Cost-effectiveness of a European preventive cardiology programme in primary care: A Markov modelling approach

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license.OBJECTIVE: To investigate the longer-term cost-effectiveness of a nurse-coordinated preventive cardiology programme for primary prevention of cardiovascular disease (CVD) compared to routine practice from a health service perspective. DESIGN: A matched, paired cluster-randomised controlled trial. SETTING: Six pairs of general practices in six countries. PARTICIPANTS: 1019 patients were randomised to the EUROACTION intervention programme and 1005 patients to usual care (UC) and who completed the 1-year follow-up. OUTCOME MEASURES: Evidence on health outcomes and costs was based on patient-level data from the study, which had a 1-year follow-up period. Future risk of CVD events was modelled, using published risk models based on patient characteristics. An individual-level Markov model for each patient was used to extrapolate beyond the end of the trial, which was populated with data from published sources. We used an 11-year time horizon and investigated the impact on the cost-effectiveness of varying the duration of the effect of the intervention beyond the end of the trial. Results are expressed as incremental cost per quality-adjusted life-year gained. RESULTS: Unadjusted results found the intervention to be more costly and also more effective than UC. However, after adjusting for differences in age, gender, country and baseline risk factors, the intervention was dominated by UC, but this analysis was not able to take into account the lifestyle changes in terms of diet and physical activity. CONCLUSIONS: Although the EUROACTION study achieved healthier lifestyle changes and improvements in management of blood pressure and lipids for patients at high risk of CVD, compared to UC, it was not possible to show, using available risk equations which do not incorporate diet and physical activity, that the intervention reduced longer-term cardiovascular risk cost-effectively. Whether or not an intervention such as that offered by EUROACTION is cost-effective requires a longer-term trial with major cardiovascular events as the outcome.This study is sponsored solely by AstraZeneca through the provision of an unconditional educational grant

Great Bay Nitrogen Non-Point Source Study

The Great Bay Estuary is 21 square miles of tidal waters located in southeastern New Hampshire. It is one of 28 “estuaries of national significance” established under the Environmental Protection Agency’s National Estuary Program. The estuary is experiencing the signs of eutrophication, specifically, low dissolved oxygen, macroalgae blooms, and declining eelgrass habitat (DES, 2012). Sixty-eight percent of the nitrogen that ends up in the Great Bay Estuary originates from sources spread across the watershed; the remainder derives from direct discharges of municipal wastewater treatment facilities (DES, 2010; PREP, 2013). In this report, these sources of nitrogen are called non-point sources and consist of atmospheric deposition, fertilizers, human waste disposed into septic systems, and animal waste. The purpose of this study is to determine how much nitrogen each non-point source type contributes to the estuary. The nitrogen loads from municipal wastewater treatment facilities have been reported elsewhere (DES, 2010; PREP, 2012; PREP, 2013) and, therefore, are not included in this study except to provide context. The intended use of this study is for planning purposes, and is not meant for regulatory allocations or specific reduction requirements. The results of the model may be useful for towns or watershed groups for prioritizing nitrogen reduction efforts or as a starting point for more detailed studies of non-point sources. However, more detailed inventories of non-point sources will be needed to track the effects of nitrogen reduction efforts in smaller areas. In addition, the model makes no conclusions about the benefits of nitrogen reductions to receiving waters or overall estuarine health

POPULATION LEVEL CONDITIONS AS SIGNALS OF ENTREPRENEURIAL OPPORTUNITIES: A COGNITVE SYNTHESIS OF THE ENTREPRENEURIAL TRAITS AND POPULATION RATES PERSPECTIVES

The ecology based environmental perspective implicitly suggests that population level founding rates, dissolution rates, and density levels influence the likelihood that entrepreneurs will launch new ventures within a given population domain. The central idea is that population rates and densities may act as signals to entrepreneurs regarding the viability of a new venture within a given population. Interestingly, whether or not population level factors actually influence the new venture creation process remains an open question. As such, the central purpose of this research is to utilize a cognitive approach to better understand how population level conditions and the individual differences of fear of failure and general self-efficacy influence entrepreneurs decisions to engage in entrepreneurial action. This thesis proposes a model that integrates the population rates and entrepreneurial traits perspectives by focusing on entrepreneurs\u27 hypothetical decisions to invest in entrepreneurial opportunities given differential levels of population factors. Because this research is focused on entrepreneurial decision making an experimental methodology using conjoint analysis was selected to test the theoretical model. Fifty seven experienced entrepreneurs participated in the conjoint experiment. Results revealed a significant main effect for founding rates, dissolution rates, and population density on the entrepreneur\u27s decision to invest in an opportunity. Specifically, our results indicated that the entrepreneurs in our sample were more likely to invest in an opportunity when founding rates were high, dissolution rates were low, and density levels were low or moderate. We found limited support for the interaction of these variables. In terms of the individual difference variables, we found support for the influence of fear of failure, but no support for the effects of general self-efficacy on the investment decision. Specifically, entrepreneurs who indicated lower levels of fear of failure were more likely to invest in the opportunity, while differential levels of general self efficacy did not enhance or reduce the probability of opportunity investment in a significant way

Photoionization of High Altitude Gas in a Supernova-Driven Turbulent Interstellar Medium

We investigate models for the photoionization of the widespread diffuse ionized gas in galaxies. In particular we address the long standing question of the penetration of Lyman continuum photons from sources close to the galactic midplane to large heights in the galactic halo. We find that recent hydrodynamical simulations of a supernova-driven interstellar medium have low density paths and voids that allow for ionizing photons from midplane OB stars to reach and ionize gas many kiloparsecs above the midplane. We find ionizing fluxes throughout our simulation grids are larger than predicted by one dimensional slab models, thus allowing for photoionization by O stars of low altitude neutral clouds in the Galaxy that are also detected in Halpha. In previous studies of such clouds the photoionization scenario had been rejected and the Halpha had been attributed to enhanced cosmic ray ionization or scattered light from midplane H II regions. We do find that the emission measure distributions in our simulations are wider than those derived from Halpha observations in the Milky Way. In addition, the horizontally averaged height dependence of the gas density in the hydrodynamical models is lower than inferred in the Galaxy. These discrepancies are likely due to the absence of magnetic fields in the hydrodynamic simulations and we discuss how magnetohydrodynamic effects may reconcile models and observations. Nevertheless, we anticipate that the inclusion of magnetic fields in the dynamical simulations will not alter our primary finding that midplane OB stars are capable of producing high altitude diffuse ionized gas in a realistic three-dimensional interstellar medium.Comment: ApJ accepted. 17 pages, 7 figure

Results from a set of three-dimensional numerical experiments of a hot Jupiter atmosphere

We present highlights from a large set of simulations of a hot Jupiter atmosphere, nominally based on HD 209458b, aimed at exploring both the evolution of the deep atmosphere, and the acceleration of the zonal flow or jet. We find the occurrence of a super-rotating equatorial jet is robust to changes in various parameters, and over long timescales, even in the absence of strong inner or bottom boundary drag. This jet is diminished in one simulation only, where we strongly force the deep atmosphere equator-to-pole temperature gradient over long timescales. Finally, although the eddy momentum fluxes in our atmosphere show similarities with the proposed mechanism for accelerating jets on tidally-locked planets, the picture appears more complex. We present tentative evidence for a jet driven by a combination of eddy momentum transport and mean flow.Comment: 26 pages, 22 Figures. Accepted for publication in Astronomy and Astrophysic

Proteins in the Nutrient-Sensing and DNA Damage Checkpoint Pathways Cooperate to Restrain Mitotic Progression following DNA Damage

Checkpoint pathways regulate genomic integrity in part by blocking anaphase until all chromosomes have been completely replicated, repaired, and correctly aligned on the spindle. In Saccharomyces cerevisiae, DNA damage and mono-oriented or unattached kinetochores trigger checkpoint pathways that bifurcate to regulate both the metaphase to anaphase transition and mitotic exit. The sensor-associated kinase, Mec1, phosphorylates two downstream kinases, Chk1 and Rad53. Activation of Chk1 and Rad53 prevents anaphase and causes inhibition of the mitotic exit network. We have previously shown that the PKA pathway plays a role in blocking securin and Clb2 destruction following DNA damage. Here we show that the Mec1 DNA damage checkpoint regulates phosphorylation of the regulatory (R) subunit of PKA following DNA damage and that the phosphorylated R subunit has a role in restraining mitosis following DNA damage. In addition we found that proteins known to regulate PKA in response to nutrients and stress either by phosphorylation of the R subunit or regulating levels of cAMP are required for the role of PKA in the DNA damage checkpoint. Our data indicate that there is cross-talk between the DNA damage checkpoint and the proteins that integrate nutrient and stress signals to regulate PKA

HexPak and GradPak: variable-pitch dual-head IFUs for the WIYN 3.5m Telescope Bench Spectrograph

We describe the design, construction, and expected performance of two new fiber integral field units (IFUs) --- HexPak and GradPak --- for the WIYN 3.5m Telescope Nasmyth focus and Bench Spectrograph. These are the first IFUs to provide formatted fiber integral field spectroscopy with simultaneous sampling of varying angular scales. HexPak and GradPak are in a single cable with a dual-head design, permitting easy switching between the two different IFU heads on the telescope without changing the spectrograph feed: the two heads feed a variable-width double-slit. Each IFU head is comprised of a fixed arrangement of fibers with a range of fiber diameters. The layout and diameters of the fibers within each array are scientifically-driven for observations of galaxies: HexPak is designed to observe face-on spiral or spheroidal galaxies while GradPak is optimized for edge-on studies of galaxy disks. HexPak is a hexagonal array of 2.9 arcsec fibers subtending a 40.9 arcsec diameter, with a high-resolution circular core of 0.94 arcsec fibers subtending 6 arcsec diameter. GradPak is a 39 by 55 arcsec rectangular array with rows of fibers of increasing diameter from angular scales of 1.9 arcsec to 5.6 arcsec across the array. The variable pitch of these IFU heads allows for adequate sampling of light profile gradients while maintaining the photon limit at different scales.Comment: 10 pages, 4 figures, presented at SPIE, Astronomical Telescopes and Instrumentation, 1 - 6 July 2012, Amsterdam, Netherland