The cost-effectiveness of the SPHERE intervention for the secondary prevention of coronary heart disease

Objectives: The Secondary Prevention of Heart disEase in geneRal practicE (SPHERE) trial has recently reported. This study examines the cost-effectiveness of the SPHERE intervention in both healthcare systems on the island of Ireland. Methods: Incremental cost-effectiveness analysis. A probabilistic model was developed to combine within-trial and beyond-trial impacts of treatment to estimate the lifetime costs and benefits of two secondary prevention strategies: Intervention - tailored practice and patient care plans; and Control - standardized usual care. Results: The intervention strategy resulted in mean cost savings per patient of 512.77 (95 percent confidence interval [CI], 1086.46-91.98) and an increase in mean quality-adjusted life-years (QALYs) per patient of 0.0051 (95 percent CI, 0.0101-0.0200), when compared with the control strategy. The probability of the intervention being cost-effective was 94 percent if decision makers are willing to pay €45,000 per additional QALY. Conclusions: Decision makers in both settings must determine whether the level of evidence presented is sufficient to justify the adoption of the SPHERE intervention in clinical practice. Copyright © Cambridge University Press 2010.

The application of colloidal gas aphrons in the recovery of fine cellulose fibres from paper mill wastewater

Colloidal gas aphrons (CGAs) are micron-sized gas bubbles of 25–30 µm in diameter produced by a high-speed stirrer in a vessel containing dilute surfactant solution. These bubbles, because of their small size, exhibit some colloidal properties. In this work, CGAs were used to separate fine fibres from a lean slurry of cellulosic pulp in a flotation column. The pulp fibres were recovered as foamate from the top. Sodium dodecyl sulphate at a concentration of 2.0 kg/m3 was used as a surfactant to generate the CGAs in a spinning disc apparatus. The results indicated that up to 70% flotation efficiency could be obtained within a short column height of 0.3–0.35 m. This technique can be applied to recover fine cellulosic pulp from paper-machine backwater.

NON-GAUSSIAN STATISTICS OF OIL PRICING TIME-SERIES: A CASE STUDY

The stochastic nature of oil price fluctuations is investigated over a twelve-year period, borrowing feedback from an existing database (USA Energy Information Administration database, available online). We evaluate the scaling exponents of the fluctuations by employing different statistical analysis methods, namely rescaled range analysis (R/S), scale windowed variance analysis (SWV) and the generalized Hurst exponent (GH) method. Relying on the scaling exponents obtained, we apply a rescaling procedure to investigate the complex characteristics of the probability density functions (PDFs) dominating oil price fluctuations. It is found that PDFs exhibit scale invariance, and in fact collapse onto a single curve when increments are measured over microscales (typically less than 30 days). The time evolution of the distributions is well fitted by a Levy-type stable distribution. The relevance of a Levy distribution is made plausible by a simple model of nonlinear transfer. Our results also exhibit a degree of multifractality as the PDFs change and converge toward to a Gaussian distribution at the macroscales.

Systematic review of the effect of diet and exercise lifestyle interventions in the secondary prevention of coronary heart disease.

The effectiveness of lifestyle interventions within secondary prevention of coronary heart disease(CHD)remains unclear.This systematic review aimed to determine their effectiveness and included randomized controlled trials of lifestyle interventions, in primary care or community settings, with a minimum follow-up of three months, published since 1990. 21 trials with 10,799 patients were included; the interventions were multifactorial (10), educational (4), psychological (3), dietary (1), organisational (2), and exercise(1). The overall results for modifiable risk factors suggested improvements in dietary and exercise outcomes but no overall effect on smoking outcomes. In trials that examined mortality and morbidity,significant benefits were reported for total mortality (in 4 of 6 trials;overall risk ratio(RR) 0.75 (95%confidence intervals (CI) 0.65, 0.87)), cardiovascular mortality (3 of 8 trials; overall RR 0.63(95%CI 0.47, 0.84)), and nonfatal cardiac events(5 of 9 trials; overall RR 0.68(95%CI 0.55, 0.84)). The heterogeneity between trials and generally poor quality of trials make any concrete conclusions difficult. However, the beneficial effects observed in this review are encouraging and should stimulate further research.

Translating policy into practice: A case study in the secondary prevention of coronary heart disease

Background: This paper focuses on the relationships between health ‘policy’ as it is embodied in official documentation, and health ‘practice’ as reported and reflected on in the talk of policy makers, health professionals and patients. The specific context for the study involves a comparison of policies relating to the secondary prevention of coronary heart disease (CHD) in the two jurisdictions of Ireland – involving as they do a predominantly state funded (National Health Service) system in the north and a mixed healthcare economy in the south. The key question is to determine how the rhetoric of health policy as contained in policy documents connects to, and gets translated into practice and action.

Methods: The data sources for the study include relevant healthcare policy documents (N=5) and progress reports (N=6) in the two Irish jurisdictions, and semi-structured interviews with a range of policy-makers (N=28), practice nurses (14), general practitioners (12) and patients (13) to explore their awareness of the documents’ contents and how they saw the impact of ‘policy’ on primary care practice.

Results: The findings suggest that although strategic policy documents can be useful for highlighting and channelling attention to health issues that require concerted action, they have little impact on what either professionals or lay people do.

Conclusion: To influence the latter and to encourage a systematic approach to the delivery of health care it seems likely that contractual arrangements – specifying tasks to be undertaken and methods for monitoring and reporting on activity - are required.

Spitzer Secondary Eclipses of WASP-18b

The transiting exoplanet WASP-18b was discovered in 2008 by the Wide Angle Search for Planets project. The Spitzer Exoplanet Target of Opportunity Program observed secondary eclipses of WASP-18b using Spitzer's Infrared Array Camera in the 3.6 µm and 5.8 µm bands on 2008 December 20, and in the 4.5 µm and 8.0 µm bands on 2008 December 24. We report eclipse depths of 0.30% ± 0.02%, 0.39% ± 0.02%, 0.37% ± 0.03%, 0.41% ± 0.02%, and brightness temperatures of 3100 ± 90, 3310 ± 130, 3080 ± 140, and 3120 ± 110 K in order of increasing wavelength. WASP-18b is one of the hottest planets yet discovered—as hot as an M-class star. The planet's pressure-temperature profile most likely features a thermal inversion. The observations also require WASP-18b to have near-zero albedo and almost no redistribution of energy from the day side to the night side of the planet.

z'-band Ground-based Detection of the Secondary Eclipse of WASP-19b

We present the ground-based detection of the secondary eclipse of the transiting exoplanet WASP-19b. The observations were made in the Sloan z' band using the ULTRACAM triple-beam CCD camera mounted on the New Technology Telescope. The measurement shows a 0.088% ± 0.019% eclipse depth, matching previous predictions based on H- and K-band measurements. We discuss in detail our approach to the removal of errors arising due to systematics in the data set, in addition to fitting a model transit to our data. This fit returns an eclipse center, T 0, of 2455578.7676 HJD, consistent with a circular orbit. Our measurement of the secondary eclipse depth is also compared to model atmospheres of WASP-19b and is found to be consistent with previous measurements at longer wavelengths for the model atmospheres we investigated.