Substituting bicycling for driving is frequently promoted as a means of reducing energy consumption and the associated degradation of the environment. This paper estimates the magnitude of this effect. The analysis takes account of the first-order effects due to the dramatically lower energy requirements of transportation by bicycle relative to automobiles. The environmental benefits of human power are, however, strongly coupled to the environmental costs of increased population, due to increased longevity of those who engage in physical activity. Paradoxically, increased use of human power for transportation is unlikely to reduce substantially the use of energy because of this second-order effect. Humanpowered transportation is therefore less an environmental issue and more an issue of public health. The interplay between longevity and environmental impact is a central feature of the conflicting societal objectives of improving human health and increasing environmental sustainability.

Preliminary–please do not cite without permission In the US, women tend to have lower levels of financial literacy than men. This is consistent with a household division of labor in which men manage finances. However, women also tend to outlive their husbands, so they will eventually need to take over this task. Using a new survey of older couples, I find that women acquire additional financial literacy as they approach widowhood. At an estimated increase of 0.04 standard deviations per year approaching widowhood, 80 % of women in my sample would catch up with their husbands prior to the expected onset of widowhood. I also demonstrate that these findings are due to actual increases by women and are not merely an artifact of cognitive decline among older men. These results are consistent with a model in which the household division of labor breaks down when a spouse dies. The model shows that women have an incentive both to delay acquiring financial knowledge and also to begin learning before widowhood. This paper represents the first empirical examination of the financial literacy of both membersofcouplesandprovidesalife-cycleinterpretationofthegendergapinfinancial literacy. This paper employs data that is generously supported by NIA grant P01 AG026571. Many thanks to

Background: Cardiovascular disease continues to be the leading cause of death in women and men in the United States. This study aimed to investigate differences in characteristics between those women who died and survived an acute myocardial infarction (MI). Methods: This secondary analysis included 109 women. Demographic variables were extracted along with presenting MI symptoms, cardiovascular risk factors (family history of cardiovascular disease, patient history of cardiovascular disease, diabetes, hypercholesterolemia, hypertension, and smoking history), type of MI, time of symptom onset and time of presentation to emergency department (ED) for treatment. Descriptive statistics described the sample, t-tests and chi-square analyzed differences between the groups. Results: There was a 12 % mortality rate for women experiencing an acute MI. The women who died had a mean age of 79 years, approximately 7 years older than those who survived (P = 0.037). The leading MI presenting symptoms were chest pain and shortness of breath. The mean number of cardiovascular risk factors for those who died were 2.15 compared to 2.75 for those who survived (P = 0.063). The majority of those women who survived had a non ST Elevation MI (94%) compared to 54 % with a non ST Elevation MI who died. Median time to ED presentation was 242.5 minutes for those who survived compared to 244 minutes who died (P = 0.951). Conclusions: These data demonstrate a MI mortality profile of women which included an older age, no family history of heart disease reported, and a high rate of hypertension. Those who died reported chest pain and shortness of breath, with several presenting with a syncopal event. In addition, the women represented in this sample had a prolonged presentation time for treatment. Manuscript accepted for publication December 9, 2009

The potential of personalized medicine to transform the treatment of mood disorders has been widely touted in psychiatry, but has not been quantified. We estimated the costs and benefits of a putative pharmacogenetic test for antidepressant response in the treatment of major depressive disorder (MDD) from the societal perspective. Specifically, we performed cost-effectiveness analyses using state-transition probability models incorporating probabilities from the multicenter STAR*D effectiveness study of MDD. Costs and quality-adjusted life years were compared for sequential antidepressant trials, with or without guidance from a pharmacogenetic test for differential response to selective serotonin reuptake inhibitors (SSRIs). Likely SSRI responders received an SSRI, while likely nonresponders received the norepinephrine/dopamine reuptake inhibitor bupropion. For a 40-year-old with major depressive disorder, applying the pharmacogenetic test and using the non-SSRI bupropion for those at higher risk for nonresponse cost $93,520 per additional quality-adjusted life-year (QALY) compared with treating all patients with an SSRI first and switching sequentially in the case of nonremission. Cost/QALY dropped below $50,000 for tests with remission rate ratios as low as 1.5, corresponding to odds ratios ~1.8–

Background: Prostate cancer (PCa) is the most common cancer affecting men in the United States. The initial treatment and subsequent monitoring of PCa patients places a large burden on U.S. health care systems. The objectives of this study were to estimate the total and disease-related per-patient lifetime costs using a phasebased model of cancer care for PCa patients enrolled in Medicare. Methods: A model was developed to estimate life-time costs for patients diagnosed with PCa. Patients ≥ 65 years old and diagnosed with PCa between calendar years 1991-2002 were selected from the SEER database. Using SEER, we estimated survival times for PCa patients from diagnosis until death. The period of time patients contributed to treatment phases was determined using an algorithm designed to model the natural history of PCa. Costs were obtained from the US SEER-Medicare database and estimated during specific phases of care. Cost estimates were then combined with survival data to yield total and PCa-related life-time costs. Results: Overall, the model estimated life-time costs of $110,520 (95 % CI 110,324-110,739) per patient. PCa-related costs made up approximately 31 % of total costs ($34,432). Conclusions: Prostate cancer places a significant burden on U.S. health-care systems with average life-time PCarelated costs in excess of $30,000.

Research article

Converging evidence suggests that high levels of education and intellectual activity increase the cognitive reserve and reduce the risk of dementia. However, little is known about the impact that different neuroprotective strategies may have on the incidence of Alzheimer’s disease. Using a simple mathematical regression model, it is shown here that age-specific counts of basic cognitive units (surrogate of neurons or synapses) in the normal population can be estimated from Alzheimer’s incidence rates. Hence, the model can be used to test the effect of neuroprotection on Alzheimer’s incidence. It was found that the number of basic cognitive units decreases with age, but levels off in older people. There were no gender differences after correcting for survival. The model shows that even modest neuroprotective effects on basic cognitive units can lead to dramatic reductions in the number of Alzheimer’s cases. Most remarkably, a 5 % increase in the cognitive reserve would prevent one third of Alzheimer’s cases. These results suggest that public health policies aimed at increasing the cognitive reserve in the general population (e.g., implementing higher levels of education) are likely the most effective strategy for preventing Alzheimer’s disease.