Intensive versus standard dose statin therapy: the costs and benefits for patients with acute coronary syndrome

Introduction: Recent NICE guidance in England and Wales states that statin therapy for secondary CVD should "usually be initiated with a drug with a low acquisition cost (taking into account required daily dose and product price per dose)". Intensive dose statin therapy is more costly than standard dose, but offers additional benefits and may potentially be more cost effective for a sub-group of high risk patients. Objective: To determine if the strategy of treating ACS patients with intensive dose statin compared with standard dose statin can be considered to be cost effective and to what extent these results are influenced by the age of the patient at start of treatment. Methods: A Markov model was used to explore the costs and health outcomes associated with a lifetime of intensive dose (represented by 80mg atorvastatin) versus standard dose (represented by 20mg simvastatin) treatment for patients with acute coronary syndrome. Health states included unstable angina, MI, stroke, fatal CHD, fatal stroke, or non vascular death. The benefits associated with statin treatment were modelled by applying the relative risks from a meta-analysis of 4 large RCTs reporting clinical endpoints. Costs and utilities assigned to health states were derived from a review of published evidence. Results: Treatment with intensive dose statin therapy offers additional benefits over standard dose therapy. The cost offsets through avoided events are less than the associated treatment costs and result in a cost per QALY of around £24,000 for patients with ACS starting treatment at 60 years of age and falling to around £14,000 for patients starting treatment at 70 years. The key driver of cost effectiveness is the relative risk for mortality. Conclusions: This analysis suggests that intensive statin regimens (represented by atorvastatin 80mg/day) are cost effective compared with standard statin regimens (represented by simvastatin 20mg/day) for patients with ACS over the age of 60 years. A recent registry study reports a mean age of 70 years for ACS patients admitted to UK hospitals and hence this comparison applies to the great majority of ACS patients

Intensive versus standard dose statin therapy: the costs and benefits for patients with acute coronary syndrome

Introduction: Recent NICE guidance in England and Wales states that statin therapy for secondary CVD should "usually be initiated with a drug with a low acquisition cost (taking into account required daily dose and product price per dose)". Intensive dose statin therapy is more costly than standard dose, but offers additional benefits and may potentially be more cost effective for a sub-group of high risk patients. Objective: To determine if the strategy of treating ACS patients with intensive dose statin compared with standard dose statin can be considered to be cost effective and to what extent these results are influenced by the age of the patient at start of treatment. Methods: A Markov model was used to explore the costs and health outcomes associated with a lifetime of intensive dose (represented by 80mg atorvastatin) versus standard dose (represented by 20mg simvastatin) treatment for patients with acute coronary syndrome. Health states included unstable angina, MI, stroke, fatal CHD, fatal stroke, or non vascular death. The benefits associated with statin treatment were modelled by applying the relative risks from a meta-analysis of 4 large RCTs reporting clinical endpoints. Costs and utilities assigned to health states were derived from a review of published evidence. Results: Treatment with intensive dose statin therapy offers additional benefits over standard dose therapy. The cost offsets through avoided events are less than the associated treatment costs and result in a cost per QALY of around £24,000 for patients with ACS starting treatment at 60 years of age and falling to around £14,000 for patients starting treatment at 70 years. The key driver of cost effectiveness is the relative risk for mortality. Conclusions: This analysis suggests that intensive statin regimens (represented by atorvastatin 80mg/day) are cost effective compared with standard statin regimens (represented by simvastatin 20mg/day) for patients with ACS over the age of 60 years. A recent registry study reports a mean age of 70 years for ACS patients admitted to UK hospitals and hence this comparison applies to the great majority of ACS patients

Monitoring anthelmintic resistance in Queensland sheep flocks

Development of anthelmintic resistance in Australian sheep flocks over the past 20 years has caused concern for sustainable sheep and wool production.1 Resistance was first reported in 1968, and by the mid-1980s resistance of the important sheep nematode species (Haemonchus, Ostertagia and Trichostrongylus) to a range of anthelmintics had been described. In a survey conducted during 1991/92, the prevalence of resistance to benzimidazole and levamisole anthelmintics was estimated to be 86 and 65%, respectively. Resistance to macrocyclic lactone anthelmintics was not detected, however resistance to ivermectin was subsequently reported. Factors associated with the emergence of resistance include excessive use of anthelmintics, underdosing and use of faulty equipment. Regional control programs, based on monitoring flock faecal egg counts (FECs), have been developed and promoted to control anthelmintic resistance. To better advise producers on the most effective anthelmintics to use, it is essential to have information on the regional anthelmintic resistance status of flocks. We describe a 2-year monitoring program for anthelmintic resistance in southern Queensland flocks that was initiated to provide this information

Chemical composition and minerals in pyrite ash of an abandoned sulphuric acid production plant

The extraction of sulphur produces a hematite-rich waste, known as roasted pyrite ash, which contains significant amounts of environmentally sensitive elements in variable concentrations and modes of occurrence. Whilst the mineralogy of roasted pyrite ash associated with iron or copper mining has been studied, as this is the main source of sulphur worldwide, the mineralogy, and more importantly, the characterization of submicron, ultrafine and nanoparticles, in coal-derived roasted pyrite ash remain to be resolved. In this work we provide essential data on the chemical composition and nanomineralogical assemblage of roasted pyrite ash. XRD, HR-TEM and FE-SEM were used to identify a large variety of minerals of anthropogenic origin. These phases result from highly complex chemical reactions occurring during the processing of coal pyrite of southern Brazil for sulphur extraction and further manufacture of sulphuric acid. Iron-rich submicron, ultrafine and nanoparticles within the ash may contain high proportions of toxic elements such as As, Se, U, among others. A number of elements, such as As, Cr, Cu, Co, La, Mn, Ni, Pb, Sb, Se, Sr, Ti, Zn, and Zr, were found to be present in individual nanoparticles and submicron, ultrafine and nanominerals (e.g. oxides, sulphates, clays) in concentrations of up to 5%. The study of nanominerals in roasted pyrite ash from coal rejects is important to develop an understanding on the nature of this by-product, and to assess the interaction between emitted nanominerals, ultra-fine particles, and atmospheric gases, rain or body fluids, and thus to evaluate the environmental and health impacts of pyrite ash materials

A 3D geological model of post Carboniferous strata in the south Fylde area of the West Lancashire Basin, Blackpool, UK

The British Geological Survey (BGS), together with a number of partners is undertaking an independent environmental monitoring programme to characterise baseline conditions in the south Fylde east of Blackpool in an area proposed for shale-gas exploration and production. The monitoring will include measurement of: water quality (groundwater and surface water), seismicity, ground motion, air quality including radon, and soil gas. The programme aims to establish the environmental baseline before any shale-gas explorations begin. This report presents the results of a desk study to develop an initial summary of the post- Carboniferous bedrock geology of the south Fylde. It is a component and specific deliverable of the environmental baseline project. The bedrock deposits form a number of shallow aquifers that are used locally for drinking water supply and agriculture. A separate report considers the superficial geology. The geological information in this report will form the basis for identifying aquifer dimensions and configurations, groundwater flow paths and potential contaminant migration pathways, as well as determining optimum locations for sampling and monitoring. It will also provide information to support the locating of new borehole infrastructure (suitable for groundwater sampling and seismometers) and will underpin the interpretation of acquired hydrogeochemical data

Wheels within Wheels: Making Fault Management Cost-Effective

Local design and optimization of the components of a fault management system results in sub-optimal decisions. This means that the target system will likely not meet its objectives (under-performs) or cost too much if conditions, objectives, or constraints change. We can fix this by applying a nested, management system for the fault-management system itself. We believe that doing so will produce a more resilient, self-aware, system that can operate more effectively across a wider range of conditions, and provide better behavior at closer to optimal cost. This document summarizes the results of the Working Group 7 - ``Cost-Effective Fault Management\u27\u27 - at the Dagstuhl Seminar 09201 ``Self-Healing and Self-Adaptive Systems\u27\u27 (organized by A. Andrzejak, K. Geihs, O. Shehory and J. Wilkes). The seminar was held from May 10th 2009 to May 15th 2009 in Schloss Dagstuhl~--~Leibniz Center for Informatics

Mental health in UK Biobank: development, implementation and results from an online questionnaire completed by 157 366 participants

Background UK Biobank is a well-characterised cohort of over 500 000 participants that offers unique opportunities to investigate multiple diseases and risk factors. Aims An online mental health questionnaire completed by UK Biobank participants was expected to expand the potential for research into mental disorders. Method An expert working group designed the questionnaire, using established measures where possible, and consulting with a patient group regarding acceptability. Case definitions were defined using operational criteria for lifetime depression, mania, anxiety disorder, psychotic-like experiences and self-harm, as well as current post-traumatic stress and alcohol use disorders. Results 157 366 completed online questionnaires were available by August 2017. Comparison of self-reported diagnosed mental disorder with a contemporary study shows a similar prevalence, despite respondents being of higher average socioeconomic status than the general population across a range of indicators. Thirty-five per cent (55 750) of participants had at least one defined syndrome, of which lifetime depression was the most common at 24% (37 434). There was extensive comorbidity among the syndromes. Mental disorders were associated with high neuroticism score, adverse life events and long-term illness; addiction and bipolar affective disorder in particular were associated with measures of deprivation. Conclusions The questionnaire represents a very large mental health survey in itself, and the results presented here show high face validity, although caution is needed owing to selection bias. Built into UK Biobank, these data intersect with other health data to offer unparalleled potential for crosscutting biomedical research involving mental health

Transition from Townsend to glow discharge: subcritical, mixed or supercritical

The full parameter space of the transition from Townsend to glow discharge is investigated numerically in one space dimension in the classical model: with electrons and positive ions drifting in the local electric field, impact ionization by electrons ($\alpha$ process), secondary electron emission from the cathode ($\gamma$ process) and space charge effects. We also perform a systematic analytical small current expansion about the Townsend limit up to third order in the total current that fits our numerical data very well. Depending on $\gamma$ and system size pd, the transition from Townsend to glow discharge can show the textbook subcritical behavior, but for smaller values of pd, we also find supercritical or some intermediate ``mixed'' behavior. The analysis in particular lays the basis for understanding the complex spatio-temporal patterns in planar barrier discharge systems.Comment: 12 pages, 10 figures, submitted to Phys. Rev.

Polarization quantum properties in type-II Optical Parametric Oscillator below threshold

We study the far field spatial distribution of the quantum fluctuations in the transverse profile of the output light beam generated by a type II Optical Parametric Oscillator below threshold, including the effects of transverse walk-off. We study how quadrature field correlations depend on the polarization. We find spatial EPR entanglement in quadrature-polarization components: For the far field points not affected by walk-off there is almost complete noise suppression in the proper quadratures difference of any orthogonal polarization components. We show the entanglement of the state of symmetric intense, or macroscopic, spatial light modes. We also investigate nonclassical polarization properties in terms of the Stokes operators. We find perfect correlations in all Stokes parameters measured in opposite far field points in the direction orthogonal to the walk-off, while locally the field is unpolarized and we find no polarization squeezing.Comment: 16 pages, 18 figure

Yield conditions for deformation of amorphous polymer glasses

Shear yielding of glassy polymers is usually described in terms of the pressure-dependent Tresca or von Mises yield criteria. We test these criteria against molecular dynamics simulations of deformation in amorphous polymer glasses under triaxial loading conditions that are difficult to realize in experiments. Difficulties and ambiguities in extending several standard definitions of the yield point to triaxial loads are described. Two definitions, the maximum and offset octahedral stresses, are then used to evaluate the yield stress for a wide range of model parameters. In all cases, the onset of shear is consistent with the pressure-modified von Mises criterion, and the pressure coefficient is nearly independent of many parameters. Under triaxial tensile loading, the mode of failure changes to cavitation.Comment: 9 pages, 8 figures, revte