Cost-effectiveness acceptability curves - facts, fallacies and frequently asked questions

Cost-effectiveness acceptability curves (CEACs) have been widely adopted as a method to quantify and graphically represent uncertainty in economic evaluation studies of health-care technologies. However, there remain some common fallacies regarding the nature and shape of CEACs that largely result from the textbook illustration of the CEAC. This textbook CEAC shows a smooth curve starting at probability 0, with an asymptote to 1 for higher money values of the health outcome (). But this familiar ogive shape which makes the textbook CEAC look like a cumulative distribution function is just one special case of the CEAC. The reality is that the CEAC can take many shapes and turns because it is a graphic transformation from the cost-effectiveness plane, where the joint density of incremental costs and effects may straddle quadrants with attendant discontinuities and asymptotes. In fact CEACs: (i) do not have to cut the y-axis at 0; (ii) do not have to asymptote to 1; (iii) are not always monotonically increasing in ; and (iv) do not represent cumulative distribution functions (cdfs). Within this paper we present a gallery of CEACs in order to identify the fallacies and illustrate the facts surrounding the CEAC. The aim of the paper is to serve as a reference tool to accompany the increased use of CEACs within major medical journals

A Chandra X-ray detection of the L dwarf binary Kelu-1: Simultaneous Chandra and Very Large Array observations

Magnetic activity in ultracool dwarfs, as measured in X-rays and H$\alpha$, shows a steep decline after spectral type M7-M8. So far, no L dwarf has been detected in X-rays. In contrast, L dwarfs may have higher radio activity than M dwarfs. We observe L and T dwarfs simultaneously in X-rays and radio to determine their level of magnetic activity in the context of the general decline of magnetic activity with cooler effective temperatures. The field L dwarf binary Kelu-1 was observed simultaneously with Chandra and the Very Large Array. Kelu-1AB was detected in X-rays with $L_{\rm X} = 2.9_{-1.3}^{+1.8} \times 10^{25}$ erg/s, while it remained undetected in the radio down to a $3 \sigma$ limit of $L_{\rm R} \leq 1.4 \times 10^{13}$ erg/s/Hz. We argue that, whereas the X-ray and H$\alpha$ emissions decline in ultracool dwarfs with decreasing effective temperature, the radio luminosity stays (more or less) constant across M and early-L dwarfs. The radio surface flux or the luminosity may better trace magnetic activity in ultracool dwarfs than the ratio of the luminosity to the bolometric luminosity. Deeper radio observations (and at short frequencies) are required to determine if and when the cut-off in radio activity occurs in L and T dwarfs, and what kind of emission mechanism takes place in ultracool dwarfs.Comment: Accepted for publication as a Letter in Astronomy & Astrophysic

How effective is the Forestry Commission Scotland's woodland improvement programme--'Woods In and Around Towns' (WIAT)--at improving psychological well-being in deprived urban communities? A quasi-experimental study

Introduction: There is a growing body of evidence that suggests that green spaces may positively influence psychological well-being. This project is designed to take advantage of a natural experiment where planned physical and social interventions to enhance access to natural environments in deprived communities provide an opportunity to prospectively assess impacts on perceived stress and mental well-being.<p></p> Study design and methods: A controlled, prospective study comprising a repeat cross-sectional survey of residents living within 1.5 km of intervention and comparison sites. Three waves of data will be collected: prephysical environment intervention (2013); postphysical environment intervention (2014) and postwoodland promotion social intervention (2015). The primary outcome will be a measure of perceived stress (Perceived Stress Scale) preintervention and postintervention. Secondary, self-report outcomes include: mental well-being (Short Warwick-Edinburgh Mental Well-being Scale), changes in physical activity (IPAQ-short form), health (EuroQoL EQ-5D), perception and use of the woodlands, connectedness to nature (Inclusion of Nature in Self Scale), social cohesion and social capital. An environmental audit will complement the study by evaluating the physical changes in the environment over time and recording any other contextual changes over time. A process evaluation will assess the implementation of the programme. A health economics analysis will assess the cost consequences of each stage of the intervention in relation to the primary and secondary outcomes of the study.<p></p> Ethics and dissemination: Ethical approval has been given by the University of Edinburgh, Edinburgh College of Art Research, Ethics and Knowledge Exchange Committee (ref. 19/06/2012). Findings will be disseminated through peer-reviewed publications, national and international conferences and, at the final stage of the project, through a workshop for those interested in implementing environmental interventions.<p></p&gt

The evolution of electron overdensities in magnetic fields

When a neutral gas impinges on a stationary magnetized plasma an enhancement in the ionization rate occurs when the neutrals exceed a threshold velocity. This is commonly known as the critical ionization velocity effect. This process has two distinct timescales: an ion–neutral collision time and electron acceleration time. We investigate the energization of an ensemble of electrons by their self-electric field in an applied magnetic field. The evolution of the electrons is simulated under different magnetic field and density conditions. It is found that electrons can be accelerated to speeds capable of electron impact ionization for certain conditions. In the magnetically dominated case the energy distribution of the excited electrons shows that typically 1% of the electron population can exceed the initial electrostatic potential associated with the unbalanced ensemble of electrons

Exceptionally preserved nontrilobite arthropods and Anomalocaris from the Middle Cambrian of Utah

24 p., 15 fig.http://paleo.ku.edu/contributions.htm