The cost-effectiveness of an early interventional strategy in non-ST-elevation acute coronary syndrome based on the RITA 3 trial

The published version of the aritcle can be found at the link below.Background: Evidence suggests that an early interventional strategy for patients with non-ST-elevation acute coronary syndrome (NSTE-ACS) can improve health outcomes but also increase costs when compared with a conservative strategy.Objective: The aim of this study was to assess the cost-effectiveness of an early interventional strategy in different risk groups from a UK health-service perspective.Design: Decision-analytic model based on randomised clinical trial data.Main outcome measures: Costs in UK Sterling at 2003/2004 prices and quality-adjusted life years (QALYs) combined into an incremental cost-effectiveness ratio.Methods: Data from the third Randomised Intervention Trial of unstable Angina (RITA 3) was employed to estimate rates of cardiovascular death and myocardial infarction, costs and health-related quality of life. Cost-effectiveness was estimated over patients' lifetimes within the decision-analytic model.Results: The mean incremental cost per QALY gained for an early interventional strategy was approximately £55000, £22000 and £12000 for patients at low, intermediate and high risk, respectively. The early interventional strategy is approximately 1%, 35% and 95% likely to be cost-effective for patients at low, intermediate and high risk, respectively, at a threshold of £20000 per QALY. The cost-effectiveness of early intervention in low-risk patients is sensitive to assumptions about the duration of the treatment effect.Conclusion: An early interventional strategy in patients presenting with NSTE-ACS is likely to be considered cost-effective for patients at high and intermediate risk, but this is less likely to be the case for patients at low risk

Removal treatments alter the recruitment dynamics of a global marine invader - Implications for management feasibility

Frameworks designed to prioritise the management of invasive non-native species (INNS) must consider many factors, including their impacts on native biodiversity, ecosystem services, and human health. Management feasibility should also be foremost in any prioritisation process, but is often overlooked, particularly in the marine environment. The Asian kelp, Undaria pinnatifida, is one of the most cosmopolitan marine INNS worldwide and recognised as a priority species for monitoring in the UK and elsewhere. Here, experimental monthly removals of Undaria (from 0.2 m2 patches of floating pontoon) were conducted at two marinas to investigate their influence on recruitment dynamics and the potential implications for management feasibility. Over the 18-month experiment there was no consistent reduction in Undaria recruitment following removals. Cleaning of pontoon surfaces (i.e. removal of all biota) led to significant short-term reductions in recruitment but caused a temporal shift in normal recruitment patterns. Non-selective removal (i.e. all macroalgae) generally promoted recruitment, while selective removal (i.e. Undaria only) had some limited success in reducing overall recruitment. The varied results indicate that the feasibility of limiting Undaria is likely to be very low at sites with established populations and high propagule pressure. However, where there are new incursions, a mixture of cleaning of invaded surfaces prior to normal periods of peak recruitment followed by selective removal may have some potential in limiting Undaria populations within these sites. Multi-factorial experimental manipulations such as this are useful tools for gathering quantitative evidence to support the prioritisation of management measures for marine INNS

Identifying niche and fitness dissimilarities in invaded marine macroalgal canopies within the context of contemporary coexistence theory

Contemporary coexistence theory provides a framework for predicting invasiveness and impact of Invasive Non-Native Species (INNS) by incorporating differences in niche and fitness between INNS and co-occurring native species. The widespread invasive kelp Undaria pinnatifda is considered a high risk INNS, although a robust evidence base regarding its invasiveness and impact is lacking in many regions. Invaded macroalgal canopies at nine coastal sites in the southwest UK were studied over three years to discern whether Undaria is coexisting or competing with native canopy-forming species across diferent habitat types. Spatial, temporal and depth-related trends in species distributions and abundance were recorded within intertidal and subtidal rocky reef as well as on marina pontoons. A primary succession experiment also examined competitive interactions between species. In rocky reef habitats, Undaria had lower fitness compared to long-lived native perennials, but was able to coexist due to niche dissimilarity between species. In contrast, Undaria was likely to be competing with short lived native annuals on rocky reef due to large niche overlap and similar fitness. In marina habitats, Undaria dominated over all other canopy formers due to low niche diversification and higher fitness. Generalisations on INNS impact cannot be made across habitats or species, without considering many abiotic factors and biotic interactions

Reinstated episodic context guides sampling-based decisions for reward.

How does experience inform decisions? In episodic sampling, decisions are guided by a few episodic memories of past choices. This process can yield choice patterns similar to model-free reinforcement learning; however, samples can vary from trial to trial, causing decisions to vary. Here we show that context retrieved during episodic sampling can cause choice behavior to deviate sharply from the predictions of reinforcement learning. Specifically, we show that, when a given memory is sampled, choices (in the present) are influenced by the properties of other decisions made in the same context as the sampled event. This effect is mediated by fMRI measures of context retrieval on each trial, suggesting a mechanism whereby cues trigger retrieval of context, which then triggers retrieval of other decisions from that context. This result establishes a new avenue by which experience can guide choice and, as such, has broad implications for the study of decisions

de Sitter symmetry of Neveu-Schwarz spinors

We study the relations between Dirac fields living on the 2-dimensional Lorentzian cylinder and the ones living on the double-covering of the 2-dimensional de Sitter manifold, here identified as a certain coset space of the group $SL(2,R)$. We show that there is an extended notion of de Sitter covariance only for Dirac fields having the Neveu-Schwarz anti-periodicity and construct the relevant cocycle. Finally, we show that the de Sitter symmetry is naturally inherited by the Neveu-Schwarz massless Dirac field on the cylinder.Comment: 24 page

Electrical conductivity and electromagnetic interference shielding of multiwalled carbon nanotube composites containing Fe catalyst

Thin and flexible composite films of raw or purified multiwalled carbon nanotube (MWCNT) with various mass fractions and poly(methylmethacrylate) (PMMA) were synthesized for electromagnetic interference (EMI) shielding material. From scanning electron microscopy and high-resolution transmission electron microscopy photographs, we observed the formation of a conducting network through MWCNTs in an insulating PMMA matrix and the existence of an Fe catalyst in MWCNTs. The dc conductivity (sigma(dc)) of the systems increased with increasing MWCNT mass fraction, showing typical percolation behavior. The measured EMI shielding efficiency (SE) of MWCNT-PMMA composites by using the extended ASTM D4935-99 method (50 MHz-13.5 GHz) increased with increasing MWCNT mass fraction as sigma(dc). The highest EMI SE for raw MWCNT-PMMA composites was similar to27 dB, indicating commercial use for far-field EMI shielding. The contribution of absorption to total EMI SE of the systems is larger than that of reflection. Based on magnetic permeability, we suggest raw MWCNTs and their composites can be used for near-field EMI shielding.open28629

Fear and Courage in Children: Two Sides of the Same Coin?

This study further investigated the construct of courage in children. Children aged 8–13 years (n = 51) were interviewed about the most courageous action that they had ever performed during their life, and to retrospectively rate their level of fear and courage experienced during that event. On a separate occasion, children also completed the Courage Measure for Children (CM-C) as an index of children’s general level of personal courage, as well as scales for assessing anxiety symptoms and sensation seeking. Results indicated that almost all children (i.e., 94%) indicated that they had carried out a courageous action at some point during their life, although the levels of fear and courage associated with these acts varied considerably. Further, there was no relation between fear and courage reported for the courageous action, but these variables were significantly correlated with respectively anxiety symptoms and personal courage as indexed by the CM-C. Finally, a significant positive correlation was observed between sensation seeking and personal courage, indicating that children who are more thrill and adventure seeking are generally also more courageous. It is concluded that fear and courage in children are largely unrelated and not just two sides of the same coin. The implications of these results for the etiology and treatment of childhood anxiety problems are discussed

Eurasian Arctic greening reveals teleconnections and the potential for novel ecosystems

Arctic warming has been linked to observed increases in tundra shrub cover and growth in recent decades on the basis of significant relationships between deciduous shrub growth/biomass and temperature. These vegetation trends have been linked to Arctic sea ice decline and thus to the sea ice/albedo feedback known as Arctic amplification. However, the interactions between climate, sea ice and tundra vegetation remain poorly understood. Here we reveal a 50- year growth response over a >100,000 km2 area to a rise in summer temperature for alder (Alnus) and willow (Salix), the most abundant shrub genera respectively at and north of the continental treeline. We demonstrate that whereas plant productivity is related to sea ice in late spring, the growing season peak responds to persistent synoptic-scale air masses over West Siberia associated with Fennoscandian weather systems through the Rossby wave train. Substrate is important for biomass accumulation, yet a strong correlation between growth and temperature encompasses all observed soil types. Vegetation is especially responsive to temperature in early summer. These results have significant implications for modelling present and future Low Arctic vegetation responses to climate change, and emphasize the potential for structurally novel ecosystems to emerge fromwithin the tundra zone.Vertaisarviointia edeltävä käsikirjoitu

Prepared to practice? Perception of career preparation and guidance of recent medical graduates at two campuses of a transnational medical school: a cross-sectional study.

BACKGROUND: Graduating medical students enter the workforce with substantial medical knowledge and experience, yet little is known about how well they are prepared for the transition to medical practice in diverse settings. We set out to compare perceptions of medical school graduates\u27 career guidance with their perceptions of preparedness to practice as interns. We also set out to compare perceptions of preparedness for hospital practice between graduates from two transnational medical schools. METHODS: This was a cross-sectional study. A Preparedness for Hospital Practice (PHPQ) survey and career guidance questionnaire was sent to recent medical graduates, incorporating additional free text responses on career preparation. Data was analyzed using descriptive statistics and tests of association including Chi-square, Mann-Whitney U and Kruskal-Wallis H tests. RESULTS: Forty three percent (240/555) of graduates responded to the survey: 39 % of respondents were domestic (Dublin, Ireland or Manama, Kingdom of Bahrain) and interning locally; 15 % were overseas students interning locally; 42 % were overseas students interning internationally and 4 % had not started internship. Two variables explained 13 % of the variation in preparedness for hospital practice score: having planned postgraduate education prior to entering medical school and having helpful career guidance in medical school. Overseas graduates interning internationally were more likely to have planned their postgraduate career path prior to entering medical school. Dublin graduates found their career guidance more helpful than Bahrain counterparts. The most cited shortcomings were lack of structured career advice and lack of advice on the Irish and Bahraini postgraduate systems. CONCLUSIONS: This study has demonstrated that early consideration of postgraduate career preparation and helpful medical school career guidance has a strong association with perceptions of preparedness of medical graduates for hospital practice. In an era of increasing globalization of medical education, these findings can direct ongoing efforts to ensure all medical students receive career guidance and preparation for internship appropriate to their destination

Data-as-a-Service Platform for Delivering Healthy Lifestyle and Preventive Medicine: Concept and Structure of the DAPHNE Project

Background: Overweight and obesity is related to many health problems and diseases. The current obesity epidemic, which is a major health problem, is closely related to a lack of physical activity, high levels of sedentary behavior, and increased energy intake; with evidence to show increasing incidence of these issues in the younger population. Tackling obesity and its comorbid conditions requires a holistic approach encompassing attention on physical activity, healthy diet, and behavioral activation in order to enable and maintain meaningful and long-term weight loss and weight maintenance. Objective: The objective of the Data-as-a-Service Platform for Healthy Lifestyle and Preventive Medicine (DAPHNE) project is to develop a breakthrough information communications technology (ICT) platform for tracking health, weight, physical activity, diet, lifestyle, and psychological components within health care systems, whereby the platform and clinical support is linked. Methods: The DAPHNE platform aims to deliver personalized guidance services for lifestyle management to the citizen/patient by means of (1) advanced sensors and mobile phone apps to acquire and store continuous/real-time data on lifestyle aspects, behavior, and surrounding environment; (2) individual models to monitor their health and fitness status; (3) intelligent data processing for the recognition of behavioral trends; and (4) specific services for personalized guidance on healthy lifestyle and disease prevention. It is well known that weight loss and maintenance of weight loss are particularly difficult. This tool will address some of the issues found with conventional treatment/advice in that it will collect data in real time, thereby reducing reliability issues known with recalling events once they have passed and will also allow adjustment of behavior through timely support and recommendations sent through the platform without the necessity of formal one-to-one visits between patient and clinician. Patient motivation/compliance is a particular issue with conventional weight loss regimes; DAPHNE aims to increase the individuals’ awareness of their own behavior and fosters their accountability. Results: The project has been funded and the research work has started. Results for the validation of the different components is due imminently. Conclusions: In contrast with previous existing solutions, the DAPHNE project tackles the obesity problem from a clinical point of view, designing the different interfaces for its use by patients (adults and children), physicians, and caregivers. A specific design for children and adolescent patients treated for obesity has been followed, guided by pediatric physicians at hospitals in Europe. The final clinical validation of the DAPHNE platform will be carried out in different European hospitals, testing the platform in both adolescents and adults