Lifetime cost effectiveness of simvastatin in a range of risk groups and age groups derived from a randomised trial of 20,536 people

<i>Objectives</i>: To evaluate the cost effectiveness of 40 mg simvastatin daily continued for life in people of different ages with differing risks of vascular disease. Design A model developed from a randomised trial was used to estimate lifetime risks of vascular events and costs of treatment and hospital admissions in the United Kingdom. <i>Setting</i>: 69 hospitals in the UK. <i>Participants</i>: 20 536 men and women (aged 40-80) with coronary disease, other occlusive arterial disease, or diabetes. <i>Interventions</i>: 40 mg simvastatin daily versus placebo for an average of 5 years. <i>Main</i> <i>outcome</i> <i>measures</i>: Cost effectiveness of 40 mg simvastatin daily expressed as additional cost per life year gained. Major vascular event defined as non-fatal myocardial infarction or death from coronary disease, any stroke, or revascularisation procedure. Results were extrapolated to younger and older age groups at lower risk of vascular disease than were studied directly, as well as to lifetime treatment. <i>Results</i>: At the April 2005 UK price of £4.87 (€7; $9) per 28 day pack of generic 40 mg simvastatin, lifetime treatment was cost saving in most age groups and vascular disease risk groups studied directly. Gains in life expectancy and cost savings decreased with increasing age and with decreasing risk of vascular disease. People aged 40-49 with 5 year risks of major vascular events of 42% and 12% at start of treatment gained 2.49 and 1.67 life years, respectively. Treatment with statins remained cost saving or cost less than £2500 per life year gained in people as young as 35 years or as old as 85 with 5 year risks of a major vascular event as low as 5% at the start of treatment. <i>Conclusions</i>: Treatment with statins is cost effective in a wider population than is routinely treated at present

Premium wheat in Western Australia

This article describes the requirements for premium wheat and suggests a simple way for farmers to predict if their wheat will be suitable. Correct initial sampling is vital

A Study of the Forcing of the 22–25 June 2006 Coastally Trapped Wind Reversal Based on Numerical Simulations and Aircraft Observations

This is the publisher's version, also available electronically from http://journals.ametsoc.org/doi/abs/10.1175/2008MWR2361.1.Coastally trapped wind reversals (CTWRs) occur periodically in the lowest several hundred meters of the marine boundary layer west of California and disrupt the northerly flow that typically occurs during summer. South winds and coastal fog or low stratus accompany the CTWR, which propagates northward along the coast. A CTWR was observed off the California coast during late June 2006 that originated in the California Bight and propagated northward to Cape Mendocino during the subsequent 2-day period. This CTWR event was explored by the University of Wyoming King Air research aircraft to document the primary characteristics of the wind reversal. Numerical simulations of the CTWR event using the Weather Research and Forecast modeling system were conducted to compare with observations and to provide a broader picture of the CTWR structure and evolution. An analysis of the forcing mechanisms responsible for the June 2006 CTWR event is presented. It is demonstrated that the mature CTWR for this case is a density current propagating northward along the coast in response to the density gradient found to the north of the CTWR with maximum speed during the nighttime hours. Establishment of the density contrast is largely a result of cloud-top longwave radiative cooling of the stratus that accompanies the CTWR, which serves to cool and deepen the boundary layer during the night. Density contrast between the cloudy CTWR air and the ambient environment is enhanced by the persistent offshore flow to the north of the CTWR with attendant warming and a flattening of the horizontal pressure gradient in the marine layer

Cessation of the 22–25 June 2006 Coastally Trapped Wind Reversal

This is the publisher's version, also available electronically from http://journals.ametsoc.org/doi/abs/10.1175/2010JAMC2242.1.Coastally trapped wind reversals (CTWRs) occur periodically in the marine boundary layer off the western coast of the United States and dramatically change the low-level wind regime and coastal weather. Southerly flow becomes established with the passage of a CTWR along with cooler temperatures and a low stratus deck in a narrow band along the coast. CTWRs can propagate northward along the coast for hundreds of kilometers. A strong CTWR commenced in southern California on 22 June 2006 and moved north along the California coastline before stalling at Cape Mendocino on 24 June 2006. A transcritical Froude number differentiates the CTWR layer from the climatologically favored northern wind regime to the north of Cape Mendocino and indicates a barrier to the movement of a density current. A well-defined cloud boundary is present as detected by radar and satellite imagery and sharp gradients exist in the basic-state parameters as measured by instrumented aircraft. As the Pacific high migrates back offshore, the horizontal pressure field near Cape Mendocino becomes increasingly adverse to the continued northward movement of the CTWR layer and typical summertime conditions are reestablished. Observations and modeling results show that the cessation phase of this CTWR was characterized by a surprising lack of topographic blocking due to the mountainous coastal terrain and Cape Mendocino massif. The horizontal pressure field over the ocean to the north of the CTWR was the key impeding force to continued propagation of this event

Sound propagation over uneven ground and irregular topography

The development of theoretical, computational, and experimental techniques for predicting the effects of irregular topography on long range sound propagation in the atmosphere is discussed. Irregular topography here is understood to imply a ground surface that (1) is not idealizable as being perfectly flat or (2) that is not idealizable as having a constant specific acoustic impedance. The study focuses on circumstances where the propagation is similar to what might be expected for noise from low-altitude air vehicles flying over suburban or rural terrain, such that rays from the source arrive at angles close to grazing incidence

Diagnosis of the Forcing and Structure of the Coastal Jet near Cape Mendocino Using In Situ Observations and Numerical Simulations

This is the publisher's version, also available electronically from http://journals.ametsoc.org/doi/abs/10.1175/JAM2546.1.Several flights were conducted by the University of Wyoming King Air near Cape Mendocino, California, during June 2004 to examine finescale features of the coastal low-level jet (CJ) that frequently forms during summer over the ocean off the West Coast of the United States. The primary goal of these flights was to measure the horizontal pressure gradient force (PGF) and hence to determine the forcing of the CJ directly. By flying a series of redundant legs on an isobaric surface, heights of the pressure surface can be obtained from radar altimeter measurements and refined position estimates from an onboard global positioning system receiver. The slope of the isobaric surface height is proportional to the PGF. Results are shown for the 22 June 2004 case study conducted to the south of Cape Mendocino. The forcing of a CJ under weak synoptic forcing and the role of the elevated terrain near Cape Mendocino are explored. Ten isobaric legs approximately 70 km in length and directed east–west were conducted near the level of the maximum CJ wind speed. The vertical structure of the CJ was obtained from sawtooth legs conducted along an east–west flight leg. Numerical simulations have been performed for this case using the fifth-generation Pennsylvania State University–National Center for Atmospheric Research Mesoscale Model (MM5) for comparison with in situ measurements. Model simulations show pressure perturbations in the vicinity of the cape as the northerly winds associated with the CJ interact with the coastal topography. Close agreement is found between in situ measurements and MM5 analyses of the various state parameters and the PGF along the east–west flight track in the lee of Cape Mendocino. Strong variation in the PGF is observed along the flight path. Large ageostrophic accelerations are present in response to the adjustment of the CJ with Cape Mendocino, reflecting the force imbalance between the observed PGF and Coriolis force

Project management of an integrated iron and steelworks during design, planning and construction

Much has been said, and many papers written, on the technical design problems associated with all branches of engineering involved in the building of a multi-million pound integrated steel plant. The object of this paper is not to add to their number, but rather to highlight the executive and management problems which arise in the course of the development and construction of this type of plant

Numerical simulation of thermally induced near-surface flows over Martian terrain

Numerical simulations of the Martian near-surface wind regime using a mesoscale atmospheric model have shown that the thermally induced near-surface winds are analogous to terrestrial circulations. In particular, katabatic wind displays a striking similarity to flow observed over Antarctica. Introduction of solar radiation strongly perturbs the slope flows; anabatic conditions develop in middle to high latitudes during the daytime hours due to the solar heating of the sloping terrain. There appears to be a rapid transition from the katabatic to the anabatic flow regimes, emphasizing the primary importance of radiative exchanges at the surface in specifying the horizontal pressure gradient force