A model to assess the cost effectiveness of statins in achieving the UK National Service Framework target cholesterol levels

Background: Coronary heart disease (CHD) is a public health priority in the UK. The National Service Framework (NSF) has set standards for the prevention, diagnosis and treatment of CHD, which include the use of cholesterol-lowering agents aimed at achieving targets of blood total cholesterol (TC) < 5.0 mmol/L and low density lipoprotein-cholesterol (LDL-C) < 3.0 mmol/L. In order to achieve these targets cost effectively, prescribers need to make an informed choice from the range of statins available. Aim: To estimate the average and relative cost effectiveness of atorvastatin, fluvastatin, pravastatin and simvastatin in achieving the NSF LDL-C and TC targets. Design: Model-based economic evaluation. Methods: An economic model was constructed to estimate the number of patients achieving the NSF targets for LDL-C and TC at each dose of statin, and to calculate the average drug cost and incremental drug cost per patient achieving the target levels. The population baseline LDL-C and TC, and drug efficacy and drug costs were taken from previously published data. Estimates of the distribution of patients receiving each dose of statin were derived from the UK national DIN-LINK database. Results: The estimated annual drug cost per 1000 patients treated with atorvastatin was £289 000, with simvastatin £315 000, with pravastatin £333 000 and with fluvastatin £167 000. The percentages of patients achieving target are 74.4%, 46.4%, 28.4% and 13.2% for atorvastatin, simvastatin, pravastatin and fluvastatin, respectively. Incremental drug cost per extra patient treated to LDL-C and TC targets compared with fluvastafin were £198 and £226 for atorvastatin, £443 and £567 for simvastatin and £1089 and £2298 for pravastatin, using 2002 drug costs. Conclusions: As a result of its superior efficacy, atorvastatin generates a favourable cost-effectiveness profile as measured by drug cost per patient treated to LDL-C and TC targets. For a given drug budget, more patients would achieve NSF LDL-C and TC targets with atorvastatin than with any of the other statins examined.

Giants and dwarfs:the multilevel lobbying strategies of national interest organizations

The article addresses the bias in interest representation within the EU by examining the lobbying strategies of national interest organisations within the EU’s multilevel political system. Both our theoretical framework, which includes the determinants of a national interest organisation's decision to act at the EU level, and the data analysis from the INTEREURO Multi-Level Governance Module (MLG) (www.intereuro.eu) reveal three main findings. Firstly, the greatest differentiation among interest organisations (IOs) appears to be between those IOs from the older member states (Germany, the UK and the Netherlands), which exhibit above-average levels of activity, and those from the newer EU member states (Sweden, Slovenia), which exhibit below-average levels of activity. Secondly, the variations in IO activity levels are much greater from country to country than from one policy field to another. Thirdly, although the IOs from all five countries in our study are more likely to employ media and publishing strategies (information politics) than to mobilise their members and supporters (protest politics), we can still observe national patterns in their selection of strategies and in the intensity of their instrumentalisation.

An analysis of the on-time graduation rate in the two-year program at National Taipei Institute of Technology in Taiwan

Taiwan's technical vocational educational system includes three levels: (1) institutes of technology (two and four year programs), (2) junior colleges (two, three and five year programs), and (3) senior vocational schools. Two-year junior colleges enroll their students through two channels: (1) based on results of the Particular Screening Entrance Examination (PSEE), (2) based on the Joint College Entrance Examination (JCEE). The PSEE has two categories: Category I includes on-time graduates with excellent performance, which means that they are within the top ten of their classes; Category II students include award-winning students in talent contests who have achieved a minimum grade point average of 75%. The JCEE is a regular entrance examination given to any senior vocation school graduate.^ Basic courses have a great impact on the students' academic performance. The purpose of the study was to focus on the effectiveness of teaching mathematics in two-year junior colleges and to analyze and correlate the results of two-year junior college students' performance in calculus and on-time graduation. The target group consisted of 521 students enrolled at National Taipei Institute of Technology in 1993.^ Calculus is a very important course for engineering majors in two-year junior colleges and has a great impact on the students' academic performance. This retrospective study showed that there was a correlation between students' performance in calculus and on-time graduation after two years of study.^ The conclusions of the study urge the Ministry of Education to reform two-year junior college curriculum standards to emphasize basic rudimentary courses. It is recommended that engineering majors receive three hours of calculus per week as the current requirement of only two hours per week is inadequate. The future job market will require a technologically advanced labor force that can be trained in a higher education system. More channels of higher education for two-year junior college graduates should be made available for those wishing to pursue bachelor degrees. Additional work in calculus will not only enhance the opportunities for two-year junior college graduates to continue their pursuit of an advanced academic degree, but also serve them well as they seek career advancement. ^

Sediment accretion and organic carbon burial relative to sea-level rise and storm events in two mangrove forests in Everglades National Park

The goal of this investigation was to examine how sediment accretion and organic carbon (OC) burial rates in mangrove forests respond to climate change. Specifically, will the accretion rates keep pace with sea-level rise, and what is the source and fate of OC in the system? Mass accumulation, accretion and OC burial rates were determined via 210Pb dating (i.e. 100 year time scale) on sediment cores collected from two mangrove forest sites within Everglades National Park, Florida (USA). Enhanced mass accumulation, accretion and OC burial rates were found in an upper layer that corresponded to a well-documented storm surge deposit. Accretion rates were 5.9 and 6.5 mm yr− 1 within the storm deposit compared to overall rates of 2.5 and 3.6 mm yr− 1. These rates were found to be matching or exceeding average sea-level rise reported for Key West, Florida. Organic carbon burial rates were 260 and 393 g m− 2 yr− 1 within the storm deposit compared to 151 and 168 g m− 2 yr− 1 overall burial rates. The overall rates are similar to global estimates for OC burial in marine wetlands. With tropical storms being a frequent occurrence in this region the resulting storm surge deposits are an important mechanism for maintaining both overall accretion and OC burial rates. Enhanced OC burial rates within the storm deposit could be due to an increase in productivity created from higher concentrations of phosphorus within storm-delivered sediments and/or from the deposition of allochthonous OC. Climate change-amplified storms and sea-level rise could damage mangrove forests, exposing previously buried OC to oxidation and contribute to increasing atmospheric CO2 concentrations. However, the processes described here provide a mechanism whereby oxidation of OC would be limited and the overall OC reservoir maintained within the mangrove forest sediments.

Possible climate change impacts on the hydrological and vegetative character of Everglades National Park, Florida

The increasing threat of global climate change is predicted to have immense influences on ecosystems worldwide, but could be particularly severe to vulnerable wetland environments such as the Everglades. This work investigates the impact global climate change could have on the hydrologic and vegetative makeup of Everglades National Park (ENP) under forecasted emissions scenarios. Using a simple stochastic model of aboveground water levels driven by a fluctuating rainfall input, we link across ENP a location's mean depth and percent time of inundation to the predicted changes in precipitation from climate change. Changes in the hydrologic makeup of ENP are then related to changes in vegetation community composition through the use of relationships developed between two publically available datasets. Results show that under increasing emissions scenarios mean annual precipitation was forecasted to decrease across ENP leading to a marked hydrologic change across the region. Namely, areas were predicted to be shallower in average depth of standing water and inundated less of the time. These hydrologic changes in turn lead to a shift in ENP's vegetative makeup, with xeric vegetative communities becoming more numerous and hydric vegetative communities becoming scarcer. Noticeably, the most widespread of vegetative communities, sawgrass, decreases in abundance under increasing emissions scenarios. These results are an important indicator of the effects climate change may have on the Everglades region and raise important management implications for those seeking to restore this area to its historical hydrologic and vegetative condition.

Curricular perceptions of adult education at National Chun -Chin University, Chia -Yi, Taiwan

This research was conducted in Chia-Yi, Taiwan to study the needs of adult education participants to determine the factors necessary to provide direction for the development of university adult education curriculum and supportive government educational policies. Factors researched were characteristics of the adult learner, theories of adult learning, demands of adult education, and implications of university adult education as the theoretical foundation for the development of specific curriculum development efforts. The study investigated adult learning needs and their relationship with demographic variable. Analyzing the needs of adult education participant and the relative factors through a survey resulted in recommendations for the development of adult education program plans, content of curriculum, and teaching. Research questions were analyzed using descriptive statistics, frequencies, chi square, one-way analysis of variance (ANOVA), and post hoc analysis. ^ The study showed that most participants in these adult education activities were under forty, middle class, of above average educational levels, and either living or working in the city. People who were older, of lesser social and economic positions, with lower educational standards, and living/working in the country, did not participate as much in adult education opportunities. Recommendations included that in the planning or setting up of adult education activities, attention be given to all the possible barriers or problems that are likely to occur in people's participation, e.g., motivation, interests, content of courses, teaching methods, willingness of participation, qualification of teachers, time, funds, locations, and so on. It is suggested that the resolution of these problems can significantly increase the participation of adult education. ^

Education policy and national income distribution: New evidence from recent cross -country data

In the mid 19th century, Horace Mann insisted that a broad provision of public schooling should take precedence over the liberal education of an elite group. In that regard, his generation constructed a state sponsored common schooling enterprise to educate the masses. More than 100 years later, the institution of public schooling fails to maintain an image fully representative of the ideals of equity and inclusion. Critical theory in educational thought associates the dominant practice of functional schooling with maintenance of the status quo, an unequal distribution of financial, political, and social resources. This study examined the empirical basis for the association of public schooling with the status quo using the most recent and comparable cross-country income inequality data. Multiple regression analysis evaluated the possible relationship between national income inequality change over the period 1985-2005 and variables representative of national measures of education supply in the prior decade. The estimated model of income inequality development attempted to quantify the relationship between education supply factors and subsequent income inequality developments by controlling for economic, demographic, and exogenous factors. The sample included all nations with comparable income inequality data over the measurement period, N = 56. Does public school supply affect national income distribution? The estimated model suggested that an increase in the average years of schooling among the population age 15 years or older, measured over the period 1975-1985, provided a mechanism that resulted in a more equal distribution of income over the period 1985-2005 among low and lower-middle income nations. The model also suggested that income inequality increased less or decreased more in smaller economies and when the percentage of the population age < 15 years grew more slowly over the period 1985-2000. In contrast, this study identified no significant relationship between school supply changes measured over prior periods and income inequality development over the period 1985-2005 among upper-middle and high income nations.

Sediment Accretion and Organic Carbon Burial Relative to Sea-Level Rise and Storm Events in Two Mangrove Forests in Everglades National Park

The goal of this investigation was to examine how sediment accretion and organic carbon (OC) burial rates in mangrove forests respond to climate change. Specifically, will the accretion rates keep pace with sea-level rise, and what is the source and fate of OC in the system? Mass accumulation, accretion and OC burial rates were determined via 210Pb dating (i.e. 100 year time scale) on sediment cores collected from two mangrove forest sites within Everglades National Park, Florida (USA). Enhanced mass accumulation, accretion and OC burial rates were found in an upper layer that corresponded to a well-documented storm surge deposit. Accretion rates were 5.9 and 6.5 mm yr− 1 within the storm deposit compared to overall rates of 2.5 and 3.6 mm yr− 1. These rates were found to be matching or exceeding average sea-level rise reported for Key West, Florida. Organic carbon burial rates were 260 and 393 g m− 2 yr− 1 within the storm deposit compared to 151 and 168 g m− 2 yr− 1 overall burial rates. The overall rates are similar to global estimates for OC burial in marine wetlands. With tropical storms being a frequent occurrence in this region the resulting storm surge deposits are an important mechanism for maintaining both overall accretion and OC burial rates. Enhanced OC burial rates within the storm deposit could be due to an increase in productivity created from higher concentrations of phosphorus within storm-delivered sediments and/or from the deposition of allochthonous OC. Climate change-amplified storms and sea-level rise could damage mangrove forests, exposing previously buried OC to oxidation and contribute to increasing atmospheric CO2 concentrations. However, the processes described here provide a mechanism whereby oxidation of OC would be limited and the overall OC reservoir maintained within the mangrove forest sediments.

Georeferenced standardized apparent wave power along the coastline of Cabrera National Park for analysis of essential habitats of littoral species

Wind- induced exposure is one of the major forces shaping the geomorphology and biota in coastal areas. The effect of wave exposure on littoral biota is well known in marine environments (Ekebon et al., 2003; Burrows et al., 2008). In the Cabrera Archipelago National Park wave exposure has demostrated to have an effect on the spatial distribution of different stages of E.marginatus (Alvarez et al., 2010). Standarized average wave exposures during 2008 along the Cabrera Archipelago National park coast line were calculated to be applied in studies of littoral species distribution within the archipelago. Average wave exposure (or apparent wave power) was calculated for points located 50 m equidistant on the coastline following the EXA methodology (EXposure estimates for fragmented Archipelagos) (Ekebon et al., 2003). The average wave exposures were standardized from 1 to 100 (minimum and maximum in the area), showing coastal areas with different levels of mea wave exposure during the year. Input wind data (direction and intensity) from 2008 was registered at the Cabrera mooring located north of Cabrera Archipelago. Data were provided by IMEDEA (CSIC-UIB, TMMOS http://www.imedea.uib-csic.es/tmoos/boyas/). This cartography has been developed under the framework of the project EPIMHAR, funded by the National Park's Network (Spanish Ministry of Environment, Maritime and Rural Affairs, reference: 012/2007 ). Part of this work has been developed under the research programs funded by "Fons de Garantia Agrària i Pesquera de les Illes Balears (FOGAIBA)".

(Table 2, Page 252) Average chemical composition of 11 manganese nodules and crust from the Pacific Ocean

The ability of the hydrated oxides of manganese and iron to adsorb ions from solution (scavenging) is considered in relation to some problems in marine geology, chemistry, and biology. In the ferruginous sediments of the Pacific Ocean, iron oxides are accompanied by titanium, cobalt, and zirconium in amounts proportional to the iron content. Similarly, copper and nickel are linearly related to the manganese content. These observations are explained on the basis of scavenging. An electrochemical theory for the formation of manganese nodules is presented. Marine sediments are classified on the basis of the geosphere in which the solid phases originate. The distribution of certain ionic species in sea water between the solid and aqueous phases is considered on the basis of scavenging and co-ordination compound theory. The concentration of minor elements by members of the marine biosphere is explained either by the direct uptake of the element or by the uptake of iron or manganese oxides with the accompanying scavenged element.

Adult orthodontics: internet information and a national survey

Aims: 1. To investigate the reliability and readability of information on the Internet on adult orthodontics. 2. To evaluate the profile and treatment of adults by specialist orthodontists in the Republic of Ireland (ROI). Materials and methods: 1. An Internet search was conducted in May 2015 using three search engines (Google, Yahoo and Bing), with two search terms (“adult orthodontics” and “adult braces”). The first 50 websites from each engine were screened and exclusion criteria applied. Included websites were then assessed for reliability using the JAMA benchmarks, the DISCERN and LIDA tools and the presence of the HON seal. Readability was assessed using the FRES. 2. A pilot-tested questionnaire about adult orthodontics was distributed to 122 eligible specialist orthodontists in the ROI. Questions addressed general and treatment information about adult orthodontic patients, methods of information provision and respondent demographics. Results: 1. Thirteen websites met the inclusion criteria. Three websites contained all JAMA benchmarks and one displayed the HON Seal. The mean overall score for DISCERN was 3.9/5 and the mean total LIDA score was 115/120. The average FRES score was 63.1. 2. The questionnaire yielded a response rate of 83%. The typical demographic profile of adult orthodontic patients was professional females between 25-35 years. The most common incisor relationship and skeletal base was Class II, division 1 (51%) and Class II (61%) respectively. Aesthetic upper brackets and metal lower brackets were the most frequently used appliances. Only 30% of orthodontists advise their adult patients to find extra information on the Internet. Conclusions: 1. The reliability and readability of information on the Internet on adult orthodontics is of moderate quality. 2. The provision of adult orthodontic treatment is common among specialist orthodontists in the Republic of Ireland.

Average chemical composition of lake ores of Finland and North-Eastern Russia extracted in the late nineteen century

According to Solitander C. P., the extraction of lake ore from Eastern Finland lakes considerably rose in the 1870 - 1880 period in relation with the increasing demand from the ironworks being operated in the region. In St. Petersburg, Nicholas Putiloff, a business tycoon and State Minister owned the Haapakosken, Huutokosken and Oravin ironworks which were using 99% of lake ore for their supply. During this period the biggest production came from lake Sysmäjärvi in the Joroinen county with 3676 tonnes at an average concentration of 35.94% Fe, 4.55% Mn, 0.26% P and 0.04% S. The Värtsilä ironworks used the lake ore coming from 49 lakes, the biggest production coming from lake Loitimojärvi with 14535 tonnes of ore with a medium at concentration of 30.8% Fe. Möhkö ironworks took advantage of the 59 lakes, the largest of which was from lake Koitere with 4301 tonnes at 41.3% Fe. The Karttula ironworks were also significant in the consumption of ferromanganese lake ore.

(Table 2, Page 270) Average chemical composition of manganese nodules and crust collected at different localities the Pacific Ocean

Considerable regional variations in the chemical composition of manganese nodules from a wide range of the Pacific Ocean have been observed. These variations can be more exactly expressed in terms of inter-element relationships. In particular, Cu-Mn and Cu-Ni associations reveal that Cu content in pelagic nodules increases rapidly in proportion to those of Mn or Ni. In nodules from continental borderland and hemipelagic areas, even if Mn or Ni contents increase, that of Cu increases only slightly. It is suggested that the considerable chemical differences within individual nodules and between nodules from the same site, at a limited pelagic area where there is no marked change in depositional conditions of nodules, are due to the role of hydrolyzable trace elements in the formation of nodules.

National Diet and Nutrition Survey: assessment of dietary sodium in adults (19 to 64 years) in England, 2014

There is an established relationship between salt intake and risk of high blood pressure (BP). High blood pressure (hypertension) is a risk factor for cardiovascular disease (CVD) and scientific evidence shows that a high salt intake can contribute to the development of elevated blood pressure. The Scientific Advisory Committee on Nutrition (SACN) recommend a target reduction in the average salt intake of the population to no more than 6g per day. This figure has been adopted by the UK government as the recommended maximum salt intake for adults and children aged 11 years and over. Following publication of the SACN report in 2003, the government began a programme of reformulation work with the food industry aimed at reducing the salt content of processed food products. Voluntary salt reduction targets were first set in 2006, and subsequently in 2009, 2011 and 2014, for a range of food categories that contribute the most to the population’s salt intakes. Population representative urinary sodium data were collected in England in 2005-06, 2008 (UK), 2011 and 2014. In the latest survey assessment, estimated salt intake of adults aged 19 to 64 years in England was assessed from 24-hour urinary sodium excretion of 689 adults, selected to be representative of this section of the population. Estimated salt intake was calculated using the equation 17.1mmol of sodium = 1g of salt and assumes all sodium was derived from salt. The data were validated as representing daily intake by checking completeness of the urine collections by the para-amino benzoic acid (PABA) method. Urine samples were collected over five months (May to September) in 2014, concurrently with a similar survey in Scotland. This report presents the results for the latest survey assessment (2014) and a new analysis of the trend in estimated salt intake over time. The trend analysis is based on data for urinary sodium excretion from this survey and previous sodium surveys (including data from the National Diet and Nutrition Survey Rolling Programme (NDNS RP) Years 1 to 5) carried out in England over the last ten years, between 2005-06 and 2014. This data has been adjusted to take account of biases resulting from differences between surveys in laboratory analytical methods used for sodium. The analysis provides a revised assessment of the trend in estimated salt intake over time. The trend analysis in this report supersedes the trend analysis published in the report of the 2011 England urinary sodium survey.

Relational and reproductive trajectories leading to adolescent pregnancy in Portugal: a national and regional characterization

INTRODUCTION: The current study aimed to describe the relational and reproductive trajectories leading to adolescent pregnancy in Portugal, and to explore whether there were differences in this process according to adolescents' place of residence. MATERIAL AND METHODS: Data were collected between 2008 and 2013 in 42 public health services using a self-report questionnaire developed by the researchers. The sample consisted of a nationally representative group of pregnant adolescents (n = 459). RESULTS: Regardless of having had one (59.91%) or multiple sexual partners (40.09%), the majority of adolescents became pregnant in a romantic relationship, using contraception at the time of the conception and knowing the contraceptive failure which led to pregnancy (39.22%). In some regions other trajectories were highly prevalent, reflecting options such as planning the pregnancy (Alentejo Region/ Azores Islands), not using contraception (Centro Region/Madeira Islands) or using it incorrectly, without identifying the contraceptive failure (Madeira Islands). On average, romantic relationships were longer than 19 months and adolescents' partners were older than themselves (> 4 years) and no longer in school (75.16%); these results were particularly significant when the pregnancy was planned. DISCUSSION: The knowledge gained in this study shows that prevention efforts must be targeted according to the adolescents' needs in each region and should include high-risk male groups. CONCLUSION: Our results may enable more efficient health policies to prevent adolescent pregnancy in different country regions and support educators and health care providers on sexual education and family planning efforts.