performance. ( Population Health Management 2013;16:397-405) [ABSTRACT FROM AUTHOR]

Chronic disease management programs (CDMPs) were introduced in Australia to reduce unnecessary health care utilization by the growing population with chronic conditions; however, evidence of effectiveness is needed. This study evaluated the impact of a comprehensive CDMP, My Health Guardian (MHG), on rate of hospital admissions, readmissions, and average length of hospital stay (ALOS) for insured individuals with heart disease or diabetes. Primary outcomes were assessed through retrospective comparison of members in MHG (treatment; n=5053) to similar nonparticipating members (comparison; n=23,077) using a difference-in-differences approach with the year before program commencement serving as baseline and the subsequent 12 or 18 months serving as the program periods. All outcomes were evaluated for the total study population and for disease-matched subgroups (heart disease and diabetes). Statistical tests were performed using multivariate regression controlling for age, sex, number of chronic diseases, and past hospitalization status. After both 12 and 18 months, treatment members displayed decreases in admissions (both, P≤0.001) and readmissions (both, P≤0.01), and ALOS after 18 months ( P≤0.01) versus the comparison group; magnitude of impact increased over time for these 3 measures. All outcomes for both disease-matched subgroups directionally mirrored the total study group, but the diabetes subgroup did not achieve significance for readmissions or ALOS. Within the treatment group, admissions decreased with increasing care calls to members (12 and 18 months, P<0.0001). These results show that MHG successfully reduced the frequency and duration of hospital admissions and presents a promising approach to reduce the burden associated with hospitalizations in populations with chronic disease. ( Population Health Management 2013;16:125-131) [ABSTRACT FROM AUTHOR]

Adverse health and productivity outcomes have imposed a considerable economic burden on employers. To facilitate optimal worksite intervention designs tailored to differing employee risk levels, the authors established cutoff points for an Individual Well-Being Score (IWBS) based on a global measure of well-being. Cross-sectional associations between IWBS and adverse health and productivity outcomes, including high health care cost, emergency room visits, short-term disability days, absenteeism, presenteeism, low job performance ratings, and low intentions to stay with the employer, were studied in a sample of 11,702 employees from a large employer. Receiver operating characteristics curves were evaluated to detect a single optimal cutoff value of IWBS for predicting 2 or more adverse outcomes. More granular segmentation was achieved by computing relative risks of each adverse outcome from logistic regressions accounting for sociodemographic characteristics. Results showed strong and significant nonlinear associations between IWBS and health and productivity outcomes. An IWBS of 75 was found to be the optimal single cutoff point to discriminate 2 or more adverse outcomes. Logistic regression models found abrupt reductions of relative risk also clustered at IWBS cutoffs of 53, 66, and 88, in addition to 75, which segmented employees into high, high-medium, medium, low-medium, and low risk groups. To determine validity and generalizability, cutoff values were applied in a smaller employee population ( N=1853) and confirmed significant differences between risk groups across health and productivity outcomes. The reported segmentation of IWBS into discrete cohorts based on risk of adverse health and productivity outcomes should facilitate well-being comparisons and worksite interventions. ( Population Health Management 2013;16:90-98) [ABSTRACT FROM AUTHOR]

Evaluation of chronic care management (CCM) programs is necessary to determine the behavioral, clinical, and financial value of the programs. Financial outcomes of members who are exposed to interventions (treatment group) typically are compared to those not exposed (comparison group) in a quasi-experimental study design. However, because member assignment is not randomized, outcomes reported from these designs may be biased or inefficient if study groups are not comparable or balanced prior to analysis. Two matching techniques used to achieve balanced groups are Propensity Score Matching (PSM) and Coarsened Exact Matching (CEM). Unlike PSM, CEM has been shown to yield estimates of causal (program) effects that are lowest in variance and bias for any given sample size. The objective of this case study was to provide a comprehensive comparison of these 2 matching methods within an evaluation of a CCM program administered to a large health plan during a 2-year time period. Descriptive and statistical methods were used to assess the level of balance between comparison and treatment members pre matching. Compared with PSM, CEM retained more members, achieved better balance between matched members, and resulted in a statistically insignificant Wald test statistic for group aggregation. In terms of program performance, the results showed an overall higher medical cost savings among treatment members matched using CEM compared with those matched using PSM (-$25.57 versus -$19.78, respectively). Collectively, the results suggest CEM is a viable alternative, if not the most appropriate matching method, to apply when evaluating CCM program performance. ( Population Health Management 2013;16:35-45) [ABSTRACT FROM AUTHOR]

With the advent of quantum information, the violation of a Bell inequality is used to witness the absence of an eavesdropper in cryptographic scenarios such as key distribution and randomness expansion. One of the key assumptions of Bell's theorem is the existence of experimental "free will," meaning that measurement settings can be chosen at random and independently by each party. The relaxation of this assumption potentially shifts the balance of power towards an eavesdropper. We consider a no-signaling model with reduced "free will" and bound the adversary's capabilities in the task of randomness expansion. [ABSTRACT FROM AUTHOR]

Tailored behavior change programs have proven effective at decreasing health risk factors, but the impact of such programs on participant well-being has not been tested. This randomized trial evaluated the impact of tailored telephone coaching and Internet interventions on health risk behaviors and individual well-being. Exercise and stress management were the primary health risks of interest; improvements in other health risk behaviors were secondary outcomes. A sample of 3391 individuals who reported health risk in the areas of exercise and stress management were randomly assigned to 3 groups: telephonic coaching that applied Transtheoretical Model (TTM) tailoring for exercise and minimal tailoring (stage of change) for stress management; an Internet program that applied TTM tailoring for stress management and minimal tailoring for exercise; or a control group that received an assessment only. Participants were administered the Well-Being Assessment and, at baseline, had relatively low well-being scores (mean, 60.9 out of 100 across all groups). At 6 months, a significantly higher percentage of both treatment groups progressed to the Action stage for exercise, stress management, healthy diet, and total number of health risks, compared to the control group. Both treatment groups also demonstrated significantly greater improvements on overall well-being and the domains of emotional health, physical health, life evaluation, and healthy behaviors. There were no differences between the groups for 2 well-being domains: basic access to needs and work environment. These results indicate that scalable, tailored behavior change programs can effectively reduce health risk and accrue to improved well-being for participants. ( Population Health Management 2012;15:276-286) [ABSTRACT FROM AUTHOR]

Citation information: Verkicharla PK, Mathur A, Mallen EAH, Pope JM & Atchison DA. Eye shape and retinal shape, and their relation to peripheral refraction. Ophthalmic Physiol Opt 2012, 32, 184-199. doi: 10.1111/j.1475-1313.2012.00906.x Abstract Purpose: We provide an account of the relationships between eye shape, retinal shape and peripheral refraction. Recent findings: We discuss how eye and retinal shapes may be described as conicoids, and we describe an axis and section reference system for determining shapes. Explanations are given of how patterns of retinal expansion during the development of myopia may contribute to changing patterns of peripheral refraction, and how pre-existing retinal shape might contribute to the development of myopia. Direct and indirect techniques for determining eye and retinal shape are described, and results are discussed. There is reasonable consistency in the literature of eye length increasing at a greater rate than height and width as the degree of myopia increases, so that eyes may be described as changing from oblate/spherical shapes to prolate shapes. However, one study indicates that the retina itself, while showing the same trend, remains oblate in shape for most eyes (discounting high myopia). Eye shape and retinal shape are not the same and merely describing an eye shape as being prolate or oblate is insufficient without some understanding of the parameters contributing to this; in myopia a prolate eye shape is likely to involve both a steepening retina near the posterior pole combined with a flattening (or a reduction in steepening compared with an emmetrope) away from the pole. Summary: In the recent literature, eye and/or retinal shape have often been inferred from peripheral refraction, and, to a lesser extent, vice versa. Because both the eye's optics and the retinal shape contribute to the peripheral refraction, and there is large variation in the latter, this inference should be made cautiously. Recently retinal shape has been measured independent of optical methods using magnetic resonance imaging. For further work on retinal shape, determining the validity of cheaper alternatives to magnetic resonance techniques is required. [ABSTRACT FROM AUTHOR]

Abstract: The Mangatini Stream drains a coal mining area in the mountains of northwestern South Island of New Zealand. Abundant rainfall on pyritic rocks yields acid mine drainage (AMD) to the stream, which flows through a steep gorge at discharges that rapidly increase from <1 to >100m3/s during frequent rain events. The AMD is treated with finely ground limestone, which is discharged as a slurry at a point in the middle of the gorge. The limestone slurry mixes and reacts with the AMD during flow ∼4km downstream over ∼12h. Neutralisation reactions increase stream pH from near 3 (untreated Mangatini Stream water impacted by AMD) to 5–6 in the first 250m downstream, although mixing is commonly incomplete in this zone. Large stream discharge volumes in rain events dilute the neutralising material input, thus driving the pH back towards 4 downstream of treatment. More complete neutralisation is achieved 4km downstream, even in major rain events, and pH can rise to >7. Partial neutralisation is sufficient to remove most of the dissolved Fe(III) (typically ∼30mg/L) from the Mangatini Stream in the first 10m, and remaining dissolved Fe is essentially all Fe(II), which decreases over time as it oxidises and precipitates. Dissolved Al in the Mangatini Stream (typically ∼50mg/L) decreases steadily downstream over ∼100m in the limestone mixing zone. Precipitated Fe and Al form amorphous oxyhydroxides that are transported as suspended solids and deposited on the stream bed with excess limestone in zones of low flow velocity. Dissolved Zn is removed from solution by adsorption to Fe oxyhydroxide when pH reaches ∼5, but dissolved Ni remains in solution despite the neutralisation process. Gypsum precipitation occurs throughout the limestone mixing zone, resulting in at least 30% decrease in dissolved . Minor ettringite forms in the first 100m, but then probably redissolves. The limestone dosing system is an effective method of neutralising the effects of AMD and removing most dissolved metals in a steep mountain stream with frequent rain events where this dynamic environment places many constraints on treatment options. [Copyright &y& Elsevier]

Abstract: The Stockton coal mine lies at 700–1100m above sea level in a mountainous orographic precipitation zone on the West Coast of the South Island of New Zealand. Rainfall exceeds 6000mm/year and arrives with frequent flood events that can deliver >200mm/day. Streams vary in discharges by up to two orders of magnitude over a time scale of hours. Pyritic waste rock at the mine interacts chemically with even the most intense rainfall, and almost all runoff is acidic to some degree. In the most intense rain event recorded in this study (>10mm/hour), dilution of acid mine drainage (AMD) occurred and pH rose from 3 to >5 over several hours, with stream discharge at a monitoring point rising from <0.5 to >100cumecs. However, most rain events of similar magnitude are less intense, longer duration, and only raise AMD pH to ~4 with similar high discharges. Results presented here for Stockton confirm that it is the intensity of rain events on the hourly scale, rather than the total amount of rainwater delivered to the site, that governs the amount and composition of AMD generated during flood events. Stream discharge loads of dissolved iron and aluminium range from ~20 to 1000kg/hour. Dissolved sulfate and acidity loads are typically ~500kg/hour but can exceed 20tonnes/hour in rain events. First flush effects observable elsewhere around the world involving peak metal loads following dry periods or seasonal changes are not obvious at Stockton due to the high and variable rainfall environment. Dissolved Fe concentrations may be limited in runoff waters by precipitation of jarosite and schwertmannite, especially when rainfall is sufficiently intense to raise pH to 4 or higher. These minerals are widespread in the exposed waste rock on site. Likewise, precipitation of alunite may occur as pH rises in rain events, but no field evidence for this has been observed. [Copyright &y& Elsevier]

We highlight common problems in the application of random treatment assignment in large-scale program evaluation. Random assignment is the defining feature of modern experimental design, yet errors in design, implementation, and analysis often result in real-world applications not benefiting from its advantages. The errors discussed here cover the control of variability, levels of randomization, size of treatment arms, and power to detect causal effects, as well as the many problems that commonly lead to post-treatment bias. We illustrate these issues by identifying numerous serious errors in the Medicare Health Support evaluation and offering recommendations to improve the design and analysis of this and other large-scale randomized experiments. ( Population Health Management 2011;14(suppl 1):S-11-S-22) [ABSTRACT FROM AUTHOR]

An increase in chronic disease prevalence is contributing to health care cost growth and decreased quality of life in industrialized nations worldwide. Inadequate management of chronic diseases is a leading cause of hospitalizations and, thus, avoidable expenditures. In this study, we evaluated the impact of nurse-delivered care calls, the primary intervention of a proactive chronic care management (CCM) program, in a population aged 65 and older in Germany. In this analysis, hospital admission rates were evaluated among program enrollees who were diagnosed with diabetes, heart failure, coronary heart disease, or chronic obstructive pulmonary disease. The Intervention group comprised those members who participated in care calls ( n = 13,486), whereas the Comparison group included enrollees who did not participate in these calls ( n = 4,582). Changes in admission rates were calculated between the year prior to and year after program commencement. Comparative analyses were adjusted for age, sex, region of residence, and disease severity (stratification of 3 [least severe] to 1 [most severe]). Overall, a 6.0% decrease in admissions was observed among Intervention group members compared with an 18.9% increase among Comparison group members ( P ≤ 0.0001). This decrease in admissions was driven by participants with the highest levels of risk. In addition, a dose-response relationship was observed in which admissions decreased with an increased number of care calls ( P = 0.0001). These results indicate that proactive CCM interventions are effective in reducing hospital admission rates in a senior population with chronic disease. ( Population Health Management 2011;14(suppl 1):S-29-S-33) [ABSTRACT FROM AUTHOR]

Hospital admissions are the source of significant health care expenses, although a large proportion of these admissions can be avoided through proper management of chronic disease. In the present study, we evaluate the impact of a proactive chronic care management program for members of a German insurance society who suffer from chronic disease. Specifically, we tested the impact of nurse-delivered care calls on hospital admission rates. Study participants were insured individuals with coronary artery disease, heart failure, diabetes, or chronic obstructive pulmonary disease who consented to participate in the chronic care management program. Intervention ( n = 17,319) and Comparison ( n = 5668) groups were defined based on records of participating (or not participating) in telephonic interactions. Changes in admission rates were calculated from the year prior to (Base) and year after program commencement. Comparative analyses were adjusted for age, sex, region of residence, and disease severity (stratification of 3 [least severe] to 1 [most severe]). Overall, the admission rate in the Intervention group decreased by 6.2% compared with a 14.9% increase in the Comparison group ( P < 0.001). The overall decrease in admissions for the Intervention group was driven by risk stratification levels 2 and 1, for which admissions decreased by 8.2% and 14.2% compared to Comparison group increases of 12.1% and 7.9%, respectively. Additionally, Intervention group admissions decreased as the number of calls increased ( P = 0.004), indicating a dose-response relationship. These findings indicate that proactive chronic care management care calls can help reduce hospital admissions among German health insurance members with chronic disease. ( Population Health Management 2010;13:339-345) [ABSTRACT FROM AUTHOR]

Abstract: Desorption canisters are routinely employed to quantify coalbed gas contents in coals. If purging with inert gas or water flooding is not used, entrapment of air with ~78.08vol.% nitrogen (N2) in canisters during the loading of coal results in contamination by air and subsequent overestimates of N2 in desorbed coalbed gas. Pure coalbed gas does not contain any elemental oxygen (O2), whereas air contamination originally includes ~20.95vol.% O2 and has a N2/O2 volume ratio of ~3.73. A correction for atmospheric N2 is often attempted by quantifying O2 in headspace gas and then proportionally subtracting atmospheric N2. However, this study shows that O2 is not a conservative proxy for air contamination in desorption canisters. Time-series of gas chromatographic (GC) compositional data from several desorption experiments using high volatile bituminous coals from the Illinois Basin and a New Zealand subbituminous coal document that atmospheric O2 was rapidly consumed, especially during the first 24h. After about 2weeks of desorption, the concentration of O2 declined to near or below GC detection limits. Irreversible loss of O2 in desorption canisters is caused by biological, chemical, and physical mechanisms. The use of O2 as a proxy for air contamination is justified only immediately after loading of desorption canisters, but such rapid measurements preclude meaningful assessment of coalbed gas concentrations. With increasing time and progressive loss of O2, the use of O2 content as a proxy for atmospheric N2 results in overestimates of N2 in desorbed coalbed gas. The indicated errors for nitrogen often range in hundreds of %. Such large analytical errors have a profound influence on market choices for CBM gas. An erroneously calculated N2 content in CBM would not meet specifications for most pipeline-quality gas. [Copyright &y& Elsevier]

Abstract: We developed orthogonal least-squares techniques for fitting crystalline lens shapes, and used the bootstrap method to determine uncertainties associated with the estimated vertex radii of curvature and asphericities of five different models. Three existing models were investigated including one that uses two separate conics for the anterior and posterior surfaces, and two whole lens models based on a modulated hyperbolic cosine function and on a generalized conic function. Two new models were proposed including one that uses two interdependent conics and a polynomial based whole lens model. The models were used to describe the in vitro shape for a data set of twenty human lenses with ages 7–82years. The two-conic-surface model (7mm zone diameter) and the interdependent surfaces model had significantly lower merit functions than the other three models for the data set, indicating that most likely they can describe human lens shape over a wide age range better than the other models (although with the two-conic-surfaces model being unable to describe the lens equatorial region). Considerable differences were found between some models regarding estimates of radii of curvature and surface asphericities. The hyperbolic cosine model and the new polynomial based whole lens model had the best precision in determining the radii of curvature and surface asphericities across the five considered models. Most models found significant increase in anterior, but not posterior, radius of curvature with age. Most models found a wide scatter of asphericities, but with the asphericities usually being positive and not significantly related to age. As the interdependent surfaces model had lower merit function than three whole lens models, there is further scope to develop an accurate model of the complete shape of human lenses of all ages. The results highlight the continued difficulty in selecting an appropriate model for the crystalline lens shape. [Copyright &y& Elsevier]

Diabetes disease management (DM) programs strive to promote healthy behaviors, including obtaining hemoglobin A1c (A1c) and low-density lipoprotein (LDL) tests as part of standards of care. The purpose of this study was to examine the relationship between frequency of telephonic contact and A1c and LDL testing rates. A total of 245,668 members continuously enrolled in diabetes DM programs were evaluated for performance of an A1c or LDL test during their first 12 months in the programs. The association between the number of calls a member received and clinical testing rates was examined. Members who received four calls demonstrated a 24.1% and 21.5% relative increase in A1c and LDL testing rates, respectively, compared to members who received DM mailings alone. Response to the telephonic intervention as part of the diabetes DM programs was influenced by member characteristics including gender, age, and disease burden. For example, females who received four calls achieved a 27.7% and 23.6% increase in A1c and LDL testing, respectively, compared to females who received mailings alone; by comparison, males who were called achieved 21.2% and 19.9% relative increase in A1c and LDL testing, respectively, compared to those who received mailings alone. This study demonstrates a positive association between frequency of telephonic contact and increased performance of an A1c or LDL test in a large, diverse diabetes population participating in DM programs. The impact of member characteristics on the responsiveness to these programs provides DM program designers with knowledge for developing strategies to promote healthy behaviors and improve diabetes outcomes. (Disease Management 2007;10:101–109) [ABSTRACT FROM AUTHOR]

Poor lipid control is a risk factor for cardiovascular diseases and diabetes complications. Frequently, however, patients with these diseases do not achieve blood lipid levels recommended by current standards of care. A retrospective study of 67,244 members eligible for disease management (DM) was initiated to evaluate the ability of interventions to promote improvement in low-density lipoprotein cholesterol (LDL-C) laboratory values for people with cardiovascular diseases or diabetes. The baseline trend in improving LDL-C values in the absence of DM was established. A two-year period prior to the start of the DM intervention was examined to measure the mean percent change in LDL-C values that was occurring in the population. The mean percent change observed for this pre-intervention group was then compared to the change in LDL-C values observed during the DM study period. A significant reduction in elevated LDL-C values (F-test; p < 0.0001) was observed for members who participated in the DM interventions, even when elevated LDL-C was defined as low as ≥70 mg/dL. Members with LDL-C values within threshold limits maintained these levels during the DM program. The significant reduction in elevated LDL-C values and maintenance of optimal values (< 100 mg/dL) was observed over the course of 3 years of participation in a DM program. A subset of the population also was examined to assess the impact of telephonic intervention on reducing elevated LDL-C values. A significant relationship between receiving care calls and reduction in elevated LDL-C levels was observed; members who received calls achieved up to a 32.5% relative reduction in elevated LDL-C values compared to members who did not receive calls. In conclusion, these findings demonstrate the ability of DM interventions to assist a large, geographically diverse member population in reducing a clinical laboratory value. [ABSTRACT FROM AUTHOR]