The Economic Cost of Community-Based Interventions to Improve Breast Cancer Control among African-American Women

A number of intervention strategies to improve the rate of early stage breast cancer detection have been proposed and evaluated. Though good effectiveness data exist, policymakers and medical administrators may be reluctant to implement such interventions because of cost considerations. Few cost-effectiveness analyses have been conducted on culturally-sensitive interventions that increase mammography screening rates or reduce barriers to receiving timely diagnostic testing and treatment for African-American women. This paper discusses an innovative cost effectiveness model, funded by the National Cancer Institute, and presents microeconomic estimates the cost of twelve community-based intervention strategies designed to improve early stage breast cancer detection rates and appropriate follow-up after an abnormal mammogram among African-American women. An innovation in the estimates is to include the value of women’s time. Community-based program costs range from $47 to$161 per patient on an ongoing basis. Same day scheduling of a mammogram with or without patient transportation, public service announcements, physician education, physician audit with feedback, and same day scheduling of a biopsy cost $47-$53 per patient per year on an ongoing basis. Interventions that require fulltime personnel to maintain the program, such as patient reminder letters, theory-based education, physician reminders, and telephone counseling, are more expensive and cost approximately $54-$57 per patient on an ongoing basis. The three most expensive interventions are the mobile mammography van, lay health workers, and church based navigators, costing approximately $67-$161 per patient In conclusion, the added costs of community-based cancer control programs for vulnerable African-American women are small and have the potential to be offset by the gains in quality-adjusted life years saved as a result of detection at an earlier stage of diagnosis and improved follow-up and treatment, particularly among high-risk communities

FloraVeg.EU — An online database of European vegetation, habitats and flora

This article describes FloraVeg.EU, a new online database with open-access information on European vegetation units (phytosociological syntaxa), vegetated habitats, and plant taxa. It consists of three modules. (1) The Vegetation module includes 149 phytosociological classes, 378 orders and 1305 alliances of an updated version of the EuroVegChecklist modified based on the decisions of the European Vegetation Classification Committee. Vegetation units dominated by vascular plants are characterized by country-based distribution maps and data on the dominant life forms, phenology, soil properties, relationships to vegetation regions, elevational vegetation belts and azonal habitats, successional status, and degree of naturalness. A list of diagnostic taxa is also provided for each class. (2) The Habitats module includes vascular-plant-dominated terrestrial, freshwater, and marine habitat types from the first to the third or fourth highest hierarchical levels of the EUNIS classification. Of these, 249 vegetated habitats are characterized by a brief description, a point-based distribution map, diagnostic, constant, and dominant taxa, and a list of the corresponding alliances. (3) The Species module provides information on 37 characteristics of European vascular plant species and some infrageneric or infraspecific taxa, including functional traits (habitus and growth type, leaf, flower, fruit and seed traits, and trophic mode), taxon origin (native vs alien), and ecological information (environmental relationships, Ellenberg-type indicator values, disturbance indicator values, and relationships to vegetation units and habitat types). Values for at least three variables are available for 36,404 species. Individual taxa, vegetation units, and habitats in these three modules are illustrated by more than 34,000 photographs. The Download section of FloraVeg.EU provides open-access data sets in a spreadsheet format that can be used for analyses. FloraVeg.EU is a new resource with easily accessible data that can be used for research in vegetation science, ecology, and biogeography, as well as for education and conservation applications

Shift from trait convergence to divergence along old field succession

Aims Ecological theories predict that assembly processes shape communities so that co‐existing species may either be functionally more dissimilar ("divergence") or more similar ("convergence") than expected by chance. Two important factors that are rarely considered in combination are spatial scale and successional stage. Our aim is to identify different functional patterns during succession across spatial scales and to discuss the likely underlying assembly processes. We expect to find convergence due to environmental filtering at early succession, especially at the largest scales, and a tendency towards divergence driven by competitive interactions as succession unfolds and at smaller spatial scales. Location Protected Landscape Area “Bohemian Karst”, Czech Republic. Methods We studied three succession stages (two, eight and 55 years after abandonment). Each field was sampled using 40 1‐m2 quadrats containing 100 pins in a regular grid. We analysed trait dispersion at several combinations of grain and extent and characterised trait similarity using phylogeny and four traits: specific leaf area, leaf dry matter content, height, and seed mass analysed individually and combined using Gower distance (multi‐trait dissimilarity). Results In the youngest field, three of the traits individually and the multi‐trait dissimilarity showed convergence regardless of scale. Phylogeny showed convergence at most spatial scales of the youngest stage. The other two fields showed greater divergence predominantly in the oldest field at the smallest spatial scale. Conclusions The results are mainly congruent with theoretical expectations and provide a valuable example of directional changes from trait convergence to divergence along succession. The scale‐invariant convergence in the early stages of succession seems to be the result of environmental filtering and weaker competitive exclusion. At later stages and particularly at smaller scales, divergence becomes more common, likely because competition limits the trait similarity of species. These results highlight the importance of predictable (non‐random) changes in ecological succession