Cost effectiveness analysis of different approaches of screening for familial hypercholesterolaemia

Objectives To assess the cost effectiveness of strategies to screen for and treat familial hypercholesterolaemia. Design Cost effectiveness analysis. A care pathway for each patient was delineated and the associated probabilities, benefits, and costs were calculated. Participants Simulated population aged 16­54 years in England and Wales. Interventions Identification and treatment of patients with familial hypercholesterolaemia by universal screening, opportunistic screening in primary care, screening of people admitted to hospital with premature myocardial infarction, or tracing family members of affected patients. Main outcome measure Cost effectiveness calculated as cost per life year gained (extension of life expectancy resulting from intervention) including estimated costs of screening and treatment. Results Tracing of family members was the most cost effective strategy (£3097 (&5066, $4479) per life year gained) as 2.6 individuals need to be screened to identify one case at a cost of £133 per case detected. If the genetic mutation was known within the family then the cost per life year gained (£4914) was only slightly increased by genetic confirmation of the diagnosis. Universal population screening was least cost effective (£13 029 per life year gained) as 1365 individuals need to be screened at a cost of £9754 per case detected. For each strategy it was more cost effective to screen younger people and women. Targeted strategies were more expensive per person screened, but the cost per case detected was lower. Population screening of 16 year olds only was as cost effective as family tracing (£2777 with a clinical confirmation). Conclusions Screening family members of people with familial hypercholesterolaemia is the most cost effective option for detecting cases across the whole population

Three IT-Business Alignment Profiles: Technical Resource, Business Enabler, and Strategic Weapon

There is a growing recognition among alignment researchers and IT professionals that one size does not fit all. In this article, we provide an important extension of alignment research that shows three profiles linking IT to different business objectives. We address the need to identify the appropriate types of IT alignment by using a multi-method study including interviews and cases. Two dimensions define the three alignment profiles: internal IT-business integration and external market engagement. The technical resource profile calls for low levels of IT-business integration and IT-market engagement. The business enabler profile deploys IT in some business processes and begins engaging IT with customers and suppliers. The strategic weapon profile uses IT to mobilize and extend the enterprise, which requires extensive IT deployment, both internally and externally. Each profile differs in strategies, criteria, capabilities, and mental models. Importantly, IT decision-makers should not adopt stage-model thinking which assumes that technical resource profiles naturally progress up the chain. Rather, successful use of IT requires specifying the requisite alignment profile as an initial design decision so that appropriate levels of resource allocation and management involvement occur

Defences against brood parasites from a social immunity perspective

Parasitic interactions are so ubiquitous that all multicellular organisms have evolved a system of defences to reduce their costs, whether the parasites they encounter are the “classic parasites” that feed on the individual, or “brood parasites” that usurp parental care. Many parallels have been drawn between defences deployed against both types of parasite, but typically, whilst defences against classic parasites have been selected to protect survival, those against brood parasites have been selected to protect the parent’s inclusive fitness, suggesting that the selection pressures they impose are fundamentally different. However, there is another class of defences against classic parasites that have specifically been selected to protect an individual’s inclusive fitness, known as “social immunity”. Social immune responses include the anti-parasite defences typically provided for others in kin-structured groups, such as the antifungal secretions produced by termite workers to protect the brood. Defences against brood parasites, therefore, are more closely aligned with social immune responses. Much like social immunity, host defences against brood parasitism are employed by a donor (a parent) for the benefit of one or more recipients (typically kin), and as with social defences against classic parasites, defences have therefore evolved to protect the donor’s inclusive fitness, not the survival or ultimately the fitness of individual recipients This can lead to severe conflicts between the different parties, whose interests are not always aligned. Here we consider defences against brood parasitism in the light of social immunity, at different stages of parasite encounter, addressing where conflicts occur and how they might be resolved. We finish with considering how this approach could help us to address longstanding questions in our understanding of brood parasitism.Peer reviewe

Reed Warbler Hosts Do Not Fine-Tune Mobbing Defenses During the Breeding Season, Even When Cuckoos Are Rare

Hosts of brood parasitic cuckoos often employ mobbing attacks to defend their nests and, when mobbing is costly, hosts are predicted to adjust their mobbing to match parasitism risk. While evidence exists for fine-tuned plasticity, it remains unclear why mobbing does not track larger seasonal changes in parasitism risk. Here we test a possible explanation from parental investment theory: parents should defend their current brood more intensively as the opportunity to replace it declines (re-nesting potential), and therefore “counteract” any apparent seasonal decline to match parasitism risk. We take advantage of mobbing experiments conducted at two sites where reed warblers (Acrocephalus scirpaceus) experience (in Italy), or do not experience (in Finland), brood parasitism. We predicted that mobbing of cuckoos should be higher overall in Italy, but remain constant over the season as in other parasitised sites, whereas in Finland where cuckoos do not pose a local threat, we predicted that mobbing should be low at the beginning of the season but increase as re-nesting potential declined. However, while cuckoos were more likely to be mobbed in Italy, we found little evidence that mobbing changed over the season at either the parasitized or non-parasitized sites. This suggests that re-nesting potential has either little influence on mobbing behavior, or that its effects are obscured by other seasonal differences in ecology or experience of hosts

Darwin's small and medium ground finches might have taste preferences, but not for human foods

Urbanization is rapidly changing ecological niches. On the inhabited Galapagos Islands, Darwin's finches consume human-introduced foods preferentially; however, it remains unclear why. Here, we presented pastry with flavour profiles typical of human foods (oily, salty and sweet) to small ground finches (Geospiza fuliginosa) and medium ground finches (Geospiza fortis) to test if latent taste preferences might drive the selection of human foods. If human food flavours were consumed more than a neutral or bitter control only at sites with human foods, then we predicted tastes were acquired after urbanization; however, if no site differences were found then this would indicate latent taste preferences. Contrary to both predictions, we found little evidence that human food flavours were preferred compared with control flavours at any site. Instead, finches showed a weak aversion to oily foods, but only at remote (no human foods present) sites. This was further supported by behavioural responses, with beak-wiping occurring more often at remote sites after finches tasted flavours associated with human foods. Our results suggest, therefore, that while Darwin's finches regularly exposed to human foods might have acquired a tolerance to human food flavours, latent taste preferences are unlikely to have played a major role in their dietary response to increased urbanization.Peer reviewe

Analysing age structure, residency and relatedness uncovers social network structure in aggregations of young birds

Animal sociality arises from the cumulative effects of both individual social decisions and environmental factors. While juveniles' social interactions with parents prior to independence shape later life sociality, in most bird and mammal species at least one sex undergoes an early life dispersal before first-year reproduction. The social associations from this period could also have implications for later life yet are rarely characterized. Here, we derived predictions from available examples of juvenile groups in the literature (mobile ‘flocks’, spatially stable ‘gangs’ or adult-associated ‘crèches’) and then used three cohorts of juvenile hihi, Notiomystis cincta, a threatened New Zealand passerine, to demonstrate how multistate modelling and social network analysis approaches can be used to characterize group type based on residency, movement, relatedness and social associations. At sites where hihi congregated, we found that juveniles were resighted at a higher frequency than adults and associated predominantly with unrelated juveniles rather than siblings or parents. Movement between group sites occurred, but associations developed predominantly within the sites. We suggest therefore that juvenile hihi social structure is most similar to a ‘gang’, a group structure in which juveniles congregate without adults at predictable sites. Such gangs have previously only been described formally in ravens, Corvus corax. By combining spatial and social network analyses, our study demonstrates how social group structures can be described and therefore facilitate broader comparisons and discussion about the form and function of juvenile groups across taxa

Development of a Microsatellite Library in \u3cem\u3eLolium Perenne\u3c/em\u3e

Lolium perenne, as one of the most important forage grasses of temperate regions, combines a number of very useful characteristics, e.g., good seedling establishment, with a low resistance to drought and limited winter hardiness. Trait selection and introgression can be greatly enhanced by the use of molecular markers in a genetic linkage map. The aim of this project was the generation of a genomic microsatellite library which when combined with microsatellites developed from a Genethresher database would give good genome coverage coupled to high levels of marker polymorphism

Cancer incidence in British vegetarians

Background: Few prospective studies have examined cancer incidence among vegetarians. Methods: We studied 61 566 British men and women, comprising 32 403 meat eaters, 8562 non-meat eaters who did eat fish ('fish eaters') and 20 601 vegetarians. After an average follow-up of 12.2 years, there were 3350 incident cancers of which 2204 were among meat eaters, 317 among fish eaters and 829 among vegetarians. Relative risks (RRs) were estimated by Cox regression, stratified by sex and recruitment protocol and adjusted for age, smoking, alcohol, body mass index, physical activity level and, for women only, parity and oral contraceptive use. Results: There was significant heterogeneity in cancer risk between groups for the following four cancer sites: stomach cancer, RRs (compared with meat eaters) of 0.29 (95% CI: 0.07–1.20) in fish eaters and 0.36 (0.16–0.78) in vegetarians, P for heterogeneity=0.007; ovarian cancer, RRs of 0.37 (0.18–0.77) in fish eaters and 0.69 (0.45–1.07) in vegetarians, P for heterogeneity=0.007; bladder cancer, RRs of 0.81 (0.36–1.81) in fish eaters and 0.47 (0.25–0.89) in vegetarians, P for heterogeneity=0.05; and cancers of the lymphatic and haematopoietic tissues, RRs of 0.85 (0.56–1.29) in fish eaters and 0.55 (0.39–0.78) in vegetarians, P for heterogeneity=0.002. The RRs for all malignant neoplasms were 0.82 (0.73–0.93) in fish eaters and 0.88 (0.81–0.96) in vegetarians (P for heterogeneity=0.001). Conclusion: The incidence of some cancers may be lower in fish eaters and vegetarians than in meat eaters