Temporal cycles and spatial asynchrony in the reproduction and growth of a rare nectarless orchid, Cypripedium calceolus

AbstractThe timing and intensity of plant reproduction vary due to internal and external factors. Although this variation has been widely studied in species exhibiting masting (intermittent synchronous reproduction), it has attracted less attention in nonmasting species. Here, we studied intra-individual variation in the flowering intensity and plant size of a nonmasting, rare terrestrial orchid, Cypripedium calceolus, using long-term monitoring data from three populations in Finland and two populations in Estonia. Flowering intensity and plant size showed 2-year cycles, indicating that reproduction and growth were regulated by past costs of reproduction and extensive clonal growth. In addition, flowering intensity and plant size were positively correlated with size from the previous year and were also affected by the weather conditions of spring and of the previous growing season. However, there was little synchrony among plants, suggesting that the climatic control of reproduction and growth is sufficiently low as to be masked by high annual variation in these two vital rates. Together, these results indicate that the reproduction and growth of C. calceolus depend on individual demographic history and past weather conditions and that intrinsic factors can also lead to cyclic fluctuation in reproduction in nonmasting species.Abstract The timing and intensity of plant reproduction vary due to internal and external factors. Although this variation has been widely studied in species exhibiting masting (intermittent synchronous reproduction), it has attracted less attention in nonmasting species. Here, we studied intra-individual variation in the flowering intensity and plant size of a nonmasting, rare terrestrial orchid, Cypripedium calceolus, using long-term monitoring data from three populations in Finland and two populations in Estonia. Flowering intensity and plant size showed 2-year cycles, indicating that reproduction and growth were regulated by past costs of reproduction and extensive clonal growth. In addition, flowering intensity and plant size were positively correlated with size from the previous year and were also affected by the weather conditions of spring and of the previous growing season. However, there was little synchrony among plants, suggesting that the climatic control of reproduction and growth is sufficiently low as to be masked by high annual variation in these two vital rates. Together, these results indicate that the reproduction and growth of C. calceolus depend on individual demographic history and past weather conditions and that intrinsic factors can also lead to cyclic fluctuation in reproduction in nonmasting species

The Cost-Effectiveness of Improving Diabetes Care in U.S. Federally Qualified Community Health Centers

Objective. To estimate the incremental cost-effectiveness of improving diabetes care with the Health Disparities Collaborative (HDC), a national collaborative quality improvement (QI) program conducted in community health centers (HCs). Data Sources/Study Settings. Data regarding the impact of the Diabetes HDC program came from a serial cross-sectional follow-up study (1998, 2000, 2002) of the program in 17 Midwestern HCs. Data inputs for the simulation model of diabetes came from the latest clinical trials and epidemiological studies. Study Design. We conducted a societal cost-effectiveness analysis, incorporating data from QI program evaluation into a Monte Carlo simulation model of diabetes. Data Collections/Extraction Methods. Data on diabetes care processes and risk factor levels were extracted from medical charts of randomly selected patients. Principal Findings. From 1998 to 2002, multiple processes of care (e.g., glycosylated hemoglobin testing [HbA1C] [71 -\u3e 92 percent] and ACE inhibitor prescribing [33 -\u3e 55 percent]) and risk factor levels (e.g., 1998 mean HbA1C 8.53 percent, mean difference 0.45 percent [95 percent confidence intervals -0.72, -0.17]) improved significantly. With these improvements, the HDC was estimated to reduce the lifetime incidence of blindness (17 -\u3e 15 percent), end-stage renal disease (18 -\u3e 15 percent), and coronary artery disease (28 -\u3e 24 percent). The average improvement in quality-adjusted life year (QALY) was 0.35 and the incremental cost-effectiveness ratio was $33,386/QALY. Conclusions. During the first 4 years of the HDC, multiple improvements in diabetes care were observed. If these improvements are maintained or enhanced over the lifetime of patients, the HDC program will be cost-effective for society based on traditionally accepted thresholds

Impact of rapid antigen detection testing on antibiotic prescription in acute pharyngitis in adults. FARINGOCAT STUDY: a multicentric randomized controlled trial

BACKGROUND: Acute pharyngitis is one of the most frequent consultations to the general practitioner and in most of the cases an antibiotic is prescribed in primary care in Spain. Bacterial etiology, mainly by group A beta-hemolytic streptococcus (GABHS), accounts for 10-20% of all these infections in adults. The purpose of this study is to assess the impact of rapid antigen detection testing (RADT) to identify GABHS in acute pharyngitis on the utilization of antibiotics in primary care. METHODS/DESIGN: Multicentric randomized controlled trial in which antibiotic prescription between two groups of patients with acute pharyngitis will be compared. The trial will include two arms, a control and an intervention group in which RADT will be performed. The primary outcome measure will be the proportion of inappropriate antibiotic prescription in each group. Two hundred seventy-six patients are required to detect a reduction in antibiotic prescription from 85% in the control group to 75% in the intervention group with a power of 90% and a level of significance of 5%. Secondary outcome measures will be specific antibiotic treatment, antibiotic resistance rates, secondary effects, days without working, medical visits during the first month and patient satisfaction. DISCUSSION: The implementation of RADT would allow a more rational use of antibiotics and would prevent adverse effects of antibiotics, emergence of antibiotic resistance and the growth of inefficient health expenses. TRIAL REGISTRATION: ISRCTN2358777

The Catholic red book of Western Maryland including Cumberland, Frostburg, Lonaconing, Mt.Savage, Midland, Westernport, Barton, Hagerstown, Hancock, Frederick and Oakland

Mode of access: Internet