Over a wide range of estimates of costs and effectiveness, a nurse-managed smoking cessation program after acute myocardial infarction is an extremely cost-effective intervention. This program is more cost-effective than beta-adrenergic antagonist therapy after myocardial infarction.

Expected utility theory is felt by its proponents to be a normative theory of decision making under uncertainty. The theory starts with some simple axioms that are held to be rules that any rational person would follow. It can be shown that if one adheres to these axioms, a numerical quantity, generally referred to as utility, can be assigned to each possible outcome, with the preferred course of action being that which has the highest expected utility. One of these axioms, the independence principle, is controversial, and is frequently violated in experimental situations. Proponents of the theory hold that these violations are irrational. The independence principle is simply an axiom dictating consistency among preferences, in that it dictates that a rational agent should hold a specified preference given another stated preference. When applied to preferences between lotteries, the independence principle can be demonstrated to be a rule that is followed only when preferences are formed in a particular way. The logic of expected utility theory is that this demonstration proves that preferences should be formed in this way. An alternative interpretation is that this demonstrates that the independence principle is not a valid general rule of consistency, but in particular, is a rule that must be followed if one is to consistently apply the decision rule "choose the lottery that has the highest expected utility." This decision rule must be justified on its own terms as a valid rule of rationality by demonstration that violation would lead to decisions that conflict with the decision maker's goals. This rule does not appear to be suitable for medical decisions because often these are one-time decisions in which expectation, a long-run property of a random variable, would not seem to be applicable. This is particularly true for those decisions involving a non-trivial risk of death.

It appears that clinical urgency is only one of many factors influencing attitudes about allocation decisions and that respondents may invoke different principles of fairness depending the relative clinical status of patients.

The effects of stepwise concentration changes of K+ and HCO3- in the basolateral solution on the basolateral membrane potential (Vbl) of proximal tubule cells of the doubly-perfused Necturus kidney were examined using conventional microelectrodes. Apparent transference numbers were calculated from changes in Vb1 after alterations in external K+ concentration from 1.0 to 2.5 mM (tK, 1.0-2.5), 2.5 to 10, and in external HCO3- concentration (at constant pH) from 5 to 10 mM (tHCO3, 5-10), 10 to 20, or 10 to 50. tK, 2.5-10 was 0.38 +/- 0.02 under control conditions but was sharply reduced to 0.08 +/- 0.03 (P greater than 0.001) by 4 mM Ba++. This concentration of Ba++ reduced Vb1 by 9 +/- 1 mV (at 2.5 external K+). Perfusion with SITS (5 X 10(-4)M) for 1 hr hyperpolarized Vb1 by 10 +/- 3 mV and increased tK, 2.5-10 significantly to 0.52 +/- 0.01 (P less than 0.001). Ba++ application in the presence of SITS depolarized Vb1 by 22 +/- 3 mV. In control conditions tHCO3, 10-50 was 0.63 +/- 0.05 and was increased to 0.89 +/- 0.07 (P less than 0.01) by Ba++ but was decreased to 0.14 +/- 0.02 (P less than 0.001) by SITS. In the absence of apical and basolateral chloride, the response of Vb1 to bicarbonate was diminished but still present (tHO3, 10-20 was 0.35 +/- 0.03). Intracellular pH, measured with liquid ion-exchange microelectrodes, increased from 7.42 +/- 0.19 to 7.57 +/- 0.17 (P less than 0.02) when basolateral bicarbonate was increased from 10 to 20 mM at constant pH. These data show that the effects of bicarbonate on Vb1 are largely independent of effects on the K+ conductance and that there is a significant current-carrying bicarbonate pathway in the basolateral membrane.(ABSTRACT TRUNCATED AT 250 WORDS)