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.

Nebular and Auroral Emission Lines of [Ar IV] in the Optical Spectra of Planetary Nebulae

Recent R-matrix calculations of electron impact excitation rates in Ar IV are used to calculate the emission-line ratio: ratio diagrams (R₁, R₂), (R_1, R₃), and (R_1, R₄), where K₁ = I(4711 Å)/I(4740 Å), R₂ = I(7238 Å)/I(4711 + 4740 Å), R₃ = I(7263 Å)/I(4711 + 4740 Å), and R₄ = I(7171 Å)/I(4711 + 4740 Å), for a range of electron temperatures (T_e = 5000-20,000 K) and electron densities (N_e = 10-10⁶ cm^-3) appropriate to gaseous nebulae. These diagrams should, in principle, allow the simultaneous determination of T_e and N_e from measurements of the [Ar IV] lines in a spectrum. Plasma parameters deduced for a sample of planetary nebulae from (R_1, R₃) and (R_1, R₄), using observational date obtained with the Hamilton echelle spectrograph on the 3 m Shane Telescope at the Lick Observatory, are found to show excellent internal consistency and to be in generally good agreement with the values of T_e and N_e estimated from other line ratios in the echelle spectra. These results provide observational support for the accuracy of the theoretical ratios and, hence, the atomic data adopted in their derivation. In addition, they imply that the 7171 Å line is not as seriously affected by telluric absorption as previously thought. However, the observed values of R₂ are mostly larger than the theoretical high-temperature and density limit, which is due to blending of the Ar IV 7237.54 Å line with the strong C II transition at 7236 Å. 

Behavioral plasticity allows short-term adjustment to a novel environment

Many species are currently experiencing anthropogenically driven environmental changes. Among these changes, increasing noise levels are specifically a problem for species relying on acoustic communication. Recent evidence suggests that some species adjust their acoustic signals to man-made noise. However, it is unknown whether these changes occur through short-term and reversible adjustments by behavioral plasticity or through long-term adaptations by evolutionary change. Using behavioral observations and playback experiments, we show that male reed buntings (Emberiza schoeniclus) adjusted their songs immediately, singing at a higher minimum frequency and at a lower rate when noise levels were high. Our data showed that these changes in singing behavior were short-term adjustments of signal characteristics resulting from behavioral plasticity, rather than a long-term adaptation. However, more males remained unpaired at a noisy location than at a quiet location throughout the breeding season. Thus, phenotypic plasticity enables individuals to respond to environmental changes, but whether these short-term adjustments are beneficial remains to be seen.

Jettisoning Ballast or Fuel? Caudal Autotomy and Locomotory Energetics of the Cape Dwarf Gecko Lygodactylus capensis (Gekkonidae)

Many lizard species will shed their tail as a defensive response (e.g., to escape a putative predator or aggressive conspecific). This caudal autotomy incurs a number of costs as a result of loss of the tail itself, loss of resources (i.e., stored in the tail or due to the cost of regeneration), and altered behavior. Few studies have examined the metabolic costs of caudal autotomy. A previous study demonstrated that geckos can move faster after tail loss as a result of reduced weight or friction with the substrate; however, there are no data for the effects of caudal autotomy on locomotory energetics. We examined the effect of tail loss on locomotory costs in the Cape dwarf gecko Lygodactylus capensis (similar to 0.9 g) using a novel method for collecting data on small lizards, a method previously used for arthropods. We measured CO2 production during 5-10 min of exhaustive exercise (in response to stimulus) and during a 45-min recovery period. During exercise, we measured speed (for each meter moved) as well as total distance traveled. Contrary to our expectations, tailless geckos overall expended less effort in escape running, moving both slower and for a shorter distance, compared with when they were intact. Tailless geckos also exhibited lower excess CO2 production (CO2 production in excess of normal resting metabolic rate) during exercising. This may be due to reduced metabolically active tissue (tails represent 8.7% of their initial body mass). An alternative suggestion is that a change in energy substrate use may take place after tail loss. This is an intriguing finding that warrants future biochemical investigation before we can predict the relative costs of tail loss that lizards might experience under natural conditions.

Testosterone levels in dominant sociable males are lower than in solitary roamers: Physiological differences between three male reproductive tactics in a sociably flexible mammal

The relative plasticity hypothesis predicts that alternative tactics are associated with changes in steroid hormone levels. In species with alternative male reproductive tactics, the highest androgen levels have usually been reported in dominant males. However, in sociable species, dominant males show amicable behaviors to gain access to females, which might conflict with high testosterone levels. We compared testosterone, corticosterone, and resting metabolic rate in male striped mice (Rhabdomys pumilio) following a conditional strategy with three different reproductive tactics: (i) philopatric group-living males, (ii) solitary-living roamers, (iii) dominant but sociable group-living territorial breeders. Philopatrics had the lowest testosterone but highest corticosterone levels, suggesting that they make the best of a bad job. Dominant territorial breeders had lower testosterone levels than roamers, which have a lower competitive status. Roamers had the highest testosterone levels, which might promote risky behavior, such as invading territories defended by territorial males. Roamers also had lower resting metabolic rates than either type of group-living males. Our results suggest that dominant males' testosterone levels reflect a trade-off between low testosterone amicable behavior and high testosterone dominance behavior.

Hot Electrons Transverse Refluxing in Ultraintense Laser-Solid Interactions

We have analyzed the coupling of ultraintense lasers (at similar to 2 X 1019 W/cm(2)) with solid foils of limited transverse extent (similar to 10 s of mu m) by monitoring the electrons and ions emitted from the target. We observe that reducing the target surface area allows electrons at the target surface to be reflected from the target edges during or shortly after the laser pulse. This transverse refluxing can maintain a hotter, denser and more homogeneous electron sheath around the target for a longer time. Consequently, when transverse refluxing takes places within the acceleration time of associated ions, we observe increased maximum proton energies (up to threefold), increased laser-to-ion conversion efficiency (up to a factor 30), and reduced divergence which bodes well for a number of applications.