The case for statins: Has it really been made?

Statin drugs are a modern success story. They are the medical treatment for coronary disease and the star of the pharmaceutical industry. Worldwide, sales of statins are running at about $19 billion a year and growing quickly.1 This success profits not only the pharmaceutical industry but also all those whose finances and careers are furthered by the research and the sales. But to what extent is it also a success for the general public? To answer this we will look at the major long-term (five to six year) clinical trials of statins. We start with the treatment offered to the participants, then look at the endpoints that were selected, and continue with a look at how the results have been reported. We conclude with a discussion of the costeffectiveness of statins for people at different levels of risk of coronary heart disease (CHD)

Genomic and proteomic profiling of responses to toxic metals in human lung cells.

Examining global effects of toxic metals on gene expression can be useful for elucidating patterns of biological response, discovering underlying mechanisms of toxicity, and identifying candidate metal-specific genetic markers of exposure and response. Using a 1,200 gene nylon array, we examined changes in gene expression following low-dose, acute exposures of cadmium, chromium, arsenic, nickel, or mitomycin C (MMC) in BEAS-2B human bronchial epithelial cells. Total RNA was isolated from cells exposed to 3 M Cd(II) (as cadmium chloride), 10 M Cr(VI) (as sodium dichromate), 3 g/cm2 Ni(II) (as nickel subsulfide), 5 M or 50 M As(III) (as sodium arsenite), or 1 M MMC for 4 hr. Expression changes were verified at the protein level for several genes. Only a small subset of genes was differentially expressed in response to each agent: Cd, Cr, Ni, As (5 M), As (50 M), and MMC each differentially altered the expression of 25, 44, 31, 110, 65, and 16 individual genes, respectively. Few genes were commonly expressed among the various treatments. Only one gene was altered in response to all four metals (hsp90), and no gene overlapped among all five treatments. We also compared low-dose (5 M, noncytotoxic) and high-dose (50 M, cytotoxic) arsenic treatments, which surprisingly, affected expression of almost completely nonoverlapping subsets of genes, suggesting a threshold switch from a survival-based biological response at low doses to a death response at high doses

Social, economic and trade characteristics of the elasmobranch fishery on Unguja Island, Zanzibar, East Africa

Understanding the socio-economic drivers underpinning fishers' decisions to target elasmobranchs is considered vital in determining sustainable management objectives for these species, yet limited empirical data is collected. This study presents an overview of elasmobranch catch, trade and socio-economic characteristics of Zanzibar's small-scale, artisanal fishery. The value of applying this information to future elasmobranch fisheries policy is demonstrated. In August 2015, interviews were conducted with fishers (n = 39) and merchants (n = 16) at two landing sites, Kizimkazi-Dimbani and Mkokotoni, along with the main market site in Stone Town. Additionally, elasmobranch catches were recorded across the same locations between June and August 2015. Elasmobranchs were listed as target species by 49% of fishers interviewed. Whilst most fishers (n = 30) stated that 76–100% of their household income came from fishing, there was variation in how elasmobranch catch and trade contributed. One-third of fishers (n = 36) that caught and sold elasmobranchs reported that 41–60% of their income came from elasmobranch catch. However, for some fishers (n = 8) elasmobranch catch represented 0–20% of their income, whilst for others (n = 4) it represented 81–100%. Differences in fisheries income and elasmobranch price could be attributed to several interacting factors including season, weather, fishing effort, fishing gear, target catch and consumer demand. Further, elasmobranch price was influenced by size and species. The study revealed information on catch, trade, markets and socio-economy that is important for future research, conservation and management of elasmobranchs and fisheries in Zanzibar. The methods utilised have potential for broader application to understudied, artisanal elasmobranch fisheries in the western Indian Ocean

Improving bycatch mitigation measures for marine megafauna in Zanzibar, Tanzania

This study was conducted to explore the governance processes and socio-economic factors relevant to the potential implementation of bycatch mitigation for various vulnerable marine megafauna (rays, sharks, marine mammals and turtles) in Zanzibar, Tanzania. Questionnaire-based interviews were conducted between February and April 2017 with fishers (n= 240) at eight landing sites. One focus group discussion was held in each site and eleven key informant interviews were carried out. The study showed that current measures to manage bycatch rates are not explicit; no rules govern rays and sharks bycatch; and rules regarding marine mammal and sea turtle bycatch are poorly enforced. Binary logistic regression was used to determine the effect of five selected socio-economic factors (education, age, proportional fishing income, fishing experience, and the number of adults who bring income into the household) on the willingness of fishers to participate in potential future bycatch mitigation measures for marine megafauna. The results indicate that only one factor (the number of adults who bring income into the household) had any significant effect (p=0.016). These findings could benefit the future governance and management of marine megafauna in Zanzibar through a better understanding of what mitigation measures are more likely to be supported

Exploring anal self-examination as a means of screening for anal cancer in HIV positive men who have sex with men: a qualitative study

Background: Anal cancer is relatively common in HIV-positive men who have sex with men(MSM). However there are no clear guidelines on how to effectively screen for anal cancer. As earlier diagnosis of anal cancer is associated with increased survival, innovative ways such as utilizing anal self-examination to identify anal cancer should be explored. Method: Semi-structured interviews were conducted with 20 HIV-positive MSM from a range of ages (35 to 78 years). This study explored acceptability and barriers to implementing ASE as a method of anal cancer screening. Framework analysis was used to identify themes. Results: Seventeen out of 20 men had conducted an ASE before - six (35%) were for medical reasons, six (35%) for sexual reasons, three (18%) for both medical and sexual reasons, and two (12%) for cleaning purposes. Only 5 men were currently confident in detecting an abnormality. Whilst men were generally comfortable with the idea of utilizing ASE as a means for detecting anal cancer, potential barriers identified operated at three levels: attitudinal (discomfort with any anal examinations, anxiety about finding an abnormality, preference for health professional examination), knowledge (lack of awareness of anal cancer risk and ignorance of anal cancer symptoms) and practical (inadequate physical flexibility, importance of hygiene). Conclusion: ASE may be an acceptable means for anal cancer detection in HIV-positive MSM but training in detecting abnormalities is needed. The preference for health professional examination and inadequate physical flexibility may preclude its use for some men. Future trials to confirm its wider acceptability will be needed before undertaking an effectiveness trial for detecting anal cancer

Marine megafauna catch in southwestern Indian Ocean small-scale fisheries from landings data

The measurable impacts of small-scale fisheries on coastal marine ecosystems and vulnerable megafauna species (elasmobranchs, marine mammals and sea turtles) within them are largely unknown, particularly in developing countries. This study assesses megafauna catch and composition in handline, longline, bottom-set and drift gillnet fisheries of the southwestern Indian Ocean. Observers monitored 21 landing sites across Kenya, Zanzibar and northern Madagascar for 12 months in 2016–17. Landings (n = 4666) identified 59 species, including three sea turtles, two small cetaceans and one sirenian (Dugong dugon). Primary gear threats to investigated taxa were identified as bottom-set gillnets (marine mammals, sea turtles and batoids), drift gillnets (marine mammals, batoids and sharks) and longlines (sharks). Overall, catch was dominated by small and moderately sized coastal requiem sharks (Carcharhiniformes) and whiprays (Dasyatidae). Larger coastal and oceanic elasmobranchs were also recorded in substantial numbers as were a number of deeper-water species. The diversity of catch demonstrates the potential for small-scale fisheries to have impacts across a number of ecosystems. From the observed catch rates we calculated annual regional elasmobranch landings to be 35,445 (95%CI 30,478–40,412) tonnes, 72.6% more than officially reported in 2016 and 129.2% more than the 10-year average (2006–16), constituting 2.48 (95%CI 2.20–2.66) million individuals. Productivity-Susceptibility Analyses indicate that small and moderately sized elasmobranchs are most vulnerable in the small-scale fisheries. The study demonstrates substantial underreporting of catches in small-scale fisheries and highlights the need to expand efforts globally to assess the extent and impact of small-scale fisheries on vulnerable marine species and their respective ecosystems

Naval History by Conspiracy Theory: The British Admiralty before the First World War and the Methodology of Revisionism

Revisionist interpretations of British naval policy in the Fisher era claim that an elaborate smoke screen was created to hide the Royal Navy’s real policies; while documents showing the true goals were systematically destroyed. By asserting this, revisionists are able to dismiss those parts of the documentary record that contradict their theories, while simultaneously excusing the lack of evidence for their theories by claiming it has been destroyed. This article shows that this methodology is misleading and untenable

Comparison of local knowledge and researcher-led observations for wildlife exploitation assessment and management

The use of local knowledge observations to generate empirical wildlife resource exploitation data in data-poor, capacity-limited settings is increasing. Yet, there are few studies quantitatively examining their relationship with those made by researchers or natural resource managers. We present a case study comparing intra-annual patterns in effort and mobulid ray catches, derived from local knowledge and fisheries landings data at identical spatio-temporal scales in Zanzibar (Tanzania). The Bland-Altman approach to method comparison was used to quantify agreement, bias and precision between methods. Observations from the local knowledge of fishers and those led by researchers showed significant evidence of agreement, demonstrating the potential for local knowledge to act as a proxy for, or complement, researcher-led methods in assessing intra-annual patterns of wildlife resource exploitation. However, there was evidence of bias and low precision between methods, undermining any assumptions of equivalency. Our results underline the importance of considering bias and precision between methods, as opposed to simply assessing agreement, as is commonplace in the literature. This case-study demonstrates the value of rigorous method-comparison in informing appropriate use of outputs from different knowledge sources, thus facilitating the sustainable management of wildlife resources and the livelihoods of those reliant upon them

Walk well:a randomised controlled trial of a walking intervention for adults with intellectual disabilities: study protocol

Background - Walking interventions have been shown to have a positive impact on physical activity (PA) levels, health and wellbeing for adult and older adult populations. There has been very little work carried out to explore the effectiveness of walking interventions for adults with intellectual disabilities. This paper will provide details of the Walk Well intervention, designed for adults with intellectual disabilities, and a randomised controlled trial (RCT) to test its effectiveness. Methods/design - This study will adopt a RCT design, with participants allocated to the walking intervention group or a waiting list control group. The intervention consists of three PA consultations (baseline, six weeks and 12 weeks) and an individualised 12 week walking programme. A range of measures will be completed by participants at baseline, post intervention (three months from baseline) and at follow up (three months post intervention and six months from baseline). All outcome measures will be collected by a researcher who will be blinded to the study groups. The primary outcome will be steps walked per day, measured using accelerometers. Secondary outcome measures will include time spent in PA per day (across various intensity levels), time spent in sedentary behaviour per day, quality of life, self-efficacy and anthropometric measures to monitor weight change. Discussion - Since there are currently no published RCTs of walking interventions for adults with intellectual disabilities, this RCT will examine if a walking intervention can successfully increase PA, health and wellbeing of adults with intellectual disabilities

Marine megafauna interactions with small-scale fisheries in the southwestern Indian Ocean: a review of status and challenges for research and management

In developing regions, coastal communities are particularly dependent on small-scale fisheries for food security and income. However, information on the scale and impacts of small-scale fisheries on coastal marine ecosystems are frequently lacking. Large marine vertebrates (marine mammals, sea turtles and chondrichthyans) are often among the first species to experience declines due to fisheries. This paper reviews the interactions between small-scale fisheries and vulnerable marine megafauna in the southwestern Indian Ocean. We highlight an urgent need for proper documentation, monitoring and assessment at the regional level of small-scale fisheries and the megafauna affected by them to inform evidence-based fisheries management. Catch and landings data are generally of poor quality and resolution with compositional data, where available, mostly anecdotal or heavily biased towards easily identifiable species. There is also limited understanding of fisheries effort, most of which relies on metrics unsuitable for proper assessment. Management strategies (where they exist) are often created without strong evidence bases or understanding of the reliance of fishers on resources. Consequently, it is not possible to effectively assess the current status and ensure the sustainability of these species groups; with indications of overexploitation in several areas. To address these issues, a regionally collaborative approach between government and non-governmental organisations, independent researchers and institutions, and small-scale fisheries stakeholders is required. In combination with good governance practices, appropriate and effective, evidence-based management can be formulated to sustain these resources, the marine ecosystems they are intrinsically linked to and the livelihoods of coastal communities that are tied to them