Cost effectiveness analysis of different approaches of screening for familial hypercholesterolaemia

Objectives To assess the cost effectiveness of strategies to screen for and treat familial hypercholesterolaemia. Design Cost effectiveness analysis. A care pathway for each patient was delineated and the associated probabilities, benefits, and costs were calculated. Participants Simulated population aged 16­54 years in England and Wales. Interventions Identification and treatment of patients with familial hypercholesterolaemia by universal screening, opportunistic screening in primary care, screening of people admitted to hospital with premature myocardial infarction, or tracing family members of affected patients. Main outcome measure Cost effectiveness calculated as cost per life year gained (extension of life expectancy resulting from intervention) including estimated costs of screening and treatment. Results Tracing of family members was the most cost effective strategy (£3097 (&5066, $4479) per life year gained) as 2.6 individuals need to be screened to identify one case at a cost of £133 per case detected. If the genetic mutation was known within the family then the cost per life year gained (£4914) was only slightly increased by genetic confirmation of the diagnosis. Universal population screening was least cost effective (£13 029 per life year gained) as 1365 individuals need to be screened at a cost of £9754 per case detected. For each strategy it was more cost effective to screen younger people and women. Targeted strategies were more expensive per person screened, but the cost per case detected was lower. Population screening of 16 year olds only was as cost effective as family tracing (£2777 with a clinical confirmation). Conclusions Screening family members of people with familial hypercholesterolaemia is the most cost effective option for detecting cases across the whole population

Empirical model for quasi direct current interruption with a convoluted arc

This contribution considers various aspects of a quasi direct current, convoluted arc produced by a magnetic field (B-field) connected in parallel with an RLC circuit that have not been considered in combination. These aspects are the arc current limitation due to the arc convolution, changes in arc resistance due to the B-field and material ablation, and the relative significance of the RLC circuit in producing an artificial current zero. As a result, it has been possible to produce an empirical equation for predicting the current interruption capability in terms of the B-field magnitude and RLC components

Valuation of Country Food in Nunavut Based on Energy and Protein Replacement

Communicating value across the pluralities of Indigenous Peoples’ food systems requires attention to economy and environment, food and wildlife, and the health of the people and that of the land. Valuation of distinct entities is always difficult but often essential to describe collective wealth and well-being, to quantify trade-offs, and to consider compensation when one is compromised for another. Here we estimate the replacement value of Nunavut country food by combining information on the amount and nutritional composition of harvested country food with the nutritional content and local price of store-bought food. Comparing the five-year average of energy and protein available in reported harvest to recommended dietary allowances indicates that 17 of 21 Nunavut communities harvest enough country food to satisfy the protein requirements of all community members. Nunavut’s country food system annually harvests five million kg of protein-rich food from across the territory, which would cost $198 million to purchase as store-bought protein, with a replacement value between$13.19 and $39.67 per kg depending on energy versus protein replacement and the inclusion versus exclusion of store-bought food subsidies. These valuations are higher than most previous estimates of local food value because they are more reflective of the energy and nutrient richness of country food and the high price of store-bought food in northern communities. The country food system is priceless in many, profound ways; better awareness of its energy and protein cost of replacement, together with the breadth of its nutritional and cultural value, may help to ensure local food systems are prioritized in northern food security and economic development initiatives. La communication de la valeur à travers les pluralités des systèmes alimentaires des peuples autochtones doit tenir compte de l’économie et de l’environnement, de l’alimentation et de la faune, de la santé des gens et de celle de la terre. L’évaluation d’entités distinctes est toujours difficile, mais souvent essentielle pour décrire la richesse et le bien-être collectifs, pour quantifier les concessions et pour considérer une compensation lorsqu’un système est compromis en raison d’un autre. Dans cet article, nous estimons la valeur de remplacement de la nourriture traditionnelle du Nunavut en combinant des données sur la quantité et la composition nutritionnelle des aliments récoltés sur le terroir, ainsi que sur le contenu nutritionnel et le prix local de la nourriture achetée en magasin. La comparaison de la moyenne quinquennale des données en valeur énergétique et protéique provenant des récoltes déclarées aux apports nutritionnels recommandés permet de constater que 17 des 21 collectivités du Nunavut récoltent suffisamment de nourriture traditionnelle pour satisfaire aux besoins en protéines de tous les membres des collectivités. Annuellement, le système alimentaire traditionnel du Nunavut donne lieu à des récoltes de cinq millions de kilogrammes de nourriture riche en protéines à l’échelle du territoire, ce qui représenterait des achats d’aliments protéinés en magasin d’une valeur de 198 millions de dollars, moyennant une valeur de remplacement s’échelonnant entre 13,19$ et 39,67 $ le kilogramme, selon que le remplacement est calculé en fonction de la valeur énergétique ou protéique, et avec inclusion ou exclusion des subventions au titre de la nourriture achetée en magasin. Ces évaluations sont plus élevées que la plupart des estimations antérieures de la valeur de la nourriture locale parce qu’elles tiennent davantage compte de la valeur énergétique et de la richesse en nutriments de la nourriture traditionnelle ainsi que du prix élevé de la nourriture achetée en magasin dans les collectivités nordiques. À bien des égards importants, le système alimentaire traditionnel a une valeur inestimable. Le fait de prendre davantage conscience du coût de remplacement de la valeur énergétique et protéique des aliments, en plus de l’ampleur de la valeur culturelle et nutritionnelle du système, pourrait aider à faire en sorte que les systèmes alimentaires locaux soient priorisés par les initiatives de sécurité alimentaire et de développement économique dans le Nord.

The pace of life under artificial selection : personality, energy expenditure, and longevity are correlated in domestic dogs

The domestic dog has undergone extensive artificial selection resulting in an extreme diversity in body size, personality, life‐history, and metabolic traits among breeds. Here we tested whether proactive personalities (high levels of activity, boldness, and aggression) are related to a fast “pace of life” (high rates of growth, mortality, and energy expenditure). Data from the literature provide preliminary evidence that artificial selection on dogs (through domestication) generated variations in personality traits that are correlated with life histories and metabolism. We found that obedient (or docile, shy) breeds live longer than disobedient (or bold) ones and that aggressive breeds have higher energy needs than unaggressive ones. These correlations could result from either human preference for particular trait combinations or, more likely, correlated responses to artificial selection on personality. Our results suggest the existence of a general pace‐of‐life syndrome arising from the coevolution of personality, metabolic, and life‐history traits

Syntax circuitry: a mobile game for practicing programming language syntax

According to the U.S. Bureau of Labor Statistics [1], computer science professions are among the fastest growing occupations in the U.S., and computer science occupations will add more than half a million new jobs in the next ten years. A similar need for computer professionals is expected in Kazakhstan. Simultaneously, universities in the U.S. and worldwide are seeing poor retention rates in computer science, a major reason being that students often view the early courses in the subject as uninteresting and dull [2]. Game-based learning is one of many techniques proposed to address this issue [2,3,4,5]. We have developed a mobile game that provides an engaging way for students to practice (not learn) the basic syntax of C, C++ and Java (since these languages share the same syntax for basic constructs like declarations, selection and iteration). Learning programming language syntax is a tedious process. Practicing by programming is, of course, ideal, but we believe that a game which is fun to play in their spare time will help students get used to distinguishing correct syntactical constructs quickly

Pressure Relief Tunnel System at US22/SR7 Interchange, OH

Construction of the US22/SR7 interchange in Steubenville, OH resulted in the need to excavate the toe of the steep 350 ft. high slope overlooking the Ohio River. To maintain the stability of the slope, the Ohio Department of Transportation (ODOT) chose to construct a 4 tier, 130- ft. high, 2,200 ft. long tieback anchor retaining wall. During the design phase, it became apparent that reductions in both the tieback loading and cost could be realized by lowering the groundwater levels in the hillside. A Pressure Relief Tunnel System (PRTS) was selected from several drainage options. The PRTS consists of a 1,945 ft. long tunnel, excavated parallel to, and 200 ft. behind, the retaining wall, and a series 85 ft. long, sub-vertical drainage holes drilled upward from inside the tunnel. This paper presents the design of the PRTS, an outline of the instrumentation program and a comparison of the observed and expected drawdowns

Spatial Dynamics and Expanded Vertical Niche of Blue Sharks in Oceanographic Fronts Reveal Habitat Targets for Conservation

Dramatic population declines among species of pelagic shark as a result of overfishing have been reported, with some species now at a fraction of their historical biomass. Advanced telemetry techniques enable tracking of spatial dynamics and behaviour, providing fundamental information on habitat preferences of threatened species to aid conservation. We tracked movements of the highest pelagic fisheries by-catch species, the blue shark Prionace glauca, in the North-east Atlantic using pop-off satellite-linked archival tags to determine the degree of space use linked to habitat and to examine vertical niche. Overall, blue sharks moved south-west of tagging sites (English Channel; southern Portugal), exhibiting pronounced site fidelity correlated with localized productive frontal areas, with estimated space-use patterns being significantly different from that of random walks. Tracked female sharks displayed behavioural variability in diel depth preferences, both within and between individuals. Diel depth use ranged from normal DVM (nDVM; dawn descent, dusk ascent), to reverse DVM (rDVM; dawn ascent, dusk descent), to behavioural patterns where no diel differences were apparent. Results showed that blue sharks occupy some of the most productive marine zones for extended periods and structure diel activity patterns across multiple spatio-temporal scales in response to particular habitat types. In so doing, sharks occupied an extraordinarily broad vertical depth range for their size (1.0–2.0 m fork length), from the surface into the bathypelagic realm (max. dive depth, 1160 m). The space-use patterns of blue sharks indicated they spend much of the time in areas where pelagic longlining activities are often highest, and in depth zones where these fisheries particularly target other species, which could account for the rapid declines recently reported for blue sharks in many parts of the world's oceans. Our results provide habitat targets for blue shark conservation that may also be relevant to other pelagic species

Variants within TSC2 exons 25 and 31 are very unlikely to cause clinically diagnosable tuberous sclerosis

Inactivating mutations in TSC1 and TSC2 cause tuberous sclerosis complex (TSC). The 2012 international consensus meeting on TSC diagnosis and management agreed that the identification of a pathogenic TSC1 or TSC2 variant establishes a diagnosis of TSC, even in the absence of clinical signs. However, exons 25 and 31 of TSC2 are subject to alternative splicing. No variants causing clinically diagnosed TSC have been reported in these exons raising the possibility that such variants would not cause TSC. We present truncating and in-frame variants in exons 25 and 31 in three individuals unlikely to fulfil TSC diagnostic criteria and examine the importance of these exons in TSC using different approaches. Amino acid conservation analysis suggests significantly less conservation in these exons compared to the majority of TSC2 exons, and TSC2 expression data demonstrates that the majority of TSC2 transcripts lack exons 25 and/or 31 in many human adult tissues. In vitro assay of both exons shows that neither exon is essential for TSC complex function. Our evidence suggests that variants in TSC2 exons 25 or 31 are very unlikely to cause classical TSC, although a role for these exons in tissue/stage specific development cannot be excluded

Room with a VDU: The Development of the ‘Glass House’ in the Corporate Workplace

Abstract This article argues that the presentation of early computer technology and its reception by the public had a causal effect on the design of computer products. It is also argued that the desire to show computers in operation led to the emergence and proliferation of the ‘glass house’, a particular element of the commercial interior landscape of the 1960s and 1970s. These glass-walled secure areas, built to house mainframe computer installations, appeared in order to meet the conflicting requirements of environmental stability, controlled access and crucially, the conspicuous display of corporate status. Although the phenomenon of the glass house disappeared as the computers they housed developed from large, centralised systems into distributed networks of stand-alone computers, this article posits that the widespread adoption of the glass house not only had a profound effect on the visual design of computers themselves but also led to the growth of a range of subsidiary industries, as well as having a lasting impact on the perception and reception of computers in the workplace and attitudes towards the specialist staff involved in their maintenance. Keywords: glass house, computers, technology, workplace, display, IB

Thermal Imaging and Physiological Analysis of Cold-Climate Caribou-Skin Clothing

Protective clothing is essential for human existence in the Arctic, and caribou-skin clothing has played a pivotal role for millennia. Although people with northern experience often extol caribou-skin clothing, few scientific studies have investigated its properties. We used infrared thermal imaging in a pilot study to compare authentic caribou-skin clothing sewn by traditional Inuit seamstresses with two other types of cold-weather clothing: a standard-issue, Canadian army, winter uniform and an ensemble of modern retail clothing designed for extreme cold (a down anorak and snowmobile pants). To make the comparison, two subjects sequentially wore the three types of clothing—caribou skin, army uniform, and modern retail—in a still air, uniform thermal environment (where radiant temperatures of all environmental surfaces were equal to air temperature) at −21°C to −23°C (−6°F to −10°F). Thermal imaging quantifies the temperature of the outer surface of clothing, thereby providing key, functionally relevant information on the interface where clothing and environment meet. Under otherwise similar conditions, a low clothing surface temperature indicates superior clothing performance and a reduced rate of heat loss from the body to the environment. Caribou-skin clothing was similar to modern extreme-cold retail clothing: the whole-body composite surface temperature of our subjects wearing caribou-skin clothing was −22.1°C to −22.7°C, compared with −21.6°C in both subjects wearing the modern retail clothing. The army winter uniform (−18.9°C to −20.0°C) was inferior. These quantitative results were mirrored by the subjects’ subjective impressions. A particular advantage of thermal imaging is that it pinpoints locations in clothing where heat leaks occur. Although the two types of modern clothing exhibited heat leaks at zippered structures (even though fully closed), the caribou-skin clothing evaded such heat leaks by lacking such structures, because it is donned over the head. The integral hood characteristic of a caribou-skin parka was also superior in comparison to the detachable hood of the army uniform.Les vêtements de protection sont essentiels à l’existence humaine dans l’Arctique, et les vêtements en peau de caribou y jouent un rôle vital depuis des millénaires. Même si les gens qui ont évolué dans le Nord vantent souvent les mérites des vêtements en peau de caribou, peu d’études scientifiques ont été réalisées au sujet de leurs propriétés. Nous nous sommes servi d’imagerie thermique infrarouge dans le cadre d’une étude pilote visant à comparer les vêtements en peau de caribou authentique cousus par des couturières inuites traditionnelles à deux autres types de vêtements pour temps froid : un uniforme d’hiver standard de l’Armée canadienne et un ensemble de vêtements modernes du détail conçus pour des froids extrêmes (un anorak en duvet et des pantalons de motoneige). À des fins de comparaison, deux sujets ont porté, dans l’ordre séquentiel, les trois types de vêtements — vêtement en peau de caribou, uniforme de l’armée et vêtements modernes du détail — dans des conditions de vent nul thermique uniforme (où les températures radiatives de toutes les surfaces environnementales sont égales à la température de l’air) moyennant des températures allant de −21 °C à −23 °C (de −6 °F à −10 °F). L’imagerie thermique quantifie la température de la surface extérieure du vêtement, ce qui permet d’obtenir de l’information fonctionnellement pertinente et essentielle sur le point de rencontre du vêtement et de l’environnement. Dans des conditions par ailleurs semblables, la faible température du vêtement en surface indique un rendement supérieur pour ce vêtement et un taux réduit de perte de chaleur du corps à l’environnement. Les vêtements en peau de caribou ont donné des résultats semblables aux vêtements pour froid extrême modernes du détail : la température composite du corps entier de nos sujets portant les vêtements en peau de caribou variait de −22,1 °C à −22,7 °C, comparativement à −21,6 °C chez les deux sujets portant les vêtements modernes du détail. Les températures de l’uniforme d’hiver de l’armée étaient inférieures (de −18,9 °C à −20,0 °C). Ces résultats quantitatifs cadraient avec les impressions subjectives des sujets. Un des avantages particuliers de l’imagerie thermique, c’est qu’elle permet de repérer là où les pertes de chaleur se produisent dans les vêtements. Bien que les deux types de vêtements modernes perdaient de la chaleur à l’endroit des fermetures éclair (même si elles étaient fermées complètement), les vêtements en peau de caribou n’affichaient pas de telles pertes de chaleur en raison de l’absence de structures de ce genre parce que ces vêtements s’enfilent par la tête. Par ailleurs, il y a lieu de noter que la caractéristique intégrale du capuchon du parka en peau de caribou était également supérieure à celle du capuchon amovible de l’uniforme militaire