Cholesterol and coronary heart disease: screening and treatment

Coronary heart disease (CHD) is a major cause of morbidity and mortality in the United Kingdom, accounting for just under one quarter of all deaths in 1995: 27% among men and 21% among women.1 Although many CHD deaths occur among elderly people, CHD accounts for 31% of male and 13% of female deaths within the 45–64 age group

Market access agreements for pharmaceuticals in Europe: diversity of approaches and underlying concepts

<p>Abstract</p> <p>Background</p> <p>Market Access Agreements (MAA) between pharmaceutical industry and health care payers have been proliferating in Europe in the last years. MAA can be simple discounts from the list price or very sophisticated schemes with inarguably high administrative burden.</p> <p>Discussion</p> <p>We distinguished and defined from the health care payer perspective three kinds of MAA: Commercial Agreements (CA), Payment for Performance Agreements (P4P) and Coverage with Evidence Development (CED). Apart from CA, the agreements assumed collection and analysis of real-life health outcomes data, either from a cohort of patients (CED) or on per patient basis (P4P). We argue that while P4P aim at reducing drug cost to payers without a systematic approach to addressing uncertainty about drugs' value, CED were implemented provisionally to reduce payer's uncertainty about value of a medicine within a defined time period.</p> <p>Summary</p> <p>We are of opinion that while CA and P4P have a potential to reduce payers' expenditure on costly drugs while maintaining a high list price, CED address initial uncertainty related to assessing the real-life value of new drugs and enable a final HTA recommendation or reimbursement and pricing decisions. Further, we suggest that real cost to health care payers of drugs in CA and P4P should be made publicly available in a systematic manner, to avoid a perverse impact of these MAA types on the international reference pricing system.</p

Costs and effects of a 'healthy living' approach to community development in two deprived communities: findings from a mixed methods study

Background: Inequalities in health have proved resistant to 'top down' approaches. It is increasingly recognised that health promotion initiatives are unlikely to succeed without strong local involvement at all stages of the process and many programmes now use grass roots approaches. A healthy living approach to community development (HLA) was developed as an innovative response to local concerns about a lack of appropriate services in two deprived communities in Pembrokeshire, West Wales. We sought to assess feasibility, costs, benefits and working relationships of this HLA. Methods: The HLA intervention operated through existing community forums and focused on the whole community and its relationship with statutory and voluntary sectors. Local people were trained as community researchers and gathered views about local needs though resident interviews. Forums used interview results to write action plans, disseminated to commissioning organisations. The process was supported throughout through the project. The evaluation used a multi-method before and after study design including process and outcome formative and summative evaluation; data gathered through documentary evidence, diaries and reflective accounts, semi-structured interviews, focus groups and costing proformas. Main outcome measures were processes and timelines of implementation of HLA; self reported impact on communities and participants; community-agency processes of liaison; costs. Results: Communities were able to produce and disseminate action plans based on locally-identified needs. The process was slower than anticipated: few community changes had occurred but expectations were high. Community participants gained skills and confidence. Cross-sector partnership working developed. The process had credibility within service provider organisations but mechanisms for refocusing commissioning were patchy. Intervention costs averaged £58,304 per community per annum. Conclusions: The intervention was feasible and inexpensive, with indications of potential impact at individual, community and policy planning levels. However, it is a long term process which requires sustained investment and must be embedded in planning and service delivery processes.12 page(s

Evaluation of cold metal transfer (CMT) process for welding aluminium alloy

Cold metal transfer (CMT) is an automated welding process based on dip transfer welding, characterised by controlled material deposition during the short circuit of the wire electrode to the workpiece. Preliminary results are presented examining the suitability of this process for welding aluminium alloy. Trials show that in comparison with pulsed metal inert gas (MIG) welding, CMT exhibits a higher electrode melting coefficient. By adjusting the short circuit duration penetration can be controlled with only a small change in electrode deposition. Furthermore, by mixing pulsed MIG welding with CMT welding the working envelope of the process is greatly extended allowing thicker material sections to be welded with improved weld bead aesthetics

Joining of lightweight sandwich sheets to aluminium using self-pierce riveting

Lightweight sandwich sheets are a novel alternative lightweight material for automotive vehicle body manufacture. This paper presents the results from an investigation into the joining of this material to aluminium using self-pierce riveting. Comparative trials conducted on similar thickness bulk aluminium joints show that whilst this material combination can be joined using SPR with a variety of die profiles, joining lightweight sandwich sheets to aluminium shows greater sensitivity to changes in this parameter, with the result that substrate defects occur within the joint. (C) 2006 Elsevier Ltd. All rights reserved

Control of weld composition when arc welding high strength aluminium alloys using multiple filler wires

An experimental method of controlling weld composition when welding Al2024 has been explored. Utilising the tandem process and a cold wire feed unit, two and three commercially available filler wires were mixed in a single weld pool to control composition. Thermodynamic modelling was used to provide optimum weld compositions for the eradication of solidification cracking. Validation showed that by controlling the principal elements, not only was cracking eliminated, the mechanical properties of the weld could be varied. In particular, a composition was identified, which offered adequate joint strength and ductility. Exceeding this composition resulted in a corresponding increase in weld hardness at the expense of joint ductility

A qualitative study of the impact of the implementation of advanced access in primary healthcare on the working lives of general practice staff

Peer reviewe