Mind the gap! A multilevel analysis of factors related to variation in published cost-effectiveness estimates within and between countries

Background. Published cost-effectiveness estimates can vary considerably, both within and between countries. Despite extensive discussion, little is known empirically about factors relating to these variations. Objectives. To use multilevel statistical modeling to integrate cost-effectiveness estimates from published economic evaluations to investigate potential causes of variation. Methods. Cost-effectiveness studies of statins for cardiovascular disease prevention were identified by systematic review. Estimates of incremental costs and effects were extracted from reported base case, sensitivity, and subgroup analyses, with estimates grouped in studies and in countries. Three bivariate models were developed: a cross-classified model to accommodate data from multinational studies, a hierarchical model with multinational data allocated to a single category at country level, and a hierarchical model excluding multinational data. Covariates at different levels were drawn from a long list of factors suggested in the literature. Results. We found 67 studies reporting 2094 cost-effectiveness estimates relating to 23 countries (6 studies reporting for more than 1 country). Data and study-level covariates included patient characteristics, intervention and comparator cost, and some study methods (e.g., discount rates and time horizon). After adjusting for these factors, the proportion of variation attributable to countries was negligible in the cross-classified model but moderate in the hierarchical models (14%−19% of total variance). Country-level variables that improved the fit of the hierarchical models included measures of income and health care finance, health care resources, and population risks. Conclusions. Our analysis suggested that variability in published cost-effectiveness estimates is related more to differences in study methods than to differences in national context. Multinational studies were associated with much lower country-level variation than single-country studies. These findings are for a single clinical question and may be atypical

High-field fMRI reveals brain activation patterns underlying saccade execution in the human superior colliculus

Background The superior colliculus (SC) has been shown to play a crucial role in the initiation and coordination of eye- and head-movements. The knowledge about the function of this structure is mainly based on single-unit recordings in animals with relatively few neuroimaging studies investigating eye-movement related brain activity in humans. Methodology/Principal Findings The present study employed high-field (7 Tesla) functional magnetic resonance imaging (fMRI) to investigate SC responses during endogenously cued saccades in humans. In response to centrally presented instructional cues, subjects either performed saccades away from (centrifugal) or towards (centripetal) the center of straight gaze or maintained fixation at the center position. Compared to central fixation, the execution of saccades elicited hemodynamic activity within a network of cortical and subcortical areas that included the SC, lateral geniculate nucleus (LGN), occipital cortex, striatum, and the pulvinar. Conclusions/Significance Activity in the SC was enhanced contralateral to the direction of the saccade (i.e., greater activity in the right as compared to left SC during leftward saccades and vice versa) during both centrifugal and centripetal saccades, thereby demonstrating that the contralateral predominance for saccade execution that has been shown to exist in animals is also present in the human SC. In addition, centrifugal saccades elicited greater activity in the SC than did centripetal saccades, while also being accompanied by an enhanced deactivation within the prefrontal default-mode network. This pattern of brain activity might reflect the reduced processing effort required to move the eyes toward as compared to away from the center of straight gaze, a position that might serve as a spatial baseline in which the retinotopic and craniotopic reference frames are aligned

The complex morphology of the young disk MWC 758: Spirals and dust clumps around a large cavity

We present Atacama Large Millimeter Array (ALMA) observations at an angular resolution of 0.1-0.2" of the disk surrounding the young Herbig Ae star MWC 758. The data consist of images of the dust continuum emission recorded at 0.88 millimeter, as well as images of the 13CO and C18O J = 3-2 emission lines. The dust continuum emission is characterized by a large cavity of roughly 40 au in radius which might contain a mildly inner warped disk. The outer disk features two bright emission clumps at radii of about 47 and 82 au that present azimuthal extensions and form a double-ring structure. The comparison with radiative transfer models indicates that these two maxima of emission correspond to local increases in the dust surface density of about a factor 2.5 and 6.5 for the south and north clumps, respectively. The optically thick 13CO peak emission, which traces the temperature, and the dust continuum emission, which probes the disk midplane, additionally reveal two spirals previously detected in near-IR at the disk surface. The spirals seen in the dust continuum emission present, however, a slight shift of a few au towards larger radii and one of the spirals crosses the south dust clump. Finally, we present different scenarios in order to explain the complex structure of the disk.Comment: 15 pages, 11 figures. The paper has been published in ApJ. References added and typos correcte

Melting of tantalum at high pressure determined by angle dispersive x-ray diffraction in a double-sided laser-heated diamond-anvil cell

The high pressure and high temperature phase diagram of Ta has been studied in a laser-heated diamond-anvil cell (DAC) using x-ray diffraction measurements up to 52 GPa and 3800 K. The melting was observed at nine different pressures, being the melting temperature in good agreement with previous laser-heated DAC experiments, but in contradiction with several theoretical calculations and previous piston-cylinder apparatus experiments. A small slope for the melting curve of Ta is estimated (dTm/dP = 24 K/GPa at 1 bar) and a possible explanation for this behaviour is given. Finally, a P-V-T equation of states is obtained, being the temperature dependence of the thermal expansion coefficient and the bulk modulus estimated.Comment: 31 pages, 8 figures, to appear in J.Phys.:Cond.Matte

The role of the striatum in effort-based decision-making in the absence of reward

Decision-making involves weighing costs against benefits, for instance, in terms of the effort it takes to obtain a reward of a given magnitude. This evaluation process has been linked to the dorsal anterior cingulate cortex (dACC) and the striatum, with activation in these brain structures reflecting the discounting effect of effort on reward. Here, we investigate how cognitive effort influences neural choice processes in the absence of an extrinsic reward. Using functional magnetic resonance imaging in humans, we used an effort-based decision-making task in which participants were required to choose between two options for a subsequent flanker task that differed in the amount of cognitive effort. Cognitive effort was manipulated by varying the proportion of incongruent trials associated with each choice option. Choice-locked activation in the striatum was higher when participants chose voluntarily for the more effortful alternative but displayed the opposite trend on forced-choice trials. The dACC revealed a similar, yet only trend-level significant, activation pattern. Our results imply that activation levels in the striatum reflect a cost-benefit analysis, in which a balance is made between effort discounting and the intrinsic motivation to choose a cognitively challenging task. Moreover, our findings indicate that it matters whether this challenge is voluntarily chosen or externally imposed. As such, the present findings contrast with classical findings on effort discounting that found reductions in striatum activation for higher effort by finding enhancements of the same neural circuits when a cognitively challenging task is voluntarily selected and does not entail the danger of losing reward

The influence of potassium on core and geodynamo evolution

We model the thermal evolution of the core and mantle using a parametrized convection scheme, and calculate the entropy available to drive the geodynamo as a function of time. The cooling of the core is controlled by the rate at which the mantle can remove heat. Rapid core cooling favours the operation of a geodynamo but creates an inner core that is too large; slower cooling reduces the inner core size but makes a geodynamo less likely to operate. Introducing potassium into the core retards inner core growth and provides an additional source of entropy. For our nominal model parameters, a core containing approximate to 400 ppm potassium satisfies the criteria of present-day inner core size, surface heat flux, mantle temperature and cooling rate, and positive core entropy production.We have identified three possibilities that may allow the criteria to be satisfied without potassium in the core. (1) The core thermal conductivity is less than half the generally accepted value of 50 W m(-1) K-1. (2) The core solidus and adiabat are significantly colder and shallower than results from shock experiments and ab initio simulations indicate. (3) The core heat flux has varied by no more than a factor of 2 over Earth history. All models we examined with the correct present-day inner core radius have an inner core age of < 1.5 Gyr; prior to this time the geodynamo was sustained by cooling and radioactive heat production within a completely liquid core

An amphipathic trans-acting phosphorothioate RNA element delivers an uncharged phosphorodiamidate morpholino sequence in mdx mouse myotube

An efficient method for the delivery of uncharged polyA-tailed phosphorodiamidate morpholino sequences (PMO) in mammalian cells consists of employing a synthetic 8-mer amphipathic trans-acting poly-2′-O-methyluridylic thiophosphate triester element (2′-OMeUtaPS) as a transfection reagent. Unlike the dTtaPS DNA-based element, this RNA element is potent at delivering polyA-tailed PMO sequences to HeLa pLuc 705 cells or to myotube muscle cells. However, much like dTtaPS, the 2′-OMeUtaPS-mediated internalization of PMO sequences occurs through an energy-dependent mechanism; macropinocytosis appears to be the predominant endocytic pathway used for cellular uptake. The transfected PMO sequences induce alternate splicing of either the pre-mRNA encoding luciferase in HeLa pLuc 705 cells or the excision of exon 23 from the pre-mRNA encoding dystrophin in myotube muscle cells of the mdx mouse model of muscular dystrophy with an efficiency comparable to that of commercial cationic lipid reagents but without detrimental cytotoxicity

Pressure tuning of structure, superconductivity and novel magnetic order in the Ce-underdoped electron-doped cuprate T'-Pr_1.3-xLa_0.7Ce_xCuO_4 (x = 0.1)

High-pressure neutron powder diffraction, muon-spin rotation and magnetization studies of the structural, magnetic and the superconducting properties of the Ce-underdoped superconducting (SC) electron-doped cuprate system T'-Pr_1.3-xLa_0.7Ce_xCuO_4 with x = 0.1 are reported. A strong reduction of the lattice constants a and c is observed under pressure. However, no indication of any pressure induced phase transition from T' to T structure is observed up to the maximum applied pressure of p = 11 GPa. Large and non-linear increase of the short-range magnetic order temperature T_so in T'-Pr_1.3-xLa_0.7Ce_xCuO_4 (x = 0.1) was observed under pressure. Simultaneously pressure causes a non-linear decrease of the SC transition temperature T_c. All these experiments establish the short-range magnetic order as an intrinsic and a new competing phase in SC T'-Pr_1.2La_0.7Ce_0.1CuO_4. The observed pressure effects may be interpreted in terms of the improved nesting conditions through the reduction of the in-plane and out-of-plane lattice constants upon hydrostatic pressure.Comment: 11 pages, 10 figure