Art Modeling Cherish Model
Freeda Provence
While strolling through the Brooklyn Bridge Park I came across many people shooting models, friends, wedding parties - you name it! It wouldn't really be polite to jump in and start shooting away at someone's model though.
The first time I shot models I was pretty intimidated. Gorgeous, half-nekkid girls! ("Why is your camera shaking there, uh, Bob?") But by the second shoot I got with the program. I really enjoyed working with the models, and I think they enjoyed working with me too. I'm still Facebook friends with many of them, so it is nice to be able to keep up with them.
The National Institute on Drug Abuse (NIDA) awarded Bruce R. Schackman, CHERISH director and Saul P. Steinberg Distinguished Professor at Weill Cornell Medicine, and Natasha Martin, CHERISH Research Affiliate and associate professor in the Department of Medicine at the University of California San Diego, a scientific conference grant to provide simulation modeling groups an opportunity to swiftly develop best modeling practices to inform public policy and reduce fatal opioid overdoses and injection-related hepatitis C and HIV infections in North America.
Drug overdose deaths have been increasing rapidly in the United States, contributing to nearly 90,000 deaths in the 12 months ending November 2020. Overdose deaths have also been rising in Canada during 2020, and the risks for greater opioid use are increasing in Mexico. Simulation models have demonstrated their relevance in informing policies and interventions to control the spread of COVID-19 and will continue to be a valuable tool to address the opioid crisis that is surging in this continent.
During the next three years, Schackman and Martin will bring simulation modelers and policymakers together to further the science of simulation modeling by addressing issues of model design, data availability, integrity, and translation. This NIDA grant builds on previous workshops co-sponsored by the Center for Health Economics of Treatment Interventions for Substance Use Disorder, HCV, and HIV (CHERISH) in 2018 and 2019 and will also support the development of early career researchers and individuals from underrepresented minority groups interested in modeling to inform the opioid crisis in North America.
"For example, if a student wants to become a virtual designer, but also wants to learn about fashion concepts and branding, then dimensions should be able to come together and offer a unique pathway," notes Leferink. AMFI believes that by creating a new curriculum which is built on collaboration and a cross-disciplinary approach, students will be able to acquire more knowledge and expertise during their studies. It will also put them in a more independent position, giving them more control of which direction their studies go, while moving away from the classical models of education. "We cherish our natural history of educating branding, design and management skills, next to embracing a future of coaching visionary fashion developers." Ultimately the fashion institute hopes its new educational offering will help better prepare all their students for the challenges they will face in the changing fashion landscape.
The manufacturer submitted separate economic models for each spinal muscular atrophy (SMA) type: type I, type II, and type III.6 The models allowed estimation of health care costs, life-years (LYs), and quality-adjusted life-years (QALYs). The models had initial cycles that reflected the timing of outcome assessment in the relevant clinical studies. For time points beyond the time horizon of the clinical studies, cycles corresponded with the timing of the administration of nusinersen (every four months). Time horizon varied by SMA type: 25 years for type I, 50 years for type II, and eight years for type III. The analyses were conducted from the Canadian public health care system perspective. Costs and outcomes were discounted at an annual rate of 1.5%, and expected values of costs, QALYs, and LYs were obtained through probabilistic analysis.
In the SMA type I model, the cohort entered the model at their baseline clinical status. Each cycle patients could transition to other health states that included maintenance of baseline clinical status; whether this improved, worsened, or had no improvement; milestones consistent with SMA type II (e.g., sits without support, stands with assistance, walks with assistance and stand/walks unaided); and death. The analysis was run over a time horizon of 25 years. Cycle length varied at the onset of the model. Patients could transition between health states at 2, 6, 10, 13, and 14 months. The first four transition points related to the timing of clinical assessment in the ENDEAR study7 and the latter cycle corresponded to a dosage of nusinersen. Subsequent cycles were every four months, which conformed to the timing of dosages of nusinersen.
In the SMA type II model, the cohort entered the model at their baseline clinical status. Each cycle patients could transition to health states reflecting worsening, no improvement, mild improvement, and moderate improvement from baseline clinical status; states relating to whether the patient could stand or walk with assistance; milestones consistent with SMA type III (e.g., stand unaided and walks unaided); and death. The analysis was run over a time horizon of 50 years. For the first 15 months of the model, the cycle length was three months conforming to the timing of clinical assessment in the CHERISH study.8 Subsequent cycles were every four months, which conformed to dosages of nusinersen.
In the SMA type III model, health states included non-ambulatory, ambulatory, and death. Patients could enter the model at either the ambulatory or non-ambulatory health states. The analysis was run over a time horizon of 80 years. For the first 27 months of the model, the cycle length was three months, which conformed to the timing of clinical assessment in the CS2 and CS12 clinical studies.5 Subsequent cycles were very four months, which conformed to dosages of nusinersen.
For both SMA types I and III, utility values were derived from a vignette study where five experts in SMA rated derived health state descriptions relating to the health states within the models. For SMA type II, utility values were obtained from a mapping study of quality of life values observed in the CHERISH trial and EuroQol 5-Dimensions questionnaire values. Both studies used to estimate utility values were unpublished.10,11
The reporting of the cost estimates used within the model lacked transparency and health care costs appear to be derived from a German study.15 The methods for interpolating the costs of care into the Canadian context are limited; however, given the high cost of nusinersen, the impact of additional health care cost would be limited.
Although utility values for SMA type II were available form this study, the manufacturer used a different set of utility values for the SMA type II model. This unpublished study used data from the CHERISH study relating to responses to the Pediatric Quality of Life Inventory instrument at each assessment point that were then mapped to the EQ-5D utility scores based on a published mapping algorithm to derive utility values for each state. The manufacturer chose to not use the actual values for specific states when it was felt the ordering of states by utility value was incorrect. The recent CADTH guidelines for economic evaluation suggest that direct measurement should be used to elicit utility values and mapping should be discouraged.9
One patient submission was received, which was prepared jointly by the Canadian Organization for Rare Disorders and Cure SMA Canada. The submission was based on the results of one focus group, four interviews, and a survey. Most of the respondents were caregivers and family members. The submission cited issues for patients with SMA, which included physical functioning, the ability to breathe unassisted, difficulties swallowing, and the ability to conduct activities of daily living. The manufacturer accounted these aspects within their economic model by considering aspects of SMA in the model health states. Impacts on families and caregivers were raised as an aspect of the condition, as well. This was not considered by the manufacturer in its pharmacoeconomic submission.
Jingxin Liu, a recent graduate of the Ph.D. in Epidemiology program in the Department of Public Health Sciences (DPHS) at the University of Miami Miller School of Medicine is the primary author of a new study that evaluated alternative viral suppression prediction models to reduce HIV transmission.
Despite the significant progress that has been accomplished, major obstacles still exist in the HIV diagnosis and care continuum. In this study, researchers targeted vulnerable populations of people living with HIV (PLWH) and assessed various prediction models for viral suppression utilizing longitudinal or recurring assessments in order to improve patient outcomes and decrease HIV transmission.
When comparing out-of-bag (OOB) error rates (method of measuring the prediction error of machine learning models) of the training dataset, person-specific trajectories performed best, yielding a 32.0% OOB error rate.
Using person-specific intercepts and slopes provides a novel and useful approach to creating predictive models using repeated measurements. It also suggests the possibility of incorporating these types of modeling efforts into ongoing clinical monitoring using medical records.
The strict link between life and death of an organism should be discussed and compared to the life cycles of molecules and cells that allow the organism's development and survival. Indeed, a brief consideration of the main features of biological functions reveals that they occur at widely different levels of organization, ranging from molecules to species and ecological systems, and occupying widely different spatio-temporal domains. Biological functions are characterized by the integrated motion of their constitutive parts, and operate in cyclic fashions that comprise on and off phases. The birth and death of molecules, cells, organisms or species represent a special class of cycling functions that support the life cycles of the entities that include them. Under this perspective, the life cycles of past, present and future human beings may be viewed as necessary support to the longer lasting and more widely spreading life cycles of families, nations, and civilizations. If due consideration is given to our deep mental nature, one may cherish the conclusion that past, present and future human beings may be all supporting the life cycle of a superior mental entity that includes us in the same way we include our own cellular and molecular components.