Quantifying the Socio-Economic Benefits of Reducing Industrial Dietary Trans Fats: Modelling Study.

BACKGROUND: Coronary Heart Disease (CHD) remains a leading cause of UK mortality, generating a large and unequal burden of disease. Dietary trans fatty acids (TFA) represent a powerful CHD risk factor, yet to be addressed in the UK (approximately 1% daily energy) as successfully as in other nations. Potential outcomes of such measures, including effects upon health inequalities, have not been well quantified. We modelled the potential effects of specific reductions in TFA intake on CHD mortality, CHD related admissions, and effects upon socioeconomic inequalities. METHODS & RESULTS: We extended the previously validated IMPACTsec model, to estimate the potential effects of reductions (0.5% & 1% reductions in daily energy) in TFA intake in England and Wales, stratified by age, sex and socioeconomic circumstances. We estimated reductions in expected CHD deaths in 2030 attributable to these two specific reductions. Output measures were deaths prevented or postponed, life years gained and hospital admissions. A 1% reduction in TFA intake energy intake would generate approximately 3,900 (95% confidence interval (CI) 3,300-4,500) fewer deaths, 10,000 (8,800-10,300) (7% total) fewer hospital admissions and 37,000 (30,100-44,700) life years gained. This would also reduce health inequalities, preventing five times as many deaths and gaining six times as many life years in the most deprived quintile compared with the most affluent. A more modest reduction (0.5%) would still yield substantial health gains. CONCLUSIONS: Reducing intake of industrial TFA could substantially decrease CHD mortality and hospital admissions, and gain tens of thousands of life years. Crucially, this policy could also reduce health inequalities. UK strategies should therefore aim to minimise industrial TFA intake

Comparing Strategies to Prevent Stroke and Ischemic Heart Disease in the Tunisian Population: Markov Modeling Approach Using a Comprehensive Sensitivity Analysis Algorithm.

Background. Mathematical models offer the potential to analyze and compare the effectiveness of very different interventions to prevent future cardiovascular disease. We developed a comprehensive Markov model to assess the impact of three interventions to reduce ischemic heart diseases (IHD) and stroke deaths: (i) improved medical treatments in acute phase, (ii) secondary prevention by increasing the uptake of statins, (iii) primary prevention using health promotion to reduce dietary salt consumption. Methods. We developed and validated a Markov model for the Tunisian population aged 35–94 years old over a 20-year time horizon. We compared the impact of specific treatments for stroke, lifestyle, and primary prevention on both IHD and stroke deaths. We then undertook extensive sensitivity analyses using both a probabilistic multivariate approach and simple linear regression (metamodeling). Results. The model forecast a dramatic mortality rise, with 111,134 IHD and stroke deaths (95% CI 106567 to 115048) predicted in 2025 in Tunisia. The salt reduction offered the potentially most powerful preventive intervention that might reduce IHD and stroke deaths by 27% (−30240 [−30580 to −29900]) compared with 1% for medical strategies and 3% for secondary prevention. The metamodeling highlighted that the initial development of a minor stroke substantially increased the subsequent probability of a fatal stroke or IHD death. Conclusions. The primary prevention of cardiovascular disease via a reduction in dietary salt consumption appeared much more effective than secondary or tertiary prevention approaches. Our simple but comprehensive model offers a potentially attractive methodological approach that might now be extended and replicated in other contexts and populations

Studies in Nietzsche and the Classical Tradition

These fifteen essays deal with Nietzsche's view of various aspects of classical antiquity as compared to those of Augustine, Thomas Aquinas, Dante, Voltaire, Winkelmann, Hamann, Goethe, Schiller, Heine, Byron, the "fin de siècle" Decadents and others. An introductory essay by classical scholar H. Lloyd-Jones plus two essays on Nietzsche's aesthetics by W. Kaufmann and K. Weinberg round out the contributions by M. L. Baeumer, E. Biser, M. Boulby, S. L. Gilman, P. Heller, R. M. Helm, M. Hester, R. S. Fraser, J. C. O'Flaherty, H. Rehder, K. Schlechta, and H. Wingler

Studies in Nietzsche and the Judaeo-Christian Tradition

This collection of essays is a sequel to the editors' 1976 volume "Studies in Nietzsche and the Classical Tradition". Philosophers, theologians, and literary historians discuss important aspects of Nietzsche's attack on Judaism and Christianity. The book contains studies of his view of biblical figures, Luther and Pascal as well as comparisons of his thought with that of Spinoza, Lessing, Heine, and Kierkegaard. Nietzsche's critique of the Old Testament, the Jewish religion of the diaspora, and historical Christianity are also investigated. Of the eighteen articles included here, thirteen were prepared expressly for this volume—five were translated from German, one from French, and one from Hebrew. Contributors to this volume are: Eugen Biser, Harry Neumann, Israel Eldad, Charles Lewis, Jorg Salaquarda, Joan Stambaugh, Max L. Baeumer, Brendan Donellan, Diana Behler, Sander L. Gilman, Gerd-Gunther Grau, Josef Simon, James C. O'Flaherty, Bernd Magnus, Georges Goedert, Hans Lung, and Karl Barth

Potential benefits of healthy food and lifestyle policies for reducing coronary heart disease mortality in Turkish adults by 2025: a modelling study

Objective This study uses a modelling approach to compare the potential impact of future risk factor scenarios relating to smoking, physical activity levels, dietary salt, saturated fat intake, mean body mass index (BMI) levels, diabetes prevalence and fruit and vegetable (F&V) consumption on future coronary heart disease (CHD) mortality in Turkey for year 2025. Design A CHD mortality model previously developed and validated in Turkey was extended to predict potential trends in CHD mortality from 2008 to 2025. Setting Using risk factor trends data from recent surveys as a baseline, we modelled alternative evidence-based future risk factor scenarios (modest/ideal scenarios). Probabilistic sensitivity analyses were conducted to account for uncertainties. Subject Projected populations in 2025 (aged 25–84) of 54 million in Turkey. Results Assuming lower mortality, modest policy changes in risk factors would result in ∼25 635 (range: 20 290–31 125) fewer CHD deaths in the year 2025; 35.6% attributed to reductions in salt consumption, 20.9% to falls in diabetes, 14.6% to declines in saturated fat intake and 13.6% to increase in F&V intake. In the ideal scenario, 45 950 (range: 36 780–55 450) CHD deaths could be prevented in 2025. Again, 33.2% of this would be attributed to reductions in salt reduction, 19.8% to increases in F&V intake, 16.7% to reductions in saturated fat intake and 14.0% to the fall in diabetes prevalence. Conclusions Only modest risk factor changes in salt, saturated/unsaturated fats and F&V intake could prevent around 16 000 CHD deaths in the year 2025 in Turkey, even assuming mortality continues to decline. Implementation of population-based, multisectoral interventions to reduce salt and saturated fat consumption and increase F&V consumption should be scaled up in Turkey

Human exposure to antibiotic resistant-Escherichia coli through irrigated lettuce

Antibiotic resistant bacteria (ARB) have been found on fresh fruit and vegetables globally. These types of ARB infections are spreading rapidly and are a major human health threat. A quantitative human exposure assessment model was created using scenario analysis to investigate the potential human exposure to antibiotic resistant Escherichia coli (AR-E. coli) through the consumption of lettuce irrigated with surface water. Scientific literature and site specific data were collected to model each process from farm to fork to calculate the concentration of AR-E. coli on the lettuce at the point of human consumption. The processes examined were the adhesion, colonisation and viability of bacteria on the lettuce; the effect of different post-harvest cleaning processes; the effect of consuming the lettuce before, on or after the expiry date; and the effect of the consumer washing the lettuce. The results show the mean human exposure levels ranged between 1.00 × 10−2 and 1.35 × 106 colony forming units (CFU) of AR-E. coli per 100 g of surface water irrigated lettuce for the different scenarios investigated. The mean probability of illness from consuming 100 g of lettuce contaminated with potential pathogenic antibiotic-sensitive E. coli was between 1.46 × 10−9 to 1.88 × 10−2. A back calculation revealed that in order for the EC No 1441/2007 regulation to be exceeded (≥1000 CFU/g of E. coli on lettuce at the manufacturing stage), the mean contamination levels required in the irrigation water would need to be 2.7, 3.1 or 4.8 log CFU/ml using the post-harvest treatments of washing with water, rapid cooling with water and washing with a chlorine solution respectively. The information generated from this model could help to set guidelines for producers on maximum permissible AR-E. coli contamination levels in irrigation water and provides recommendations on the best post-harvest treatment to use. Keywords: Antibiotic resistance, Escherichia coli, Irrigation, Human exposure, Lettuc

A simplified design approach to prevent shrinkage cracking in patch repairs

This paper outlines two procedures for determining the interfacial shrinkage stresses in a repair patch. The first is an analytical approach based on the analogy of a bimetallic strip undergoing contraction (shrinkage). The second is a semi-empirical procedure based on strain monitoring of in situ repairs to in-service bridges. The procedures determine conversion factors to relate the specified properties of the repair materials to their in situ properties in a field repair patch. For example, the shrinkage of a repair patch is influenced by the volume–surface effect, site temperature and relative humidity which are not considered in repair material specification. Creep is initiated in situ by differential shrinkage stresses in the repair material and is determined by adopting an effective elastic modulus approach. Both procedures require the basic material properties (elastic modulus, shrinkage, creep) and geometrical details (width, depth) of the repair patch. The analytical approach incorporates the repair material creep coefficient to predict the interfacial tensile stresses. Alternatively, it uses a less rigorous, elastic approach that omits creep. The creep approach provides higher accuracy whereas the elastic approach overestimates stresses since relaxation by creep is neglected. The elastic approach is recommended for design due to its simplicity and the in-built factor of safety provided by the overestimation of tensile stress. The semi-empirical approach uses an expression derived from long-term field data to determine the strain (and consequently stresses) at the interface of the repair patch and the substrate concrete. The procedures predict the maximum interfacial tensile stress during the service life of a repair patch. They can be used to design crack-free repair patches and optimise repair material selection through a better understanding of the interaction between the repair patch and substrate concrete.</p