Lifetime effects and cost-effectiveness of standard and higher-intensity statin therapy across population categories in the UK: a microsimulation modelling study.

Background: Cardiovascular disease incidence and mortality have declined across developed economies and granular up-to-date cost-effectiveness evidence is required for treatments targeting large populations. To assess the health benefits and cost-effectiveness of standard and higher intensity statin therapy in the contemporary UK population 40-70 years old. Methods: A cardiovascular disease microsimulation model, developed using the Cholesterol Treatment Trialists' Collaboration data (117,896 participants; 5 years follow-up), and calibrated in the UK Biobank cohort (501,854 participants; 9 years follow-up), projected risks of myocardial infarction, stroke, coronary revascularization, diabetes, cancer and vascular and nonvascular death for all UK Biobank participants without and with statin treatment. Meta-analyses of trials and cohort studies informed statins' relative effects on cardiovascular events, incident diabetes, myopathy and rhabdomyolysis. UK healthcare perspective was taken (2020/2021 UK£) with costs per 28 tablets of £1.10 for standard (35%-45% LDL cholesterol (LDL-C) reduction) and £1.68 for higher intensity (≥45% LDL-C reduction) generic statin. Findings: Across categories by sex, age, LDL-C, and cardiovascular disease history/10-year cardiovascular risk, lifetime standard statin increased survival by 0.28-1.85 years (0.20-1.09 quality-adjusted life years (QALYs)), and higher intensity statin by further 0.06-0.40 years (0.03-0.20 QALYs) per person. Standard statin was cost-effective across all categories with incremental cost per QALY from £280 to £8530, with higher intensity statin cost-effective at higher cardiovascular risks and higher LDL-C levels. Stopping statin early reduced benefits and was not cost-effective. Interpretation: Lifetime low-cost statin therapy is cost-effective across all 40-70 years old in UK. Strengthening and widening statin treatment could cost-effectively improve population health. Funding: UK NIHR Health Technology Assessment Programme (17/140/02).

Comparative life history patterns of female gorillas.

OBJECTIVES: Several theories have been proposed to explain the impact of ecological conditions on differences in life history variables within and between species. Here we compare female life history parameters of one western lowland gorilla population (Gorilla gorilla gorilla) and two mountain gorilla populations (Gorilla beringei beringei). MATERIALS AND METHODS: We compared the age of natal dispersal, age of first birth, interbirth interval, and birth rates using long-term demographic datasets from Mbeli Bai (western gorillas), Bwindi Impenetrable National Park and the Virunga Massif (mountain gorillas). RESULTS: The Mbeli western gorillas had the latest age at first birth, longest interbirth interval, and slowest surviving birth rate compared to the Virunga mountain gorillas. Bwindi mountain gorillas were intermediate in their life history patterns. DISCUSSION: These patterns are consistent with differences in feeding ecology across sites. However, it is not possible to determine the evolutionary mechanisms responsible for these differences, whether a consequence of genetic adaptation to fluctuating food supplies ("ecological risk aversion hypothesis") or phenotypic plasticity in response to the abundance of food ("energy balance hypothesis"). Our results do not seem consistent with the extrinsic mortality risks at each site, but current conditions for mountain gorillas are unlikely to match their evolutionary history. Not all traits fell along the expected fast-slow continuum, which illustrates that they can vary independently from each other ("modularity model"). Thus, the life history traits of each gorilla population may reflect a complex interplay of multiple ecological influences that are operating through both genetic adaptations and phenotypic plasticity.

Population dynamics of western gorillas at Mbeli Bai.

Long-term studies of population dynamics can provide insights into life history theory, population ecology, socioecology, conservation biology and wildlife management. Here we examine 25 years of population dynamics of western gorillas at Mbeli Bai, a swampy forest clearing in Nouabalé-Ndoki National Park, the Republic of Congo. The Mbeli population more than doubled from 101 to 226 gorillas during the study. After adjusting for a net influx of gorillas into the study population, the increase represents an inherent growth rate of 0.7% per year, with 95% confidence limits between -0.7% and 2.6%. The influx of gorillas mainly involved immigration of individuals into existing study groups (social dispersal), but it also included the appearance of a few previously unknown groups (locational dispersal). The average group size did not change significantly during the study, which is consistent with the possibility that western gorillas face socioecological constraints on group size, even when the population is increasing. We found no significant evidence of density dependence on female reproductive success or male mating competition. The distribution of gorillas among age/sex categories also did not change significantly, which suggests that the population had a stable age structure. Our results provide evidence of population stability or growth for some western gorillas (albeit within a small area). The results highlight the value of law enforcement, long-term monitoring, and protected areas; but they do not diminish the importance of improving conservation for this critically endangered species.

Fairness, technology and the ethics of Paralympic sport classification.

Fairness in sport is a widely shared meritocratic norm. Its application is usually restricted to equality of opportunity to compete for victory. Paralympic sports lay down a further challenge in that equality of opportunity must be shaped by considerations of fairness, evidenced by the development of discrete competition categories to construct fair and meaningful contests. In this article, we extend these philosophical ideas to consider how Fair Equality of Opportunity might operate in the context of Paralympic sports classification. We articulate three conceptions of fairness relevant to these sports: (i) background fairness; (ii) procedural fairness; and (iii) stakes fairness. We critically review the International Paralympic Committee's Policy on Sport Equipment in relation to the first two conceptions and argue that greater clarification, theorization and rule modification is required if physical prowess, as opposed to equipment technology, is to be assured as the dominant determinant of Paralympic athletic success.

The long lives of primates and the 'invariant rate of ageing' hypothesis.

Is it possible to slow the rate of ageing, or do biological constraints limit its plasticity? We test the 'invariant rate of ageing' hypothesis, which posits that the rate of ageing is relatively fixed within species, with a collection of 39 human and nonhuman primate datasets across seven genera. We first recapitulate, in nonhuman primates, the highly regular relationship between life expectancy and lifespan equality seen in humans. We next demonstrate that variation in the rate of ageing within genera is orders of magnitude smaller than variation in pre-adult and age-independent mortality. Finally, we demonstrate that changes in the rate of ageing, but not other mortality parameters, produce striking, species-atypical changes in mortality patterns. Our results support the invariant rate of ageing hypothesis, implying biological constraints on how much the human rate of ageing can be slowed.

Threats of illegal, unregulated, and unreported fishing to biodiversity and food security in the Republic of the Congo.

Illegal, unregulated, and unreported (IUU) fishing poses a major threat to effective management of marine resources, affecting biodiversity and communities dependent on these coastal resources. Spatiotemporal patterns of industrial fisheries in developing countries are often poorly understood, and global efforts to describe spatial patterns of fishing vessel activity are currently based on automatic identification system (AIS) data. However, AIS is often not a legal requirement on fishing vessels, likely resulting in underestimates of the scale and distribution of legal and illegal fishing activity, which could have significant ramifications for targeted enforcement efforts and the management of fisheries resources. To help address this knowledge gap, we analyzed 3 years of vessel monitoring system (VMS) data in partnership with the national fisheries department in the Republic of the Congo to describe the behavior of national and distant-water industrial fleets operating in these waters. We found that the spatial footprint of the industrial fisheries fleet encompassed over one-quarter of the Exclusive Economic Zone. On average, 73% of fishing activity took place on the continental shelf (waters shallower than 200 m). Our findings highlight that VMS is not acting as a deterrent or being effectively used as a proactive management tool. As much as 33% (13% on average) of fishing effort occurred in prohibited areas set aside to protect biodiversity, including artisanal fisheries resources, and the distant-water fleet responsible for as much as 84% of this illegal activity. Given the growth in industrial and distant-water fleets across the region, as well as low levels of management and enforcement, these findings highlight that there is an urgent need for the global community to help strengthen regional and national capacity to analyze national scale data sets if efforts to combat IUU fishing are to be effective.

Amenazas de la Pesca Ilegal, No Regulada y No Reportada para la Biodiversidad y la Seguridad Alimentaria en la República del Congo Resumen La pesca ilegal, no regulada y no reportada (INN) representa una amenaza importante para el manejo efectivo de los recursos marinos, lo que afecta a la biodiversidad y a las comunidades que dependen de estos recursos costeros. Los patrones espaciotemporales de las pesquerías industriales en los países en desarrollo a menudo están poco comprendidas, y los esfuerzos globales para describir los patrones espaciales de la actividad de los navíos pesqueros actualmente están basados en los datos del sistema automático de identificación (SAI). Sin embargo, el SAI no es siempre un requerimiento legal en los navíos pesqueros, lo que probablemente resulta en valores subestimados de la escala y la distribución de la actividad pesquera legal e ilegal, lo que podría tener ramificaciones significativas para los esfuerzos enfocados de aplicación de la ley y para el manejo de los recursos de las pesquerías. Para ayudar a completar este vacío en el conocimiento, analizamos tres años de datos del sistema de monitoreo de navíos (SMN) en asociación con el departamento nacional de pesquerías de la República del Congo para describir el comportamiento de las flotas industriales nacionales y de altura que operan en estas aguas. Descubrimos que la huella espacial de la flota de pesquerías industriales abarcó más de un cuarto de la Zona Económica Exclusiva. En promedio, el 73% de la actividad pesquera se realizó en el talud continental (aguas con una profundidad menor a 200 m). Nuestros descubrimientos resaltan que el SMN no está actuando como un disuasivo o no se está usando efectivamente como una herramienta proactiva de manejo. Un máximo del 33% (13% en promedio) de los esfuerzos de pesca ocurrieron en áreas prohibidas apartadas para proteger a la biodiversidad, incluyendo los recursos para la pesca artesanal, con el 84% de la responsabilidad de esta actividad ilegal cayendo sobre las flotas de altura. Dado el crecimiento de flotas industriales y de altura en la región, así como los bajos niveles de manejo y aplicación de la ley, estos resultados resaltan la necesidad urgente que existe para que la comunidad global ayude a fortalecer la capacidad regional y nacional para analizar los conjuntos de datos de escala nacional si se espera que los esfuerzos para combatir la pesca INN sean efectivos.

"Too Big To Ignore": A feasibility analysis of detecting fishing events in Gabonese small-scale fisheries.

In many developing countries, small-scale fisheries provide employment and important food security for local populations. To support resource management, the description of the spatiotemporal extent of fisheries is necessary, but often poorly understood due to the diffuse nature of effort, operated from numerous small wooden vessels. Here, in Gabon, Central Africa, we applied Hidden Markov Models to detect fishing patterns in seven different fisheries (with different gears) from GPS data. Models were compared to information collected by on-board observers (7 trips) and, at a larger scale, to a visual interpretation method (99 trips). Models utilizing different sampling resolutions of GPS acquisition were also tested. Model prediction accuracy was high with GPS data sampling rates up to three minutes apart. The minor loss of accuracy linked to model classification is largely compensated by the savings in time required for analysis, especially in a context of nations or organizations with limited resources. This method could be applied to larger datasets at a national or international scale to identify and more adequately manage fishing effort.

Using satellite tracking to optimize protection of long-lived marine species: olive ridley sea turtle conservation in Central Africa.

Tractable conservation measures for long-lived species require the intersection between protection of biologically relevant life history stages and a socioeconomically feasible setting. To protect breeding adults, we require knowledge of animal movements, how movement relates to political boundaries, and our confidence in spatial analyses of movement. We used satellite tracking and a switching state-space model to determine the internesting movements of olive ridley sea turtles (Lepidochelys olivacea) (n = 18) in Central Africa during two breeding seasons (2007-08, 2008-09). These movements were analyzed in relation to current park boundaries and a proposed transboundary park between Gabon and the Republic of Congo, both created to reduce unintentional bycatch of sea turtles in marine fisheries. We additionally determined confidence intervals surrounding home range calculations. Turtles remained largely within a 30 km radius from the original nesting site before departing for distant foraging grounds. Only 44.6 percent of high-density areas were found within the current park but the proposed transboundary park would incorporate 97.6 percent of high-density areas. Though tagged individuals originated in Gabon, turtles were found in Congolese waters during greater than half of the internesting period (53.7 percent), highlighting the need for international cooperation and offering scientific support for a proposed transboundary park. This is the first comprehensive study on the internesting movements of solitary nesting olive ridley sea turtles, and it suggests the opportunity for tractable conservation measures for female nesting olive ridleys at this and other solitary nesting sites around the world. We draw from our results a framework for cost-effective protection of long-lived species using satellite telemetry as a primary tool.

Supported community exercise in people with long-term neurological conditions: a phase II randomized controlled trial.

OBJECTIVE: Adults with long-term neurological conditions have low levels of participation in physical activities and report many barriers to participation in exercise. This study examines the feasibility and safety of supporting community exercise for people with long-term neurological conditions using a physical activity support system. DESIGN: A phase II randomized controlled trial using computer-generated block randomization, allocation concealment and single blind outcome assessment. SETTING: Oxfordshire and Birmingham community Inclusive Fitness Initiative gyms. SUBJECTS: Patients with a long-term neurological condition. INTERVENTIONS: The intervention group (n = 51) received a 12-week, supported exercise programme. The control group (n = 48) participants received standard care for 12 weeks and were then offered the intervention. MAIN MEASURES: Physical activity, adherence to exercise, measures of mobility, health and well-being. RESULTS: Forty-eight patients (n = 51) completed the intervention, achieving 14 gym attendances (range 0-39) over the 12 weeks. Overall activity did not increase as measured by the Physical Activity Scale for the Elderly (change score mean 14.31; 95% confidence interval (CI) −8.27 to 36.89) and there were no statistically significant changes in body function and health and well-being measures. CONCLUSIONS: People with long-term neurological conditions can safely exercise in community gyms when supported and achieve similar attendance to standard exercise referral schemes, but may reduce other life activities in order to participate at a gym.

Tracking leatherback turtles from the world's largest rookery: assessing threats across the South Atlantic.

Despite extensive work carried out on leatherback turtles (Dermochelys coriacea) in the North Atlantic and Indo-Pacific, very little is known of the at-sea distribution of this species in the South Atlantic, where the world's largest population nests in Gabon (central Africa). This paucity of data is of marked concern given the pace of industrialization in fisheries with demonstrable marine turtle bycatch in African/Latin American waters. We tracked the movements of 25 adult female leatherback turtles obtaining a range of fundamental and applied insights, including indications for methodological advancement. Individuals could be assigned to one of three dispersal strategies, moving to (i) habitats of the equatorial Atlantic, (ii) temperate habitats off South America or (iii) temperate habitats off southern Africa. While occupying regions with high surface chlorophyll concentrations, these strategies exposed turtles to some of the world's highest levels of longline fishing effort, in addition to areas with coastal gillnet fisheries. Satellite tracking highlighted that at least 11 nations should be involved in the conservation of this species in addition to those with distant fishing fleets. The majority of tracking days were, however, spent in the high seas, where effective implementation of conservation efforts is complex to achieve.

Physical maturation, life-history classes and age estimates of free-ranging western gorillas--insights from Mbeli Bai, Republic of Congo.

Physical maturation and life-history parameters are seen as evolutionary adaptations to different ecological and social conditions. Comparison of life-history patterns of closely related species living in diverse environments helps to evaluate the validity of these assumptions but empirical data are lacking. The two gorilla species exhibit substantial differences in their environment, which allows investigation into the role of increased frugivory in shaping western gorilla life histories. We present behavioral and morphological data on western gorilla physical maturation and life-history parameters from a 12.5-year study at Mbeli Bai, a forest clearing in the Nouabalé-Ndoki National Park in northern Congo. We assign photographs of known individuals to different life-history classes and propose new age boundaries for life-history classes in western gorillas, which can be used and tested at other western gorilla research sites. Our results show that western gorillas are weaned at a later age compared with mountain gorillas and indicate slower physical maturation of immatures. These findings support the risk-aversion hypothesis for more frugivorous species. However, our methods need to be applied and tested with other gorilla populations. The slow life histories of western gorillas could have major consequences for social structure, mortality patterns and population growth rates that will affect recovery from population crashes of this critically endangered species. We emphasize that long-term studies can provide crucial demographic and life-history data that improve our understanding of life-history evolution and adaptation and help to refine conservation strategies.

Social structure and life-history patterns in western gorillas (Gorilla gorilla gorilla).

Life-history traits and ecological conditions have an important influence on primate social systems. Most of what we know about the life-history patterns and social structure of gorillas comes from studies of eastern gorillas (Gorilla beringei sp.), which live under dramatically different ecological conditions compared to western gorillas (Gorilla gorilla sp.). In this paper we present new data on western gorilla social structure and life histories from four study sites, and make comparisons with eastern gorilla populations. Data were obtained from two study sites with gorilla groups undergoing the habituation process (Lossi, Democratic Republic of Congo and Bai Hokou, Central African Republic) and two "bai" studies (Maya Nord and Mbeli Bai, Republic of Congo). The size and structure of these groups were similar to those seen in eastern gorillas. However, differences in the occurrence of various group transitions (group formations, changes between one-male and multimale composition, and group disintegrations) exist, and western gorillas notably exhibit much higher rates of male emigration and correspondingly fewer multimale groups compared to mountain gorillas. Certain phenomena have been observed only rarely, including predation by leopards. The preliminary data show no significant differences in birth rates between western gorillas and mountain gorillas. The ecological variability across gorilla habitats likely explains the flexibility in the social system of gorillas, but we need more information on the social relationships and ecology of western gorillas to elucidate the causes for the similarities and differences between western and eastern gorillas on the levels of individuals, social groups, and population dynamics.

Group size and structure in western lowland gorillas (Gorilla gorilla gorilla) at Mbeli Bai, Republic of Congo.

This paper describes the size and structure of western lowland gorilla groups visiting Mbeli Bai, a swampy forest clearing in northern Congo. An observation platform at the edge of the clearing was used over a 3-yr period, with gorillas visible for 1,681 hr. Data are presented on 14 groups and seven solitary males. Mean group size (excluding solitary males) was 8.4 +/- SD 4.3, and did not differ significantly from most other gorilla studies. All groups at Mbeli contained only one fully mature male and did not show evidence of fission-fusion or regular subgrouping. All emigrating males that remained in the population became solitary, and "bachelor" groups were not observed. Methodological issues are raised, including the classification of multi-male groups, and the demographic profiles of other populations are discussed in the light of results from Mbeli.